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Separation, Deprivation & Privation #4

PART 4
Romanian Orphan Studies
Much of the Western world went through a GREEN-tinged liberalisation of cultural norms during from the 1960s onwards. One outcome of this was the increasing acceptance of couples living together without being married and of children being born out of wedlock. The result was that far fewer babies and young children ended up in orphanages and similar institutions. Those that did were cared for much better and much more holistically, with much more attention paid to their psychological and emotional well-being. This was very much a consequence of psychological  research into the damaging effects of institutionalisation in preceding decades.

Cleo Dontas et al (1985) provide a good example of a Greek orphanage where each baby was allocated a member of staff to care specifically for them and form an attachment. 15 babies, aged 7 to 9 months, were observed in the 2-week adjustment period of adoption and were found to be forming good attachments with their new adoptive parents – perhaps reflecting J0hn Bowlby’s (1953) Continuity Hypothesis of a good internal working model.

However, such progress meant there was little opportunity for a new generation of developmental psychologists to replicate the kinds of studies René Spitz (1945) and William Goldfarb had undertaken. However, that changed with  the overthrow of the Romanian dictator Nicolae Ceaucescu at the end of 1989.

Under President Ceaucescu, it had been a legal requirement for women to have 5 children. Ceaușescu thought that the best way to boost production in his isolated and backward rural country was to increase the population for labouring on the land. His policies banning abortion and contraception led to an estimated 170,000 children being neglected in around 700 understaffed institutions. Parents were too poor to look after their children and ended up dumping them at the massive, very poor quality orphanages dotted around the country.

After the revolution, the appalling conditions in Romanian orphanages were revealed to the world. Some 40,000 of the infants in the institutions were deemed to be ‘non-recoverables’. They were found tied to steel cribs, rhythmically rocking or banging their heads against walls, lying in their own excrement, and poorly supervised by the overwhelmed staff who had little time to interact with the children. Often they had never been held; no one had talked much to them. They had had little or no opportunity to develop close attachments.

An American paediatrician holding an orphanage baby , in front of rows of shabby steel cribs containing other babies – photo copyright © 1990 Taro Yamasaki/The LIFE Images Collection/Getty Images

As Romania opened up to the outside world, the media created great interest in ‘saving’ Romanian orphans and many were brought to Western Europe and North America for adoption in the early 1990s. A number of studies were carried out on groups of Romanian children, as they came into Western countries, to investigate the effects of what was in most cases privation. These research projects were all interested in whether the children could recover from their sufferings. Michael Rutter, with the assistance of the English & Romanian Adoptees Study Team (ERA), carried out a particularly important longitudinal study on a group of 111 Romanian children adopted in the UK before they were 2 years old.

These children were assessed on a variety of measures of physical and intellectual ability on arrival in Britain. Most of them had been in institutional care from shortly after they were born – though a subgroup had spent only a few weeks in an orphanage. The children’s IQ was tested upon arrival in the UK and the average score for the Romanian orphans was 63. For those over 6 months old, the average was 45. Physical development was also poor, 51% of them being in the bottom 3% of the population for weight. They were also shorter in height than was normal for their age and had smaller head circumferences. In 1998 Rutter & ERA produced their first report on the group. The Romanian orphans had been tested again at the age of 4 and compared to a control group of 52 British-adopted children, all aged 4, who had showed none of the negative effects suffered by the Romanians. The 2 groups of adopted children showed no significant differences in either intellectual or physical development. The average IQ of the Romanians had increased from 63 to 107. For those adopted after 6 months, it had gone from 45 to 90. The older adoptees tended to do less well in terms of physical development too. From these results it was concluded that the negative outcomes shown by the Romanian children could be overcome through adequate substitute care and that intervention should take place before 6 months of age. Rutter also concluded that separation from mother alone is not sufficient to cause negative outcomes as the British children had been separated too but were not developmentally delayed. However, it is important to note that the Romanian children were within what John Bowlby (1969) regarded as the sensitive period – ie: under 2.5 years – when they first came to Britain. This may help explain why the age of adoption was a factor in this study.

The results of another ERA Team study led by Jana Kreppner et al (1999) appear rather less promising. Kreppner et al studied 104 Romanian orphans adopted into British families before the age of 2. They had a lower frequency of pretend play, role play and ability to appreciate others’ mental states than a UK control group. These differences did not appear to be related to general cognitive or verbal ability; so the negative outcomes were assumed to be due to their early deprivation. It’s of note here that Kreppner et al described the children’s early experiences in Romania as deprivation, rather than privation.

K Chisholm et al (1999), studying Romanian orphans adopted into Canadian families, found that many of them showed an  insecure-resistant style of attachment. Eg: they would not be easily comforted when distressed. However, Lucy Le Mare & Karyn Audet (2006) did find that the Canadian children had recovered more or less physically and substantially cognitively, thus supporting Rutter’s 1998 findings.

Unfortunately a later ERA report (2004) by Michael Rutter & Thomas O’Connor  (2004) found that many of the children, now around 6 years, displayed disinhibited attachment . This is characterised by:-

  • a lack of close, confiding relationships
  • rather indiscriminate friendliness and clingy, attention-seeking behaviour
  • a relative lack of differentiation in response to adults – treating them all alike
  • a tendency to go off with strangersa,
  • lack of checking back with a parent in anxiety-provoking situations.

