A Neurobiological Perspective on Early Human Deprivation

The number of children who are abandoned or orphaned around the world is rapidly increasing owing to war, AIDS, and poverty.Many of these children are placed in institutional settings for lack of individual or societal resourcesor becauseof long-standing cultural traditions. It hasbeenknown for overhalf a century that rearing children in institutional care characterized by profound sensory, cognitive, linguistic, and psychosocial deprivation can be deleterious to their development. This article examines the neuralmechanisms that likelyunderlie themaldevelopment many institutionalized children experience. KEYWORDS—deprivation; institutionalization; brain development; orphanage; neural plasticity; psychosocial An extraordinary number of children throughout the world begin their lives in psychologically adverse circumstances. In some cases, these children live with their parents in profound poverty; in others, they either do not have parents (such as those orphaned by war or AIDS) or they are abandoned by their parents. Vast numbers of abandoned or orphaned children living in Eastern Europe, China, and Latin America live in institutional settings. This article describes the effects of profound early deprivation (common in many institutional settings) on brain and behavioral development. THE NATURE OF THE PROBLEM UNICEF estimates that approximately 1.5 million children in Central and Eastern Europe live in public care (orphanages, group homes, psychiatric units). These include children who have been abandoned by their parents, whose parents have died, who live in hospitals because of chronic illness (e.g., AIDS), and who live in penal institutions. The European Commission for Social Cohesion estimates that 10–20 per 1,000 children birth to age 18 in Bulgaria, Russia, and Romania and 5–10 per 1,000 in Poland, Hungary, Moldova, Lithuania, Latvia, and Estonia live in orphanages, group homes, or psychiatric units. In Sweden, Finland, Ireland, Belgium, The Netherlands, Italy, and Spain, 1.5–3.0 per 1,000 children younger than 3 years are institutionalized (Browne, Hamilton-Giachritsis, Johnson, Leth, & Ostergren, 2004). Collectively, institutionalizing young children is a common practice throughout many parts of the world. The majority of these children will remain in such settings for many years, whereas a relatively small minority will be adopted, most internationally. Indeed, in 2004, nearly 23,000 international adoptions took place in the United States. Not surprisingly given the figures cited above, the vast majority of these children were from Eastern Europe and Asia (Russia and China in particular). As it does in families, the quality of care varies among institutions; there is also variability in the nature and degree of deprivation. For example, in some model institutions in Russia, the caregiver-to-child ratio is reasonable and the degree of sensory, cognitive, and linguistic deprivation not severe. At the other end of the spectrum, institutional life can be characterized by profound global deprivation. The ratio of children to caregivers can exceed 15:1; caregivers are generally poorly trained and, in many cases, uncommitted to the welfare of children and unresponsive and insensitive to children’s needs. Nutrition can be substandard, cognitive stimulation can be inadequate, and Charles A. Nelson, Development Medicine Center Laboratory of Cognitive Neuroscience, Children’s Hospital Boston, Harvard Medical School, 1 Autumn Street, Mailbox #713, Office AU621, Boston, MA 02215-5365; e-mail: [email protected]. Although Romania has made great strides in reducing the number of children living in institutions—from more than 100,000 a decade ago to 30,000 today—the number of children being abandoned has actually held steady at approximately 8,000 per year. Again, using Romania as an example, because there is a moratorium on international adoption and because domestic adoption remains uncommon, abandoned children typically remain in institutions or, more recently, are placed in state-run foster care or are reunited with their biological parents (although the child protection system in Romania generally does an inadequate job of supporting foster care or policing reunification). Volume 1—Number 1, Pages 13–18 # 2007, Copyright the Author(s) Journal compilation # 2007, Society for Research in Child Development 13 exposure to mature language is frequently lacking owing to a paucity of adult caregivers. Basic sensory stimulation can be lacking across multiple modalities, leading to perceptual deficits (e.g., lack of patterned light stimulation because walls and ceilings are painted white and infants are left in their cribs for long periods of time; infants are not held or touched, leading to tactile deprivation). Finally, institutional care is frequently characterized by strict adherence to conformity (e.g., children are dressed alike) and regimen (e.g., children all eat at the same time, use the toilet at the same time). It would not be unreasonable to suggest that life in institutions that globally deprive young children resembles peer-rearing common in some nonhuman primate studies (e.g., Suomi, 1997). Of course, even this is misleading because nonhuman primates typically huddle together when left without caregivers, whereas human children typically do not. EFFECTS OF EARLY INSTITUTIONALIZATION ON