Discuss research into the effects of institutionalisation

Question 10 Mark Scheme

Discuss research into the effects of institutionalisation. Refer to the English and Romanian Adoptees project in your answer.

[16 marks]

What is expected in the answer?

The command word “discuss” requires students to explain the effects that institutional care can have on development and then evaluate the research used to establish these effects. Because the English and Romanian Adoptees project is specifically named, students should accurately describe its procedure and findings, particularly the relationship between age of adoption and later outcomes, before considering issues such as recovery, generalisation, confounding variables and practical implications.

The current specification explicitly requires the effects of institutionalisation, including the English and Romanian Adoptees project.

Marks for this question: AO1 = 6, AO3 = 10

This exact assessment structure appears in the specimen materials for a 16-mark question on the effects of institutionalisation and Romanian orphan research. The official allocation is AO1 = 6 and AO3 = 10.

Level	Marks	Description
4	13–16	Knowledge of the effects of institutionalisation is accurate and generally well detailed. Discussion is thorough and effective. There is appropriate reference to the English and Romanian Adoptees project and clear links are made between the research and the effects of institutionalisation. The answer is clear, coherent and focused, with effective use of specialist terminology.
3	9–12	Knowledge of the effects of institutionalisation is evident. Discussion is mostly effective, although there may be occasional inaccuracies. There is appropriate reference to Romanian orphan research, although links to the effects are not always well explained. The answer is mostly clear and organised but may lack focus in places.
2	5–8	Knowledge of the effects is present but may be vague or inaccurate. The response is mainly descriptive and discussion is only partly effective. Reference to the English and Romanian Adoptees project may be partial or absent.
1	1–4	Knowledge of the effects of institutionalisation is limited and may consist mainly of a list. Discussion is limited, poorly focused or absent. The answer contains substantial inaccuracies or little relevant research evidence.
0	0	No relevant content.

The level descriptors above closely follow the official specimen mark scheme for this topic.

Indicative content

AO1: Institutionalisation

Credit relevant knowledge such as:

• Institutionalisation refers to the effects of living for a prolonged period within an institutional setting, such as an orphanage or children's home.

• Institutions may involve:

  • large numbers of children

  • high child-to-caregiver ratios

  • frequent changes of staff

  • limited opportunities to form selective attachments

  • reduced emotional and social stimulation.

• Severe institutionalisation can affect:

  • intellectual development

  • language development

  • physical growth

  • attachment

  • social and emotional development.

The Romanian institutions studied following the fall of the communist regime involved extremely poor conditions, including limited physical and emotional care and very high child-to-staff ratios.

Intellectual and physical development

Possible effects include:

• delayed intellectual development

• lower cognitive functioning or IQ

• delayed language development

• poor physical growth.

In the English and Romanian Adoptees research, approximately half of the Romanian children were intellectually delayed at age four. Later recovery was strongly related to how old the child had been when adopted.

Children who had experienced longer periods of severe institutional care were also more likely to display poor physical growth and delayed language and intellectual development.

Disinhibited attachment

One of the most characteristic effects is disinhibited attachment.

Credit relevant knowledge such as:

• Children show unusually friendly behaviour towards unfamiliar adults.

• They may:

  • approach strangers readily

  • seek physical contact

  • show little stranger anxiety

  • treat familiar and unfamiliar adults similarly.

• This contrasts with typical selective attachment, where the child distinguishes clearly between attachment figures and strangers.

• Disinhibited attachment may result from having many changing caregivers and few opportunities to develop a stable selective attachment.

The specimen mark scheme also identifies attention seeking and clinginess as relevant effects of institutionalisation.

Quasi-autistic symptoms

The English and Romanian Adoptees research also identified quasi-autistic patterns among some children exposed to longer periods of institutional deprivation.

These included difficulties in areas such as:

• social interaction

• communication

• restricted or unusual patterns of behaviour.

The term describes behaviours resembling some autistic characteristics rather than necessarily a diagnosis of autism.

Quasi-autistic symptoms are specifically identified among the ERA findings in both specimen and 2024 mark schemes.  

English and Romanian Adoptees project

Procedure

Credit relevant knowledge such as:

• Rutter and colleagues conducted the English and Romanian Adoptees, or ERA, project.

