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How detention causes long-term harm to children

Detaining children indefinitely, particularly in a place where their basic needs are not met, can cause long-term damage, according to decades of research on early child development.

The Trump administration plans to detain immigrant children who enter the U.S. illegally with their families with no deadline for release, ending a long-standing settlement that capped the detention of immigrant children at 20 days. The government says holding children in the facilities is for their own safety and well-being. But child advocates and pediatric health experts are outraged and say these children and their needs are being neglected and whole families left traumatized.

One of those experts is Charles Nelson, a neuroscientist and psychologist at Harvard Medical School, who has studied the effects of child neglect around the world. Much of his research took place in Romania in the 2000s and has zeroed in on how institution-based care left long-lasting marks on children’s developing brains.

For young children who do not have a sense of time, staying in detention facilities feels like it will last forever. Time stands still as they wait, Nelson said, leading “to more despair and hopelessness.”

While the administration’s most recent move is focused on detaining family units, the Trump administration also separated thousands of children from their caregivers at the border. And evidence suggests it is still happening. When a child loses the protective buffer of a trusted adult, the trauma can rewire their brain’s architecture and leave that child with lasting emotional, mental and physical damage, according to experts.

The relationship between detention and increased mental health problems among children and families has been well-documented, according to Jaime Diaz-Granado, deputy chief executive for the American Psychological Association. His group has called the Trump administration’s rule change “a misguided attempt by this administration to stem the flow across the southern border.”

“The large majority of these children have already experienced trauma before arriving at immigration facilities, and the longer they are held in detention, the more likely their mental health will continue to suffer,” Diaz-Granado said.

Ample research has shown neglect harms children. In 2003, researchers published a series of foundational studies of the children raised in Romania’s orphanages that showed horrible consequences to those children and their society as a result of their institutionalization. Nelson was among the lead authors. When he hears reports of the U.S. separating immigrant children from their caregivers in federal custody, Nelson reflects on Romania where children were dropped off in institutions that had one untrained caregiver for more than a dozen children. “Yes, there are parallels,” he said.

Veronica Macovei Clark also hears echoes of her childhood in news reports about the condition of migrant children along the U.S. border. At age 26, she still wraps her arms around her knees and sways from side to side when she is stressed or has a bad dream — a coping mechanism she built while growing up in a Romanian orphanage.

Left to right: Veronica Macovei Clark (childhood photo on right) spent the first years of her life in an orphanage less than 100 miles from Bucharest, Romania. After she was adopted by a U.S. couple, she later returned to one of the facilities where she lived (seen on left). Photos courtesy Veronica Macovei Clark

“I would rock myself,” she said. “I don’t like a hug if I’m upset.”

Days after she was born, her parents left Clark at an orphanage for infants in Râmnicu Sărat, a town 93 miles northeast of Bucharest, Romania’s capital city, she said. She remained in state care until shortly before her fifth birthday when, in 1999, a couple from Kansas City, Kansas, adopted her. She could not walk properly and spoke only a single word (tata, or “father” in Romanian). She weighed 27 pounds, was Vitamin D-deficient and pale. Her skull was disproportionately small, she said, because she had been malnourished, eating primarily oatmeal porridge that tasted like coffee. She stuffed food in her cheeks to prevent anyone from taking it from her.

How the Romanian orphanages began

In 1966, Communist dictator Nicolae Ceaușescu banned abortion and contraception in Romania to expand the country’s population, grow more workers and pay off the nation’s global debts. Ultimately under what was then known as Decree 770, women had to carry each pregnancy to term unless they already had given birth to five children, were age 45 or older, conceived through rape or incest, or if the pregnancy put the mother’s life at risk. Women underwent forced gynecological exams where they worked. A celibacy tax docked a woman’s wages if she did not bear children.

As a result of these policies, the nation’s fertility rate spiked in just one year, nearly doubling from 1.9 children per woman in 1966 to 3.7 in 1967, according to World Bank data. Families suffered under the financial strain. Unable to care for so many babies, parents surrendered thousands of infants and children, leaving 170,000 children in 700 overcrowded orphanages across Romania.

In 1989, Ceausescu’s government was overthrown, and on Christmas Day, a firing squad executed him and his wife, Elena.

