There’s child poverty in the US, so why study children in Bangladesh?
I’m interested in the effects of early adversity. Researchers in the US have studied the effect of maltreatment and poverty, but no children in the US face the level of adversity seen in poor areas of Bangladesh. So we’ve built a lab in a Dhaka slum to investigate the effects on brain and behavioural development.
What are these slums like for children?
Advertisement
The level of poverty is mind-boggling. A family of five might live in a single room. None have kitchens or bathrooms. Everything is communal. People cook with wood or coal, so the air pollution is unbelievable. The roads are just dirt, so when the wind blows you have all this dirt in the air. There are open sewers. People use latrines in the street, which flood when the monsoon season comes – it lasts for months. The polite way to put it is that stool gets into everything, and can spread disease. The kids have chronic diarrhoea, which makes them malnourished. On top of that, around 20 to 30 per cent of the mothers we’ve assessed are depressed. There are high levels of domestic violence. We thought the work in Romania was messy – but this is even messier.
Tell me about that work.
Romania had a long and egregious history of institutionalising kids. In 1989, when the communists were overthrown, there were 170,000 children in institutions. We thought, just from sheer numbers, it would be a good place to do some research. So in the late 1990s, we started a study of children who had been abandoned in government-run institutions.
What were the institutions like?
We had a rule: no crying in front of the children. But it was tough. I can’t tell you how emotional this was. Sometimes you’d have to leave the room because you were so overwhelmed by the suffering of the children and the callousness of the staff.
On the second day of my first trip there, I saw a kid who was maybe 18 months old, standing in the middle of the room, crying. She had wet her pants and no one was paying any attention to her. I asked the staff: “What’s her story?” And they told me that her mother had left her there that morning and that she’d been like that all day.
There were significant developmental delays. The growth stunting would shock you – the kids were very, very small.
Why were the children in such a bad way?
They’re deprived of key experiences during critical periods of development. Babies lie in cribs for their first year or more and their visual experience is limited because often the ceilings are painted white. There’s no one to talk to them and caregiving is limited, so they’re deprived of psychosocial stimulation.
What was the aim of the study?
We wanted to find out how growing up in an institution affected the children’s development and if high-quality foster care could remediate whatever negative outcomes they might have. We were also interested in timing: whether recovery would be influenced by the age at which they were placed into foster care. We recruited a sample of 136 kids who had been abandoned shortly after birth. They were all babies aged from 6 to 31 months.
So you placed the kids into foster care?
We randomly assigned half of the kids to foster care; half remained in institutional care. There was no government foster care available, so we had to start our own – and having seen what life was like for the kids in these institutions, we decided we wanted it to be really good.
We advertised intensively in Bucharest for volunteer foster care parents, and then we interviewed and screened the respondents. When all was said and done, we could only find 58 families that we thought would be good. We paid the families a wage and provided material support, such as diapers and toys. The families were closely monitored: social workers visited their homes every 10 days and we had a paediatrician on-call 24 hours a day.
What was the impact of foster care?
Two or so years into the study, the findings were overwhelming. Across the board, the kids in institutions lagged behind. They had much lower IQs and delayed language development. They had smaller brains. They had all kinds of mental health problems. In every domain, they were hurting. The kids in foster care were doing much, much better.
Some of the improvements – such as in language and IQ – were only seen if children were placed in foster care before the age of around 2. The prevalence of mental health problems such as anxiety and depression were reduced no matter how old the kids were when they were placed. But foster care seemed to have no effect on attention deficit disorder.
How are the children doing now?
They’re 16 or so. Those assigned to institutions are not good. They’re starting to experience significant mental health issues, such as psychotic disorder and paranoia. Around 20 showed a precipitous drop in IQ from the age of 12. That’s surprising and really worrying. IQ is generally stable over time. The kids in foster care are doing much better across the board.
“We had a rule: no crying in front of the kids. But I can’t tell you how tough it was“
Shouldn’t all the children have been offered foster care?
When you do a randomised controlled trial like this and you find that the intervention is really effective, then you generally have to make the treatment available to everyone or stop the study. But we didn’t have more foster care families, and if we stopped the study, all the kids would have gone back to the institution, which would not have been good.
So what did you do?
We called a national press conference. We invited members of the government and the press, and we announced our findings. It was our way of leaving it in the lap of the government, for them to do something. And sure enough, they started to. A year later they passed legislation forbidding the institutionalisation of any kid under the age of 2 unless they were severely disabled. They also started government foster care.
Any results from the Bangladesh study?
We’re nearly done with data collection and we’re just now starting to go through the data.
What do you hope to achieve in the long run?
I want to develop the political will to improve the lives of kids. When it’s a specific problem, we can develop targeted interventions. That’s the hope, anyway.
Profile
is a professor of neuroscience and paediatrics at Harvard Medical School in Boston, Massachusetts
This article appeared in print under the headline “I’ve seen brain damage caused by terrible poverty”
