Aspects ofAspects ofCognitive Cognitive

Development for Development for Orphanage ChildrenOrphanage Children

Laura Florescu MD, PhDLaura Florescu MD, PhD

The lack of family environment, in The lack of family environment, in particular the lack of maternal particular the lack of maternal care, unbalances the entire care, unbalances the entire process of development.process of development.

Frustration appears, with Frustration appears, with biological and psychological biological and psychological consequences.consequences.

Method:Method:We used a database containing We used a database containing data on 100 children protected in data on 100 children protected in the Placement Center Iasi, the Placement Center Iasi, between 2001 – 2003.between 2001 – 2003.Age: from 1 through 24 months at Age: from 1 through 24 months at the time of admissionthe time of admissionPeriod of protection (time in Period of protection (time in residence at the Center): from 4 residence at the Center): from 4 months through 3 years (on an months through 3 years (on an average , 18 months)average , 18 months)Children with abnormalities or Children with abnormalities or congenital problems were not congenital problems were not included.included.

Evaluation was done at the time Evaluation was done at the time of admission and every 3 of admission and every 3 months thereafter, using Denver months thereafter, using Denver Developmental Screening Test Developmental Screening Test (DDST).(DDST).

The DDST is designed to detect The DDST is designed to detect developmental delays in:developmental delays in:

personal – socialpersonal – social

fine motor – adaptivefine motor – adaptive

languagelanguage

gross motor dimensionsgross motor dimensions

The DDST is only a measure of The DDST is only a measure of developmental attainment and developmental attainment and not a measure of intelligence.not a measure of intelligence.

Results:Results:

Distribution of the sample by age Distribution of the sample by age of admission to the orphanage and of admission to the orphanage and where they came fromwhere they came from

13

84

210

5

54

13

0

45

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-3 4-6 7-9 10-12 13-24 25-36

Age of admission

institutions

family

The cognitive behavior evolution The cognitive behavior evolution based on age of admissionbased on age of admission

99.7792.07

74.75 74 75.6

46.33

81.6

65.2271.53

60.25 59

75.5

62

80

0

20

40

60

80

100

120

0-3 4-6 7-9 10-12 13-24(fam.)

13-24(inst.)

25-36

Age of admission

first test

last test

The evaluation of cognitive The evaluation of cognitive behavior based on the length of behavior based on the length of residence in the orphanageresidence in the orphanage

78.28

85.83

95.94

75.8568.94

64.9

0

20

40

60

80

100

120

4-12 13-24 25-36

Months in orphanage

First test

Last test

Conclusions:Conclusions:The results show the lack of The results show the lack of stimulation after separation and stimulation after separation and the regression of cognitive the regression of cognitive behavior.behavior.The negative effects are more The negative effects are more evident when separation occurs in evident when separation occurs in infancy.infancy.The longer the period outside the The longer the period outside the family environment, the harder it family environment, the harder it is to improve cognitive behavior.is to improve cognitive behavior.

Reducing children’s cognitive Reducing children’s cognitive behavior problems means focusing behavior problems means focusing on strategies to improve on strategies to improve parenting.parenting.Interaction techniques explained Interaction techniques explained by Vygotsky and illustrated in by Vygotsky and illustrated in resources such as resources such as LearningGamesLearningGames can support parenting.can support parenting.Parents are the major agent of Parents are the major agent of health promotion in children.health promotion in children.

If we are to achieve a healthier If we are to achieve a healthier world, we must emphasize health world, we must emphasize health promotion during childhood.promotion during childhood.

2 Experimental Studies 2 Experimental Studies used used LearningGames LearningGames as an as an

interventionintervention

Conducted by:Conducted by: Joseph Sparling, Joseph Sparling, Ph.D.Ph.D. , , USAUSA, , Cristiana Dragomir, M.D.,Cristiana Dragomir, M.D., Romania, Romania, Laura Florescu, M.D., Ph.D., Laura Florescu, M.D., Ph.D., Romania, Romania, Sharon L. Ramey, Ph.D.Sharon L. Ramey, Ph.D., , USAUSA

Iasi, RomaniaIasi, Romania

169 children169 children

Overall Intervention Overall Intervention ProgramProgram

Formal staff training, active supervisionFormal staff training, active supervision Clear curriculum, daily documentationClear curriculum, daily documentation 1:4 child:caregiver ratio, group size = 41:4 child:caregiver ratio, group size = 4 6+ hours per day, 5 days per week6+ hours per day, 5 days per week Stable groups and staffingStable groups and staffing Duration: Duration:

Study 1 = 13 mos.; Study 2 = 14 Study 1 = 13 mos.; Study 2 = 14 mos.mos.

Key Elements of Key Elements of Educational ProgramEducational Program

Enriched caregivingEnriched caregiving Conversational book readingConversational book reading Invatin ImpreunaInvatin Impreuna curriculum curriculum

(translation of (translation of LearningGamesLearningGames, Sparling & , Sparling & Lewis, 1985)Lewis, 1985)

Sample Item from Invatin Impreuna Curriculum

28

10.5

22

15

18

13.2

7.68.1

8

0

5

10

15

20

25

30

Pretest Midpoint Posttest

De

ve

lop

me

nta

l G

row

th (

in m

on

ths

)

Normative Development, USA

Experimental Group, n=76

Control Group, n=28

Language (Study 1)

0

2

4

6

8

10

12

14

Personal-Social Fine Motor-Adaptive

Language Gross Motor

Ga

in (

in d

ev

elo

pm

en

tal

mo

nth

s o

f c

ha

ng

e)

Experimental Group, n=35

Control Group, n=30

Denver Developmental Gains, Study 2

0

2

4

6

8

10

12

14

Experimental Group,n=15

Control Group, n=15

Min

ute

s

Adult talks to & touches child

Adult talks to child

Duration of Two Types of Adult Talk in Videotaped Adult-Child Sessions, Study 1

““When I approach a child, he When I approach a child, he inspires in me two inspires in me two

sentiments: tenderness for sentiments: tenderness for what he is, and respect for what he is, and respect for

what he may become.” what he may become.” Louis Louis

PasteurPasteur