Child neglect and its consequences : the contribution of studies on Romanian children

Neglect is one of the most common forms of child abuse. In order to better understand it, the Chair focused on the case of the Romanian orphanages.

Neglect occurs when the person responsible for a child fails to provide for the needs that are essential to the child's development and well-being. Among the different types of abuse, neglect is the most prevalent, accounting for 61% of abuse cases in the United States. Neglect is abuse by omission, so it may not be intentional. Nevertheless, it is still dangerous to the child, hence its classification as abuse.

Neglect can be divided into 4 categories : physical neglect is when basic needs (food, clothing, shelter) are not met or are poorly supervised; educational neglect is when the caregiver fails to ensure that the child receives an education; emotional neglect, for its part, refers to a lack of stimulation and attention to the child  and medical neglect is the failure of the caregiver to ensure that the child receives needed medical care or to follow medical recommendations.

In children who have suffered from neglect, there is a lack of performance in executive functioning, which can result in working memory deficits and response inhibition. This lack of attention promotes the development of attention deficit disorder with or without hyperactivity (ADHD). In addition, children who have been neglected show a decrease in reactivity to stress, which increases the risk of developing psychopathology.

The specificity of institutional neglect

When we talk about neglect, we can distinguish parental neglect, which occurs in a family setting, from institutional neglect, in an orphanage. Where neglect is due to the inadequacy of the caregiver(s) in the first case, it results from the absence of this reference figure in the second. Institutional neglect is therefore inherent to the structure of orphanages and to the age of the children raised there.

Indeed, although orphanages mobilize a staff that educates, cares for, feeds and accompanies children, these supervisors are not always sufficiently numerous in relation to the number of children in their care. In addition, while they have a specific role in accompanying the child, they are not a reference or a model for him/her. All of this leads to a lack of attention, stimulation and closeness to each child. So emotional neglect that takes place in an orphanage and results from the functioning and structure of this type of institution.

Neglect in orphanages : the case of Romania

Under the totalitarian communist regime led by Nicolae Ceauşescu, the government's natalist policy prohibited abortion and contraception. In addition, families with less than 5 children had to pay more taxes. This policy resulted in tens of thousands of children being abandoned in orphanages, both official and unofficial. After the fall of Ceaușescu's regime in 1989, the world discovered these orphanages in which the children were not only completely neglected, but also physically abused.

Subsequently, and with the help of non-governmental organizations, Romania has undertaken work to treat these children and improve their care. The number of orphanages was therefore reduced and foster care was favored. In addition, several large scientific studies have pointed out that the most significant sequelae of neglect were observed in children under 3 years of age who had been placed in orphanages. These sequelae include a decrease in IQ and brain size as well as diminished cognitive abilities compared to children who grew up in foster care. The stimulation of the brain during the first years of life is indeed crucial to guarantee the good development of the child. This is what led Romania to legislate on the subject to prohibit the placement of children who are too young in orphanages. In 2004, Romania banned the placement of children under the age of 3 in orphanages, and then extended this ban to children under the age of 7 in 2019. In 2021, there were still 12,890 children in orphanages in Romania, compared to 57,181 in 2000.

Caring for children who have been neglected

The many Romanian children who have suffered from neglect in orphanages are still involved in scientific studies and help us understand the effects of neglect as well as find ways to treat those who have already been victims. Several psychotherapies have been shown to be effective in treating children who suffered from neglect. For example, group play activities with other children from their age can help neglected children develop cooperative and interactive skills. In addition, a therapeutic program could improve the self-esteem of these children. Multisystemic therapy could also improve relationship dysfunctions, especially family dysfunctions, which are often present in children who have been neglected. Finally, another study has shown that exposing children to a more positive and higher quality living environment between the ages of 12 and 16 years would improve their executive functioning, their reward processing and their externalizing or internalizing symptoms. Foster care was shown to have positive effects on IQ, social skills and brain alterations: it can fully counteract the effects of neglect if childrens are adopted early (before the age of 3) and it partially prevents the effects of neglect if it occurs later. 

This last study demonstrated that adolescence is a period of increased sensitivity of an individual to the influence of his/her environment. It is therefore possible to use the plasticity of the cognitive and affective systems of the adolescent to try to remedy the harmful effects of neglect at a young age. This has been proven in particular with regard to the re-calibration of reactivity to stress. Therefore, adolescence would be an ideal time to treat those who have been neglected in early childhood by targeting their social environment.

Detecting and preventing neglect

Neglect may not be easy to detect, but there are several signs that a child is being neglected. These signs can be observed on the child (lack of hygiene, food, medical care, inappropriate clothing, etc.) but also in his or her behavior (aggressiveness, depression, anxiety, obsessive behavior, eating or attention disorders, drug or alcohol use, self-mutilation, school absenteeism, etc.). Because school is the primary place outside of the family or orphanage that a child attends, it is often where these signs of neglect can be identified. As such, teachers and school staff play a key role in the detection of neglect and it is important that they know how to identify and report potential child neglect.

While it is important to detect neglect, the ideal is to prevent it in the first place. The best way to do this is to give preference to foster care over orphanages whenever possible, especially when the child is young. Studies have shown that there is a real gap — in terms of cognitive abilities and adaptive functioning — between children who grew up in foster care and those who grew up in orphanages. This is illustrated in particular by studies involving young adults who grew up in Romanian orphanages. The laws preventing the youngest children from being placed in orphanages thus make it possible to move in this direction, although it is also necessary to ensure the quality of the foster family. In addition, even if young children have already been neglected, placing them in foster care early on can reverse the negative effects of that neglect after a few years. However, if foster care is not possible, the quality of orphanages can be further improved by reducing the number of children per caregiver. This would provide the children with sufficient proximity and attention, and thus a quality environment in which they can develop peacefully.

Gauthier Pichevin