The psychological effect on child's behavior produced
by living in orphanage did not attract the attention of scientists
until the first international adoptees from Romania arrived to
America. The last US orphanage was closed almost 70 years ago,
and the notion of "orphanage behavior" disappeared from
the researchers' radar. But when adoption of children from the
overseas orphanages reached big numbers during the last two decades,
the monster returned but was not recognized. It was given many
fancy names, from "institutional autism" to "attachment
disorder." In cases of "institutional autism,"
those children would be later diagnosed with "real"
autism or, more often, their behavior would gradually morph into
normal family-oriented and acceptable patterns (see my article
Institutional autism in children adopted internationally: myth
or reality?). The situation with attachment diagnoses was
even more complex (see my article Attachment
disorder: are we trying to fit square pegs into the round holes?
), as a child's unruly or unusual behavior in a family setting
was not necessarily a sign of any medical/psychiatric condition.
In fact, in many cases this was a post-orphanage behavior, magnified
by an early childhood trauma and reinforced by the abrupt loss
of first language and new negative circumstances.
We all intuitively understand that an institutional
culture must be the breeding ground for institutional behavior
among children who do not get adequate care and proper mediation
from adults in their early most formative years, are continuously
traumatized, and often forced into survival mode. We do not have
any reliable research on these depraving forces, but we do see
the psychological effects and consequences of these conditions
for children in their post-institutional period, which I will
identify and describe based on my observations and on hundreds
of psychological assessments I have conducted over 20 years.
Post-Orphanage Behavior (POB) syndrome is a cluster of learned
(acquired) behaviors that could have been adaptive and effective
in orphanages but became maladaptive and counter-productive in
the new family environment. I believe that to some extent we can
initially observe some patterns of POB in the majority of post-institutionalized
children. As one can see further, some characteristics of POB
may even contradict each other (e.g., learned helplessness and
self-parenting), but nevertheless can still be found in the same
child. In fact, the illogical combination of seemingly opposite
characteristics is the very essence of POB.
Though it is difficult to trace the direct link between certain
environmental conditions affecting a former orphanage resident
with the resulting psychological traits of the growing up person
who now lives in the family - it's always a complex combination
of biological and social aspects - we have to identify the main
patterns of expected and common post-orphanage behavior and separate
temporary from long-term psychological problems. Below we will
look at several components of post-orphanage behavior. They are
most common among international adoptees, but there may be some
additional traits which I do not review here like hoarding, stealing,
habitual lying, and other anti-social acts reported by adoptive
Poor self regulation
A peculiar combination of rigid routine with ongoing uncontrollable
changes in the environment is typical for foreign institutions:
constant turnover of caregivers and frequent transfers of children
between institutions create unpredictability in living arrangements
and lead to a tremendous sense of instability and lack of control.
On the other hand, children's everyday routines are fixed with
rigid schedules, virtually no personal choices, and no private
possession of toys or other goods. As a result of this everyday
routine combined with sudden uncontrollable change, there is a
minimal need for behavioral self-regulation, long-term planning,
or a need to practice goal-directed consistent behavior. The orphanage
residents live in a "reactive" mode, surviving "one day at a time."
Immaturity in self-regulation of behavior and emotions can be
seen in such behavior patterns as:
- Difficulties with sustaining goal-directed
behavior, independent generating of problem-solving strategies
and methods toward achieving goals, carrying out multi-step
activities and following complex instructions, monitoring/checking
and keeping track of performance.
- Emotional volatility - the inability to
modulate emotional responses. These children are easily aroused
emotionally - whether happy or sad, the speed and intensity
with which they move to the extreme of their emotions is much
greater than that of their same age peers; they are often on
a roller coaster ride of emotions. As observed by one parent:
"When my 8-year-old is happy, he is so happy that people tell
him to calm down. When he is unhappy, he is so unhappy that
people tell him to calm down."
