Institutionalization & Surrogacy Flashcards

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1
Q

institutionalization

A
  • Care in an established organization (ex. Orphanage, children’s home, etc.)
  • Many problems documented in institutionalized children (ex. Medical problems, physical deformities, cognitive problems, social difficulties, etc.)
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2
Q

Romanian Orphans

A
  • In 20th century Romania, birth control and abortion outlawed -> huge increase in birth rates, but families were too poor to care for them -> many children abandoned or sent to orphanages (became culturally normative)
  • Institutional standard of care very poor: overcrowding; few caregivers; little tactile, languale, or visual stimulation; dirty
  • In 1990, media reports of these conditions emerged -> some improvement; increase in adoptions from outside of Romania (but cultural norm of institutionalizing children continued)
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3
Q

Bucharest Early Intervention Project (BIE): basics

A
  • Began in Romania in 2000-2001

- Looking for impacts of institutional care and whether affects could be ameliorated by high-quality foster care

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4
Q

BIE: study design

A
  • Randomized, controlled study of institutionalization vs. Foster care
  • Subjects: institutionalized children 6-31 months (all relatively healthy); matched never-institutionalized children
  • Half of institutionalized children randomly assigned to foster care, half remained in institution with care-as-usual (avg. age of placement = 2 yrs.)
  • Assessed children at various points in time over years
  • “Intent to treat” model: even if kids didn’t stay in foster care/institution, they were analyzed as such
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5
Q

BIE: creation of foster care system

A
  • Before study, there was no pre-existing government foster care in Romania
  • System designed and implemented by study investigators; high-quality; children matched according to need
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6
Q

BIE: findings -> institutionalized children vs. control group

A
  • Institutionalized children worse off in every domain
  • Attachment: only 15-20% of children in institutionalized care showed secure attachment; 70% showed disorganized attachment, many showed Reactive Attachment Disorder
  • IQ/DQ: institutionalized children showed much lower rates
  • Brain Activity: less activity (alpha/beta waves), slower processing, reduced facial recognition -> suggests delayed brain development
  • Emotion/Attention: display less positive emotions and less attention
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7
Q

BIE: findings -> foster care children vs. institutionalized children

A
  • Foster care children showed some improvements, but not in all domains
  • Attachment: foster care children showed big improvements in secure attachment rates (slight improvements in RAD reduction)
  • IQ/DQ: foster care children showed big improvements compared to those who remained in institutionalized care
  • Psychiatric disorders: no difference between institutionalized and foster children
  • More positive emotions and increased attention
  • Increased language ability
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8
Q

BIE: findings -> timing of placement

A
  • Timing of placement into foster care matters -> the earlier you enter foster care, the better the outcomes (approx. 2 years or younger is ideal)
  • Ex. Those placed before 2 years show greater improvements in secure attachment; show no differences in social skills compared to control group (whereas those who were placed after 2 months showed same social skills as those who remained in institutions) -> same thing with brain activity
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9
Q

BIE: implications

A
  • In response to this project, Romanian government instituted a foster care system
  • Romania forbade infants to enter institutions if they were younger than 2
  • Led to a global questioning over the use of institutions for orphaned/abandoned children
  • Raised questions about neglect, even in non-institutionalized children (ex. What is enough stimulation for proper development?)
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10
Q

BIE: ethical arguments AGAINST

A
  • Children not selected for foster care did not experience positive intervention
  • Inclusion criteria -> only chose healthy children for study
  • Consent -> institutions consented for the children
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11
Q

BIE: ethical arguments FOR

A
  • Huge positive impact of the study (benefits outweigh risk)
  • Without intervention, no children would benefit -> they’re not causing anyone to be worse off than they already are
  • Advancing psychological knowledge
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12
Q

BIE: 3 key findings

A
  • Institutionalization associated with negative outcomes
  • Placement in foster care can ameliorate some of the negative outcomes
  • Timing matters -> placement must happen early (ie. before 2 years) in order to be beneficial -> Suggests sensitive period for social/sensory stimulation
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13
Q

sensitive period

A
  • Time in development in which input needs to be received in order for development to progress normally
  • Ex. We need to get vision early in development in order for our visual systems to develop
    • Example study: if a cat does not get enough input within the first 2 months of life, their visual system never develops properly, regardless of how much input they get later on
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14
Q

surrogacy

A
  • various types (traditional, gestational, commercial, altruistic)
  • research mixed on parent/child outcomes
  • other options: egg/sperm donation, embryo donation/”embryonic adoption”
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15
Q

4 main types of surrogacy

A
  • Traditional surrogacy (intended father inseminates surrogate mother -> baby is biologically related to intended father and surrogate mom)
  • Gestational surrogacy (intended father inseminates intended mother’s egg, which is then implanted in surrogate mother -> baby is biologically related to intended father and intended mother)
  • Commercial surrogacy: surrogate mom is paid (not legal in Canada and in many states in the US)
  • Altruistic surrogacy: surrogate mom is not paid
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