Over 88% of  internationally adopted children are raised in orphanages.  Some countries provide foster care for a number of orphans prior to adoption.  However, the majority of children adopted from Chin , Eastern Europe, Latin America and other third world countries will have their initial language learning experiences in orphanages.  

Study after study documents that orphanage care results in growth failure and developmental delays.  Growth failure occurs frequently in internationally adopted children.  Johnson and Dole (1999) found that 48% of all children evaluated in their international adoption clinic had low birthweights, likely due to poor prenatal care.  Orphanage care after birth leads to further lags in growth.  Romanian, Chinese and Russian children raised in orphanages lose approximately 1 month of linear growth for every 3 months in orphanage care (Albers et al., 1997; Johnson, 2000; Johnson & Dole; Miller & Hendric, 2000).  Although specific figures vary, at the time of adoption children are frequently below the -2 standard deviation for height (32 - 51% of all children studied), weight (18 - 34%) and head circumference (24 - 45%) (Benoit, Jocelyn, Moddemann & Embree, 1996; Johnson; Miller & Hendric; Rutter, 1998). Growth failure leads to more than just petite children.  Growth failure after birth is highly correlated with lower intelligence and poor language abilities.

In addition to health concerns, children raised in orphanage environments are at high risk for developmental delays including language.  Reviews of medical records of orphans in Eastern Europe indicate that delayed language development occurs frequently (Gindis, 1999).  Dubrovina et al (1991, as translated and noted in Gindis, 1999), found that 60% of orphanage children ages 24 to 30 months were not talking, a year later only 14% were reported to use two word phrases.  By age 3 and 4 the children were described as having limited vocabulary, receptive language delays, and unintelligible speech.  These patterns of institutional delay are not limited to orphanages in Eastern Europe .  Orphanage care was relatively common in the United States in the first half of the last century.  Province and Lipton (1962 as cited in Johnson, 2000) studied the development of children in U.S. orphanages and noted that infant speech development "showed signs of maldevelopment early, became progressively worse, and was the most severely retarded of all functions that could be measured" (Johnson, 2000, p. 141).

Delays in language development are directly related to lack of adequate stimulation in the orphanage.  No matter how caring or well-equipped an orphanage appears to be, placing a large number of children in the care of a few adults is a recipe for delayed language.  I observed this first-hand when adopting my daughter from Russia .  Due to circumstances, my husband and I were not able to take her from the orphanage for several days.  Although we would have preferred to adopt her more quickly, the situation provided us with an opportunity to enter and observe her world.   We visited with her daily in the Baby Home over an 8-day period from 9:00 in the morning until she was put down for her afternoon nap.  My husband speaks Russian, which provided us with eyes and ears to fully observe her situation.  The orphanage was bright, clean, and had a 1:5 ratio of caregivers to children.  These children were well-fed, our daughter was even on the chunky side though her height, weight and head circumference indicated growth failure.  She was in a group of 10 toddlers, ages 14 to 23 months, with two caregivers providing care.  Although the caregivers were physically loving towards the children and provided basic needs, little language interaction with the children occurred.   What follows is an overview of what was observed.

• Children were segregated into groupings based on age and ability.  They were rarely allowed to play or interact with older children who might have served as language models. 
• Although two caregivers were present at all times, the caregivers changed from day to day.  During an 8-day period, there were 7 different caregivers on the day shift.  We assumed that different caretakers also rotated through the evenings.
• Younger children who needed help to feed were fed by caregivers.  However the caregivers rarely talked to the children and spent most of the time talking to other caregivers.
• When children were carried, they were often held facing out, away from the caregiver.  This limited interactions between caregiver and child
• Staff were busy attending to basic needs of the children and could not easily monitor the children as they played.  Although children were down on the floor and allowed to freely roam the room, toys were limited to small rattles and plastic blocks scattered around the floor.  When larger toys were provided, children had to be closely watched to make sure older children didn't accidentally hurt other children with them.  Because staff didn't have time to provide this monitoring, appropriate developmental toys were placed out of reach most of the time.
• The children spent all of their time in the orphanage sleeping/play area, or outside in a small section of the playground.  They were only taken to other rooms in the orphanage for medical checkups, or for therapies.  They were never taken outside the orphanage compound.
• When children were talked to, it was typically in the form of simple commands such as "come here," "sit down," "don't do that."  Across the 8 days of visits, there were only 3-4 instances of interactions where the caregivers described objects, actions, or provided other types of "teaching language" experiences.  

When children have limited exposure to language, and limited opportunities to interact with caregivers, language delays result.  The children in my daughter's group were all language delayed.  These children ranged in age from 14-23 months, therefore the majority of them should have been saying a few words, and  the older children should have been saying lots of words.  Of the 10 children, only the two oldest were talking and they only produced 2-3 words each.  None of the younger children were talking.  In fact, the younger children rarely vocalized, babbled, or made any vocal noise.  Considering that 10 toddlers were in the same room, the children were eerily quiet.  These delays in language development are considered "normal" by professionals who work in the orphanages.  When the Medical Director of the Baby Home was asked questions regarding my daughter's development, she replied "of course her language is delayed, it is to be expected."  

Despite the lack of words, most of the children had good non-verbal social interaction skills.  They smiled when adults spoke to them, made good eye contact during interactions, pointed and reached to indicate what they wanted, pushed away toys or items they didn't want, and brought toys and other items over to adults to show and share.  When new toys were presented, such as a new Busy Box, the children were curious and spent time learning to manipulate the features of the toy.  They were also quick imitative learners.  I gave them several sets of stacking cups to play with.  Within a few minutes one child began to bang two cups together.  After a few more minutes all of the older children had found two cups and were happily banging away, creating an impromptu percussion symphony (much to the dismay of the caregivers).  The few children in the group who did not have good non-verbal social interaction skills appeared to have significant delays affecting more than just language abilities.

Since that experience, I have traveled to other Russian orphanages and have observed similar patterns of caretaking, and language learning.  There are differences in orphanages, with some providing better nutritional, physical, and emotional care than others.  However no matter how ' good' the orphanage appears,  when children lack sufficient adult language models, appropriate play experiences, and enriching community outings, delays in language occur.

In summary, parents should expect children raised in orphanages to have mild to moderate delays in spoken language development. However, nonverbal social interaction skills appear to be less affected by the orphanage environment.  These social interaction skills should be the primary focus during the pre-adoption process. 

Contributed by Dr. Sharon Glennen , Assistant Professor of Communication Sciences & Disorders, Towson University.