- Reluctance/unwillingness to perform tasks
that are repetitive, uninteresting, require effort, and that
have not been chosen by the child (but that is what life in
general and school learning in particular consist of!). It is
very hard for them to shift (to make transitions, change
focus from one mindset to another, switch or alternate attention)
and to inhibit, resist, or not act on an impulse, including
an ability to stop one's activity at the appropriate time.
- Difficulty with delaying gratification and
accepting "No" for an answer. In this respect many post-institutionalized
children are rather similar to much younger children than to
These are only a small sample of the characteristics
of immature self-regulation, which, being a part of POB, may appear
as symptoms of ADHD and other neurologically-based disorders.
Poor self-regulation often comes across as phenomenon of mixed
maturity, when the same post-institutionalized child at times
may demonstrate the behavior of an older child and at times of
a much younger one. For example, in terms of self-care and performed
chores, a child may be well advanced for their age, may tend to
interact more with older children and have interests advanced
for their age, but in reaction to stress and frustration they
may behave in a way that is usually expected from a child several
years their junior. This obvious inconsistency is very confusing
for parents and teachers.
Self-parenting in adopted children
(not to be confused with the psychological technique of "inner
talk" promoted by Dr. J. Pollard) is, in essence, an attempt to
assume the role of parent, thus denying the actual parents their
major social role. Post-institutionalized children may:
- Constantly attempt tasks that are normally beyond
their age level abilities and skills.
- Resort to taking "justice" into their own hands
in their relationships with peers instead of appealing to adults
in resolving conflicts as is expected at a certain age.
- Try to reverse the child-parent role by "supervising"
parents and generally "bossing around" both their siblings and
Although sometimes looking "funny" and even "cute"
(when a seven year old girl teachers her mother how to use makeup
or a nine year old boy gives his father instructions on how to
drive a car), these patterns of behavior can be quite annoying
for parents. Such behaviors may impede the bonding process and
negatively affect biological children. In essence, such inappropriate
social skills reveal an attempt to prove one's own self-esteem
and self-worth and are an intrinsic part of POB.
This behavior seems to be the opposite of "self-parenting"
but can be found in the same child. Both patterns of behavior
are clearly "learned skills" in origin. Children in
orphanages have been conditioned to get more attention from caregivers
when they appear helpless: the more independent children in an
institutional environment are, the less attention they receive.
Some post-institutionalized children have deeply internalized
this behavior and manage to appeal to a wide audience with demonstrated
helplessness. This behavior has also been observed in abused children,
who would rather have negative reinforcement than no attention
at all. Learned helplessness is tolerated by society much longer
than acting-out behavior. Many of these children actually have
the needed skills or knowledge, but are resistant to any attempt
to encourage them to act independently. There is, of course, a
genuine need for help, but sometimes the line between learned
helplessness and real need may be rather thin.
and avoiding behavior
Another important characteristic of POB is a global sense of insecurity
that results in controlling and avoiding behaviors. It takes different
forms in school and at home. In school, with their fragile and
vulnerable sense of competence, a former orphanage resident feels
(subconsciously) that it is better to be perceived as being uncooperative
rather than an underachiever. Being insecure and too sensitive
to failure, these children tend to avoid classroom assignments
or activities that they perceive as "difficult," hence
their refusal or noncompliance. It can be open defiance or hidden
sabotage, but it is rooted in their overwhelming need to be always
in control, to be on known and manageable "turf." This
is an obstacle in their learning: to be a good learner means to
take risks, to step into unknown territory, to be sure of one's
own ability to cope, and to be prepared to accept help.
A substantial part of controlling and avoiding behavior
comes from separation anxiety that may be a bizarre form of fear
of being sent back to the orphanage, being passed to another family,
or just being left alone. For a long time this fear stays in the
mind of many international adoptees in spite of verbal assurances
of their adoptive parents, and it may interfere with normal functioning
in school and in the family.
The early childhood experiences of deprivation and insecurity
force a post-institutionalized child to fight for control at home.
