Children adopted after the institute: the effects of early deprivation on their development – The main studies
Poiché anche l’adozione internazionale, pur senza il periodo di ricovero in istituto, può essere considerata un evento traumatico, dividere i bambini adottati e quelli adottati post-istituzionalizzati permette di verificare con maggiore chiarezza gli effetti delle cure istitutive precoci indipendentemente dall’adozione.
Il presente contributo è il secondo di una serie di tre articoli sull’argomento. Nel primo articolo è stata effettuata una disamina generale della situazione attuale relativa agli orfanotrofi e agli istituti per minori. Presenteremo oggi le principali ricerche sull’argomento, i cui risultati verranno poi illustrati nel terzo e ultimo articolo.
I principali studi su questo tema fanno riferimento all’adozione internazionale, cioe l’adozione di un minore il cui stato di abbandono e di adottabilità sia stato dichiarato dalle autorità competenti di un Paese estero. I bambini sono stati valutati sotto diversi aspetti. Nel caso della valutazione dei comportamenti problematici (disturbi esternalizzanti ed internalizzanti), i questionari utilizzati più frequentemente sono quelli della Child Behavior Checklist. Queste schede valutative fanno parte del Sistema di valutazione su base empirica di T. Achenbach e possono essere considerate ottimi strumenti per una prima valutazione globale del comportamento.
Uno degli importanti lavori di ricerca che hanno utilizzato la Child Behavior Checklist è quello di Merz e McCall (2010). Questi ricercatori hanno osservato i problemi comportamentali di 342 bambini e ragazzi dai 6 ai 18 anni, adottati da istituti russi di San Pietroburgo. Tali istituti fornivano adeguate risorse fisiche, ma scarse cure ed attenzioni da parte dei caregivers. I bambini in queste istituzioni potevano, infatti, fruire di sostegno medico, nutrimento, sicurezza, igiene, giocattoli e attrezzature, ma sono stati esposti ad un alto turnover di caregivers, scarse interazioni e bassi livelli di stimolazione psicosociale (Kossover, 2004). L’obiettivo dello studio di Merz e McCall era quello di dimostrare che, anche in assenza di grave deprivazione materiale, l’istituzionalizzazione precoce fosse associata ad un maggiore rischio di problemi comportamentali, in particolare in caso di esposizione prolungata alle cure istitutive (superiore ai 18 mesi a partire dalla nascita). I bambini del gruppo PSD (psycho-socially deprived), adottati in età compresa dai 5 ai 60 mesi, avevano dai 6 ai 18 anni al momento della valutazione. I loro risultati sono poi stati confrontati con quelli di bambini non adottati, nati nel paese adottivo (Stati Uniti) e cresciuti con la famiglia biologica.
Sono diverse le ricerche che hanno utilizzato lo stesso questionario: è possibile confrontare gli stessi parametri in studi simili a quello di Merz e McCall (Audet et al. 2006; Hoksbergen et al. 2004), condotti in istituzioni rumene. Anche in queste ricerche, l’obiettivo principale era quello di verificare gli effetti della deprivazione istituzionale; per questa ragione il gruppo di confronto non deprivato (ND) era composto da gruppi rappresentativi di bambini nati nei paesi adottivi (Paesi Bassi e Canada). La principale variabile associata agli scarsi risultati nella compilazione del questionario è risultata essere l’età al momento dell’adozione, un dato generalmente correlato con la durata dell’istituzionalizzazione. Poiché molti genitori non ottengono informazioni precise riguardo al tempo speso in istituto dal proprio figlio, l’età al momento dell’adozione è un dato che puo essere riportato in maniera più accurata (Hawk età al. 2010).
The studies previously presented by Merz and McCall (2010) and Hoksbergen (2004), together with that conducted by Gunnar (2007), have been particularly attentive to this variable, and compared early adopted children with later adopted children. The importance of these researches is given by the exclusion of the variable adoption: the focus is placed exclusively on the duration of hospitalization. While the previous comparison took into account adopted children and unadopted peers, these studies focused only on adoptive children, dividing the samples into “early adopted” and “late adopted” to verify more clearly the existence of a correlation between the duration and the effects of institutionalization. The limit between “early” and “late” varies according to the different authors: Hoksbergen (2004) defines children adopted after six months as “late adopted”, Merz and McCall (2010) have set the limit to eighteen months, while Gunnar (2007) to twenty-four months. Children raised in institutionalized settings have, as a rule, experienced a large number of different caregivers, whose attentions have often been scarce and poorly directed (Monti et al. 2010). Once removed from institutions and entrusted to a family, they are overrepresented in their new country’s mental health and special education services (Juffer & van Ijzendoor 2005; Miller et al. 2009). Several studies have shown that their school performances remain lower than those of their classmates, with a double referral to special education services compared to unadopted peers (12.8% vs 5.5%) (van Ijzendoorn &
The psychological mediators that could link these academic difficulties to early deprivation are represented by attachment disorders: RAD (Reactive Attachment Disorder) and DSED (Disinhibited Social Engagement Disorder), characterized by behavior patterns presented by both children raised in the institution and children. mistreated. DSM IV (APA, 2000) had two subtypes of the RAD disorder: the inhibited one and the uninhibited one, characterized in the first case by lack of social interaction and absence of attachment relationships, and in the second case by superficial and direct attachment relationships not selectively even to strangers.
