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Detecting and Remediating the Cumulative Cognitive Deficit
in School Age Internationally Adopted Post-institutionalized Children

Published in: THE POST (The Parent Network for the Post-Institutionalized Child), Issue # 27, 2000-1, Meadow Land, PA, pp. 1-6.

Boris Gindis, Ph.D.,
NYS Licensed Psychologist

Definition and structure of CCD

Parents of school age internationally adopted post-institutionalized (IAPI) children sometimes express their concerns and frustrations over the slower than expected academic progress of their children in school. After an initial phase of seemingly fast new language acquisition and adjustment to their new homes and schools, some of these children may show significant difficulty in their academic work (which, in turn, often brings behavioral and emotional problems). Their learning difficulties may persist and even worsen, well after the time when their academic problems may be attributed to bilingual and adjustment issues. Moreover, as they progress through the developmental stages and school grades, they seem to fall farther and farther behind in their performance on academic tasks and cognitive tests. What happens even more often, the overall dynamic of cognitive/language development and academic performance of some IAPI children fails to match the comprehensive and relentless efforts of their adoptive parents and professionals in different fields.

These IAPI children may experience what is known as the "Cumulative Cognitive Deficit" (CCD) - a term coined by a psychologist, M. Deutsch in the 1960s (see: Cox, 1983). CCD refers to a downward trend in the measured intelligence or scholastic achievement of culturally/socially disadvantaged children relative to age-appropriate societal norms and expectations. The theory behind cumulative deficit is that children who are deprived of enriching cognitive experiences during their early years are less able to profit from environmental situation because of a mismatch between their cognitive structural maturity and the requirements of the new, more advanced learning situation. According to current research, there are several major characteristics of CCD:

  1. Cognitive language deficiency (that blocks cognitive processing).
  2. Lack of age-appropriate cognitive skills (which results in progressive cognitive/behavioral incompetence).
  3. Insufficient task-intrinsic motivation in cognitive activities (which may appear as an attention and memory problem).
  4. Chronic mismatch between a child’s learning capacity and his/her academic placement , teaching style, and level of instruction.

CCD is usually associated with certain emotional/behavioral problems. Constant failure in cognitive activities feeds upon itself in a negative spiraling fashion which results in low self-esteem, lack of interest in and constant frustration associated with cognitive efforts. Lack of intrinsic motivation in cognitive activities grows with age and becomes one of the major characteristics of CCD.

The causes, nature, and dynamic of CCD in IAPI children, are in many ways akin to the same phenomenon in the general population. There are, however, some substantial differences that must be recognized and addressed in our remedial efforts. In order to do this, let us consider a clinical case of an IAPI child who experienced cumulative cognitive deficit.

A Clinical Case

Alyona was adopted at the age of 8, having completed the 1st grade in her native Russia. She had been brought up in an orphanage since her birth. Her medical documentation confirmed her as a "basically healthy" child at the time of adoption. Nevertheless, in her early childhood, she suffered from anemia (iron deficiency), rickets (vitamin D deficiency), severe underweight (malnutrition), and delays in gross-motor development. The same medical record carried the diagnosis of "delays in psychological and language development" (which is almost a "standard feature" of children coming from Russian orphanages). She was evaluated within two months of her arrival in the USA in order to verify this diagnosis and recommend the appropriate academic placement for her.

No evidence of neurological impairment was found during her examination by a developmental neurologist. At the time of her initial psychological evaluation, Alyona was a practically monolingual (Russian) child. It was a challenge to meaningfully quantify cognitive ability of this limited English proficiency child with an "atypical" background through standardized testing. Alyona's academic skills were tested informally against the Russian curriculum (pre-school to grade 1) in language, math, and general knowledge. She was found to have unevenly developed and rather delayed literacy skills, being an "emerging reader" at best. Her developmental/functional status, estimated in terms of skills of daily living, self-help, socialization, and gross/fine motor skills appeared age-appropriate. Her cognitive functioning was tested through the Universal Nonverbal Intelligence Test and through several classical Piagetian tasks (presented orally in Russian) on hierarchical classification, comprehension of sequential events, and understanding of "double-meaning" expressions. Alyona's performance, although inconsistent and somewhat immature, was judged to be within the age-appropriate range. Her particular weakness was in sequential skills: it was difficult for her to recall auditory and visual information in proper sequence and detail, and in applying cognitive strategies that require step-by-step procedures. As a much younger child, she needed constant visual references to support her understanding or reasoning. Although her communicative fluency in her native language was age-appropriate, her ability to use language as a tool of mental operation was limited, immature, and ineffective. It was observed by the examiner, that Alyona was in the escalating process of losing her native language while the second language acquisition process was somewhat slow. At that time, Alyona's relatively weakness in cognitive/ language skills was attributed to her background of deprivation and hope was expressed that she would "catch-up", given the appropriate educational opportunities. In spite of the obvious mismatch between Alyona's level of readiness and the demands of her school setting, she was placed according to her age in a regular 3rd grade with ESL and remedial reading as supportive services.

