I’ve been wanting to post my notes from the workshop I did at The Idea Camp, but I’ve struggled with how to present it, because it really was more of a conversation. What I’m sharing below is really just an outline – there was so much more meat in the discussion that took place in that room full of people who cared passionately and deeply about these issues. But here is a general overview of what what discussed in relation to the psychological ramifications for orphaned children: 
The Orphan Archetype:
First we looked at the dichotomy of presentation in the “orphan achetype” (in plainspeak – the stereotypes and oversimplified ideas we hold of orphans) We talked about the idea of the orphan as a plucky, happy child whose only issue is a need of parents (i.e. Annie, Oliver, Newsies, Meet the Robinsons) and how this may affect idealized notions, especially for prospective adoptive parents. Then we talked about the presentation of orphans as troubled, damaged goods with inevitable attachment disorders and problematic behavior, and how this may deter the adoption of older children. The reality in both of these stereotypes is that orphaned children are complex human beings with unique strengths and needs.
The Psychological Needs of Orphans
If we want to help orphans become fully functioning adults, we must address their psychological needs along with their physical needs. Adoption into a loving family can be a solution to healing the wounds of abandonment, but prospective adoptive parents must have an understanding of the psychological effects of abandonment. Too often, parents are simply looking to add a child to their family and then shocked, disappointed, and resentful of the unique psychological needs of a child adopted from a difficult place. Orphanages and those working in in-country care must adapt the caregiving to address the whole child: physical, spiritual, and psychological. It is not okay to assume that Christian education or academic prep will erase deeply ingrained developmental or psychological issues.
Orphans and Loss
At the base of the orphan experience is loss. The loss of parents is probably the most significant loss any child can experience. How and when that loss occurred will likely affect a child’s development and ability to attach. A child who was cognitive at the time of loss or relinquishment may deal with severe abandonment issues. At the same time, a child who received the nurture of a consistent caregiver in the first three years of life may fare better than a child relinquished at birth into an orphanage setting. While a child who was placed as an infant may not have a cognitive memory of abandonment, they may also not have had the benefit of individualized care during the critical first two years of life. By nature of being orphaned, a child’s psychological needs will be greater. Simultaneously, by nature of being orphaned, that child is likely to receive less attention into their psychological well-being, especially in an institutionalized setting. This is the tragedy for most orphans: high psychological needs, deficient psychological care. Thus, problems are compounded. Specifically, institutionalization compounds the effects of abandonment.
Orphan Culture
Both anecdotally and empirically, we see a subset of behaviors that tend to emerge in children who live in setting where there are multiple children and multiple caregivers. (This is often due to the combination of low staff-to-child ratios +the revolving door of shift-working caregivers, and most orphanages have this. Even the best. It is extremely expensive and difficult for an orphanage to create a family environment with consistent caregivers. The behaviors that emerge from this setting may indicate reactive attachment disorder, but most kids will fall short of that diagnosis and yet still struggle behaviorally and relationally. This is what prospective adoptive parents need to understand: there is a huge spectrum between a typically developing child and a child with reactive attachment disorder, and most children coming from orphanages will fall somewhere in the middle. Therefore, parents should still be prepared for attachment challenges and transitional issues, which may include:
· Superficially charming behaviors · difficulties with eye contact · indiscriminant affection with strangers · destructive tendencies · hoarding or gorging · manipulation · lying and deceitful behaviors · fear of abandonment · difficulty making decisions or veering from routings · aggressiveness · entitlement issues · power struggles (lord of the flies) · self-soothing behaviors · sexual acting out or sex play with other children
(There was quite a bit of discussion from the participants about how these behaviors manifest, in both orphanage and home settings. To respect privacy, I won’t go into detail, but there was definitely a consensus that these issues are prevalent for institutionalized children).
