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these behaviors as a defense mechanism to block out pain and misery and had ultimately become self-absorbed and withdrawn in a way similar to children with autistic conditions” (Federici, 1998, p. 74).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.
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.