Monday, December 28, 2009

Scientific American December 18, 2009 article

PEAR would like to share an interpretation of a recently released study. We applaud all efforts to study foster and orphanage populations, but wish to caution the adoptive community on making conclusions without understanding the basis of the study, populations and methods used.

Scientific American published a report called Orphanages Rival Foster Homes for Quality Child Care on December 18, 2009 about a December 18, 2009-published study called A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6–12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations

The first sentence of the Scientific American article misinterprets the population of the actual children studied. This was not a comparison of adoptive children (domestic or international) with those in orphanages. This compared children in some orphanages with children mostly in family care settings in select countries. Since 90% of community-cared children were being taken care of by a biological parent, grandparent, aunt or uncle, “foster care” is a grossly misused term. The breakdown of community care is as follows: 55 percent of the community sample was being taken care of by one biological parent, 22 percent by grandparents and 13 percent by aunts or uncles. Seventy-six percent had one parent known to be alive.

Besides looking at six- to twelve-year olds only, they excluded street children and special needs children (those which have repeatedly been identified as suffering cognitively and emotionally without good care) and children deemed for international adoption (the determination of which is unclear), only 10 percent of the sample of children had been institutionalized for greater than 5 years, 25 percent had resided in the institution for less than one year and 75 percent didn't enter the institution life until age 5 or older. The quality or quantity of previous familial care was not ascertained. It is notable that most children were pre-pubescent. There is increasing evidence that puberty is associated with worsening or onset of many mental illnesses.

There was only one measurement of skills taken. One cannot conclude that the child will continue to develop appropriately or if there will be a discrepancy as the child ages compared to those living in foster care in the community.

There was no evaluation of the training of caregivers in either of the settings.
In large institutions, only 20 children were selected, albeit randomly. In small institutions, all children were selected. There was no analysis of caretaker ratio differences in the large and small institutions, just a report of the average.

Human Development (HDI) rankings used to determine countries for this study can be found at Five countries were studied. Cambodia represented 12% of the institution sample and placed 0 children to the US (fiscal 2009, Ethiopia represented 18% of institution sample size and placed 2277 children to the US in fiscal 2009, making it the #2 sending country. Tanzania represented 18% of institution sample and placed 4 children to the US in fiscal 2009. Kenya represented 18% of the institution sample and placed 21 children to the US in fiscal 2009. India had two regions in this study representing 33% of the institution sample and placed 297 children to the US in fiscal 2009 making it the #9 sending country.

We encourage further studies. We would recommend including the following features that are important for the adoptive community.

For population of children studied:
• Studying population groups of ages infant to toddler, primary school aged, pre-pubscent, within a year post-pubescent, teenage years in addition to analyzing due to length of time in institution.

• Getting a baseline measurement and obtaining multiple measurements for a individual child over time.

• Studying children with special needs, “street” children and those that may meet international adoption criteria.

• Omit or analyze separately children being raised by a single parent as there has been no break in attachment for these children.

• Study children in from countries in the low category on the 2009 Human Development Index (HDI), not just the medium category that this study only looked at and in more countries where international adoptions occur, such as China, Russia and the other top 20 sending countries.

For communities:
• Have a baseline measure of quantity and type of training that each caretaker has and include that in the analysis.

• Specifically define the different types of institutions and compare them.

For testing choices:
• Test more categories of cognition, This study reported only the Sequential Processing/Short term Memory and Simultaneous Processing/Visual Processing portions of the Kaufman Assessment Battery for Children-II. It would be useful to understand how children score on the other sections Learning Ability/Long Term Storage and Retrieval, Planning Ability/Fluid Reasoning, and Crystallized Ability or to use a standardized measure for attention, motivation, and memory instead of a modified, non-standardized version of the California Verbal Learning Test.

• Instead of brief behavioral screening tools that have no published data for psychometric properties as the SDQ was used in this study, we recommend using a standardized form that has psychometric properties or first undergoing a standardization process of a form specific to these populations.

• This study had only the children's self-identified primary caregivers respond to surveys about behaviors the children. It does not appear that health professionals trained to identify behavioral issues answered questions about the specific children. We recommend a method more robust than caregiver self-reporting for behavioral issue identification.

• Health issues were caregiver reported only. We recommend some standardized health check given by a health care practitioner.

• Evaluate social abilities, abilities to obtain a vocation and suicide rates.

Due to the exclusion of so many of the features we have identified as important, we do not feel this study has enough data to make conclusions about better care in any situation.

Ethics, Transparency, Support
~ What All Adoptions Deserve.

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