Before It's Too Late: Understanding the Impact of Institutionalization on Children

Through all the dark shadows that Russia has cast with its ban on adoptions by Americans -- on the affected girls and boys, on the U.S. citizens seeking to become their parents and on the process of international adoption itself -- a thin glimmer of light is struggling to emerge.
01/23/2013 05:36pm ET | Updated March 25, 2013
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Children play on May 12, 2010 in an orphanage in Moscow. One out of three children adopted in Russia in the last three years -- or 30,000 orphans -- has been returned to state institutions, child rights activist Albert Likhanov said on September 20. Most of those who adopted have returned the orphans because they failed to receive promised state child support since the global economic crisis hit Russia in late 2008, said Likhanov, head of the Russian Children's Fund. AFP PHOTO / NATALIA KOLESNIKOVA (Photo credit should read NATALIA KOLESNIKOVA/AFP/Getty Images)

Through all the dark shadows that Russia has cast with its ban on adoptions by Americans -- on the affected girls and boys, on the U.S. citizens seeking to become their parents and on the process of international adoption itself -- a thin glimmer of light is struggling to emerge. That is, for the first time in recent memory, the consequences of institutionalization on children are receiving serious (albeit still superficial and sporadic) public attention.

For the record, the consequences can include emotional and social disorders; loss of IQ points and intellectual capacity; stunted growth and other physical ailments; and a host of additional psychological, physiological and behavioral challenges. Some of these impairments cause developmental delays that can be remediated and others can severely undermine the child for his or her lifetime.

Even knowing all this, I am not about to suggest that international adoption is the optimal answer for the vast majority of infants, children and youth around the world -- including in our own country -- who don't live in secure, nurturing families. Nor do I intend to single out Russia as an exemplar of the problem, though the way in which it cut off one potential escape route for a small minority of its institutionalized children was particularly disconcerting.

Finally and very importantly, I do not mean to alarm potential adoptive parents or to stigmatize the children who need our help by laying out these realities so starkly. The uplifting fact is that children are resilient, and many of all ages do well from the get-go once they are being raised by parents who provide the individualized love and attention they need; for the rest, providing permanency and nurture as early as possible can make a titanic difference -- which is to say that even those who face the challenges listed above begin to heal, make progress and even thrive once they are in caring families.

All of which leads to a few bottom-line suggestions for politicians, policymakers, child welfare officials and the general public in the United States, Russia and every other country:

• Beginning tomorrow morning, provide the funding and resources necessary to ensure that children can grow up safely and successfully in their families, cultures and nations of origin -- and so that the women and men who created them are treated without stigma and with respect.

• Beginning tomorrow morning, provide the funding and resources necessary to prevent institutionalization, to replace institutions with more-beneficial interventions, to make out-of-home care as short and effective as possible, and to restore families whenever feasible.

• Beginning tomorrow morning, reshape domestic norms so that adoption and other types of permanency are understood as positive ways of forming families for children who need them -- and so that the parents who choose these paths are treated without stigma and with respect.

Those aren't quick or easy solutions; in fact, it would be fair to describe them as idealistic, long-term dreams rather than as realistic, near-term goals, and that's the point. Taking the steps necessary to help the millions of children who deserve to live in safe, stable and successful circumstances will take a long time, a lot of money and a level of commitment that few governments, anywhere, have ever provided.

So, while I mightily hope that President Vladimir Putin means it when he says Russia will now strive to take better care of its children, including getting more of them adopted domestically if they cannot return to their families of origin, I need to ask: Can you do that by tomorrow morning and, if not, what will happen to those who remain in government custody during the years, and probably decades, it will take to improve your child welfare system?

Again, that is not a question just for or about Russia. There are many children, everywhere, whose parents and other relatives should get the financial and social support to keep their families intact. There are many children, everywhere, who need interim living arrangements while they receive help for their medical and mental health issues. And there are many children, everywhere, who would benefit from moving into families willing to provide them with love and sustenance for the rest of their lives.

It's hard to imagine there are many children, anywhere, who are better off remaining institutionalized.

The public discourse about these children to date has focused primarily on other concerns, ranging from national pride to money and regulation; from protecting the rights of parents to preventing the exploitation of children; from retaining original cultures to creating new opportunities. And, of course, they have included provocative debates about whether international adoption should play a role and about why Americans adopt from abroad when there are children in the U.S. who need families. (There are good answers to these questions, by the way, but that's a conversation for another day.)

For now, I think it's fair to say that these concerns and many others are real, vital and should be seriously discussed. They illustrate the complexity of the problems faced by the international community, by individual nations and by the interested parties in solving the so-called "orphan crisis," which is a misnomer because a large percentage of the affected children still have at least one living parent -- which, of course, makes the whole matter even more complicated.

Perhaps it is because the puzzle has so many pieces that so few countries, including our own, have been able to see the big picture, the one that shows millions of children languishing in temporary care while the adults who control their lives engage in genuinely important deliberations. So I suggest that whenever we look at these important issues, on the ground or at a policy level, we use the glimmer of light that Russia provided a few weeks ago to see them within a different framework, defined by a cliché that every country at some point claims to embrace: the best interests of the child.

It simply cannot be in the best interests of any girl or boy to remain in a setting where she or he loses ground every day. So, while we adults attempt to find the best possible medium- and long-range solutions for these children, let's also carefully, thoughtfully, ethically implement every short-term measure possible -- including family preservation and adoption -- to prevent them from deteriorating to the point where even the best solutions will no longer make any difference.