Author: Katie Kavanagh
Artist: Naomi Chung
Editor: Savina Hui
As human beings, our abilities, behaviour, and emotions differ substantially. We are not intrinsically identical from birth, but instead are shaped by the world around us. Each experience plays a part in moulding us into who we are today. The beginning of this shaping occurs during infancy, the crucial first frame that will continue to be observed in adulthood. However, this shaping cannot occur without someone to make the mould. The resources we are given, the stimulation we receive, and most importantly, the intimacy we engage in are all ingredients that enable us to perform to the best of our abilities mentally, physically and emotionally. How big is the impact of these early years? Pavlos Zournatzidis, a PhD student at UCL based in Greece, is studying this by focusing on the effects of institutionalisation during infancy on adulthood.
Childhood experiences are largely dependent on how and where we grow up. Those who develop in happy, loving families often have very different experiences than those who grow up in an abusive environment or in an institution, both during childhood and in later life. Here in the UK, infants who cannot live with their biological families go into the foster system, where they are placed to live temporarily with a family until hopeful adoption. However, in Greece where fostering is less common, this situation is very different, leading infants to instead be placed into institutions or orphanages, along with many other children in the same situation. These infants often largely outnumber caregivers with a usual ratio of 1:5-6 and between the shift changes and high turnover of these carers, the children are unable to make connections or establish a nurturing environment.
This absence of a primary caregiver leads to problems in the future, even in adulthood. These problems include issues with attachment, behaviour, emotions and the ability to manage difficulties in the environment such as anxiety and depression. Pavlos is currently in the process of conducting his research and has therefore not yet produced results. However, he has a hypothesis of what these results will reveal based on previous similar research conducted by others and on psychological theories.
Previous studies on infant institutionalisation are not very plentiful but appear to obtain consistent results. The low number of experiments is due to the unethical nature of subjecting an infant to conditions that deprive them of attachment and intimacy. However, the abundance of institutions in Greece provides an opportunity for investigation. This type of experiment is referred to as a “natural experiment”, as the subject is already naturally exposed to the environment. The results of these experiments revealed that children who had been institutionalised during infancy underperformed cognitively and emotionally compared to children who grew up with their biological families. The degree of this underperformance varied depending on the conditions of the institution, from mild conditions such as lack of stimulation and attachment to more severe conditions such as maltreatment and abuse. These previous studies focused predominantly on more extreme cases where infants were mistreated, but Pavlos is focusing on the milder, more common conditions. This leads him to expect slightly different results, however these previous experiments provide a good framework for his hypothesis.
Pavlos’s research and expected results are influenced by the psychological theory of attachment. Attachment theory is the idea that infants must form a relationship with at least one primary caregiver for normal social, emotional and cognitive development. This attachment is divided into 4 different categories by severity of the problem, respectively, secure, anxious, avoidant and disorganised. A child in a normal situation, living with their biological family has a secure attachment. Since infancy they have had a strong relationship with their primary caregiver, and this has led them to have normal development. On the other end of the scale, disorganised attachment occurs when infants have been unable to make connections with a primary caregiver and as a result experience difficulties in development. Interestingly, this same disorganised attachment occurs when children are mistreated or abused and is also the riskiest for future psychopathology or developmental delays, indicating the severe impact of institutionalisation.
An interesting result of these studies, and something Pavlos expects to find in his own research is that adoption proves to be a successful intervention against the impact of institutionalisation. A previously institutionalised child that was observed to underperform cognitively, socially and emotionally, eventually caught-up with children in normal conditions after adoption. This is evident in institutionalised children aged 2-5 who, after adoption, began to catch up with children living with their biological families, eventually reaching the same performance levels, indicating a lack of long-term effects of institutionalisation with early intervention. However, the efficacy of adoption as an intervention is dependent on the time spent in an institution, in combination with the severity of the environment. This emphasises the importance of removing children from institutions as early as possible to give them a chance of overcoming negative impacts.
Another focus of Pavlos’ work is not just the impacts of institutionalisation but how people are able to cope with these effects. This coping ability is known as a protective factor, which is a characteristic that enables someone to manage distressing events more effectively. A protective factor that is of particular interest to Pavlos is “mentalising” or “reflective functioning”, which is our ability to understand ourselves and what is happening in our social world mentally, such as beliefs, desires, and emotions. Reflective functioning is believed to protect against future psychopathology, such as anxiety and depression. Children from institutions have a higher risk of future abnormal cognition, so it is important to increase awareness about the possible coping mechanism of reflective functioning to adoptive families, to make the transition as comfortable as possible.
Institutionalisation is ongoing in Greece and remains the predominant solution for infants who cannot live with their biological families. There has been an increase in foster care in recent years, however this is still rare in comparison with institutionalisation. Pavlos hopes that his research will demonstrate the negative impact of institutionalisation, and encourage increasing foster care and adoption.
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