The socioemotional development of orphans in orphanages and traditional foster care in Iraqi Kurdistan

Child Abuse& Neglect,Vol. 20, No. 12, pp. 1161-1173. 1996 Copyright © 1996ElsevierScienceLtd Printed in the USA.All rights reserved 0145-2134/96 $15.00 + .00

Pergamon

PII S0145-2134(96) 00067-1

THE SOCIOEMOTIONAL DEVELOPMENT OF ORPHANS IN ORPHANAGES AND TRADITIONAL FOSTER CARE IN IRAQI KURDISTAN ABDULBAGHI A H M A D Department of Child and Adolescent Psychiatry, Uppsala University Hospital, Uppsala, Sweden

KIRMANJ M O H A M A D Kurdistan Save the Children, Suleimanyah, Iraqi Kurdistan

Abstract--In order to investigate orphans' situation and development in Iraqi Kurdistan, samples from the two available orphan care systems, the traditional foster care and the modem orphanages, are examined at an index test and at 1-year follow-up regarding competency scores and behavioral problems at both test occasions, and posttraumatic stress reactions at a 1-year follow-up. Achenbach Child Behavior Check List (CBCL) and two instruments regarding post-traumatic stress disorder (PTSD) were used. While competency scores showed an improvement in both samples at the follow-up test, the problem scores increased in the orphanage sample and decreased among the foster care subjects. Moreover, the orphanage sample reported higher frequency of post-traumatic stress disorder (PTSD) than the foster care children. The results are discussed with regard to the value of the Kurdish society's own traditions in taking care of orphans. Copyright © 1996 Elsevier Science Ltd Key Words--Achenbach, Foster care, Kurd, Orphan, PTSD.

INTRODUCTION IN M A N Y C O U N T R I E S all over the world, the huge n u m b e r of orphans produced by poverty, underdevelopment, disasters, and war conditions is the main factor behind the p h e n o m e n o n of "street c h i l d r e n " (Apteker, 1989; Williams 1993), although family disparity also plays a big role in this aspect (Brian, 1995). The accompanied varieties of child abuse as in army, labor, organized criminality, and prostitution, and the subsequent diseases like AIDS (Crane & Carswell, 1992; L a u n a & Rotherham, 1992) and substance abuse (Carlini, 1993; Griesel, Jansen, & Richter, 1990; Jansen, Richter, & Griesel, 1992) are major related problems that face the societies in these countries. The idea of building orphanages is still the most c o m m o n solution available today in order to get rid of this increasing problem, as individual adoption has not proved to be a realistic hope for these children (Aboud, Samuel, Hadera, & Addus, 1991; Johnson et al., 1992). However, from published research on orphanage children, we know that the institutional e n v i r o n m e n t can have a detrimental effect on intellectual and socioemotional development This study was carried out with support from the Swedish Program for Developmentin Iraqi Kurdistan (Qandil) and in coordinationwith the Ministry of Health and Social Affairs and the Kurdistan Save the Children in Iraqi Kurdistan. Received for publication October 16, 1995; final revision received March 4, 1996; accepted March 6, 1996. Reprint requests should be addressed to Dr. Abdulbaghi Ahmad, Department of Child and Adolescent Psychiatry, University Hospital, S-750 17 Uppsala, Sweden. 1161