What researchers found

In 2000, neuroscientist and psychologist Charles Nelson joined a team of researchers in Bucharest, more than a decade after the fall of Ceausescu. With thousands of children abandoned in orphanages, they wanted to understand how institutionalization left its mark on a young brain’s development. They conducted the Bucharest Early Intervention Project, the first-ever randomized study to compare the emotional and physical wellbeing and outcomes of children raised in orphanages to those raised in home settings, including foster care.

No institutional review board would approve a study on young children that risks traumatizing them, child development experts have said. But in Romania at this time, the children would have remained in orphanages either way. And the researchers had to construct a foster care system for their purposes because available services were woefully under-resourced and in no position to place so many children, Nelson said.

Researchers found 72 children who never left home, and 136 children aged between five and 31 months who had spent most of their lives in orphanages. Nelson and his team assigned every child a number and drew the numbers from a hat, randomly assigning each child to continue to receive care in orphanages or be moved to foster homes. Researchers ensured that children were of comparable age, gender, health and background with the only significant difference being how adults nurtured them.

In the institutions, strict schedules ruled a child’s day with virtually no time or effort devoted to forming meaningful relationships or sense of safety with a trusted adult. At one facility, 36 infants, toddlers and preschoolers awoke daily at 6:30 a.m. and were put to bed at 8 p.m. During mealtimes, children clustered around a caretaker who typically sat in silence and “fed them a bite at a time in turn,” the study authors wrote. Caretakers washed and changed the children’s clothes before or after they ate. Children played for a total of three-and-a-half hours, outdoors if the weather allowed, under the watchful gaze of caretakers who did not interact with them. Children stayed indoors if there weren’t enough staff members or if children were quarantined for illness. As many as 17 adults — housekeepers, teachers, medical staff — cycled rapidly through each child’s day.

In the study, researchers evaluated all children when they were nine, 18, 30 and 42 months old. Each time, they observed the children where they received care. They measured their height, weight and head circumference. They examined cognitive function, how well they could speak, interact with others, recognize people’s faces and emotions and focus their attention. They used puppets to interview the children to gauge their temperament. They took electrophysiological readings to see if differences in brain development emerged.

In 2005, the project published a study of electroencephalograms that showed brain images of children who received institutionalized care resembled those of children who had been traumatized or were diagnosed with learning disorders. Their nervous system typically developed more slowly than children who had never been institutionalized. Fewer neural connections took place in young children’s brains if they grew up neglected in institutions, evidence suggested. This lapse limited a child’s memory and ability to learn.

In their study, the researchers wanted to know how the absence of engaging adults influenced early child development so they could answer bigger questions.

“How much recovery is possible for children who experience early social deprivation?” they wrote in their 2003 study. “Are there critical periods that limit recovery from early deprivation?”

Over the years, answers started to come into focus. In a 2007 study, the group compared the three groups of children — those who remained in the orphanages, those randomly placed in foster care homes and those who were never removed from their families — and monitored them at 42 and 54 months of age. On average, institutionalized care blunted a child’s IQ over time. Similar evidence emerged among children in foster care, but the losses were less dramatic. And children who stayed with their caregivers saw their IQ improve over time.

“What happens early matters a lot,” Nelson, who is now at Harvard, said. And when trauma and neglect occur over prolonged periods of time, “development can be seriously derailed.”

After the studies were released, Romania made it illegal to place a child in institutional care until age 2. The population within the nation’s orphanages is a fraction of what it once was, and birth rates have slowed down.

Do child advocates and health experts see parallels between Romania and the U.S.?

Early child development experts and pediatric health advocates still point to Nelson’s studies of Bucharest orphanages when asked about the effects of institutionalized care and neglect on children.

After devoting his career to understanding how trauma can rewire a child’s brain architecture, Nelson said separating families at the border under the Trump administration’s zero-tolerance policy is “the worst thing you could be doing.”

“One of the things that makes what’s going on at the border so horrific is the very thing that should provide comfort to a child — a caregiver — is taken away from them,” Nelson said.

Since summer 2017, at least 2,737 children have been separated from a parent at the U.S. border, according to data released in January from the Department of Health and Human Services Office of the Inspector General. But this number is incomplete, the federal government admits.

“Thousands of children may have been separated during an influx that began in 2017, before the accounting required by the court,” the inspector general’s report said.

