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Q & A

Bringing home plight of abandoned children

Dr. Charles Nelson, a professor of pediatrics at Harvard Medical School and Boston Children’s Hospital, has studied the effects of abandonment and institutionalization on children in Romanian orphanages. KATHERINE C. COHEN/BOSTON CHILDREN’S HOSPITAL

For nearly 15 years, Charles Nelson, a professor of pediatrics at Harvard Medical School and Boston Children’s Hospital, and two of his colleagues have been tracking a group of children abandoned in Romanian orphanages as infants. They helped place some of those children in foster care as babies, and have shown that the ones who remained institutionalized are behind their peers socially, intellectually, and physically. Now they’ve written a book, “Romania’s Abandoned Children: Deprivation, Brain Development, and the Struggle for Recovery.”

Q. What first inspired you to study children who grow up under the worst possible circumstances?

A. When I was an undergraduate at McGill University in Montreal, I started to get interested in how early experience impacts development. Then I got interested in how early bad experience impacts development: what happens when what should be experiences common to everyone in our species just don’t exist.


Q. Were you a deprived, neglected child yourself?

A. Not according to my mother.

Q. What happens to children who don’t have the kind of supportive care you say we were biologically designed to have?

A. These kids have a hard time regulating their emotions, regulating their behavior. In our sample [of Romanian orphans], 20 percent have attention deficit disorder; 45 percent of the kids who were assigned to institutional care have an anxiety disorder. Third on the list would be attachment problems — they have a very difficult time forming and maintaining appropriate attachments to caregivers.

Q. These problems happened because the children missed out on experiences early in life when the brain is more open?

A. We know that many aspects of brain development after birth depend on experience. In many of those domains, those experiences have to occur during a narrow window for development to be normal. If you’re born with a hearing impairment and [you remain deaf, but learn to speak], you’ll always talk in a way that’s clear you didn’t have normal hearing early on. On the other hand, if you lose hearing when you’re 3 or 4, you’ll speak with an almost perfect tone of voice.


Q. What does that imply for our system of child protection in the United States?

A. When little kids are being maltreated and they sit in the child protection system for several years, the window of opportunity has passed. I think we really need to pay close attention to moving with alacrity to get kids under, say 2, out of bad situations.

Q. Are you saying that more children should be taken away from their parents’ custody?

A. I sometimes worry — and this will sound harsh — that we give biological parents too much credit and too many chances rather than being biased toward the best interests of the child.

Q. What about our foster care system?

A. Certainly there is a lot of room for improvement. Perhaps we should stop thinking of foster care as the remedy — instead of adoption as the remedy — and get kids into permanent homes, because one thing we know that wreaks havoc with a kid’s development is multiple foster care placement. I’m not pretending this is going to be easy or popular, but the bulk of the scientific evidence supports the need for kids having stability.

Q. What are the implications of your findings for international adoption?


A. Parents need to be aware that, particularly if the kids are older than 2-3 when they get adopted, that they could have certain developmental challenges. There’s been this mistaken belief that if they just loved them enough the kids would be fine, but it just doesn’t work like that.

Q. How has this research on Romanian children changed you personally?

A. It’s opened my eyes to thinking about the sheer number of kids who are growing up in really profoundly disadvantaged environments. Leaving aside the trauma of seeing what institutions are like, and the whole idea that families just give up their kids to the state, which was incomprehensible both professionally and as a father — [it’s made me wonder] can we do better by our kids worldwide?

Q. What do you think might help these kids? What could somebody do to help?

A. We wouldn’t have a problem with kids going into institutions if we didn’t have a problem with parents abandoning kids or dying. If you could prevent HIV and other diseases that kill parents, we wouldn’t have orphans. If we had better programs for preventing new parents from abandoning their kids, we wouldn’t have social orphans.

This interview has been edited and condensed. Karen Weintraub can be reached at Follow her on Twitter @kweintraub.