Lifelong implications:
The psychological impact of being abandoned does not end in childhood. If children do not form healthy attachments it is very likely they will struggle into adulthood as well. This is one of the reasons we see a statistical cycle of abandonment – children who were abandoned are more likely to abandon their children (and former foster youth are more likely to have their children removed). Some of the issues abandoned children may face in adulthood:
- · difficulty in relationships
- · legal problems
- · occupational problems
- · homelessness
- · depression and anxiety
- · abandoning children
- · sexual acting out
- · drug/alcohol addictions
- · poor coping skills
Again, there are many orphanages that are attempting to raise “future leaders” in their country of origin, but this is unlikely if psychological needs are not met. Academic and spiritual education are valuable, but there needs to be an intact psychological foundation for children to succeed.
Solutions:
Adoptive parents must prepare themselves for the unique needs and traumas their children may hold from being abandoned and from orphanage life. Orphanages and homes for children need to set up a family environment with consistent caregivers. Directors need to be trained in best practice for attachment and pass that training on to the staff that is working directly with the children. (We also spent a good deal of time talking about the impact of short-term mission trips on orphans and I will talk about that more in another post).
Research Findings:
In conclusion, I shared the findings of The St. Petersburg – USA Orphanage Research Team (a huge thank-you to Megan who gave me this information). I think the findings here are really important for anyone doing orphan care:
This research group is looking at best practice for group care. In the study, the made the orphanage more family-like by integrating groups by age and disability status, changing caregivers’ schedules and assigning two "primary caregivers" to each group, and training caregivers to care for the children more like they’d care for their own children (sensitive, responsive care). Children who experienced the intervention showed improvements in every domain of development, including height/weight (even though their diet/nutrition never changed). I think this intervention is a good demonstration that orphanages *can* be made to be more family-like, and these kinds of changes might help to ameliorate some of the problems that are typical of children adopted from orphanages. Notably, this intervention can be sustained on the same budget that the orphanages already get from the government. Of course, it’s important for there to be a dedicated orphanage director and staff for the intervention to work. From a practice and policy standpoint, because orphanages aren’t likely to disappear any time soon, this type of intervention might be a direction to go in the future.
Some other things to think about–
1) Our research shows that most of the problems experienced by children adopted from orphanages stems from their experience during the first two years of life. This is *not* to say that experience beyond that age is not important (it clearly is). But we’re finding that the rate of problems that these children have is greater for children adopted after two years of age, but the rate of problems does not continue to go up with even later ages at adoption. The specific age when this "shift" in levels of problems occurs does vary depending on how depriving the orphanages are–the orphanages we study show the shift around 18 months of age at adoption, whereas the 1990s Romania orphanages show that shift closer to 6-12 months. 2) We’re thinking that a lot of the problems that children adopted from orphanages have can be traced back to very basic interactions that would tend to happen quite frequently for children in a typical family (but, are relatively rare in an orphanage environment). One thing we’re thinking about is the degree to which children experience contingently responsive care. So, when baby does X, a specific caregiver always or usually does Y. When the same caregiver interacts with a child over time, responding to the child’s needs (instead of just providing care according to a predetermined schedule), patterns begin to develop, and children develop understandings of basic, fundamental concepts like contingencies (if X happens, then Y happens) and social cues (this facial expression means X, this tone of voice means Y). If a child doesn’t have these experiences early on, and doesn’t learn these fundamental skills at those early ages, its very likely that the child’s brain development is affected, and its perhaps not surprising that parents report that their adopted children have some difficulties in social situations and with logic/science understanding. 3) Indiscriminate friendliness or disinhibited social behavior is often reported in children adopted from orphanages. There’s no doubt that some of this behavior is reinforced in the orphanage environment, but it seems like it stems from things even more fundamental than that. The early experiences children have in orphanages often produce deficits in children’s executive functioning skills (things like planning, organization, decision making, inhibiting responses, etc). It’s quite possible that this superficial social "charm" that children show is actually showing their inability to inhibit social responses around strangers.
This is by no means a complete representation of the conversation that happened at Idea Camp. There was so much good feedback shared from those present and this is just a small snapshot of all that was discussed. I will be talking more about orphan culture and the transition to family culture at the upcoming Together for Adoption Conference in Phoenix. If this is of interest to you, think about attending in October.