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A. Ahmadand K. Mohamad

(Dennis, 1973; Tizard, 1979). As early as the empirical period of 1850-1930, unsystematized pediatric observations drew attention to a high incidence of both death and developmental retardation among children housed in institutions, particularly orphanages and hospitals (Langmeier & Matejcek, 1975). Spitz's early writings on hospitalism, anaclitic depression, and deprivation syndrome are commonly known to describe the unfavorable long-term effects of institutionalization on the intellectual and personality development of child survivors (Spitz, 1945; Spitz & Wolf 1946). The research on orphan survivors of the Holocaust is still very sparse (Dalianis-Karambatzakis, 1994). While some longitudinal follow-up studies reveal persistent adjustment difficulties, psychosomatic complaints and chronic reactive depression, regardless of the type of care (e.g., Keilson, 1980; Sterba, 1968) others conclude normal adult lives in most of the survivors (Freud & Dann, 1951; Moskovitz, 1985; Sprengle, 1952). The normality had been attained through a solid family unit, a successful rehabilitation in self-help group centers (Robinson, 1976), mastering anxiety by finding out an alternative placement of their libido (Freud & Dann, 1951), and effective coping by focusing on happy memories and having satisfactory human contact in the camp (Hogman, 1985). Adaptation was found to be easier for a child with longer and better pre-Holocaust life (Kestenberg, 1985). Mental damage was found to be more severe in children under 3 years of age although no difference in psychopathology could be ascribed to the nature of their persecution (Robinson, 1976). A new research era using a more parametric approach and considering psychological deprivation as a stressor in children's lives was to inlxoduce new terms to describe those children who, despite high risk status, could present clear signs of competence and healthy adaptation. Such children had been termed "invulnerable" (Anthony & Cohler, 1987), "invincible" (Werner & Smith, 1982) or "stress resistant" (Garmezy, 1984). However, this prospective has been used very little to study orphan survivors concerning the significance of the type of care. Orphanage children in Ethiopia reported higher intellectual scores but fewer interactions and weaker attachment to adults as compared with family children (Aboud, Samuel, Hadera, & Addus, 1991 ). Children living in a collective shelter have been found to be at greater mental health risk than their peers housed with the host families (Ajdukovic & Ajdukovic, 1993). A study of Guatemalan Indian children who had experienced the trauma of the loss of immediate family members, the witnessing of violent crimes, and the displacement from their homes during the civil war revealed that children living in orphanages had the lowest expectations for the future (Melville & Lykes, 1992). The quality of the foster environment is suggested to be the most significant factor in breaking the traumatizing process for orphans after manmade disasters (Keilson, 1980).

BACKGROUND Since it was to be divided among Turkey, Iran, Iraq, and Syria after the First World War, the society in Kurdistan has survived a long-lasting war and persecution situation. By developing it's own survival strategies it was able to resist the genocide attempts of the occupying forces (Amnesty International, 1990; Calbrith, 1991; Kurdo, 1988; Middle East Watch, 1993). As a consequence, a large number of orphans has been produced who were to be taken care of by the only available system; the traditional foster care system. In Spring 1991 and in the aftermath of the Gulf War, a Safe Haven zone in the liberated area in Iraqi Kurdistan was to be created by the United Nations (Figure 1). The region practically became separated from Iraq, both politically and economically. Since then, the way has been open for Non-Governmental Organizations (NGO) to establish reconstruction

Orphans in Kurdistan

1163

Figure 1. Kurdistan (the shaded area) is divided among Turkey, Iran, Iraq, and Syria since the aftermath of World War I. The society has preserved it's own language, culture, and traditions in spite of the assimilating policies and genocide attempts. Reprinted with permission from Reichman, H., & Foggensteiner, A. (1989). Den Kurdiska Knuten (in Swedish). Taby: Tryckariir6rlaget.

operations in the region. Among others, an increasing trend to build orphanages has been noted. This study attempts to investigate the socioemotional development of a group of orphans in Iraqi Kurdistan in relation to the type of care they receive.

MATERIAL AND METHODS

Subjects Orphanage sample. One year after the establishment of the Safe Haven area in Iraqi Kurdistan in Spring 1991, one of the authors visited all of the four orphanages that had been started in the cities of Sulaymania and Duhok in the region (Figure 1 ). Twenty-four orphans (15 boys and 9 girls, mean age 8.9 years), were found to fulfill the criteria for this study. In order to reduce heterogeneity in the samples the inclusion criteria were restricted to those children who had lost both parents during the A1-Anfal military operations of 1988, were aged 4 to 16 years, and did not have manifested mental retardation or evidence of major systemic illness. The conditions in all of the four orphanages were essentially similar. At a 1 - y e a r follow-up, only 21 of the original 24 children were still in the orphanages ( 12 boys and 9 girls, mean age 9.9 years). Three boys had left the orphanages to live with their relatives. They could not be traced.

