Predictors of Developmental Status in Young Children Living in Institutional Care in Kazakhstan
The main objective of this study was to assess the developmental status of children living in the severely adverse environment of institutional care and the examination of risk factors with regard to developmental status, including degree of stunting and emotional–behavioral and anemia status. The Bayley Scales of Infant Development were used to assess development status in 103 children aged 14.9 months (SD = 6.8) in six Kazakh institutions. The Behavioral Rating Scales were used to assess emotional–behavioral regulation. Physical growth measures were converted to z scores using World Health Organization growth charts. Venous blood was collected for assessment of anemia. Our findings indicated that young children in institutions were developmentally compromised, with duration of institutional care correlated with the severity of delay. Negative predictors of developmental status included: Poor emotional–behavioral regulation, degree of stunting and age at assessment. A particularly large percentage of children were found to be anemic. Additionally, low birth weight was found to be a significant negative predictor of development. Our findings indicate that institutional care has a detrimental impact on the development and emotional regulation of young children. Time in institutional care is a negative predictor for cognitive status for children placed at birth. Moreover stunting was found to be a useful indicator of the degree of impact of early adversity on cognitive development. Particular attention is needed for special-needs children such as those with low birth weight, since their development was found to be more sensitive to early adversity than that of normal birth weight children.
KeywordsInstitutional care Development Orphans Children Nutrition
The authors would like to thank the partnership with the Kazakh Academy of Nutrition. In addition, we would like to thank the SPOON Foundation data collection team and the baby house directors for allowing this important work to occur. Funding for this project was provided by the SPOON Foundation through grants received by Nestle Food Kazakhstan LLP, Ferrosan A/S, Chevron Munaigas Inc, Hillblom Foundation, the International Foundation and the General Mills Foundation.
Conflict of interest
None to report.
- 4.Petersburg S. BabyHomes in the Russian Federation. (2009). The Effects of early social-emotional and relationship experience on the development of young orphanage children (pp. 16–29). New Jersy: Wiley-Blackwell.Google Scholar
- 7.van IJzendoorn, M. H., Palacios, J., Sonuga-Barke, E. J., Gunnar, M. R., Vorria, P., McCall, R. B., et al. (2011). I. Children in institutional care: Delayed development and resilience. Monographs of the Society for Research in Child Development, 76(4), 8–30.CrossRefPubMedCentralPubMedGoogle Scholar
- 8.Johnson, D. E., Guthrie, D., Smyke, A. T., Koga, S. F., Fox, N. A., Zeanah, C. H., et al. (2010). Growth and associations between auxology, caregiving environment, and cognition in socially deprived romanian children randomized to foster vs ongoing institutional care. Archives of Pediatrics and Adolescent Medicine, 164(6), 507–516.CrossRefPubMedCentralPubMedGoogle Scholar
- 10.Taneja, V., Aggarwal, R., Beri, R. S., & Puliyel, J. M. (2005). Not by bread alone project: A 2-year follow-up report. Child: Care, Health and Development, 31(6), 703–706.Google Scholar
- 12.van IJzendoorn MH, Luijk MP, Juffer F. (1982). IQ of Children Growing Up in Children’s Homes: A Meta-Analysis on IQ Delays in Orphanages. Merrill-Palmer Quarterly, 54(3), 341–366.Google Scholar
- 14.Crockenberg, S. C., Rutter, M., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Juffer, F., Collins, W. A., et al. (2008). The effects of early social-emotional and relationship experience on the development of young orphanage children. Monographs of the Society for Research in Child Development, i–298.Google Scholar
- 15.Beckett, C., Castle, J., Rutter, M., & Sonuga-Barke, E. J. (2010). VI. Institutional deprivation, specific cognitive functions, and scholastic achievement: English and Romanian Adoptee (ERA) study findings. Monographs of the Society for Research in Child Development, 75(1), 125–142.CrossRefPubMedGoogle Scholar
- 16.Fox, N. A., Almas, A. N., Degnan, K. A., Nelson, C. A., & Zeanah, C. H. (2011). The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project. Journal of Child Psychology and Psychiatry, 52(9), 919–928.CrossRefPubMedCentralPubMedGoogle Scholar
- 19.Miller BS, Kroupina MG, Mason P, Iverson SL, Narad C, Himes JH, et al. (2010). Determinants of catch-up growth in international adoptees from Eastern Europe. International Journal of Pediatric Endocrinology, 2010, 107252. doi: 10.1155/2010/107252.
