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Romanian orphans in Bucharest, 1990Photograph by Reuters * Mike Fisher * Archive Photos

They rock, they sway, they stare blankly into space. they are disturbingly quiet, antisocial, and exhibit behavior resembling autism. They are typical of many of the children in Romanian state-run residential institutions, a legacy of decades of Communism under Nicolae Ceauçescu's iron-fisted policies that forced families to bear more children than they could afford. It is estimated that an unprecedented 2 percent of Romanians under the age of 18 are being raised by the state.

These children are also reminders of how institutional care can fail due to inadequate social nurturing, says Mary Carlson, M.P.A. '92, associate professor of neuroscience in psychiatry and a science fellow at the Bunting Institute. She is exploring connections between these children's disturbed behavior and disruptions in their bodies at the molecular level. A neurobiologist who has spent close to three decades studying the effect of touch on the developing brain, Carlson recently began looking at how early social neglect affects the adrenal cortex, the outer layer of the adrenal gland located on top of each kidney.

Specifically, Carlson has focused on cortisol, a stress hormone regulated by the hypothalamic-pituitary-adrenal system. Cortisol works in concert with the other stress hormone, adrenaline, to regulate sugar levels in the blood. In contrast to adrenaline's famous fast-pumping ways, cortisol dampens the body's reaction to stress by suppressing other systems, such as the immune and reproductive systems. Touch is crucial to the regulation of that stress-response system, which in turn influences metabolism, immunity, and neural functioning. "After 25 years of working in the cerebral cortex," Carlson says, "I realized I was working in the wrong cortex."

Many institutionalized children in Romania aren't touched, cuddled, and loved. That is due to a number of factors, says Carlson, the most overwhelming of which is economic hardship. Romanian custodial institutions are characterized by high ratios of children to caretakers and an overemphasis on mechanical and medicinal aspects of care--at the expense of simple physical stimulation like cuddling an infant or tickling its toes. Carlson warns that many toddlers raised in such conditions exhibit serious social problems, as well as suppressed physical growth and impaired immune systems. She notes the widespread belief that such orphans filled the ranks of Romania's once feared, now defunct, police force, the Securitate. "They made wonderful secret police," Carlson says. "Because they have no social allegiance, they lose the basic social emotions."

For the study, Carlson traveled to the northeastern Romanian town of Iasi to measure cortisol in saliva samples from institutionalized children. She compared cortisol levels in two groups of toddlers between 2 and 3 years old, who had been placed in residential institutions called leagane, or "cradles," when they were between the ages of 2 and 9 months. Not quite orphanages, leagane generally care for the children of indigent parents. The control group were toddlers in typical leagane conditions--as many as 20 children per caretaker, and little or no social interaction or playing. The intervention group had only four children per caretaker and plenty of toys, conversation, and hugging.

Initially, the intervention group showed significantly more physical and behavioral growth than the controls. In fact, Carlson says, the behavior of many children in the control group deteriorated to the point where they became almost silent; they had trouble walking, holding crayons, or even voicing basic needs. Overall, however, cortisol levels in both sets of children were twice those of the typical American child. Children with the highest cortisol levels had the lowest scores--they were the ones who couldn't balance on one foot, remember words, or look you straight in the eye. They were the ones with the bizarre, stereotypical rocking and swaying behavior. Thus, the overall environment of leagane and the life conditions of these poor children appear--at least at the hormonal level--to generate more stress than the interventions could offset.

On a second trip to Iasi, Carlson tested 2- and 3-year-olds who lived at home but spent their days at crese--state-run, understaffed day-care centers with poorly trained workers. (Romanians call such centers "day-orphanages.") Elevated cortisol levels correlated with low mental and motor performance in these children also, but--as a group--their behavioral scores and growth measures were in the normal range.

Overall, Carlson found that cortisol levels were much closer to normal when children were tested at home on the weekends rather than in crese--suggesting that low-quality institutional settings trigger abnormally high cortisol levels. "If you're in bad day care during the week," she asserts, "two days off is not enough. The hormonal findings corroborate the known behavioral problems."

Carlson is returning to Romania in June to discuss her findings with UNICEF and other children's advocates. Their goal is to develop effective rehabilitation strategies and alternatives to leagane care.

~Cristina Merrill

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