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A prospective longitudinal study beginning whilst the infants were living in the Metera Babies Centre showed that the great majority showed a disorganized attachment during the period of residential care, even though neither abuse/neglect nor subnutrition were involved. There was an initial follow-up post-adoption age at four years. This paper concerns a further follow-up of the 52 adopted adolescents aged 13 years who had spent their first two years of life in Metera Babies Centre. They were compared to 36 adolescents reared in their biological families who, during their infancy, attended full-time public day care. The key aim was to examine continuities and discontinuities between early and contemporary relationships. The Child Attachment Interview was employed in adolescence. The main findings were a significant decrease in the rate of disorganization and a lack of a significant difference between the previously institutionalized group and the family care comparison group on attachment qualities in adolescence. There was not sufficient statistical power, however, to detect a small difference.

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RESUMEN

The aim of the study was to examine possible influences on individual differences in adolescence in response to early institutional care in infancy not involving either generalized privation or subnutrition. Fifty-two adopted adolescents aged 13 years who received institutional care in infancy at the Metera Babies Centre and 36 adolescents of the same age who were raised in their biological families participated in the study. Adolescents' attachment relationships, cognition, behavioral adjustment and use of psychological services were assessed. Marked heterogeneity in outcomes was found. No predictive effects were found for preinstitutional features or for adoptive circumstances. By contrast a large effect was found for institutional care extending beyond the age of 2 years and for quality of institutional care as experienced at an individual level. There was a close association between prolonged institutional care and disorganized attachment while in the institution, but the main institutional effect derived from the length of time in the institution.

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Children exposed to institutional care often suffer from "structural neglect" which may include minimum physical resources, unfavorable and unstable staffing patterns, and social-emotionally inadequate caregiver-child interactions. This chapter is devoted to the analysis of the ill effects of early institutional experiences on resident children's development. Delays in the important areas of physical, hormonal, cognitive, and emotional development are discussed. The evidence for and against the existence of a distinctive set of co-occurring developmental problems in institutionalized children is weighed and found to not yet convincingly demonstrate a "post-institutional syndrome". Finally, shared and non-shared features of the institutional environment and specific genetic, temperamental, and physical characteristics of the individual child are examined that might make a crucial difference in whether early institutional rearing leaves irreversible scars.

RESUMEN

Attachment has been assessed in the extreme environment of orphanages, but an important issue to be addressed in this chapter is whether in addition to standard assessment procedures, such as the Strange Situation, the lack of a specific attachment in some institutionalized children should be taken into account given the limits to the development of stable relationships in institutionalized care. In addition, this chapter discusses disinhibited or indiscriminately friendly behavior that is often seen in institutionalized children. Enhanced caregiving quality alone appears to be insufficient to diminish indiscriminate behavior, at least in some children, as evidenced by the persistence of indiscriminate behavior in children adopted out of institutions into adoptive families. We suggest that the etiology and function of indiscriminate friendly behavior may be different for institutionalized versus not-institutionalized children. In the first case it may reflect a distortion or disruption of early attachment relationships, in the latter case it is likely to result from the lack of expected input in the form of contingent interactions with a stable caregiver in early life. We try to delineate infant and caregiver characteristics that are associated with secure attachment in institutional settings, given the inevitable fact that large numbers of infants worldwide are being raised, and will be raised, in contexts of institutional care. We conclude that much further study is needed of the development of children's attachments following adoption out of an institutional setting.

RESUMEN

BACKGROUND: Research suggests that institutional care has long-lasting effects on children. However, no study has longitudinally studied infants in an institution and their subsequent development at age four. METHODS: Sixty-one adopted children aged four years who had spent their first two years of life in an institution were compared to 39 children reared in their own two-parent families. Cognitive development, security of attachment, shyness, children's emotional understanding and behavioural problems were examined in both groups. Parental health and stress were also assessed. RESULTS: At four years adopted children still had lower scores on cognitive development, were less secure, and less able to understand emotions than family-reared children. Children with a secure attachment type in infancy were found to be less secure at age four, compared with those who were classified in infancy as having an insecure attachment type. Their physical development had recovered, they were less shy, had no behavioural problems and no problems in the relationship with their teacher. CONCLUSIONS: Early residential group care has long-lasting effects on important socio-emotional and cognitive aspects of preschool children's development.

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BACKGROUND: The attachment relationships of infants reared in residential group care from birth, and links between attachment quality and psychosocial development and caregiver sensitivity were studied, with 86 infants reared in group care and 41 infants reared in their own two-parent families who attended day-care centres. METHODS: Attachment, cognitive development, temperament, and observed social behaviour of the two groups were studied, as was the quality of care by caregivers and mothers. RESULTS: Sixty-six per cent of infants reared in residential group care showed disorganised attachment to their caregivers, compared with 25% of control infants; 24% of group care infants were securely attached, compared with 41% of control infants. The two groups differed in cognitive development, in temperament and observed social behaviour. Within the residential group care babies, those that were securely attached were observed to express more frequent positive affect and social behaviour, and to initiate more frequent interaction with their caregivers. CONCLUSIONS: Residential care affected all aspects of the infants' development and was linked to a high rate of disorganised attachment.

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