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.

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.

No abstract

To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and cognitive development, with a larger effect of the rearing environment. Family care, even of compromised quality, was found to be more favorable for children's physical and cognitive development than institutional care. The impact of the quality of child care on physical and cognitive development is discussed in light of future interventions.

Etiology and function of indiscriminate friendliness may differ for family-reared versus institution-reared children. The findings of this study suggest the necessity of early interventions improving the quality of care for HIV-infected children.