Institutionalization & Surrogacy

Question 1

institutionalization

Answer 1

• Care in an established organization (ex. Orphanage, children’s home, etc.)
• Many problems documented in institutionalized children (ex. Medical problems, physical deformities, cognitive problems, social difficulties, etc.)

Question 2

Romanian Orphans

Answer 2

• In 20th century Romania, birth control and abortion outlawed -> huge increase in birth rates, but families were too poor to care for them -> many children abandoned or sent to orphanages (became culturally normative)
• Institutional standard of care very poor: overcrowding; few caregivers; little tactile, languale, or visual stimulation; dirty
• In 1990, media reports of these conditions emerged -> some improvement; increase in adoptions from outside of Romania (but cultural norm of institutionalizing children continued)

Question 3

Bucharest Early Intervention Project (BIE): basics

Answer 3

• Began in Romania in 2000-2001

- Looking for impacts of institutional care and whether affects could be ameliorated by high-quality foster care

Question 4

BIE: study design

Answer 4

• Randomized, controlled study of institutionalization vs. Foster care
• Subjects: institutionalized children 6-31 months (all relatively healthy); matched never-institutionalized children
• Half of institutionalized children randomly assigned to foster care, half remained in institution with care-as-usual (avg. age of placement = 2 yrs.)
• Assessed children at various points in time over years
• “Intent to treat” model: even if kids didn’t stay in foster care/institution, they were analyzed as such

Question 5

BIE: creation of foster care system

Answer 5

• Before study, there was no pre-existing government foster care in Romania
• System designed and implemented by study investigators; high-quality; children matched according to need

Question 6

BIE: findings -> institutionalized children vs. control group

Answer 6

• Institutionalized children worse off in every domain
• Attachment: only 15-20% of children in institutionalized care showed secure attachment; 70% showed disorganized attachment, many showed Reactive Attachment Disorder
• IQ/DQ: institutionalized children showed much lower rates
• Brain Activity: less activity (alpha/beta waves), slower processing, reduced facial recognition -> suggests delayed brain development
• Emotion/Attention: display less positive emotions and less attention

Question 7

BIE: findings -> foster care children vs. institutionalized children

Answer 7

• Foster care children showed some improvements, but not in all domains
• Attachment: foster care children showed big improvements in secure attachment rates (slight improvements in RAD reduction)
• IQ/DQ: foster care children showed big improvements compared to those who remained in institutionalized care
• Psychiatric disorders: no difference between institutionalized and foster children
• More positive emotions and increased attention
• Increased language ability

Question 8

BIE: findings -> timing of placement

Answer 8

• Timing of placement into foster care matters -> the earlier you enter foster care, the better the outcomes (approx. 2 years or younger is ideal)
• Ex. Those placed before 2 years show greater improvements in secure attachment; show no differences in social skills compared to control group (whereas those who were placed after 2 months showed same social skills as those who remained in institutions) -> same thing with brain activity

Question 9

BIE: implications

Answer 9

• In response to this project, Romanian government instituted a foster care system
• Romania forbade infants to enter institutions if they were younger than 2
• Led to a global questioning over the use of institutions for orphaned/abandoned children
• Raised questions about neglect, even in non-institutionalized children (ex. What is enough stimulation for proper development?)

Question 10

BIE: ethical arguments AGAINST

Answer 10

• Children not selected for foster care did not experience positive intervention
• Inclusion criteria -> only chose healthy children for study
• Consent -> institutions consented for the children

Question 11

BIE: ethical arguments FOR

Answer 11

• Huge positive impact of the study (benefits outweigh risk)
• Without intervention, no children would benefit -> they’re not causing anyone to be worse off than they already are
• Advancing psychological knowledge

Question 12

BIE: 3 key findings

Answer 12

• Institutionalization associated with negative outcomes
• Placement in foster care can ameliorate some of the negative outcomes
• Timing matters -> placement must happen early (ie. before 2 years) in order to be beneficial -> Suggests sensitive period for social/sensory stimulation

Question 13

sensitive period

Answer 13

• Time in development in which input needs to be received in order for development to progress normally
• Ex. We need to get vision early in development in order for our visual systems to develop
• • Example study: if a cat does not get enough input within the first 2 months of life, their visual system never develops properly, regardless of how much input they get later on

Question 14

surrogacy

Answer 14

• various types (traditional, gestational, commercial, altruistic)
• research mixed on parent/child outcomes
• other options: egg/sperm donation, embryo donation/”embryonic adoption”

Question 15

4 main types of surrogacy

Answer 15

• Traditional surrogacy (intended father inseminates surrogate mother -> baby is biologically related to intended father and surrogate mom)
• Gestational surrogacy (intended father inseminates intended mother’s egg, which is then implanted in surrogate mother -> baby is biologically related to intended father and intended mother)
• Commercial surrogacy: surrogate mom is paid (not legal in Canada and in many states in the US)
• Altruistic surrogacy: surrogate mom is not paid