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Institutional care

Many children raised in the deprived conditions of orphanages and state institutions in economically-poor countries exhibit emotional and psychological disturbances (aggressive or passive behaviour; withdrawal from other children); difficulty forming attachments (Attachment Disorder); overactivity and distractibility (ADHD); delayed development; learning disabilities; and medical problems (Fetal Alcohol Syndrome, Hepatitis B and C, cleft palate).

Instrumental in bringing to public attention the effects of institutional care on adopted children are four women: Thais Tepper, Lois Hannon, Lily Romine and Carol Jansson. The parents of severely delayed children from Romania, they founded in 1993 the Parent Network for the Post-Institutionalized Child, based in Pennsylvania. PNPIC works to debunk the myth that with love, medical care and good nutrition the adopted child will become "typical" in six months ... in fact, most children from a deprived background will have some issues that will not go away on their own, making professional intervention inevitable.

Dr. Victor Groza studied over 400 Romanian adopted children and concluded that 20% "overcame their pasts and are thriving"; 60% "have made vast strides, but continue to lag behind their peers" and 20% "have shown little improvement and are almost unmanageable".

It's a sobering picture borne out by a study done by Dr. Dana Johnson with Dr. Laurie Miller and by a Canadian study by Dr. Elinor Ames. Dr. Ames studied 46 children adopted in the early 1990s from Romanian orphanages -- two-thirds are now doing very well, while one-third still have behaviour and attachment problems, and developmental delays, years after the adoption. Dr. Ames found that the longer the stay in an orphanage, the more severe the problems. She advised parents planning to adopt from an orphanage to weigh their resources -- time, money, energy and outside support -- against the special needs of an orphanage child, who might need expert care for a long time.

Neuropsychologist Dr. Ronald Federici specializes in evaluating post-institutionalized children from economically-deprived countries. He blames noxious chemicals for interfering with brain growth. Pre- and post-natal exposure to alcohol, nicotine, heavy metals and pesticides damages the child's central nervous system. The result: mental retardation, attention deficit disorder, learning disabilities, developmental delays or behaviour disorders.

Adopting an Institutionalized Child: What are the Risks?, Effects of institutional care on physical growth and cognitive development. "The chance of an institutionalized child being completely normal on arrival in your home is essentially zero." Dana Johnson, M.D.
Ames: Adapting to New Life Difficult For Romanian Orphans, News release on results of the Ames study on Romanian orphanage children. 1997.
Ames: Children Adopted from Romanian Orphanages Have Special Needs, Findings and recommendations. AFABC.
Ames: Orphanage Experiences Play a Key Role in Adopted Romanian Children's Development, Dr. Ames summarizes her findings. 1997.
Are Institutions a Place to Call Home?, Impacts of long term institutionalism on children adopted from Romania. Victor Groza, Daniela F. Ileana, Ivor Irwin
BGCenter, Center for Cognitive-Developmental Assessment, Rehabilitation and Training. Boris Gindis,, director. English/Russian psychological services for children adopted from Eastern Europe and Russia. Pre-adoption document review; psycho-educational evaluation.
International Adoption: Lessons Learned from Romania, Impacts of institutionalism. Tips for parents adopting abroad. Victor Groza interview.
Neuropsychological Evaluation and Rehabilitation of the Post-Institutionalized Child, Ronald S. Federici, at the Conference for Children and Residential Care, Stockholm, May 3, 1999.
Our Children from Romanian Orphanages, In Post-adoption Helper. Jennifer Smart, Family Helper.
Parent Network for the Post-Institutionalized Child, Medical, developmental, emotional and educational needs of children adopted from hospitals, orphanages and institutions throughout the world. Meadow Lands PA.
Preparing Families for Adoption of Institutionalized Children with Special Needs, Advice for parents on adopting children at risk for special needs. Victor Groza and Daniela F. Ileana
Raising the Post-Institutionalized Child, Impact of institutionalization on internationally adopted children. "Early assessment is the key." Ronald S. Federici, Alexandria VA. June 2001.
Speak, Read, Succeed Interactive Checklist, Checklist of questions to assess your child's speech problems. Richmond BC Public Library.
Speech and language development in children adopted from China, Karen E. Pollock, Univ. of Alberta.


Cermak, S., and Daunhauer, L. (1997). Sensory processing in the post-institutionalized child. The American Journal of Occupational Therapy, 51, 500-507.