By June 2018, nearly 20 percent of children who officials had accounted for were under age 13, Kaiser Health News reported, and more than 100 children were younger than four-years-old, according to Propublica. Since 2018, at least seven immigrant children are estimated to have died while in federal custody, according to NBC News.

Age matters when it comes to trauma, stress and early brain development, says Jack Shonkoff, who directs the Harvard Center for the Developing Child. Previous trauma, including gang wars, poverty and the violence many migrant children fled to come to the U.S., destabilizes a child’s resilience.

Migrant children are led by staff in single file between tents at a detention facility next to the Mexican border in Tornillo, Texas June 18, 2018. REUTERS/Mike Blake

“When you keep kids separated from their parents this long and put them in an institutionalized setting, not a home setting, there’s no question that the harm they have will be directly a result of what we’re doing to them,” Shonkoff said. “The longer it goes on, the more damage is inflicted.”

In June, Willamette University lawyer Warren Binford described her visit to the Clint, Texas, facility to the PBS NewsHour’s William Brangham.  She said she saw “the worst conditions I have ever witnessed in several years of doing these inspections.”

“What we saw are dirty children who are malnourished, who are being severely neglected,” she said. “They are being kept in inhumane conditions. They are essentially being warehoused, as many as 300 children in a cell, with almost no adult supervision.”

Shonkoff called that the “most profound form of neglect,” adding that “neglect is more damaging than actually physically beating a child.”

Pediatrician Julie Linton has treated hundreds of migrant children released from federal detention whose immune systems are unable to fight off infections due to severe stress of family separation. In the facilities, they were exposed to illnesses, such as pneumonia or diarrhea-related dehydration, that later required hospitalization, said Linton, speaking on behalf of the American Academy of Pediatrics.

Linton also saw regressive behavior and cognitive delays emerge from detained children soiling themselves, detachment, temper tantrums in older children, rolling back speech milestones and difficulty completing tasks. No amount of time in detention is safe for immigrant children, she said.

Pia Rebello Britto, the chief of early childhood development for UNICEF, said children without a responsive caregiver rarely have anyone to comfort them. These children lose out on stimulating activities to promote how they think and learn, their health and happiness. Out of fear and anxiety, their stress hormone cortisol surges, obstructs new neural connections and breaks down old ones, “causing long-term psychological and physical damage.”

“It’s incredibly hard to bring a child back from that,” Britto said. “There are no second chances.”

Children separated from their families and detained by U.S. officials are returning to their loved ones traumatized. That is the argument the Southern Poverty Law Center made on behalf of three immigrant families against the U.S. government in court filings this month.

In one instance, a Guatemalan father and his 7-year-old son were separated in November 2017 after arriving in Arizona to seek asylum. The father refused to surrender his son, but agents took him away, his son’s cries becoming more distant until “he could not hear his son anymore,” according to the court documents.

The father was told if he signed deportation papers, he would be reunited with his son. The father was sent back to Guatemala in January 2018. His son was not given back to his family until July 26, 2018, the documents said.

His son returned a changed boy, the father said, according to the filings. At night, he woke up crying. At school, he struggled to focus and burst into tears whenever children asked him about his time in the United States. He angered easily and refused food.

What the future could hold for these children

Every day a young immigrant child spends in detention robs them of a day of healthy development, pediatric health advocates say. But now that the U.S. has these children in custody, what should be done?

Linton wants to see lawmakers improve conditions in the detention facilities for immigrant children and families. Under the Humanitarian Standards for Individuals in Customs and Border Protection Custody Act, federal officials would meet basic needs for medical care, nutrition, water and sanitation. The legislation has been pushed as a partial response to government’s refusal to provide toothbrushes and soap to immigrant children in custody.

But Shonkoff pushed back on the idea of making the detention centers more livable for children and their families, saying the presence of the institutions is the issue.

“It normalizes these facilities,” he said. “That is not a radical position. That is bread-and-butter child health and the science of child development. Children are harmed by institutional settings.”

Everyone needs people to love and support them in life, Veronica Macovei Clark said. When she thinks about the migrant children detained on the U.S. border, she said those in charge of caring for the children should “at least play with these kids, talk to them. That’s better than nothing.”

“Kids shouldn’t grow up without a mom or a dad,” Clark said. “They shouldn’t be in a center with zillions of other people.”

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