title: The science of early adversity: is there a role for large institutions in the care of vulnerable children?
abstract: It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.
authors: Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
authors: Anne E
authors: AE
authors: Berens
authors: Harvard Medical School, Boston Children's Hospital, Boston, MA, USA; Harvard Center on the Developing Child, Harvard Graduate School of Education, Cambridge, MA, USA. Electronic address: charles.nelson@childrens.harvard.edu.
authors: Charles A
authors: CA
authors: Nelson
mesh_terms: D001921:Brain / Q000254:growth & development; D002648:Child; D002657:Child Development; D002669:Child Welfare; D002674:Child, Institutionalized / Q000523:psychology*; D003688:Deinstitutionalization; D002658:Developmental Disabilities / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007326:Institutionalization; D019372:Orphanages; D012944:Social Support
references: Attach Hum Dev. 2012;14(6):585-600
references: 23106180
references: Child Abuse Negl. 2012 Oct;36(10):685-8
references: 23092938
references: J Am Acad Child Adolesc Psychiatry. 2004 Oct;43(10):1283-92
references: 15381896
references: Arch Pediatr Adolesc Med. 2010 Jun;164(6):507-16
references: 20368481
references: Int Rev Psychiatry. 2008 Jun;20(3):317-28
references: 18569183
references: Dev Cogn Neurosci. 2012 Feb 15;2 Suppl 1:S59-66
references: 22682911
references: Child Abuse Negl. 2012 Oct;36(10):743-51
references: 23107455
references: PLoS One. 2009 Dec 18;4(12):e8169
references: 20020037
references: Mol Psychiatry. 2012 Jul;17(7):719-27
references: 21577215
references: Physiol Behav. 2012 Jul 16;106(5):728-35
references: 22133521
references: Child Dev. 2006 May-Jun;77(3):696-711
references: 16686796
references: Dev Sci. 2012 May;15(3):345-58
references: 22490175
references: J Child Psychol Psychiatry. 2003 Nov;44(8):1208-20
references: 14626461
references: Biol Psychiatry. 2009 Dec 15;66(12):1100-6
references: 19660739
references: PLoS One. 2010 Jul 01;5(7):e11415
references: 20617175
references: Biol Psychiatry. 2015 Feb 15;77(4):314-23
references: 24993057
references: Monogr Soc Res Child Dev. 2011 Dec;76(4):127-146
references: 25018565
references: Dev Psychopathol. 2003 Fall;15(4):885-907
references: 14984131
references: Proc Natl Acad Sci U S A. 2012 Aug 7;109(32):12927-32
references: 22826224
references: J Child Psychol Psychiatry. 2007 Feb;48(2):210-8
references: 17300560
references: J Child Psychol Psychiatry. 2010 Dec;51(12):1368-76
references: 20456538
references: AIDS Patient Care STDS. 2009 Apr;23(4):297-303
references: 19281431
references: J Child Psychol Psychiatry. 2009 Aug;50(8):943-51
references: 19457047
references: Lancet. 1991 Sep 14;338(8768):645-9
references: 1679471
references: Cereb Cortex. 2010 Mar;20(3):561-9
references: 19546156
references: Dev Psychopathol. 2003 Winter;15(1):19-38
references: 12848433
references: J Child Psychol Psychiatry. 2007 Jan;48(1):17-30
references: 17244267
references: J Cogn Neurosci. 2004 Oct;16(8):1412-25
references: 15509387
references: Front Behav Neurosci. 2009 Sep 01;3:16
references: 19750200
references: Child Dev. 2010 Jan-Feb;81(1):28-40
references: 20331653
references: Dev Med Child Neurol. 2008 Sep;50(9):664-71
references: 18754915
references: Monogr Soc Res Child Dev. 2011 Dec;76(4):92-126
references: 25364058
references: Monogr Soc Res Child Dev. 2010 Apr;75(1):143-66
references: 20500637
references: Monogr Soc Res Child Dev. 2010 Apr;75(1):48-78
references: 20500633
references: Psychoanal Study Child. 1945;1:53-74
references: 21004303
references: Dev Sci. 2010 Jan 1;13(1):46-61
references: 20121862
references: J Dev Behav Pediatr. 2007 Aug;28(4):334-43
references: 17700087
references: Child Abuse Negl. 2012 Oct;36(10):711-21
references: 23084623
references: J Child Psychol Psychiatry. 1998 May;39(4):465-76
references: 9599775
references: J Child Psychol Psychiatry. 2012 Jan;53(1):46-55
references: 21733136
references: AIDS. 2004 Jun;18 Suppl 2:S55-65
references: 15319744
references: Child Dev. 2010 Jan-Feb;81(1):224-36
references: 20331664
references: J Child Psychol Psychiatry. 2013 Jan;54(1):37-45
references: 22924462
references: Science. 2007 Dec 21;318(5858):1937-40
references: 18096809
references: J Child Psychol Psychiatry. 2011 Sep;52(9):919-28
references: 21244422
references: Monogr Soc Res Child Dev. 2008;73(3):vii-viii, 1-262, 294-5
references: 19121007
references: J Am Acad Child Adolesc Psychiatry. 2012 Jul;51(7):683-93
references: 22721591
references: Dev Sci. 2011 Mar;14(2):190-204
references: 21399712
references: BMJ. 2006 Feb 25;332(7539):485-7
references: 16497769
references: AIDS Care. 2009;21 Suppl 1:3-12
references: 22380973
references: Pediatrics. 2006 Jun;117(6):2093-100
references: 16740852