• The research followed children who had experienced severe institutional care in Romania and were subsequently adopted into British families.

• The study included approximately 165 Romanian adoptees.

• Their development was compared with 52 British adoptees who acted as a comparison group.

• Emotional, social, intellectual and physical development was assessed repeatedly.

• Assessments took place at ages 4, 6, 11 and 15, with later follow-up into young adulthood.

The June 2024 mark scheme gives these participant numbers and follow-up ages, and notes the most recent follow-up at approximately 22 to 25 years.

ERA findings

Credit relevant findings such as:

• At age four, around half of the Romanian adoptees showed intellectual delay.

• Many children demonstrated substantial recovery after adoption into supportive families.

• Later outcomes were strongly associated with age of adoption.

• Children adopted earlier generally showed much better recovery.

• Children adopted after approximately six months were more likely to show persistent difficulties.

• These could include:

  • disinhibited attachment

  • quasi-autistic symptoms

  • delayed language development

  • delayed intellectual development

  • poor physical growth.

• The findings suggest that both:

  • duration of institutionalisation

  • quality of subsequent care

are important influences on development.

These findings are explicitly identified in the 2024 mark scheme.

AO3: Discussion and evaluation

The importance of age of adoption

One of the most important findings is that the effects of institutionalisation were related to how long children remained in institutional care.

Children adopted earlier generally showed better recovery, whereas children adopted after around six months were more likely to show persistent developmental difficulties.

This provides strong evidence that the duration of deprivation matters.

It also means institutionalisation should not be treated as producing the same outcome in every child. Exposure for a shorter period followed by high-quality care may lead to very different development from prolonged exposure.

The specimen mark scheme specifically identifies age of adoption and the quality and stability of aftercare as important discussion points.

Institutional effects are not necessarily permanent

A major strength of the ERA research is that it demonstrates considerable recovery.

Many children who experienced extremely poor early care improved substantially after adoption into supportive families, particularly when adoption occurred relatively early.

This challenges a strongly deterministic view that severe early deprivation inevitably results in permanent psychological damage.

The specimen mark scheme explicitly identifies evidence that the adverse effects of institutionalisation can be overcome with adequate substitute care, citing Rutter and Hodges and Tizard.

This suggests that early experience is extremely important, but later experience also has a substantial influence on developmental outcomes.

The findings suggest a sensitive period

The age-of-adoption findings have implications for theories of attachment.

If children adopted relatively early can show considerable recovery, there may not be a completely fixed critical period after which normal development is impossible.

Instead, the findings are more consistent with a sensitive period, where development is particularly vulnerable to deprivation early in life but recovery remains possible when good-quality care is subsequently provided.

The June 2024 mark scheme explicitly identifies the implication that the critical period may be better understood as a sensitive period and that difficulties associated with a poor early internal working model may be overcome with adequate aftercare.

The extreme Romanian institutions limit generalisation

A major limitation is that conditions in Romanian institutions were unusually severe.

Children experienced:

• extremely high child-to-staff ratios

• little emotional care

• limited stimulation

• poor physical conditions.

The specimen and 2024 mark schemes both identify the difficulty of generalising from Romanian research because standards of care were particularly poor.  

Therefore, the findings should not automatically be applied to all children raised in institutional care.

A modern residential setting with stable key workers and good emotional and physical care may produce very different outcomes.

Institutionalisation contains many confounding variables

A further problem is determining which aspect of institutional care caused the later difficulties.

Romanian children experienced many disadvantages simultaneously, including:

• lack of stable attachments

• poor nutrition

• limited cognitive stimulation

• overcrowding

• poor physical care.

If a child later shows impaired intellectual development, it is difficult to know whether this resulted from lack of attachment, malnutrition, lack of stimulation or a combination of these factors.

This limits the ability to make a simple causal claim that institutionalisation itself, or one specific feature of it, produced the observed developmental difficulty.

The 2024 examiner report warns that generic comments about control of extraneous variables gained limited credit unless students explained the specific relevance to Romanian orphan research.

The ERA groups were not randomly allocated

A methodological limitation is that children could not ethically be randomly assigned to institutional care or adoption.

The Romanian adoptees and British comparison group were therefore naturally occurring groups.