1164

A. Ahmad and K. Mohamad Table 1. Characteristics of the Foster Families in Percents

Index (%) (n = 30)

Item Relation to the Orphan: Sibling Grandparent Parents sibling Other relative Nonrelative Number of Children: 0 1-3 4-7 8-12 >12 Standard of Livinga: 0 1

2 3 Region: Country Town City

Missing (%) (n = 10)

13.3 6.7 73.3 6.7 0

0 0 90 10 0

43.3 13.3 30 13.3 0

60 0 10 30 0

10

20

55

0

35 0

80 0

16.7 60 23.3

20 50 30

"Living standard is determined by having: salary, farming and house. 0 = None of the above; 1 = one of them; 2 = two of them; 3 = all of them.

Foster care sample. A m o n g the o r p h a n s l i v i n g in c o m p l e t e foster families in the s a m e p r o v inces, data o n 30 o r p h a n s ( 1 0 b o y s a n d 20 girls, m e a n age 9 . 8 ) , were o b t a i n e d f r o m the o n l y o r g a n i z a t i o n with access to s o m e k i n d o f registration o n o r p h a n s in Iraqi K u r d i s t a n , n a m e l y the K u r d i s t a n Save the C h i l d r e n , as the y o u n g g o v e r n m e n t a l authorities h a d n o t yet b e e n able to do their o w n registers. A t a 1-year f o l l o w - u p , o n l y 20 c h i l d r e n a m o n g the foster care s a m p l e were able to be traced a n d r e - e x a m i n e d (7 b o y s a n d 13 girls, m e a n age 12.4 y e a r s ) . T h e m i s s i n g subjects had either c h a n g e d foster families or m o v e d to u n k n o w n addresses. T h e characteristics o f the foster families in both I n d e x T e s t a n d in the M i s s i n g G r o u p are illustrated in T a b l e 1. T a b l e 2 shows the age a n d sex d i s t r i b u t i o n in all the samples. T h e difference in sex d i s t r i b u t i o n ( m o r e b o y s in the o r p h a n a g e s a m p l e a n d m o r e girls in

Table 2. Age and Sex Distribution in Both Samples at Both Test Occasions

Foster Care Boys Age in Years 4-6 7-9 10-12 13-15 16 Total

Orphanage Girls

Boys

Girls

Index

One Year

Index

One Year

Index

One Year

Index

One Year

3 1 4 1 1 10

1 (2) 0 (1) 4 (0) 1 (0) 1 (0) 7 (3)

4 4 8 2 2 20

1 (3) 1 (3) 7 (I) 2 (0) 2 (0) 13 (7)

2 6 5 2 0 15

1 (1) 5 (1) 4 (1) 2 (0) 0 (0) 12 (3)

3 1 3 2 0 9

1 (0) 3 (0) 3 (0) 2 (0) 0 (0) 9 (0)

Numbers in parentheses were missing at follow-up.