In 2006 Rutter reflected how brain structure and functioning might have been affected by the child’s attempt to adapt to the poor environmental conditions they faced in the orphanages at the sensitive period in their development. He was particularly concerned with the effects of having multiple relatively-disengaged caregivers, none of whom they saw enough to form an attachment. When  adults are rarely available to children, he reasoned, they become indiscriminately warm and friendly to anyone, unlike securely attached children of the same age. In a further ERA Team follow-up to the age of 11, Michael Rutter et al (2007) found that disinhibited attachment was still persistent in many of the children, though it became less frequent as they got older. Interestingly, the children adopted after 6 months did not display it significantly more than the children adopted before. Michael Rutter & Edmund Sonuga-Barke (2010) also comment on the children having problems with peer relationships.

The disinhibited attachment Rutter identifies can be seen as coming from a PURPLE/RED vMEME harmonic. The children’s PURPLE’s need for attachment, without an attachment figure to bond with, becomes pathological while RED facilitates dangerous and indiscriminate behaviour without thought of consequences beyond the need to bond.

As part of the Bucharest Early Intervention Project, Charles Zeanah et al (2005) investigated the relationship between disinhibited attachment and institutionalisation. 95 Romanian children aged 12-31 months, who had spent most of their lives in institutions (90% on average), were assessed using the Strange Situation and compared to a control group of 50 children who had never lived in an institution. The institutionalised group’s carers were questioned about indiscriminate attachment behaviour. On a scale of 0-6, 44% of the institutional group scored 3+ for indications of disinhibited attachment, compared to 20% of the control group. 74% of the control group were classified as securely attached but only 19% of the institutionalised group, with 65% of them showing disorganised attachment. However, the study was not longitudinal so could not report on change over a period of time.

Conclusions…?
As a result of research into deprivation and privation and the criticality of the sensitive period, in the West it has become accepted that babies unwanted by their birth mother should be adopted within their first week of life where possible. Research, such as that of Leslie Singer et al (1985) has shown that these children and their adoptive mothers can become as securely attached as non-adoptive families. However, Nancy Newton Verrier (1993) strongly contests the findings of such research, noting that relationships between unwanted children and their adoptive mothers are often highly problematic. From the start the baby’s biological drivers for attachment are frustrated. In many cases ‘Mum’ just doesn’t smell ‘right’ to the child!

Jill Hodges & Barbara Tizzard’s longitudinal study of 65 ex-institutional children (1989) is regarded as a classic; yet it largely contradicts Bowlby’s (1951) predictions of the effects of maternal deprivation and provides support for Singer et al. The participants in the study were all aged 16 and had all been in institutional care until at least 2 years of age. At this age most of the children had either been adopted or restored to biological parents. An early finding of the study was that the children all received good physical care in the institutions, which also appeared to provide adequately for their cognitive development. However, staff turnover, and an explicit policy against allowing too strong an attachment to develop between children and the carers who looked after them, had given the children little opportunity to form close, continuous relationships with an adult. (By the time they were 2, the children had had an average of 24 carers; by 4, between 50 and 70 carers.) As a result, the children’s’ attachment behaviour was deemed very unusual. At 2, they seemed to be attached to a large number of adults – ie: they would run to be picked up when anyone familiar entered the room and cry when they left. At the same time they were more fearful of strangers than a home-reared comparison group. This behaviour would later be classified as disinhibited attachment. A total of 33 children were placed in adoptive families after the age of 2. 25 other institutional children were restored to their biological parents after they turned 2.

At age 4 most of the ex-institutional children formed attachments to their parents although they did show some differences compared to a control group in terms of social development. About a third were markedly attention seeking and over friendly to strangers, and a few were indiscriminately affectionate to all adults. By 8 the majority of adopted children and some of the restored children had formed close attachments to their parents, despite their lack of early attachments in the institutions. According to their parents, the ex-institutional children did not present more problems than the control group – though they did tend to have problems with siblings. However, according to their teachers, more of them showed problems, notably attention seeking behaviour, especially from adults, restlessness, disobedience, and poor peer relationships; they were quarrelsome and unpopular. Their earlier over-friendliness also persisted. However the children had adequate language and cognitive skills. At this stage of the study it appeared that early institutional care and the lack of close attachments had not had the drastically damaging effects predicted by Bowlby. On the other hand, there were indications that, despite in many cases the formation of deep and permanent attachments to parents once the child entered families, some of the children still showed lasting effects of their earlier institutional rearing. At 16 the majority of the adoptive mothers felt that their child was deeply attached to them. By contrast only a half of the restored children were described as deeply attached. Adopted adolescents were also more often said by their mothers to be attached to their father than the restored group. (Verrier too notes that adopted children often have better relationships with their adoptive fathers than their adoptive mothers.)

In summary Hodges and Tizard found that maternal deprivation did not necessarily prevent the children forming strong and lasting attachments to parents once placed in families. Whether such attachments developed depended on the family environment; good attachments were found to be much more common in adopted children than in those restored to a biological parent. Hodges & Tizzard note a number of key variables in the success of these adoptions and restorations:-

  • How the adults behave in nurturing the relationships. The adoptive parents were highly motivated to have a child and to develop a relationship with that child. The biological parents in Hodges and Tizard’s sample, on the other hands, seemed to have been “more ambivalent about their child living with them”.
  • The financial situation of the parents. The adoptive families were often better off and had on average fewer children to provide for.
  • The effect of the institutional experiences on the individual child.

These factors show just how complex the attachment process can be and how easy it is to over-generalise from limited samples. For all the critical importance of his work and the way he pioneered changes in the way society deals with the care and wellbeing of young children, Bowlby does not take into account either individual differences (dispositional) or wider social/familial (situational) factors. This makes for more cohesive theorising but also makes the work more vulnerable to criticism and the results of the supporting research more difficult to replicate. Eg: Hilda Lewis (1954) carried out a partial replication of Bowlby’s 44 Thieves study with 500 young people but could not find a link in her sample between prolonged early separation from the mother and either later criminality or difficulty forming close relationships.

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