Hospitalism in the year 2000. The psychological development of children in a Romanian orphanage

In a two-year prospective study of a group of children institutionalized since birth in a Romanian orphanage, marked deficits are noted as early as 8 months of age, Bayley scales of development reveal a mean mental performance of 4.5 months for these children. At a mean real age of 32 months, mean mental age is 18 months. A test evaluating communication (ECSP) in its main parameters (interaction, joint attention, behaviour regulation) brings forth new ways of understanding the effects of << hospitalism >> : what is particularly notable is the deficit in initiating interaction behavior. The symbolic level is rarely obtained. At the mean real age of 32 months, performances are situated at 17 to 24 months. This is a particular form of psychopathology : the infant lacks initiative and does not become the agent of his wishes and his thinking. We analyse the type of institutional pathology that creates the severe psychopathologies encountered. A combined form of prevention/intervention was carried out : a course for educators and the creation of a pilot unit that fosters attachment. These interventions bring about modest gains in the performances under study. An analysis of the difficulties encountered by the << foreign >> team points to the inertia and the rejecting power of the local system. This experience could be helpful for other non governmental agencies that wish to engage in similar programs.