Orphans in Kurdistan

1165

the foster care sample) may be partially explained by the sociocultural characteristics in the Kurdish society: Girls are to be kept at home until their marriage, and the protection of the female is a great issue with her kinship or clan. Thus, it is dishonorable and more difficult for a caregiver to leave a girl to orphanage care than to leave a boy. Trauma sample. Two subjects (a 5-year-old boy from the Foster care sample and a 5-year-old girl from the Orphanage group) were excluded from trauma interviews that were conducted at a 1-year follow-up. Their ages were below the lower valid age limit of trauma instruments. Two other children refused to complete the interview (a 10-year-old girl from the foster care sample and a 6-year-old boy from the orphanage sample). The remaining subjects (a total number of 37 children, 19 living in orphanages and 18 in the foster care sample) were interviewed about their post-traumatic reaction, focusing on the A1-Anfal military operations of 1988 (Middle East Watch, 1993) and the Mass-Escape Tragedy (MET) of 1991 (Ahmad, 1992). Instruments Achenbach Child Behavior Check List (CBCL) (Achenbach & Edelbrock, 1983) was administered in interview form to the caregivers. The items in the first part compose three competency scales: School Competence Scale including school attendance; Social Scale including friendship, behavior at home and with others, participation in activities and organizations; and the Activity Scale which includes participation in sports and other activities. The remaining part consists of 113 items regarding socioemotional externalizing and internalizing problems that cover eight syndromes: Withdrawal Tendency, Somatic Complaints, Anxious/Depressed, Social Problems, Thought Problems, Attention Problems, Delinquent Behavior, and Aggressive Behavior. Two child-specific instruments for identification of post-traumatic stress disorder (PTSD) were conducted in semistructured interviews to all the subjects at a 1-year follow-up: The standardized Post Traumatic Reaction Index according to Pynoos (Pynoos & Spencer, 1986) was used in order to test the reliability of a 30-item yes/no instrument developed by the author to identify PTSD cases and to assess other stress related symptoms among the children in Kurdistan (Ahmad, 1992). Regarding the psychometric information on the assessments used, the CBCL's competency scale has a three degree scale system for each item, ranging from the lowest (0) to the highest (2). The means of scores for each scale are then added to get the total competency scale with a potential range between the lowest (0) and the maximum (28). Each item in the problem scale part of CBCL has three alternative answers ranging from 0 (not true) to 2 (very true). The total problem scores, then, range from 0 to 244. CBCL is very widely used and has good validity (Achenbach, Howell, Quay, & Conners, 1991, McConaughy, 1992). The Post-Traumatic Stress Disorder Reaction Index (PTSD-R1) consists of 20 items based on DSM-III-R criteria for PTSD. Each item has five alternative answers ranging from 0 to 4 to determine the diagnosis and severity of PTSD. A total score of more than 12 is considered diagnostic for PTSD. Correlation is .95 with established cases of PTSD from a variety of stressors (Pynoos & Spencer, 1986). The other PTSD instrument (Post Traumatic Stress Symptom Check List for Children; PTSSCL-C) consists of 30 items mainly based on DSM-III-R criteria for PTSD (APA, 1987). It includes other items as well to detect stress symptoms not specific for PTSD. The items have been chosen to be suitable for interviewing children in Kurdistan. The first 17 items are arranged according to DSM-III-R's PTSD symptom categories and indicate a PTSD diagnosis accordingly.

1166

A. Ahmad and K. Mohamad

Procedure During the index-interview, the adult person (caregiver) with the best relationship to the orphan was interviewed. The child had the opportunity to comment on the items when the first part of (CBCL) was conducted. All the interviews were conducted by one of the authors. The interviews took place either at the children's foster homes or at the respective orphanage. The interviews were conducted in Kurdish language, directly translated from the original English questionnaire, as many adults in the study were illiterate. No one refused to participate. At a 1-year follow-up, in addition to the initial interview technique, the two trauma-instruments were administered in personal semistructured interviews to all subjects in the trauma sample. To examine differences between the groups, the t-test, chi-square test, ANOVA, and ANCOVA were used in the statistical analyses. A partial correlation test by ANCOVA was used to test the effects of the missing groups and to do a statistical comparison of the results obtained at index and 1-year follow-up, both regarding the total competency scores, the total problem scores, and the types of problems.

RESULTS Both the foster care and orphanage sample reported a significant increase in the means of total competency scores at the 1-year follow-up as compared with the index-interview ( # = 9 - 1 2 and 7 - 1 2 respectively) t(19) = 5.17, p < .001, and t(20) = 7.69, p < .001 respectively (Figure 2). The means of total problem scores increased among the orphanage sample ( # = 9 - 1 3 ) t(20) = 2.02, p = .06 and significantly decreased in the foster care sample (# = 146) t ( 19 ) = - 2.32, p < .05 (Figure 3 ). The improvement in competency scores in orphanage sample can be explained by the obvious increase in school attendance among the orphanage children t2( 1 ) = 10.1, p < .001 (38.1%-87.5%) while that of the foster care sample proved to be nonsignificant (45 % - 65 % ) ( Figure 4). The increase in total competency scores in both samples can be considered fairly reliable,

n=20

1 1 0 o O9

r.-

8 6 4

2,

~Fostercare

O.

