Institutional Autism, secondary to orphanage living conditions.

By: George Rogu M.D. of Adoptiondoctors.com
http://www.adoptiondoctors.com/articles/profile/George-Rogu-M.d.-Of-Adoptiondoctors.com/2

Used with permission


Many children who are available for international adoption have either
been placed in hospital-run orphanage or a classic institutional care
setting for a multitude of reasons. These reasons range can from illness
or untimely deaths of biological parents, to the parents' inability to
care for the child's basic needs necessary for survival. Over the past
15 years there has been a dramatic rise in the number of children who
are internationally adopted and a majority of these children have been
raised in an institutional care facility.

In countries from the Eastern European block such as Russia, Romania,
Ukraine and Moldova, children are still being placed into orphanages at
an alarming rate. Reasons for abandonment stem from the fact that since
the fall of the Communism, democracy and freedom have left many people
poverty stricken and homeless. The lower socioeconomic class no longer
has the social support of the government to help with their survival.
Because of the poor economic situations of these people, families are no
longer able to care for the medical, physical and psychological needs of
their young. Families that are condemned to a life of poverty find
orphanages to be the only viable alternative that their children have
for survival and maybe even a future. Strange as this may sound it does
occur all too frequently.

Hospital-based institutions are still state-run facilities with little
or no resources. Children who have any type of medical condition (even
minor problems) are placed in institutions, which also house patients
with the more severe and sometimes neuropsychiatric conditions that no
child should ever be exposed to. Children with more complicated or
chronic medical conditions (such as blood disorders; infectious disease,
congenital malformations and classic autism) are doomed to a forgotten
life behind closed cold walls of the institutions.

The biggest problem that I personally have with the institutional
setting is medical diagnoses that are given to these children. These
diagnoses often are false, exaggerated and unfortunately sometimes very
real. The disparity to the severity of the medical problems found in
these children is is sometimes incomprehensible. They mix the severely
mentally retarded, autistic, and handicapped patients with the
relatively normal child who is abandoned, with mild developmental delay
or the child who required minor surgery that is unable to acquire the
procedure in order to lead a normal and healthy life..

Unfortunately, once a child was placed in a orphanage, that label
follows the child for years, especially in countries like communist
Romania during the 1980s. These children were fated to remain there for
a life without appropriate medical care or even the possibility of
having a family to care for their needs..

Developmental delays are frequently found in many of the orphanage
children, even before they are placed in the institution. This is
usually a direct result of poor pre-natal and post-natal factors,
nutritional inadequacies and medical neglect. Once placed in an
institutional care setting, these minor delays are often misconstrued as
a metal deficiency or mental retardation.

During the critical years of neurobiological development of the child's
brain, orphanages are notorious for being deficient in providing the
social, emotional and cognitive stimulation required for normal
development of the child. Many children are starved, neglected, and
forced to stay in their cribs in order to follow safety protocols.

Children are frequently and repetitively moved from one age group to
another. As the child ages out, he can no longer learn anything new for
the younger children in the group and often regresses to a more immature
behavior.

All of these factors combined with profound medical, nutritional, and
physical neglect cause these children to revert back to a more primitive
state in the child's mental development. Speech, language, and
intellectual abilities languish, and over time developmental milestones
deteriorate to levels where the child may appear to be truly mentally
delayed or retarded.

As a defense mechanism, in order to maintain the child's own inner well
being, neglected children generally shut out all environmental and
interpersonal contact that could cause them harm. There is sometimes a
component of learned helplessness. It is this type of behavior that
often gets labeled as Institutional Autism. Once this pattern of
regression occurs, it tends to be insidious and progressive.
The following is a list of characteristics that children with
Instititutional Autism exhibit:

Loss of physical height and weight. These children look much younger
than their chronological age.
Severe language delay which can regress to infant babbling
Lack of eye contact, aloofness
Failure to orient to child's name
Lack of interactive play
Lack of interest in peers
Failure to use gestures to point or show
Sometimes there are severe issues with bedwetting and soiling
Behavioral control issues and lack of social development
Attention and concentration problems. Example: ADHD-like behavior
Deficient in learning and memory
Institution-acquired autistic behaviors
Some of the most worrisome and disturbing characteristics of children
afflicted with Institutional Autism are that when they have complete
regression, they resort to self-stimulating behaviors in order to fill
the lapses regarding loneliness, deprivation and despair.

Examples of these behaviors are:

Rocking and head banging
Uncontrollable outbursts of rage and aggression
Body thrusting into inanimate objects such as walls
Self-mutilating behaviors such as hair pulling and picking at the body
During the adoption process many parents are faced with the dilemma of
acquiring a child who exhibits some or all of the above mentioned
characteristics. Parents become saddened when the child does not come
running or show any type of emotion towards them when they arrive to
meet the child. During the first hours to days for these children to be
withdrawn, exhibit lack eye contact and lack of communication with the
families. Observation over time is the best means to differentiate
adjustment problems versus more severe conditions.

After the adoption process is complete and the child returns to the
United States, some of these children continue to display some
quasi-autistic behaviors learned from in the institution for a period of
time after the adoption is completed.

It must be remembered that all orphan children have significant
impairment in both communication and their social skills. These children
cannot be expected to come home, put on a pair of blue jeans and
function immediately in our society. There is a great deal of work that
is required to rehabilitate these children. In contrast to true Autism,
Institutional Autism tends to improve with time and proper
interventional services. It has also been found that some children who
arrive with severe mental impairment upon arrival have a dramatic
improvement in their IQ points in the first years post-adoption.

I must once again stress the importance of rehabilitation, education and
a great deal of work on behalf of the parents in order to obtain these
results.

*Institutional Autism is not a term found in your everyday Pediatric
Textbook. It is a term described by Ronald Federici, Psy.D who has done
extensive research and was the first to write about this subject in his
book "Help for the Hopeless Child: A Guide for Families (With Special
Discussion for Assessing and Treating the Post-Institutionalized Child),
Second Edition, by Dr. Ronald S. Federici*

*More information and research on the topic of Institutional autism can
be found at www.Drfederici.com** *

by George Rogu M.D.