A recent modification made in DSM 5 (APA, 2013) speaks of RAD to define the inhibited subtype and DSED (Disinhibited Social Engagement Disorder) to describe the uninhibited subtype: in both cases it is inappropriate social behavior. DSED subjects, in particular, exhibit undifferentiated behavioral responses with different adults, easily move away with strangers and do not rely on parents even in times of difficulty (Rutter et al. 2007). A study conducted in England on adopted children from Romania showed a clear correlation between this indiscriminate subtype and the use of special education services or cognitive deficits (ibidem).
A research of great importance, especially for the size of the sample of subjects studied (395 adoptive children), was carried out in Finland in 2011 (Raaska et al. 2011). These researchers wanted to see if the learning difficulties encountered in the large sample of children adopted were associated with symptoms of RAD or DSED. They used another questionnaire for assessing learning difficulties: the Five to Fifteen (FTF) (Kadesjo et al. 2004; Trillingsgaard et al. 2004), addressed partly to parents and partly to children themselves. This evaluation form includes 181 statements related to behavioral and developmental problems, grouped into eight categories: memory, learning, language, executive functions, motor skills, perception, social skills and emotional / behavioral problems. In a previous validation, the category of learning in the FTF was correlated with the general intellectual quotient obtained with the WISC III scale (Wechsler Intelligent Scale For Children) (Kadesjo, Trillingsgaard et al. 2004). For the evaluation of the affective sphere, as a validated questionnaire was not yet available, the parents were asked to respond to statements such as “often goes away with strangers”, “withdraws from contact”, “and too attached to one of the parents”, “Does not seek comfort in stressful situations.” Adoptive parents in Finland receive lots of information and extensive training before they get the chance to adopt and tend to accurately report the behaviors of their adoptive children: for this reason,
The study is particularly significant because, in addition to the percentage of time spent in the institution, it considers other factors: the gender, the number of institutions changed and the continent of origin of the subjects (Asia, Africa, South America and Eastern Europe). From the study, therefore, the peculiar characteristics of the child emerge who may, in all likelihood, need special education services: the results are particularly useful if you consider the importance of early interventions in the educational field. A further negative outcome, frequent in deinstitutionalized children and associated with numerous other problems, is attention deficit hyperactivity disorder (ADHD).
Wiik and colleagues (2011) studied the incidence in a sample of adoptive children from different countries of the world (Russia, Ukraine, Slovakia, China, India and the Philippines) highlighting the possible association between the onset of this deficit and the early experiences of multiple caregivers (Hodges and Tizard, 1989; Haddad and Garralda, 1992). Wiik’s study is particularly relevant for sample management: in this case, to isolate the variables and verify the role of institutional care, the children were divided into three groups: (1) not adopted, (2) adopted not institutionalized (from temporary custody situations) and (3) deinstitutionalized.
Since even international adoption, even without the period of hospitalization, can be considered a traumatic event, dividing the children adopted and those adopted post-institutionalized allows to verify more clearly the effects of early institutional care regardless of the adoption.
Finally, Smyke and colleagues’ study (2007) aimed to demonstrate the importance of the role of caregivers during the institutionalization period. They represent the reference adults and it can plausibly be assumed that, for the majority of the children in the institution, they represent the most important people, especially in the first period of life. However, the stressful work shifts, the high number of orphans and the high turnover rate make sure that an emotional relationship between adult and child does not always succeed. Smyke and his team of collaborators, observing series of video recordings of caregivers in the workplace, studied the quantity and quality of interactions with the children entrusted to them, to verify if those who received more attention and were involved in more interactions had a better state of cognitive (Bayley evaluation scale, 1993) and affective development (Infant Toddler Social Emotional Assessment, Carter et al. 2003). In particular, five areas of development were considered: physical growth, cognitive development, emotional expression, skills and behaviors. The subjects examined, 208 infants and children aged between 5 and 31 months at the time of the evaluation, came from all six institutions in Bucharest: the study can therefore be considered representative of institutional assistance in Romania. Five development areas were considered: physical growth, cognitive development, emotional expression, skills and behaviors. The subjects examined, 208 infants and children aged between 5 and 31 months at the time of the evaluation, came from all six institutions in Bucharest: the study can therefore be considered representative of institutional assistance in Romania. Five development areas were considered: physical growth, cognitive development, emotional expression, skills and behaviors. The subjects examined, 208 infants and children aged between 5 and 31 months at the time of the evaluation, came from all six institutions in Bucharest: the study can therefore be considered representative of institutional assistance in Romania.