Physician: Institutional Autism

I have heard the term "institutional autism" as being a complication of living in an institution or orphanage. Autism sounds like a very scary word and I am nervous about this condition. Could you explain this diagnosis and what are the expected outcomes for these children?

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.

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In countries from the Eastern European bloc such as Russia, Romania, Ukraine and Moldova, children are still being placed into orphanages at an alarming rate. Reasons for abandonment stem from the fact that since the fall of the Communism, democracy and freedom have left many people poverty stricken and homeless. The lower socioeconomic class no longer has the social support of the government to help with their survival. Because of the poor economic situations of these people, families are no longer able to care for the medical, physical and psychological needs of their young. Families that are condemned to a life of poverty find orphanages to be the only viable alternative that their children have for survival and maybe even a future. Strange as this may sound it does occur all too frequently.

Hospital-based institutions are still state-run facilities with little or no resources. Children who have any type of medical condition (even minor problems) are placed in institutions, which also house patients with the more severe and sometimes neuropsychiatric conditions that no child should ever be exposed to. Children with more complicated or chronic medical conditions (such as blood disorders; infectious disease, congenital malformations and classic autism) are doomed to a forgotten life behind closed cold walls of the institutions.

The biggest problem that I personally have with the institutional setting is medical diagnoses that are given to these children. These diagnoses often are false, exaggerated and unfortunately sometimes very real. The disparity to the severity of the medical problems found in these children is is sometimes incomprehensible. They mix the severely mentally retarded, autistic, and handicapped patients with the relatively normal child who is abandoned, with mild developmental delay or the child who required minor surgery that is unable to acquire the procedure in order to lead a normal and healthy life..

Unfortunately, once a child was placed in a orphanage, that label follows the child for years, especially in countries like communist Romania during the 1980s. These children were fated to remain there for a life without appropriate medical care or even the possibility of having a family to care for their needs..

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 neurobiological 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. Many children are starved, 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 out, he can no longer learn anything new for 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 or retarded.

© George Rogu, M.D.