Aloyna's next testing took place two years later, this time requested by the school district due to her "slow progress" in academic subjects. As it happened two years ago, Alyona again was virtually a monolingual child, this time, however, in English. She had completely lost her native language, not only in the expressive mode, but in the receptive one as well, to say nothing of her literacy skills - a case of the so-called "subtractive bilingualism". Although her communicative fluency in English seemed to be at least functional, her cognitive/academic English was very limited, as measured by the Woodcock-Munoz Language Survey. Her academic level was 3 to 4 grades below her current academic placement (5th grade). Standardized testing (WISC-V) showed a Low Average to Borderline level of intellectual functioning. A "dynamic assessment" through the Application of Cognitive Functioning Scale in a "test-teach-test" format revealed many cognitive deficiencies: Alyona demonstrated distorted spatial and temporal sequencing, incorrect comprehension of notion/concept meaning, and poor ability to recall/memorize academic material (or just about any abstract material for that matter). She revealed poor mastery of language as an instrument for cognitive activity. Her learning behavior was inefficient and immature: she was engaged in impulsive and disorganized "exploratory" actions (mostly through "trial-&-error" attempts). Her short-term memory ("working memory") was weak, with particular difficulty in grasping the sequence in which tasks were presented. Her attention, motivation, and ability to tolerate frustration in cognitive activities were even worse than two years earlier. It was obvious that Alyona did not take advantage of her new environment: her cognitive functioning was progressing too slowly in comparison with the changing demands of her educational setting. This time, Alyona was classified as a "learning disabled" student and a recommendation for a "small class" (special education) with language therapy was made.

A year later, during an annual review, Alyona's progress was discussed again, vis-à-vis the requirements of her current grade curriculum. She made only a few gains in her academic achievements and her deficit in cognitive functioning continued to increase. An examination completed by a school psychologist using the Stanford-Binet, revealed Borderline to Mental Deficiency range of general cognitive ability - a decline since her previous evaluations. She revealed particular difficulties in all language-based tasks that measured comprehension. Her selective attention, processing speed, and mastery of cognitive operations (such as: associations, categorization, classification, discrimination) were found to be well below age expectations. Alyona's teachers reported delayed academic skills in reading and writing activities, poor comprehension of abstract notions and concepts, incompetence in many age-appropriate mental activities, constant "tiredness", "daydreaming", and "boredom" in class (which is in sharp contrast to her keen interest and energy in social situations). There was an obvious disparity between her current instructional setting and her ability to benefit from it.

The Essence and Specificity of Cumulative Cognitive Deficit in IAPI children

Alyona’s case illustrates the essential qualities of CCD: it looks as if this child has been "racing against time" being unable to catch up with age-appropriate academic standards. Because of the discrepancy between steadily rising academic requirements and relatively slow cognitive/language progress in some of the IAPI children, the overall trend appears to be a "downward" one. Resembling the population at large in its nature and dynamic of development, the CCD in IAPI children has the following specific features:

  • Traditionally, in education and cognitive psychology, the causes of CCD have been attributed mostly (if not exclusively) to a "culture of poverty", that is, to ongoing cultural/educational deprivation. As opposite to this "single cause approach", the determinant of CCD in IAPI children may be associated with a combination of medical (e.g. failure to thrive syndrome), socio/economical (neglect/abuse, poor nutrition), and cultural/educational deficiencies in early childhood. Consequently, the remedial efforts should be multifaceted.
  • The effect of bilingualism on cognitive functioning depends in part on whether children are adding a second language to a well-developed first language (the so-called "additive" model) or whether a second language is sharply replacing the first language (the "subtractive" model). The subtractive nature of new language acquisition in IAPI children definitely contributes to CCD (Gindis, 1999) and may constitute the "core" factor in cumulative cognitive deficiency in IAPI children. It may even be suggested that CCD might be reinforced during the time when the first language is lost for all practical purposes and second language is barely functional communicatively and not in existence cognitively. The overall length of this period depends on child’s age and individual differences, but all IAPI children adopted after three years old appeared to live through this period and for some of them, it is the time when their cognitive weaknesses were consolidated into CCD.
  • In internationally adopted "older" (school-aged) children, there are cultural differences that may be perceived as "incompetence" (McGuinness, 1998) in social, cognitive, or adaptive behavior domains. A value of cognitive activity, intrinsic motivation in cognitive operations, learning behavior in general, and attitude toward teaching authority may be influenced by cultural differences. We have to understand that CCD in IAPI children is diagnosed against the US middle class norms and expectations. The relationship between the cultural differences (in both IAPI children and the adoptive families) and CCD should be further explored and explained.
  • In IAPI children, CCD may occur concurrently with or as one of the consequences of such behaviorally defined disabilities as Post-Traumatic Stress Disorder and Attachment Disorder – these are the most often psychiatric diagnoses found in IAPI children. More research is needed, however, to define this clinically observed correlation.
  • The phenomenon of CCD is attributed to cultural/educational deprivation experienced in the early formative years and is traditionally associated with children from low SES families (Parker, et al. 1988). Most IAPI children now live in middle-class families with well-educated parents. Probably for the first time in the history of CCD, families are not ongoing contributing factors in CCD; on the contrary, they may be considered as powerful remedial factors for CCD. Due to adoptive parents' sensitivity to and awareness of possible learning problems in IAPI children and because of higher parental expectations in this respect, symptoms of CCD are earlier reported and are more often subjected to professional attention.


The question of great practical significance for many adoptive families is: to what degree can CCD be remedied and what are the most effective treatments to overcome such a deficit. With the IAPI children, remedial efforts should be as diversified as the causes of their CCD.

Thus, from a pediatric perspective, rehabilitation strategies for cognitive problems are concentrated on medical intervention, proper nutrition and vitamin supplements. It is well documented now that inadequate nutrition - which is a common occurrence in overseas orphanages (see: Generation in Jeopardy: Children in Central and Eastern Europe and the former Soviet Union, 1999) is one of the most critical insults to early child development. The effects of malnutrition on the developing nervous system's functional and structural elements are known to impair cognition. The brain is uniquely vulnerable to malnutrition damage during the critical period of rapid brain growth which takes place from the last trimester of gestation through the early preschool years (Parker, et al. 1988). It means that even when a child has been adopted younger than school age, the risk of CCD (as far as it relates to malnutrition) may still be present. However, nutritional intervention is a necessary but not sufficient mode of treating cognitive difficulties. Current scientific data demonstrates that adequate medical and nutritional intervention alone produced no changes in intellectual development and may not restore developmental functions to the right track of timely development (Cox, 1983). The overall body of research data indicates that the cognitive difficulties due to early malnutrition and environmental deprivation are treatable only through interventions that include nutritional, medical, and developmental/educational components. The last part of this triad is the topic of our discussion.

Although our experience with IAPI children having CCD is limited, we may use research data and practical "know-how" that relates to CCD in the population at large. One of the stunning findings was that "traditional" remediation (that is: more intense work in a smaller group or even individually using basically the same teaching methodology as in the classroom) may not be effective or, at times, is just counterproductive in attempts to overcome the cumulative cognitive deficit (Haywood, 1987). The CCD has a complex nature: it is a combination of internal (e.g.: language, cognition, motivation) and external (e.g.: teaching methods, learning environment, peer interaction) factors. This makes the CCD a challenge for educators. To complicate the picture further, due to the "summative" nature of CCD it may not be found in the early stages of a child's educational journey: it takes time for cognitive deficit to become "cumulative". Therefore, when CCD is properly diagnosed, it may not be responsive to even "heroic" efforts from parents and school alike, if they use "traditional" remediation methods. One of the possible explanations may be that the cognitive deficiencies in IAPI children are deeply rooted in their early childhood experience. Almost all cognitive abilities are developmentally hierarchical, that is, the appearance of more complex cognitive structures rest upon the prior appearance of simpler cognitive components (Vygotsky, 1978). Traditional remediation "assumes" the presence of the appropriate base in cognition upon which it tries to build the compensatory structures. However, the very lack of the proper foundation constitutes major difficulty in reversing the negative trend in CCD. Therefore, effective and appropriate teaching methods are the crucial element in remediation of children with CCD.