This fight may assume ugly forms and can be very upsetting for
parents. Controlling and avoiding behavior is often considered
to be the core of "attachment disorder." The question
remains to what extent this "disorder" is a learned
survival skill for achieving security as understood by a traumatized
Self-soothing and self-stimulating
A consistent state of abandonment, deprivation,
and neglect of basic emotional needs "educates" orphanage
residents on how to "take care" of their own emotional
needs with self-soothing and self-stimulating behavior, which
might have been copied or arrived at independently by a child.
These might be:
- Withdrawal/aloofness with finger sucking,
hair twisting, full-body spinning and rocking, head spinning and
banging, covering ears to block out even ordinary sounds.
- Active resistance to any changes in routine
and environment, excessive reaction to even ordinary stimuli,
extreme restlessness, obsessive touching of self and objects,
unusual reaction to some sensory stimuli (taste, smell, touch),
making unusual, animal-like sounds.
Children who are neglected and traumatized
during early formative years tend to display higher levels of
aggressive behavior (Gunnar, M., & Van Dulmen, M. (2007). Behavior
Problems in Post-institutionalized Internationally Adopted Children.
Development and Psychopathology, 19, 1, pp. 129-148). "Hyper-arousal,"
a heightened alertness and vigilance combined with an inability
to correctly interpret the emotional side of the situation, is
typical for many post-orphanage children, and it often results
in inadequate social interactions both with peers and adults.
Perceived threats can objectively be typical day-to-day events
(like a new environment, loud re-direction, the mother's simple
request to clean the table, disrupted routine, perceived rejection
by peers, etc.). In such situations boys can be "tough" and proactively
aggressive in their urge to dominate peers and protect themselves
from the "expected" hostility of their environment. Girls can
present themselves in a seductive and promiscuous way, trying
to control the situation by means unexpected in their age group.
Feeling of entitlement
Due to the very nature of orphanage life, when
"goods and services" come from "out of the blue" and are delivered
seemingly evenly to everyone in the group, it produces the feeling
of entitlement in the orphanage inmates. The dictionary defines
"entitle" as "to furnish with a right or claim to something."
Entitlement is a normal stage of human development: when an 18-month-old
demands possession of everything he sees, it is a natural and
passing stage of growth. However, for a 9-year-old it is not appropriate
developmentally: a child should have learned by this time to balance
taking and giving. A normally developing child of a certain age
(at least by the toddler stage) learns that goods (e.g.: toys)
come as rewards for achievements or as presents given in certain
situations (birthday, holidays, etc.) and not just because the
"thing" exists and he/she wants to have it. When a child whines
and screams, demanding a new toy she sees on the store shelf or
a new pair of sneakers he has seen his classmates wear, or a new
cereal just advertised on TV - this is the feeling of entitlement
of which we are speaking. A child who was raised in an ordinary
family may also have a sense of entitlement, of course. But children
raised in orphanages have this feeling on much greater scale.
They are conditioned to the notion that if one member of a group
has something (say, is given a pencil or a notebook), other members
of the same group are supposed to get the same, too, whether they
need it or not. They may not understand the appropriateness of
their demand (when a 17-year-old sibling has a privilege of returning
home at 10 in the evening, a 12-year-old may hysterically request
the same privilege for himself). While a sense of entitlement
in children raised in families may result from poor parental techniques
(like giving rewards randomly and for no reason), in orphanage
residents this is a survival skill determined by institutional
care. As such, it is only one small step away from the feeling
of entitlement to obtain things though theft, robbery, or deception.
Extreme attention seeking
Adult attention is a rare and most valuable
commodity in an orphanage, and children there fiercely compete
for adult attention, sometimes through negative behavior (it is
better to be punished than ignored). Orphanage residents constantly
seek adult attention, approval, and encouragement. Often, no matter
what they do, the motivation is to evoke a reaction from the grown-up,
not to solve a problem or achieve some goal. This extreme urge
to obtain attention is borderline with pathology. Thus, I often
observe in post-institutionalized children what I call "person-oriented"
versus "goal-oriented" behavior. For example, during testing the
child is asked to make a block design according to a model presented
in a booklet in front of her. However, the girl will not look
at the model but will keep looking at me, randomly moving blocks
in anticipation of my reaction. As soon as she infers that I am
pleased with her performance, she stops her activity, in spite
of the fact that her result is not the same as the model. Her
motivation is not to accomplish the task but to please the adult
and evoke his sympathy and attention. This urge to win an adult's
attention and approval is typical for children in general, but
in post-institutionalized children it often reaches extremes at
the expense of independent goal-directed activity. It may adversely
affect their performance on standardized tests where the examiner's
behavior, by definition, is supposed to be "neutral" and "impartial."