- 21.Gustafson KL, Eckerle JK, Howard CR, Andrews B, Polgreen LE. (2013). Prevalence of Vitamin D Deficiency in International Adoptees Within the First 6 Months After Adoption. Clinical Pediatrics, 52(12), 1149–1153.Google Scholar
- 22.Fuglestad AJ, Georgieff MK, Iverson SL, Miller BS, Petryk A, Johnson DE, et al. (2012). Iron Deficiency After Arrival is Associated with General Cognitive and Behavioral Impairment in Post-Institutionalized Children Adopted from Eastern Europe. Matern and Child Health Journal, 17(6), 1080–1087.Google Scholar
- 27.UNICEF. Second Child Protection Forum. (2009) “Building and Reforming Child Care Systems in Central Asia, Azerbaijan and Turkey.” Kazakhstan Fact Sheet. Bishkek, Kyrgyz Republic. Accessed August 05, 2013, from http://www.unicef.org/ceecis/KA_fact_sheet_eng.pdf.
- 28.Bayley, Bayley N. (1993). Scales of infant development (2nd ed.). San Antonia: The Psychological Corp.Google Scholar
- 29.van den Dries, L., Juffer, F., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2010). Infants’ physical and cognitive development after international adoption from foster care or institutions in China. Journal of Developmental and Behavioral Pediatrics, 31(2), 144–150.CrossRefPubMedGoogle Scholar
- 30.Onis, M. (2006). WHO child growth standards based on length/height, weight and age. Acta Paediatrica, 95(S450), 76–85.Google Scholar
- 31.Ritchie, R. F., Palomaki, G. E., Neveux, L. M., Navolotskaia, O., Ledue, T. B., & Craig, W. Y. (1999). Reference distributions for the negative acute-phase serum proteins, albumin, transferrin and transthyretin: A practical, simple and clinically relevant approach in a large cohort. Journal of Clinical Laboratory Analysis, 13(6), 273–279.CrossRefPubMedGoogle Scholar
- 32.Boyd, L. A. C., Msall, M. E., O’Shea, T. M., Allred, E. N., Hounshell, G., & Leviton, A. (2013). Social–emotional delays at 2 years in extremely low gestational age survivors: Correlates of impaired orientation/engagement and emotional regulation. Early Human Development, 89(12), 925–930.CrossRefPubMedGoogle Scholar
- 33.Janssen, A. J. W. M., der Nijhuis-van, M. W. G., Akkermans, R. P., Oostendorp, R. A. B., & Kollée, L. A. A. (2008). Influence of behaviour and risk factors on motor performance in preterm infants at age 2 to 3 years. Developmental Medicine and Child Neurology, 50(12), 926–931.CrossRefPubMedGoogle Scholar
- 35.UNICEF.(2012). Kazakhstan country profile: Maternal, Newborn and Child Survival. Accessed August 01, 2013, from http://www.childinfo.org/files/maternal/DI%20Profile%20-%20Kazakhstan.pdf.
- 36.Messinger, D., Lambert, B., Bauer, C. R., Bann, C. M., Hamlin-Smith, K., & Das, A. (2010). The relationship between behavior ratings and concurrent and subsequent mental and motor performance in toddlers born at extremely low birth weight. Journal of early intervention, 32(3), 214–233.CrossRefPubMedCentralPubMedGoogle Scholar