The research and practice point to "cognitive education" as one of the possible methods of remediation of CCD in IAPI children. There are many "cognitive education" approaches created for different age groups. Among the most well known are "Instrumental Enrichment" (R. Feuerstein), "Bright Start" (H. C. Haywood), "Process-Based Instruction" (B. Ashman), "PASS Remedial Program" (J. P. Das & E. Carlson), and "Cognitive Instruction" (Kirby & Williams). All these different systems of cognitive remediation are based on the assumption that cognitive processes are acquired mental operations that can be mastered through appropriate learning. In this respect "cognitive", is different from "intellectual": the former is said to be learned while the latter is seen as the native ability that is largely genetically determined" (Haywood. 1987, p. 193). The efficiency of learning cognitive skills depends, of course, on "inborn' intellectual capacity, however, the learning environment has at least comparable significance and tremendous remedial potential. "Cognitive education" methodology assumes that while children with CCD have difficulty in originating cognitive strategies spontaneously, they can be taught how to create cognitive algorithms and to apply them to cognitive tasks. Through carefully crafted methodology, they may be taught how to inhibit impulsive responses, how to analyze a problem using a certain "algorithm", and how to experiment mentally with the possible solutions of the problem. In other words, they must be specifically taught "how to learn" (this is the core of cognitive education) and how to use their learned cognitive skills ("generalization" or "transference" of cognitive processes). In order to compensate for the detrimental effect of CCD in IAPI children, cognitive interventions must be age-appropriate, disability-specific, well-planned, and persistent. As indicated by H. C. Heywood (1987), these remedial strategies are to be applied through four closely connected directions: 1/ enriching cognitive language, 2/ teaching specific cognitive skills (thus increasing cognitive competence), 3/ facilitating task-intrinsic motivation, and 4/ providing appropriate (optimal) learning settings.


It is the common understanding that children who have spent any appreciable time in institutional care are "at risk" for having cognitive deficiencies, developmental delays and psychological problems (Ames, 1997). Why, then, do some IAPI children have CCD and others do not? The absence of irrefutable scientific data does not allow us to determine which specific factors of institutionalized life are most damaging to the cognitive abilities of children of a certain age and lead to CCD. Is it the age of placement in an orphanage or time spent there, or, perhaps, both? We still do not know for sure. The fact of life is that many IAPI children seem to escape CCD and are able to fully benefit from their new environment, to recover on their own from the detriments of their past, and to flourish in their new homes. A study of their resilience may help us to understand why the same protective factors failed with other IAPI children. One of the most interesting researches in this respect was the study by T. McGuinness (1998) of children adopted from the countries of Eastern Europe and the former USSR. However, we need more research data to build up effective remedial strategies to reverse the detrimental trend in intellectual and academic performance known as cumulative cognitive deficit.


  • Ames, E. (1997). Recommendations from the Final Report "The development of Romanian Orphanage Children Adopted in Canada". The Post, #10, 03/97, pp. 1-3 (publication of the Parental Network for the Post-institutionalized Child).
  • Cox, T. (1983). Cumulative deficit in culturally disadvantaged children. British Journal of Educational Psychology. November, Vol. 53(3). pp. 317-326
  • Generation in Jeopardy: Children in Central and Eastern Europe and the former Soviet Union. (1999). UNICEF compilation of documents, edited by A. Zouev, published by M.E. Sharp Publication, NY
  • Gindis, B. (1999). Language-Related Issues for International Adoptees and Adoptive Families. In: T. Tepper, L. Hannon, D. Sandstrom (Eds.) "International Adoption: Challenges and Opportunities". PNPIC, Meadow Lands, PA, pp. 98-108.
  • Haywood, C.H. (1987). The Mental Age Deficit: Explanation and Treatment. Upsala Journal of Medical Science, 44, pp. 191-203.
  • McGuinness, T. (1998). Risk and Protective Factors in Children Adopted from the Former Soviet Union. The POST (PNPIC, Meadow Lands, PA) Issue # 18, pp. 1-5.
  • Parker, S., Greer, S., Zuckerman, B. (1988). Double Jeopardy: The impact of poverty on early child development. Pediatric Clinics of North America, 35, (6) 1227-1240.
  • Vygotsky, L. (1978). Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press.


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