07/14/2014 02:49 pm ET Updated Sep 13, 2014

Self-care for a Civil Society: Orphans Need to Learn Self-regulation

As I look back on all the orphans I have met through my international development work as a pediatrician and adoption medicine specialist, I recognize that the most startling aspect of the orphan is their lack of self-soothing skills.

Occupational therapists (OTs) refer to this aspect of the human constitution as "self-regulation." OTs can specialize in sensory integration -- the human capacity to integrate all sensory experience in order to cope with the animate and inanimate stimuli in the environment. Professionals like psychologists, psychiatrists, and social workers who are unaccustomed to this population of kids, often disdainfully dismiss the importance of this aspect of brain function. It is even found in the animal world and still there is little attention given to it from the orthodoxy.

What does self-regulation look like? It is not a complex observation, but likely extremely complex in its brain architecture. A child cries endlessly regardless of your comforting and kind verbal reassurances... maybe after you sway/rock the child, the crying subsides. Perhaps with consistent comforting over time, one can reach the inner fragility of this orphan child. However, without adult role modeling, there is little ability for the child to calm themselves in an organized quick manner. When adults, through their handling of children, are sweet and communicative, the child's inner resources of self-soothing grow strong and are life-long.

Enduring periods of lack of comfort lead to very odd responses for the child who has not found ways to bring peace to the dangling neurons in his/her brain. Rocking and other self-stimulatory behaviors ensue. If you haven't seen an orphan rock all the way down to the floor desperately seeking comfort to the chaos in his head, you should. This is the ultimate result of unjust and cruel institutionalized care around the world. Some kids move in slow motion (psycho-motor retardation) and don't rock. Other kids look like they might turn their heads 360 degrees in order to protect themselves from the disorganization they feel internally as a result of sounds, touch, and smells around them.

Kids without inner self-calming skills have disturbed sleep, desperate eating behavior (hoarding), reactive responses to change, resistance to coming and going, major challenges in group settings i.e. classrooms, poor depth perception, and exaggerated responses to most environmental stimuli. These behaviors are challenging to interpret and are often misinterpreted. Kids are characterized as having attachment disorder and many do, but the focus on the self-regulation can be completely lost.

I am going to go out on a limb now, and tell you that this lack of self-calming is likely rampant in the non-orphan population too. I hope that by this point in your reading, you realize that we all may have some issues with our self-regulatory processing. We likely compensate with intellectual rationalizations which mostly includes avoidant behavior. Children become deeply depressed and their self-esteem suffers. Kids have trouble learning and success does not come easily. Many kids need special classrooms.

Without secure self-regulation, we are not civilized; we are irritable, edgy and angry. We may become violent. Think about how pervasive this necessary human behavior of self-soothing and sensory integration is and then you will see as I do...we have much to learn about civil society from the orphan.