October 29, 2002
Romanian dictator Nicolae Ceausescu thought of children as future workers. More children meant more workers, more workers meant more production and more production meant prosperity. And so, under his rule, Romanian women were strongly encouraged or even coerced into bearing four or five children. When poor women couldn't afford their new babies, they often turned them over to state-run institutions.
In 1989, at the time of the Romanian revolution, more than 170,000 children were living in these bleak and crowded institutions where care was often impersonal at best. When Westerners learned of their plight, there was a rush to adopt these abandoned children. Unfortunately, the adoption process was widely exploited for profit, leading the government to ban all international adoptions in the late 1990s. Today, about 40,000 Romanian children remain in institutions.
Conditions have improved, but few alternatives have materialized for institutionalized children. I don't think the institutions are going to be eliminated quickly, said Charles Zeanah, professor of psychiatry. Many of the kids who are left are handicapped and wont be easy to place. And there were 8,000 newly abandoned kids in 2001, because poverty is still a huge problem. For a couple of generations of poor families, institutionalization has been something you do.
Zeanah is the principal investigator of an intervention study in which a number of infants and toddlers were taken out of the oldest institution in Bucharest and placed in foster care. Their development is being compared to that of the children who remained in the institution, as well as to a group of children who have never been institutionalized. Researchers were invited to develop the study by the Romanian Secretary for Child Protection.
The problem was that at the time we started the study there was virtually no foster care in Romania, Zeanah said. We had to create it and fund it. They recruited and trained 56 foster families in Bucharest and placed 66 children in their homes, allowing some sibling pairs to stay together. After a baseline study, children were randomly assigned to stay in the institution or to go into foster care.
Some critics have questioned the ethics of this random assignment, but Zeanah points out that without the intervention study few if any of the children would have had foster care, and that reducing the number of children in the institutions improved conditions for those who remained.
In addition, researchers have allowed any child in the study to move into a better situation if one became available. The children are assessed at 9, 18, 30 and 42 months for cognitive function, language, behavior, social relatedness, and attachment. Neuropyschological and neurophysiological testing is included. Already there's suggested evidence that cognitive recovery occurs in a quicker and more straightforward manner than social and emotional recovery, Zeanah said.
Different domains of development respond differently to intervention, and we need to know more about why this is the case and what can be done to ameliorate those problems. That information could be used to help neglected children everywhere. The fundamental problem with institutionalization is neglect, which also occurs outside of institutions. We're just looking at an extreme version of a problem that exists throughout the world, including right here at home.
Heather Heilman may be reached at firstname.lastname@example.org.
Tulane University, New Orleans, LA 70118 504-865-5000 email@example.com