The specimen mark scheme notes that adoption and control groups in the ERA research were not randomly assigned, and suggests that more sociable children may potentially have been selected for adoption.

This creates the possibility of selection effects.

If children who were adopted earlier differed systematically from those who remained in institutions for longer, age of adoption might not be the only reason for their better outcomes.

However, ethical constraints make true experimental manipulation impossible in this area.

Zeanah et al. provide supporting evidence

Further support comes from the Bucharest Early Intervention Project, associated with Zeanah and colleagues.

Attachment was assessed using Ainsworth's procedure, and institutionalised children showed evidence of disinhibited and disorganised attachment.

This supports the broader conclusion that severe institutional care can disrupt normal attachment development.

The study also used random allocation in parts of its design, providing greater control over some confounding variables than the ERA study. However, the specimen mark scheme notes that this raises ethical concerns, because research involving allocation of vulnerable children to different care conditions creates serious welfare issues.

Converging evidence strengthens the conclusions

A strength of research into institutionalisation is that findings do not depend solely on the ERA project.

Other work, including Zeanah et al., Tizard and Hodges, and Quinton, has also investigated the developmental consequences of inadequate early institutional care. The June 2024 mark scheme explicitly recognises these as relevant supporting studies.

Where different studies identify problems in attachment and social development, this increases confidence that the effects are genuine.

However, the exact conditions and samples vary between studies, so they should not be treated as perfect replications of one another.

Longitudinal research is a major strength

The ERA project followed the same children repeatedly from childhood into later development.

This longitudinal design allowed researchers to investigate:

• whether early difficulties persisted

• whether children recovered

• whether age of adoption predicted later outcomes.

This is particularly valuable because the question is about developmental effects. A one-off assessment could show that children differed at one age but could not reveal whether those differences were temporary or persistent.

However, long-running longitudinal research can experience attrition, where participants drop out over time. If those who remain differ from those who leave, later findings may become less representative.

Practical applications

Research into institutionalisation has produced important practical applications.

The findings suggest that children in care benefit from:

• adoption or fostering as early as possible

• stable, continuous relationships with caregivers

• lower child-to-caregiver ratios

• consistent key workers

• emotionally responsive care.

The specimen mark scheme specifically notes that research into the negative effects of institutionalisation contributed to the establishment of key workers in institutions.

The June 2024 mark scheme likewise identifies implications for the care system, including continuity of care and a preference for adoption or foster care.

This gives the research considerable real-world value.

Example answer

Institutionalisation refers to the effects of spending a prolonged period in an institution such as an orphanage, particularly where children receive little consistent emotional care. Institutional care can affect intellectual, physical, social and attachment development.

One important effect is disinhibited attachment. Children with disinhibited attachment may show indiscriminate friendliness towards unfamiliar adults, seek physical contact with strangers and show little preference for familiar caregivers. This may develop because children in institutions experience many different caregivers and therefore have little opportunity to form a selective attachment.

Institutionalisation can also affect intellectual and physical development. Children exposed to severe institutional deprivation may show delayed language, lower intellectual functioning and poor physical growth. Some children have also displayed quasi-autistic patterns involving difficulties with social interaction and communication.

Important evidence comes from Rutter and colleagues' English and Romanian Adoptees project. The researchers followed 165 Romanian children who had been adopted into British families and compared them with 52 British adoptees. The children's intellectual, physical, emotional and social development was assessed repeatedly at different ages.

At age four, approximately half of the Romanian children showed intellectual delay. However, many showed substantial improvement after adoption. A particularly important finding was that later outcomes were related to age of adoption. Children adopted earlier generally recovered well, whereas children adopted after about six months were more likely to show persistent difficulties including disinhibited attachment, quasi-autistic behaviour, language and intellectual delay and poor physical growth.

This is a strength of the research because it shows that the effects of institutionalisation are not necessarily permanent. Children who experienced poor early care could make substantial developmental progress after entering supportive adoptive families. This suggests that good-quality substitute care can reduce the effects of early deprivation.

The age-of-adoption findings also suggest that there may be a sensitive period for attachment and development rather than an absolute critical period. Early institutional care appears particularly damaging, but later recovery is still possible. This means that early experiences are important without necessarily determining development permanently.