Groze, Victor, and Daniela Ileana. A Follow-Up Study of Adopted Children from Romania, Child and Adolescent Social Work Journal. Dec. 1996. Experience of families adopting from institutions vs. other placements.

Hough, S. (1999). Risk factors for speech and language development of children adopted from Eastern Europe. In T. Tepper, L. Hannon, & D. Sandstrom (Eds.), International adoption: Challenges and opportunities. Meadowlands, PA: PNPIC.

Johnson, D. (1999). Adopting an institutionalized child: What are the risks? In T. Tepper, L. Hannon, & D. Sandstrom (Eds.), International adoption: Challenges and opportunities. Meadowlands, PA: PNPIC.

Johnson, D., et al. (1992). The health of children adopted from Romania. Journal of the American Medical Association, 268, 3446-3451.

Marcovitch, Sharon et al. Determinants of Behavioural Problems in Romanian Children Adopted in Ontario, International Journal of Behavioural Development, 20 (I), 17-31

Marcovitch, Sharon et al. Recovery from Early Institutional Care: Predictors of Attachment and Development for Internationally Adopted Romanian Orphans, Health Canada, Mental Health Division.

Marcovitch, Sharon et al. Romanian Adoption: Parents' Dreams, Nightmares and Realities, Child Welfare, 74, 936-1032.

Meese, Ruth Lyn, "A Few New Children: Postinstitutionalized Children of Intercountry Adoption," The Journal of Special Education, Volume 39, Number 3, Fall 2005, pp. 157-167(11). Review of 29 studies on children adopted from orphanages in Romania, Russia and China shows the best predictor of ongoing problems is the length of orphanage stay. Children in care a year or more were at higher risk for cognitive delays and behavioral problems.

Rijk, Catharina, Rene Hoksbergen, Jan ter Laak, Cor van Dijkum and L. Robbroeckx, "Parents Who Adopt Deprived Children Have a Difficult Task," Adoption Quarterly (Volume 9, Issue 2/3). Study of 72 Dutch families adopting 80 children from Romania found that the child's age at adoption was not related to the level of parents' satisfaction. Adoptive parents had higher parenting stress because they had children needing professional help.

Rutter, M. (1998). Developmental catch up, and deficit, following adoption after severe global early deprivation. English and Romanian adoptees (ERA) study team. Journal of Child Psychology and Psychiatry, 39, 465-476.


Ames, Elinor W., The Development of Romanian Orphanage Children Adopted To Canada, 1997. Psychology Department, Simon Fraser University, Burnaby, B.C. V5A 1S6, 604-983-9317, Summarized in Post-adoption Helper No. 1,

Burlingham and Freud, Infants Without Families, International Univ., 1973.

Federici, S., and Ugent, C. (1998). Help for the hopeless child: A guide for families. Alexandria VA: Ronald Federici & Assoc.. With discussion on assessing and treating the post-institutionalized child.

Flint et al, Pathways to Maturity: Insights from a Thirty-year Study of Deprived Children, Univ. of Toronto Press, 1996.

Flint, B.M., New Hope for Deprived Children, Univ. of Toronto Press, 1978.

Galbraith, Lindsay. Romanian Orphans, Adopted Daughters. Stoveridge. 1998.

James, Beverly. Treating Traumatized Children, Lexington Books.

Money, John. The Kaspar Hauser Syndrome of "Psychosocial Dwarfism". Prometheus Books. Facts about institutionalization.

Provence, Sally and Lipton, Rose, Infants in Institutions, International Univ., 1962.

Smart, Jennifer. Our Children from Romanian Orphanages. Post-adoption Helper.

Swanson, Catherine A., MA, The Creation of a Socially Shared Past: Romanian Adoption. SPARK, Ontario, Oct. 1995. 416-763-3345. Interviews of 30 mothers adopting from Romania. Lifebooks; shared experience of adopting.

Tepper, Thais and Lois Hannon, Dorothy Sandstrom, eds. International Adoption: Challenges and Opportunities. 1st. ed. 1999. Parent Network for the Post-Institutionalized Child, Authorities on adoption pronounce on the essential issues: Risks of Adopting an Institutionalized Child; Health Needs Of Your Institutionalized Child; Alcohol-Related Birth Defects; Ames Study of Romanian Orphans; Risk Factors for Speech and Language Development.

Tizard, B., Adoption: A Second Chance, London: Open Books, 1977.


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Updated, Mar. 19, 2007

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