Inherent Difficulties Accounting for Prenatal and Perinatal Risk Factors in Samples of Post-institutionalized Children
Abstract
Titus Asbury
Research on international adoption has indicated that a majority of children present with a variety of special needs [1, 2]. Researchers often cite the institutional environment as the source of special needs in foreign adopted children [3, 4]. While the current article provides a general overview of developmental delays and deficits in post-institutionalized children, the overriding tenet is a call for better identification of pre- and perinatal risk factors in post-institutionalized children.
The Prenatal History “Wild Card”: Inherent Difficulties Accounting for Prenatal and Perinatal Risk Factors in Samples of Post-institutionalized Children
Over the past decade and a half, an increasing body of literature pertaining to international adoption has emerged. In 2004 alone, the U.S. Department of State reported more than 20,000 children were adopted from foreign countries [2]. In the United States however, the number of international adoptions have more than doubled since 1992 [5]. While similarities exist between international and domestic adoptions, children adopted from foreign countries present a number of unique issues and challenges [6]. Many of these issues and challenges stem from the fact that internationally-adopted children are very likely to have experienced out-of-home or institutionalized care. Gunnar, Grotevant and Johnson’s survey of internationally adopted children in Minnesota for example, indicated that prior to adoption 72% had experienced multiple transitions [7]. In addition Johnson suggests that roughly the same number of children adopted from foreign countries have a history of institutionalization [6].
There is now considerable evidence linking numerous poor developmental outcomes to children with a history of institutionalization [1; 8]. These findings are not surprising when considering the likelihood of exposure to the many conditions hazardous to physical, cognitive and socio-emotional development institutionalized children may face [2]. It is now well recognized, for example, that many foreign orphanages are understaffed, and institutionalized children will likely experience malnutrition, attachment problems and cognitive delays and deficits [1].
It may be obvious to even the casual observer that poor developmental outcomes are a direct result of early caretaker neglect and insufficient stimulation in the institutionalized setting. However, the general assumption that such outcomes are a direct result of the institutionalized environment is only part of the story. Although the relative contribution of nature and nurture to human development has been argued for centuries, a current review of the literature on post-institutionalized children is overwhelmingly focused on the post-natal (nurture) influences. While it is usually recognized that pre-and-perinatal influences contribute, the recognition is typically based on assumptions and speculation without the support of empirical data. The following sections will highlight what we know about the developmental outcomes for many post-institutionalized children. In contrast, we will then see that we know very little about the specific pre- and perinatal life history factors that may have contributed to these outcomes.