[---[Orphanage Index

Missing

1 year

Figure 2. M e a n s of Total C o m p e t e n c e Scores. Potential R a n g e of Scores = 0 - 28.

Orphans in Kurdistan

1167

r1=3 1 n=20

1 a)

12

o (3 o3

10

n=21

n0I

"6

8 6 4

liFostercare

2 0

I~Orphanage Index

Missing

1 year

Figure 3. Means of Total Problem Scores. Potential Range of Scores = 0 - 226.

because the differences between the means of the competency scores in the missing and nonmissing groups of both samples at the index test were nonsignificant (Figure 2). Similarly, the increase in total problem scores in the orphanage sample and their decrease in the foster care sample seem to be independent of the missing groups (Figure 3), as a partial correlation test showed no significant effect of the missing groups whatsoever, even when using sex, age, type of problems, or type of care as covariates. In the orphanage sample, boys showed more symptoms than girls, both at the index test and at 1-year follow-up, while in the foster care sample, boys and girls exhibited almost similar means of problem scores at both test occasions (Figure 5 ). The reductions in problem scores in the foster care sample and their increase in the orphanage sample were more apparent among girls than boys. However, a t-test showed no significant gender effect on the change of problem scores over time. 20" n=21 (1) ..(3

o3 "6 E

n=20~ ] -

Im loi

n=20

Q) 0 E t~ "13 1-

< "5

0 ¢o CO

n=lO

H Index

1Fostercare

n=3 Missing

I--lOrphanage 1 year

Figure 4. Number of Children Reporting School Attendance at Both Test Occasions and in the Missing Groups.

1168

A. Ahmad and K. Mohamad a.

Boys

2~ 2

1 1 ~'

I

i

1Fostercare ~]Orphanage

Index

22

Missing

1 year

b. Girls

2O

18 16 14

12

n=9

10

8 6 4

1Fostercare 2

n=O

0

Index

Missing

~]Orphanage

1 year

Figure 5. Sex Differences in Total Problem Scorees. Potential Range of Scores = 0 - 226.

In both the orphanage and foster care samples, the younger age group ( < 11 years) reported higher competency scores than the older age group ( > 11 years) at the index test, while at the 1 - y e a r follow-up, the younger age group showed higher competency scores only in the orphanage sample (Figure 6). No significant age differences could be shown, however, in the increasing rate in competency scores among the two samples between the two test occasions. The means of total problem scores in the foster care sample were higher among the younger age group than among the older age group, both at the index test and at the 1-year follow-up, while in the orphanage sample the older age group showed higher problem scores than the younger age group at both test occasions (Figure 7). Again no significant age differences in the total problem scores between the two samples at the two test occasions could be seen. Using t-test for paired samples, both the decrease in the means of problem scores among the older age group in the foster care sample and their increase in the younger age group in the orphanage sample were significant t(12) = - 2 . 2 4 , p <.05 and t(13) = 2.32, p <.05 respectively. Aggressive behavior was dominating in both samples at the index-interviews. At 1-year follow-up, aggressive behavior showed an obvious improvement among the foster care group,

1169

Orphans in Kurdistan a. Younger Age Group ( <11 years)

,41

n=10

12

10 E c~ "6

8

4

BBFoslercare [~}Orphanage Index

Missing

1 year

b. Older Age Group ( >~11 years) n=l 7 1 -f n=17

BBFostercare n=0 [~Orphanage Index

Missing

1 year

Figure 6. Age Differences in Total Competence Scores. Potential Range of Scores = 0 - 28.

