Insitutional autism and child abandonment

Institutionalization early in life can have dire consequences if the children are emotionally neglected. Thus far American families have adopted thousands of children from orphanages in Eastern Europe and Russia that lacked in proper caregiving, were overwhelmed by a high child-to-caregiver ratio, and/or lacked physical resources to provide necessary nutritional and/or medical care. Over the years a significant percentage of these children have exhibited serious mental problems from which they have either recovered, or in other cases, remained affected despite the love and care of their adoptive families. These children may exhibit aggressive behaviors, hyperactivity, refuse to make eye contact, temper tantrums, attention deficits, extreme sensitivity to touch, and an inability to form emotional bonds. Some of these behaviors, e.g., attention disorder and social problems, are positively correlated with age at adoption (worse symptoms with a longer exposure to institutional deprivation) and may increase as children transition from middle childhood to adolescence. At assessment these behaviors along with the difficulties in learning a second language can provide for an autism-like syndrome variously called: quasi-autism, post-institutionalization autistic syndrome or institutionally induced autism. Although arguable, some people believe that these problems may be specific to the regions previously mentioned (Eastern Europe and Russia) as children have been culturally primed by higher rates of alcohol exposure during gestation.

Children with institutional autism have undergone a number of traumatic events (e.g., losing their primary caregivers, lack of stimulation, isolation in hospital cribs).  Some authors have stated that orphans deprived of social interaction “learn” autistic patterns of behaviors.  According to Federici, “Over time they practiced these behaviors as a defense mechanism to block out pain and misery and had ultimately become self-absorbed and withdrawn in a way similar to children with autistic conditions” (Federici, 1998, p. 74). This would lead us to consider whether institutionalized or “learned” autism is the same as the innate autism first described by Kanner.

According to Rutter (2007) although there are similarities in the symptoms (e.g. rocking, self-injury, unusual and exaggerated sensory responses), “the dissimilarities suggest a different meaning”.  Many of the autistic-like symptoms due to institutionalization tend to diminish, with the apparent exception of unusual sensory responses, once the child enters the environment of their adoptive parents.  These behaviors may even disappear, but may resurface in response to stress.  The symptoms of institutional autism describe separate patterns of behaviors that can often be explained by environmental influences and contrast to the well-known clusters of symptoms described for “organic” autism.

The difference between institutional autism and “organic” autism has practical implications. Therapy for institutional autism addresses behavioral modification techniques that target learned maladaptive behaviors proper for non-autistic children. Of great importance is the recommendation not to include institutional autism children in the same educational programs as those with “organic” autism. Inclusion of these children may lead to their imitating behaviors that may prove inappropriate.

References

Federici R. Help for the hopeless child. A guide for families. Federici and Associates, Alexandria, Virginia, 1998.

Gindis B. Institutitonal autism in children adopted internationally: myth or reality? International Journal of Special Education 23(3):118-123, 2008.

Rutter M, Kreppner J, Croft C, Murin M, Colvert E, Beckett C, Castle J, Sonuga-Barke E. Early Adolescent Outcomes of Institutionally Deprived and Non-deprived Adoptees. III. Quasi-autism. Journal of Child Psychology and Psychiatry 48, 12, pp. 1200–1207, 2007.

7 responses to “Insitutional autism and child abandonment

  1. Manuel, These control system response anomalies are especially sad in children. The large gene-imaging consortium studies give strong evidence of factorial numbers (astronomical) of SNPs in epistasis, and environments, predisposing/causing these diagnostically uncertain anomalies. Best wishes, Joe

    Like

  2. I think Joe here is trying to say what I am thinking.Who is to say these children did not already have autism or ADHD at the time they were institutionalized.I am sure there were very few children who were diagnosed with autism in Eastern Europe during the Cold War years.The availability of diagnostic services probably still lags behind much of the rest of the world.As you say,alcoholism has been a serious problem for many years,especially in Russia,and fetal alcohol syndrome is a major cause of autism,ADHD,and other developmental disabilities.

    Like

  3. During my professional years in chilld psychiatry in the UK I did see children (“pre-school”) of this type; they were called, in the CIE 10. “attachment disorders”. of a “reactive” (somewhat similar to autism) and “desinhibited” ( with marked hyperactivity and overfamiliarity). Of the first ones I saw two cases with remarkable improvements in three to four monts of good adoptive care and quality nurseries. These were children that social services considered hypervigilant but frozen, The “desinhibited” ones which I saw several not only adopted but from very disorganized families had no such dramatic transformations. Interesting, for theoretically these ones were far less damaged than the first ones who to start with were mute.
    I also saw a patient who institutionalized as autistic during childhood made in adolescence, when he learnt to read and soon started with Jung and Niestzche, an incredible transformation and it is possible that the institutionalizations and the very early abuse that led to it were the causes of his autism. As an adult he had bouts of depression.

    Like

  4. Institutional autism opens the door to many discussions and possible learning points. Thank you for the comments Mariano. I hope that you keep posting, especially insightful notes based on your experience.

    Like

  5. I will Manuel.
    I think in the ones I am referring to, it was the grossly chaotic and negligent environment with or without institutional input but changing unpredictable carers which was an issue.
    I think, but I am not sure. René Spitz did some study with imprisoned mothers which showed that if they were allowed regular supervised contact with their mothers the damaged was less.

    Like

  6. I will venture to make some predictions here, derived from the perspective of the antiinnatia theory of autism (declaration of interest, myself author). Updated presentation at: http://energyark.net/auttheonew.pdf
    The basic idea is that autism is caused by “antiinnatia factors”, that is factors which reduce gene-expression of innate tendencies such as relating to one’s own species, being able to communicate with them, and more.
    Mainly that would be genetic and chemical factors. But also of course our socialisation and communication skills depend on having others to learn with. We could call this “psychoenvironmental quasi-autism” or “socioenvironmental quasi-autism”.
    From the perspective of the antiinnatia theory, I would expect some similarities and some differences.
    Such deprived children would be held back in their communication skills, and in their social skills at least in more advanced respects. They could also have some of the “distress” symptoms which could include self-stimulatory rocking.
    But there are other features which would be expected not to be increased in such children. For instance spinning without dizziness. The peculiar bursts of handflapping (often alternating with posturing). Probably the lining up of objects. Toe-walking. Special skills and above average Raven’s scores. And more which might be discerned from the Table 2 in above cited.
    The thing is that those latter features of autism would be produced by endogenous suppression of gene-expression, but not by environmental deprivations. Are there enough accessible such children that a study could be done of these predictions?

    Like

  7. Interesting
    You might want to include in such theory a consideration of “sensitive periods” during which the particular innatia factors would be most active. Oliver Sachs wrote a book: “Seeing voices” or something like this on the subject. Children who were mute could be taught to learn language if they had been exposed to communication between adults in the first years of life even if sach communication had been in the form of sign language, but they remained unable to learn such lagnguage if they had not even if they were well equipped to it anatomically.
    Autistic children would lack those tools (for genetic or other organic reasons) with wich to articulate their drives towards the external world with the guiding cues in the environment wich led to the semantic and social levels; pseudoautistic would no be able to use them but migyht if exposed to some evidences of them use them at later stages.
    The subject is a very complex one and I belive has been visited very ainteligently in the past albeit not with autism in mind.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s