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The Effects of Institutional Care On Children Handout
The Effects of Institutional Care On Children Handout
The Effects of Institutional Care On Children Handout
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the neglect and damage caused is equivalent to studies and in-depth investigations into cognitive,
violence to a child (Johnson et al 2006). psychosocial and physical development of children in
institutions and the subsequent changes when they
Research documents the way in which children’s are placed into family-based care and also
brains develop in a context of deprivation, and the summarises the evidence on long term outcomes,
profound negative consequences in adult life. Even in although the scope and volume of this research is
better-resourced institutions, this deprivation less extensive and robust evidence is limited.
prevails as a consequence of the instability and
insufficiency of caregiving, inadequate living
conditions including poor nutrition, health, hygiene
and education, neglect and abuse, strict routines,
poor provision of learning and play, lack of identity,
individuality and integration, and isolation and
segregation from communities which characterise
institutional care worldwide. Together, these
contribute to poor brain development and
attachment with damaging consequences for
children’s physical, cognitive and psychosocial
development during childhood.
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Brain Development: How does it work and brain. Neglect leads to excessive pruning of brain
cells, which can result in developmental and
why is it important? behavioural deficits (Schore 2001a, 2001b).
Institutional care has been associated with reduced
The first few years of life is a period of rapid brain
metabolism in the temporal and frontal cortices,
development and an unparalleled time of
reductions in white matter connectivity and brain
developmental change, particularly during the first
electrical activity, dysregulation of the hypothalamic-
three years. 80% of the brain cells a person will ever
pituitary-adrenocortical system, and changes in brain
have are formed in the first three years of life (ref??).
volume (Walker et al 2011). This results in neural and
An infant is born with some 100 billion neurons
behavioural deficits, especially for social interactions
(brain cells) and each neuron forms about 15,000
and emotions (right temporal cortex), and language
connections - or synapses - during the first few years
(left temporal cortex) (Schore, 2001a 2001b).
of life. By the age of 3 the child has formed about
1,000 trillion connections which allows the brain to
Furthermore, without a caring adult to protect the
adapt in response to the environment (Balbernie,
child, toxic stress (the strong, unrelieved activation of
2001). Connections that are frequently used are
the body’s stress management system caused by
strengthened whilst redundant synapses are ‘pruned’
poverty, neglect and abuse) can further weaken the
– in other words, they die (Harvard Centre for Brain
architecture of the developing brain (Centre on the
Development 2014). Thus, early experience
Developing Child 2014). This evidence suggests that
determines which neural pathways will become
the neglect that can occur in institutional settings is,
permanent and which will be eliminated.
therefore, damaging to brain development and the
earlier age at which a child is placed in an institution,
For normal brain development to occur, a young
the more profound the damage will be
child needs a living and responsive environment and
particularly needs social interaction with a consistent
Evidence from the Bucharest Early Intervention
caregiver. One of the most essential experiences in
Project reveals brain scans of two three-year olds
shaping the architecture of the developing brain is
showing the profound effect that neglect has on the
"serve and return" interaction between children and
neurological development of young children.
significant adults in their lives (Centre for Brain
Children who were placed shortly after birth into
Development 2014). Young children naturally reach
institutional care with conditions of severe neglect
out for interaction through babbling, facial
show dramatically decreased brain activity compared
expressions and gestures, and adults respond with
to children who were never institutionalized.
the same kind of vocalizing and gesturing back at
them. This back-and-forth process is fundamental to
the wiring of the brain, especially in the earliest years Brain Development: Evidence from the Bucharest Early
as the nervous system is stimulated, triggering the Intervention Project
release of β-endorphins and dopamine which
regulate the uptake of glucose and enables the brain These brain scans of two three-year olds
to grow. demonstrate the profound effect that neglect – a
Neglect, abuse or the lack of a consistent primary characteristic of institutional care – has on the
caregiver in the early years of life has the potential to neurological development of young children.
adversely affect brain functioning. A child raised in Children who were placed shortly after birth into
institutional care is typically deprived of the orphanages with conditions of severe neglect show
supportive, intensive, one-to-one relationship with a dramatically decreased brain activity compared to
primary caregiver that is essential for optimal children who were never institutionalized.