while it still composed the largest problem mean scores among the orphanage sample. An A N O V A revealed significant increase in the means of problem scores of the following types of problems among the orphanage sample, as compared with the foster care sample; Aggressive behavior (t = -2.03, p = .05), Anxious/Depressed (t = -2.11, p < . 0 5 ) , Attention Problems (t = - 1.91, p = .06), Delinquent Behavior (t = - 2.73, p < . 0 5 ) , Externalizing Problems (t = -2.48, p < .05) and Internalizing Problems (t = -2.16, p < . 0 5 ) . Among the orphanage sample, 47.4% fulfilled the criteria of PTSD according to the two trauma measures, while 33.3% of the foster care sample did so (Table 3). The differences, however, were not significant. Only in one case did the yes/no PTSD instrument miss the diagnoses manifested by the Pynoos instrument. Testing the reliability between the two test occasions showed a Cohen's kappa of .94. DISCUSSION Two groups of orphans in Iraqi Kurdistan who had lost both parents in a man-made disaster self-survived the event: they were examined 1-year after their placement in foster care or

1170

A. Ahmad and K. Mohamad a. Younger Age Group ( <10 years) 22 20 18

n=3

qZEq

16 14

n=3 _ ,,

12 10 8 6 4

mmFostercare

2 0

E~Orphanage Index

Missing

1 year

b. O l d e r A g e G r o u p (>,11 y e a r s ) 22 2O 18

n=10

16 ~ 14 o n=lO

"6 ~ 10

8

8 n=17

6 4

1Fostercare n=0

0

E~]Orphanage

Missing

Index

1 year

Figure 7. Age Differences in Total Problem Scores. Potential Range of Scores = 0 - 226.

orphanage care respectively. A follow-up 1-year later r e v e a l e d deterioration in mental health and b e h a v i o r a m o n g the orphanage s a m p l e as c o m p a r e d with the foster care sample. Both samples, however, showed i m p r o v e m e n t in competencies. Furthermore, the discrepancy in sex and age distribution a m o n g the two samples could not explain the change in means o f p r o b l e m scores o v e r time, as no gender or age effect was shown b y A N C O V A in testing the means o f total p r o b l e m scores b e t w e e n the two samples at the two test occasions. The findings are in

Table 3. The Frequency of Post-Traumatic Stress Disorder (PTSD) in Numbers (N) and Percents (%), and the Average Age in Years (Years) and the Sex of the Cases in Both Samples

Boys

Girls

Group

T

N

%

Years

T

N

%

Years

Orphanages Foster Homes

11 6

5 4

45.4 66.6

10.2 13.2

8 12

4 2

50.0 18.2

10.7 12.8

T = Total number of cases in each group.

Orphans in Kurdistan

1171

line with the literature (Aboud et al., 1991; Ajkukovic & Ajdukovic, 1993; Dennis, 1973; Ekblad, 1988; Tizard 1979). Although the missing groups showed no statistical effect on the results, probably because of the small size of the samples, they seem to be selected groups. Specially among the orphanage sample, the missing group consisted of three boys younger than 11 years and exhibiting more problem scores then the index group. This can explain their inability to stay in the orphanage care and their return to the foster care. The caregiver for all subjects in the foster care samples in this study was a relative to the orphan. Both the improvement in problem scores and the relatively low frequency of PTSD among this group may support previous research suggesting that the best predictor of positive outcome for a child who survives a traumatic event is the ability of the important adults around him to cope with the traumatic event (Lyon, 1989). Results from previous studies that consider both placement with other than kin and having previous traumatic experiences as two predictors for high-risk orphan boys (Black, Kaplan, & Hendriks, 1993) can also be supported by the findings in this study. However, being a near relative to the caregiver can not be the only explanation to the favorable outcome of the foster care children in this study. A 10-year-old boy who was the only foster child living with distant relatives showed the best improvement (means of problem scores from 14 to 1 ). Thus, we suggest that the improvement among the foster care children mainly is caused by the family construction of this care system, in contrast to the collective care of the orphanage system where a family environment is totally lacking. This reasoning is in line with other results from earlier studies of separated children (Robertson & Robertson, 1971 ). The findings suggest the traditional foster care in the Kurdish society to be more favorable for the care of orphans than the orphanages in the study. The results, however, are not conclusive, although the subjects in this study are fairly homogeneous in background and time and reasons of orphanhood. There are many limiting factors, such as the small size of the samples, the discrepancy in age and sex distribution, the large missing group, and the restriction in inclusion criteria. Furthermore, the samples are only representing South Kurdistan (the Iraqi part of Kurdistan) when speaking of the indigenous character of traditional foster care in Kurdistan. Thus, further research is needed in order to provide the large number of orphans in the Kurdish society with the required environment for normal growth and well-being, to improve the orphanage care to be more similar to family environment, and to contribute to the research on management of orphans elsewhere in the world.

