Link to full paper : Against the odds: psychomotor development of children under 2 years in a Sudanese orphanage


Providing abandoned children the necessary medical and psychological care as possible after their institutionalization may minimize developmental delays. We describe psychomotor development in infants admitted to an orphanage in Khartoum, Sudan, assessed at admission and over an 18-month follow-up. Psychological state and psychomotor quotients were determined using a simplified Neonatal Behavior Assessment Scale (NBAS), the Brunet-Lezine and Alarm distress baby (ADBB) scale. From May-September 2005, 151 children were evaluated 2, 4, 9, 12 and 18 months after inclusion. At admission, ~15% of children ≤1 month had a regulation impairment according to the NBAS, and 33.8% presented a distress state (ADBB score >5). More than 85% (129/151) recovered normal psychomotor development. The results of the program reinforce the importance of early detection of psychological disorders followed by rapid implementation of psychological case management to improve the development of young children in similar institutions and circumstances.

Expert’s note: The ADBB is used in this research both as a screening tool and as a follow-up tool under intervention. Babies with behavioral problems or developmental delays were treated with specific psychological care, consisting of individual therapy, group therapy, physiotherapy and/or speech therapy. Regular outings and activities were also carried out outside the orphanage (horseback riding, swimming and picnics). All staff (nannies) were trained by Sudanese psychologists and an expatriate psychologist to provide attention, social stimulation and reciprocity in social communication. This research demonstrates, once again, the importance of early intervention, the impact of the lack of care, because it is indeed the improvement of the care within the orphanage and the improvement of the training and the follow-up of the caregivers that allows the drastic reduction of the level of relational withdrawal of baby confronted with adversity. We can then talk about neuroprotection, that is to say the protection of the development and the functioning of the brain of an individual throughout his life by the early intervention of the first months of his existence.