development. Without a caregiver to guide infant
learning, there is no process to direct synaptic
connections and the development of pathways in the
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Attachment
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caregiver can produce children who are desperate for primary caregiver is considered to be a ‘blueprint or
adult attention and affection”. inner working model’ for all later emotional
attachments, as the young child learns how to love
This pattern is not an inevitable consequence of and to be loved, which forms the basis of self-worth
institutionalisation and there are mediating factors, and empathy for others (Bowlby, 1969). The lack of
such as the child being a particular favourite of a secure attachment therefore has consequences for
residential care worker and receiving more sensitive physical, cognitive, behavioural and psychosocial
care giving. Nevertheless, children in institutional development of children and for the development of
care have limited opportunities to form selective emotions and relationships in later life (Browne et al
attachments compared to children in family-based 2006).
care. The child’s first emotional attachment to their
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1 Stereotype behaviours are defined as repetitive, invariant different medical conditions, including autism, and are also
movements with no obvious goal or function (Mason 1991) known to develop in association with atypical and especially
Stereotypies are commonly associated with a number of restricted sensory environments or deprivation
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institutional care is often very visible, but is not Growth and Physical Development: Evidence from
always so, depending on the level of deprivation. the Bucharest Early Intervention Project
Diagram source: Johnson (2001).
– Children raised in institutions displayed lower height,
weight and head circumference compared to children
Catch-up in height and weight are rapid when raised in families.
children are placed in family-based environments,
and the potential for growth recovery is greatest in – Children moved into foster care significantly recovered
younger children and within more nurturing height and weight, but not head circumference, within
environments where caregiver sensitivity and 12 months
positive relationships are higher (Johnson and – The percentage of children within the normal range
increased from 91% to 100% for height, 75% to 90% for
weight, and 84% to 94% for height-weight.
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Neglect and Abuse more than a third knew of children who had been
forced to have sex. (Stativa, 2000)
The isolated and closed nature of institutions makes – Ireland: 800 perpetrators were identified as having
children particularly vulnerable to a wide range of perpetrated physical and sexual abuse of 1,090
abuse. Indeed, physical, emotional and sexual abuse children in residential institutions between 1914
has been reported as existing in a number of and 2000. (Commission to Enquire into Child
institutions worldwide (e.g., Barter, 2003; UNICEF, Abuse, 2009)
2002). These include systematic rape and other
forms of sexual abuse; exploitation, including – India: 52% of children in institutions were
trafficking; physical harm such as beatings and subjected to beatings and other forms of physical
torture; and psychological harm including isolation, abuse. (Kacker et al 2007)
the denial of affection and humiliating discipline. – Middle East and North Africa: Children highlighted
violence in institutions as a key concern for them in
A survey undertaken by UNICEF (2002) covering 7.8% the 2005 Regional Consultation for the UN Study on
of all children in residential care in Romania found Violence against Children. (UNICEF and National
that 37.5% of children reported they had been Council for Childhood and Motherhood, 2009)
victims of severe physical punishment or “beatings”
(approximately two-thirds were boys and one-third – North America: violence against children in
girls). The perpetrators of this physical abuse were residential institutions is six times more prevalent
residential care staff in the vast majority of the than violence in foster care (Barth 2002)
reports (77%). Nearly one fifth (19.6%) of the
respondents (approximately half boys and half girls) While it is especially difficult to obtain statistical data
claimed to have been blackmailed for sexual on the exploitation and trafficking of children in
activities and a further 4.3% claimed that they were institutions, there is evidence to suggest this is a
“constrained” to have sex. The reported perpetrators widespread and growing concern. Some children
of these acts of sexual abuse were older residents of placed in institutions are, in effect, then ‘trafficked’
the same sex (50%), older residents of the opposite under the guise of intercountry adoption (Csáky
sex (12%) and institutional staff (1.3%) (UNICEF, 2009)
2002). It is this group that is most at risk of offending
against others in later life (Haapasalo and Moilanen, Furthermore, poor health and sickness often result
2004; Hamilton, Falshaw and Browne, 2002). from overcrowded conditions, with cots back to back
Anecdotal evidence suggests that children abused in and limited environmental experiences inhibiting the
institutions may have greater difficulty in reporting development of the immune system. Soiled clothing
the abuse, escaping from the situation, or getting is often left on babies and infants for long periods of
support from outsiders. Due to the child’s time and poor hygiene practices are widespread.
