Gross motor development in children adopted from orphanage settings.

Many children adopted internationally have had less than optimal early life experiences, often suffering severe deprivation frequently associated with institutional care. Such deprivation is known to affect skill acquisition negatively across a wide range of developmental areas.1 Longer periods of institutionalization have been linked to increased difficulties in specific areas, including memory, attention, learning, and inhibitory control,2 as well as internalizing and externalizing behavioral problems.3 Identifying motor deficits in internationally adopted, postinstitutionalized children is important given the evidence that children with motor problems are often stigmatized, with poor motor performance leading to exclusion from social activities. As a result, motor delays are implicated in a cycle of decreasing participation in peer play, decreasing social competence, and low self-esteem. Furthermore, exercise and motor development are closely related to physical and mental health.4–7 Institutional (also called orphanage) environments usually afford inadequate opportunities for motor activity. Rutter8 emphasized that children adopted from Romanian orphanages were more severely deprived than almost any other group of children previously studied. Romanian orphans were mainly confined to cribs or cots with few if any toys. A time use study by Tirella et al.9 found that children in a Russian orphanage spent 50% of their time alone. Additional factors such as high child-to-caregiver ratios and regimented schedules contribute to limited opportunities for children to participate in gross motor play with caregivers or peers.10,11 Most extant studies of the motor skills of institutionalized children were conducted before or just after children were adopted into family settings, rather than following a period in the enriched environment. A study by Sweeney and Bascom12 is one that assessed children before adoption. Participants in that study, who resided in nine orphanages across Romania, were screened to be free of overt neurological impairments. These children scored below the 4th centile in motor skills using the Peabody Developmental Motor Scales. One of the first studies of international adoptees at entry into the USA reported gross motor delays in 33% of the children.13 These authors suggested future studies would be necessary to examine any possible reversibility of the delays after adoption into a family environment. Developmental `catch-up' in children adopted from institutional settings is often attributed to radical improvement in the child's environment, shorter time in an institution, and/or younger age at adoption. Some studies also emphasize the length of time spent in the enriched environment. One such study of children from Eastern Europe who had been in their adoptive homes for an average of 5 years found that 34% of the participants were identified with developmental coordination disorder even after exposure to an enriched environment.14 However, 90% of this sample was also diagnosed with neurological and/or neurodevelopmental disorders. A study by Pomerleau et al.15 examined the development of 123 children adopted before 18 months of age from China, East Asia (Vietnam, Taiwan, Thailand, South Korea, Cambodia), and Eastern Europe (mainly Russia). Rapid gains in motor development were observed postadoption, especially for those children with a shorter length of institutional experience or those who were younger at the time of adoption. Lin et al.16 examined the motor/sensory skills of children also adopted from Eastern Europe. Using the Sensory Integration and Praxis Tests, they evaluated 60 children aged from 4 to 9 years who had been living with their adoptive families for an average of 3 to 5 years. Half of the children had spent an average of 34 months in an institution and half had spent an average of 3 months in an institution. Children with longer periods of institutionalization displayed higher levels of problems with sensory discrimination, praxis, and sensory modulation. The present study was designed to assess and then compare the gross motor development of children raised in orphanages before adoption with age-matched peers being reared in their birth families. Tests of gross motor development used in this study were selected based on a preliminary study in our laboratory of 18 9-year-old children adopted from orphanages in Romania. These children showed delays in balance and bilateral coordination that appeared to persist over time.17 Therefore, tests of balance and bilateral coordination were selected for the present study. None of the children who participated in the preliminary study was included in the study reported here. Our aim was to select children without overt neurological problems who had been living in a family environment for a number of years following adoption from an institutionalized setting. We sought to assess motor skill `catch-up' once children had spent time in an enriched environment. We also tested to determine if longer histories of institutionalization, or more severely deprived settings, would be associated with gross motor development. Our primary hypothesis was that internationally adopted postinstitutionalized children would display weaker balance and bilateral coordination skills than their peers even after years in an enriched environment, with longer periods of institutionalization and more severe deprivation leading to more significant delays.