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(1994). Children in turmoil during the Greek civil war 1946-49: Today's adults. Thesis, Stockholm, Sweden: Karolinska Institute. Dennis, W. (1973). Children of the Chrech. New York: Appleton-Century-Crofts. Ekblad, S. (1988). Influence of child-rearing on aggressive behavior in a transcultural perspective. Acta Psychiatrica Scandinavica, 344(suppl. 78), 133-140. Freud, A., & Dann, S. (1951). An experiment in group upbringing. Psychoanalytic Study of Children, 61951, 127168. Garmezy, N. (1984). Stress-resistant children: The search for protective factors. In J. E. Stevenson (Ed.), Recent research in development psychopathology (pp. 213-233) (Book supp. No. 4). Oxford: Pergamon Press. Griesel, R. D., Jansen, P., & Richter, L. M. (1990). Electro-encephalographic disturbances due to chronic toxin abuse in young people with special reference to glue-sniffing. South African Medical Journal, 78(9), 544-547. Hrgman, F. (1985). Role of memories in lives of World War II orphans. 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Orphans in Kurdistan

1173

R ~ u m 6 - - - D a n s le but d'6tudier la situation et le d6veloppement des orphelins dans le secteur iraquien du Kurdistan, on a retenu deux 6chantillons, l'un venant de foyers d'accueil traditionnels et l'autre, des orphelinats modernes. On s'est pench6 sur leur niveau de comp6tence et leurs probl~mes de comportement, puis on a r6p6t6 l'6preuve une ann6e plus tard. Dans le deuxi~me cas, on a aussi examin6 les r6actions post-traumatiques. Le Achenback Child Behaviour Checklist et deux instruments pour mesurer les d6sordres de stress post-traumatique ont 6t6 utilis6s comme mesures. Alors que les scores sur la comp6tence d6montraient une am61ioration dans les deux 6chantillons lors de la deuxi~me 6preuve, les scores ont d6montr6 plus de probl~mes chez les enfants plac6s dans les orphelinats. De plus, ces derniers avaient des scores de d6sordre de stress post-traumatique plus 61ev6s que les enfants des foyers d'accueil. Les auteurs consid~rent les r6sultats h la lumi~re des traditions de ce groupe ethnique au niveau des soins prodigu6s aux orphelins. R e s u m e n m P a r a investigar la situaci6n de los hu6ffanos en Kurdistan, Irwin; se tomaron muestras de los dos sistemas de cuidado para hu6rfanos disponibles; se estudian el cuidado sustituto tradicional y los orfelinatos modernos con indicadores en una prueba y un estudio de seguimiento al afio, relacionados con puntajes de competencia y problemas conductuales en ambas pruebas y reacciones de stress post-traum~itico en el estudio de seguimiento al ailo. Se utilizaron el "Achenback Child Behavior List" (CBCL) y dos instrumentos relacionados con el Desorden de Stress Posttraum~itico. Mientras los puntajes de competencia mostraban una mejorfa en ambas muestras en la prueba de seguimiento, los puntajes de problemas aumentaron en la muestra del orfanatorio y disminuyeron en los sujetos en cuidado sustituto. Adem~s, la muestra del ofranatorio report6 mayor frecuencia de Desorden de Stress Post-traum~itico (PTSD) que los nifios en cuidado sustituto. Se discuten los resultados en relaci6n con el valor de las tradiciones propias de la sociedad durda en el cuidado de los hu6rfanos,