However, a major limitation is that the Romanian institutions were extremely deprived. Children experienced poor physical care, little emotional attention and very high child-to-caregiver ratios. These conditions may have been much worse than those in other institutions. It is therefore difficult to generalise the findings to all children raised in care.

Another problem is the presence of confounding variables. The Romanian children experienced several disadvantages at the same time, including lack of stable attachment figures, poor stimulation and possibly poor nutrition. If a child showed delayed intellectual development, it is difficult to know which particular aspect of institutionalisation was responsible. This limits conclusions about the exact cause of the developmental difficulties.

The ERA research was also not a true experiment. Children could not ethically be randomly assigned to remain in institutions or be adopted. It is possible that children adopted earlier differed in some way from those adopted later. For example, more sociable or healthier children might have been more likely to be selected for adoption. This means age of adoption may not be the only variable explaining later differences.

Further support comes from Zeanah and colleagues' Bucharest research. Institutionalised children showed high levels of disinhibited and disorganised attachment, which supports the conclusion that severe institutional care can disrupt normal attachment development. Evidence from different investigations therefore strengthens the general conclusion that poor early institutional care can affect attachment and social development.

A further strength of the ERA project is its longitudinal nature. The same children were assessed repeatedly across development. This allowed researchers to see whether early difficulties disappeared or persisted and to examine the long-term consequences of age of adoption. However, longitudinal studies can suffer from participant attrition over time, which may make later samples less representative.

The research has also had important practical applications. It suggests that children should be placed into stable foster or adoptive homes as early as possible and that institutions should provide consistent caregivers. The use of key workers can give children a greater opportunity to form stable relationships rather than being cared for by many different adults.

Overall, research shows that severe institutionalisation can lead to difficulties in intellectual development, physical growth and attachment, particularly disinhibited attachment. However, the ERA project also demonstrates that these effects are not inevitable. Early adoption and good-quality subsequent care can produce substantial recovery, suggesting that both the duration of institutionalisation and the quality of later care are crucial.

Indicative mark: 16/16

Examiner-style commentary

This would be a strong Level 4 response because the English and Romanian Adoptees project is used to answer the question about the effects of institutionalisation, rather than being described as an isolated study.

The AO1 contains the key features identified in the 2024 mark scheme:

• approximately 165 Romanian adoptees and 52 British controls

• repeated assessment of development

• intellectual delay at age four

• the importance of age of adoption

• greater difficulties following adoption after around six months

• disinhibited attachment

• quasi-autistic symptoms

• delayed language and intellectual development

• poor physical growth.

The AO3 is effective because each methodological or theoretical point is connected to what can actually be concluded about institutionalisation:

• recovery after early adoption challenges a deterministic interpretation;

• age of adoption supports the idea of a sensitive period;

• extreme Romanian conditions limit generalisation;

• multiple forms of deprivation make specific causal conclusions difficult;

• lack of random allocation creates possible selection effects;

• other research such as Zeanah et al. provides converging evidence;

• practical applications demonstrate the value of the research.

This closely reflects the June 2024 examiner report. The actual 16-mark Romanian orphan question was generally answered well, with over 10% of students reaching Level 4. Strong answers used detailed evidence from Rutter and Zeanah et al., but many students struggled with discussion because they gave generic comments about ecological validity or extraneous variables without explaining why those issues mattered for the research.

How a weaker answer could be improved

A weaker response might simply list the effects:

“Institutionalised children have low IQ, poor growth and disinhibited attachment. Rutter studied Romanian orphans and found children adopted earlier did better.”

This contains useful knowledge, but there is little discussion.

For stronger AO3, each point should make an explicit chain:

finding → what it tells us about institutionalisation → limitation or implication.

For example:

children adopted before about six months generally recovered better → longer institutional exposure is associated with greater developmental difficulty → this supports the importance of early experience → but later recovery means the effects are not inevitably permanent.

For methodology:

Romanian institutions involved severe emotional, physical and cognitive deprivation → several variables changed together → later difficulties cannot be attributed solely to absence of an attachment figure → therefore the study demonstrates the risks of severe institutionalisation more convincingly than the effect of any single feature of institutional care.

The key is to use the ERA project as evidence about institutionalisation, not simply to reproduce its procedure and findings.