dependence on the institution, the abuse may Infectious diseases and serious medical illness are
continue for a long time. Children with disabilities are frequent, and children are routinely isolated when
especially vulnerable. they are sick (Miller et al 1995, Hostetter 1991).
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Example: Institutional Care and Delayed IQs and poor language skills often result in children
Development Leads to High Unemployment performing poorly at school. As a result they are less
Children in institutions often experience cognitive likely to obtain good qualifications, and are over
development delays as a result of their environment represented in special education and vocational
and care giver interaction, and lower than average schools. Communication problems are also common
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in children who grow up in institutional care. With factors. Indeed, many problems show rapid
depersonalised routines and little social interaction improvement once the child is removed from
children can find it hard to form normal relationships, institutional care and placed in a supportive family
even later on in life. These developmental delays environment.
affect children’s abilities and behaviours and are
compounded by poor preparation for independent The level of deprivation experienced in institutional
living and lack of support networks, limiting their care plays an important role, including consistency
ability to secure employment later in life and and sufficiency of caregiving, group size, rigidity of
contributing to poverty in adulthood routine, provision of healthcare and education,
degree of integration, and experience of abuse.
Example: Institutional care leads to early parenthood
Young adults leaving care usually crave adult Furthermore, and very importantly, a strong body of
attention, have no support network, and become evidence shows that age and duration of
dependent on the state for their basic welfare. They institutionalisation is strongly correlated with
often yearn for a meaningful relationship and developmental delay and recovery.
something to love and nurture, leading them into Institutionalisation at the youngest age has the most
early parenthood. With no experience of family life, severe and long lasting negative impact. Children
many struggle when they become parents under the age of 3 years are acknowledged to be the
themselves, putting their children at risk of most at-risk of developmental delay in institutional
institutionalisation and transmitting the problem care, and particularly those under 6 months (Johnson
from one generation to the next. et al 2006.) The earlier a child is placed into family-
based care the greater the recovery. In other words,
Reliable evidence regarding the long term outcomes early deprivation significantly compromises long
of institutional care is relatively scare. Evidence is term outcomes for children, and early intervention
more widely available for children in care, rather can result in recovery. For example, a study
than in institutional care per se, and from developed following the progress of children removed from
country contexts such as the U.K. U.S and Australia. institutional to family care before the age of 2 years
Children in care have worse outcomes than children in Romania found that the children were severely
who have never been in care, of whom those in cognitively impaired when they were first placed with
foster care achieve better outcomes whilst those their families. However, by the age of 4, children had
who have lived in institutional care are particularly made substantial developmental catch-up. Those
disadvantaged. In the absence of evidence regarding who had been placed into family care before the age
children raised in institutions, evidence related to of 6 months performed no differently to children
children in care more widely can be considered who had never been separated from their families.
indicative, thus the outcomes of both institutional Children placed into family care later made
care and alternative care more broadly have both significant developmental gains after leaving
been reflected in this discussion. institutional care but recovery was incomplete and
they were still disadvantaged some years later
(O’Connor et al., 2000).
Factors Mediating Development Delays
and Long-Term Outcomes of The nature of the family-based environment after
Institutionalisation institutional care also affects the recovery of
developmental delays and the long term outcomes
The nature and severity of children’s developmental for children. Evidence demonstrates that many
delays and outcomes in institutional care, and the children with institutional care backgrounds can
extent to which these can be recovered after they make a rapid recovery and ‘catch up’ on their
have been placed into family based care or physical and cognitive development when they are
independent living, is dependent on a variety of placed in a caring family environment at an early age
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