Editor's Note : I share this article today because I believe that Dr. Rogu is giving straight talk about older children who are adopted from orphanages. By no means does this article represent all older kids. But there is a very real number of kids who come out of orphanages and exhibit behaviors of moderate to severe developmental delay. Parents must be prepared and willing to accept their child's development and given the tools and knowledge to help their child reach his or her full potential.

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.

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 neuro-biological 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. Some children suffer malnutrition, are 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, he can no longer learn anything new from 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.

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 Retardation. The following is a list of characteristics that children with Institutional Retardation exhibit:

• Loss of physical height and weight. These children look much younger than their chronological age.
• Lack of eye contact (this can also be associated with attachment issues)
• Lack of interest in peers
• Failure to use gestures to point or show
• Attention and concentration problems. Example: ADHD-like behavior
• Deficient in learning and memory
• Institution-acquired autistic behaviors
• Maturity level years below chronological age
• Difficulty distinguishing reality from fantasy (often seen in children from orhpanges where the television was left on for hours)

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, however, that all older orphan (institutionalized) 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 Retardation, Institutional Retardation 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*

by George Rogu M.D.

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