In such situations, post-institutionalized children may lose interest
and motivation to perform: to "achieve" for many of them means
to get an adult's approval, not to accomplish the task.
Orphanage raised children, similar to patients
with personality disorders, may show indiscriminate and superficial
friendliness with strangers. They may behave inappropriately with
complete strangers they meet at a party or in a store. In fact,
to their adoptive parents' frustration, they may demonstrate more
intimate feelings towards strangers than to their parents. It
is always a shock to adoptive parents when I explain them that
for an orphanage resident any and every adult is a potential parent,
and this disconcerting attitude may stay with them for many months
after the actual adoption. I remember a 7 year old boy whom I
evaluated after more than a year in the adoptive family. On the
second day of testing he leaned over to me and said: "Will you
adopt me? I do not like them (meaning his adoptive parents), I'll
better stay with you. I am good at cleaning up an apartment."
The above behaviors may all be presented in the same child and
with a wide range of intensity. There are no gender differences
in these behaviors, except withdrawal being more typical for girls
and aggressiveness being more typical for boys. Some of these
behaviors are similar to those observed in a range of psychiatric
conditions such as ADHD, PTSD, and RAD. It is important to note
that some POB patterns are mostly found in younger and some in
Managing post-orphanage behavior
in your child
After adoption, a child faces the task of transforming
his/her orphanage survival skills into functional family/school
relationships. The child has to learn new patterns of behavior
and new social skills to interact with adults and peers. The time
spent in orphanage sometimes, but not necessarily always, may
correlate with the intensity of orphanage behavior internalized
by the child. The range of individual differences here is very
broad. In some adopted children the transformation of social skills
and maturation of self-regulation comes naturally with time and
practice. In many cases, POB will diminish by itself through observation
and participation in family life (social learning) and figuring
out what the most appropriate and productive behavior is. Indeed,
in some children POB may be very mild and may vanish quickly.
In others it may go away quickly, but suddenly reappear under
stress. In others yet it takes a long time, great effort, and
special help (counseling) to get rid of POB.
It is extremely important to realize that POB has
shared symptoms with serious mental/emotional disorders. Therefore,
those professionals who have no experience with post-institutionalized
children may be easily confused and find a host of disorders from
ADHD to RAD and affective disorders in children who may in fact
demonstrate just POB. On the other hand, POB may mask, be in addition
to, and be reinforced by organic and neurologically based genuine
disorders, as can bi-polar or ADHD. In talking about "learned"
behavior, by no means do I discount the possibility that some
of these children may have childhood depression, post-traumatic
stress disorder, or ADHD. However, it takes time to diminish the
effects of POB in order to understand the underlying emotional
problems. Hopefully, a skillful clinician is able to recognize
the roots of the issue before putting these children on medication.
(For more info about the differential analysis of a host of medical
conditions in international adoptees, see my article Cognitive,
Language, and Educational Issues of Children Adopted from Overseas
The question is, how long do you need to wait for
POB to subside before you know "something is still not right,
there is a problem"? I have no answer for all individual situations,
but the rule of thumb is this: POB has a tendency to recede with
time (several months to a year or longer in some cases), while
a genuine disorder will stay and get worse. The bottom line is
that POB is a "learned" behavior: a set of survival skills that
are functional and adaptive in the specific milieu of an orphanage.
Therefore, the only remedy is to substitute these orphanage skills
with newly learned, different, and at times opposite behavior.