Institutionalisation, Rutter’s English and Romanian Adoptees project | AQA A-Level Psychology Revision
Updated: Sep 9
For 7182 specification, first teach in September 2025
AQA A-Level Psychology | Free Revision Notes
Estimated study time: 45 minutes
These Institutionalisation A-Level Psychology revision notes examine the possible effects of spending early childhood in an institution where emotional care, stimulation and stable attachments may be limited. You will study Rutter and colleagues’ English and Romanian Adoptees project, which followed Romanian children adopted into British families. Its findings show that many children recovered considerably, but later adoption was associated with intellectual delay, disinhibited attachment and other developmental difficulties. You will also evaluate causality, generalisability, ethics and the practical value of institutionalisation research.
Learning Objectives 🎯
By the end of this revision page, you should be able to:
Define institutionalisation.
Explain the possible intellectual, physical, emotional and social effects of institutional care.
Explain disinhibited attachment.
Describe the English and Romanian Adoptees project.
Explain how age of adoption affected developmental outcomes.
Apply institutionalisation research to unfamiliar scenarios.
Evaluate the methods, conclusions and practical value of institutionalisation research.
Revision Notes 📚
What is institutionalisation?
Institutionalisation refers to the effects of living in an institutional setting, such as an orphanage or children’s home.
Institutional care may involve:
Large numbers of children.
Few caregivers.
High child-to-staff ratios.
Care organised around routines.
Frequent changes of caregiver.
Limited individual attention.
Restricted emotional interaction.
Limited physical and cognitive stimulation.
Living in an institution does not automatically cause developmental difficulties.
The effects depend on the quality of care provided.
A well-run institution might offer:
Stable key workers.
Warm and responsive relationships.
Suitable nutrition.
Play and education.
Opportunities to form attachments.
Consistent routines.
A severely deprived institution may provide very little of this care.
Romanian institutions
After the fall of Romania’s communist government, the extremely poor conditions in many Romanian orphanages became widely known.
Large numbers of children had been placed in institutions where they often experienced:
Minimal emotional care.
Very little stimulation.
Poor nutrition.
Limited medical support.
Few opportunities to form attachments.
High child-to-caregiver ratios.
Rigid daily routines.
Little individual attention.
Some children spent most of the day in cots and received care only when basic physical needs had to be met.
These circumstances allowed researchers to investigate what happened when children were later adopted into supportive families.
However, the conditions were unusually severe. This must be considered when applying the findings to other forms of institutional care.
Institutionalisation, deprivation and privation
Institutionalisation should not be treated as another word for deprivation.
Deprivation
Deprivation is the loss or serious disruption of an attachment that has already formed.
A child must first have formed an attachment before they can be deprived of it.
This distinction is explored fully through the loss of an existing attachment relationship.
Privation
Privation is the failure to form an attachment in the first place.
Children raised from infancy by many changing caregivers may never have had the opportunity to form one stable attachment.
Institutionalisation
Institutionalisation describes the experience and possible effects of living in institutional care.
It may involve:
Deprivation, if an existing attachment was lost.
Privation, if no attachment ever formed.
Physical deprivation.
Cognitive understimulation.
Poor nutrition.
Several forms of adversity at once.
Key distinction
Concept | Meaning |
Separation | Physical absence from an attachment figure |
Deprivation | Loss or disruption of an attachment that had formed |
Privation | Failure to form an attachment |
Institutionalisation | Effects associated with living in institutional care |
A child can live in an institution without necessarily experiencing severe attachment difficulties if the institution provides stable and responsive care.
Equally, a child may experience deprivation or privation outside an institution.
Why might institutional care affect development?
Lack of a stable caregiver
A child may be cared for by many staff members working different shifts.
As a result, the child may not experience one dependable adult who consistently:
Responds to distress.
Provides comfort.
Recognises individual signals.
Encourages exploration.
Maintains an emotional relationship.
This may prevent the formation of a secure attachment.
Limited emotional interaction
Care in a large institution may focus on physical tasks such as:
Feeding.
Washing.
Dressing.
Changing bedding.
Administering medication.
These tasks are necessary but do not automatically provide sensitive emotional care.
An infant also benefits from:
Eye contact.
Smiling.
Conversation.
Physical reassurance.
Play.
Responses matched to their behaviour.
Limited cognitive stimulation
Children need opportunities to:
Explore.
Play.
Hear language.
Interact with adults.
Solve problems.
Experience different environments.
Limited stimulation may affect:
Language development.
Intelligence quotient, or IQ.
Concentration.
School progress.
Problem-solving skills.
Poor physical care
Some institutions may also provide inadequate:
Nutrition.
Hygiene.
Medical treatment.
Physical activity.
Sleep conditions.
Poor physical growth cannot therefore be attributed only to attachment.
Changing caregivers
Repeated changes of caregiver may teach the child that relationships are temporary.
The child may not develop consistent expectations that adults are:
Available.
Dependable.
Responsive.
Worth forming a selective relationship with.
This may affect the internal working model proposed by Bowlby.
Possible effects of institutionalisation
Institutionalisation may affect several areas of development.
The main possible effects include:
Intellectual delay.
Delayed physical development.
Disinhibited attachment.
Difficulties forming selective relationships.
Quasi-autistic patterns.
Emotional and social difficulties.
Not every institutionalised child will experience every effect.
Intellectual delay
What is intellectual delay?
Intellectual delay refers to slower development of intellectual abilities than would normally be expected for the child’s age.
Possible signs include:
Lower IQ.
Delayed language.
Poor problem-solving.
Limited concentration.
Slower educational progress.
Difficulty understanding instructions.
Why might institutionalisation cause intellectual delay?
Possible causes include:
Limited adult conversation.
Few toys or learning activities.
Restricted exploration.
Poor nutrition.
Lack of individual teaching.
Emotional stress.
Little encouragement.
A child’s intellectual development is supported by responsive interaction.
For example, when a child points at an object, a caregiver may:
Name the object.
Explain its function.
Encourage the child to touch it.
Respond to questions.
Extend the conversation.
If this interaction is absent, cognitive and language development may be delayed.
Recovery
Intellectual delay may be partly reversible.
After adoption into a stimulating family, a child may receive:
Individual attention.
Conversation.
Play.
Education.
Good nutrition.
Emotional security.
Research suggests that earlier adoption is associated with greater intellectual recovery.
Delayed physical development
Children raised in severely deprived institutions may show:
Low weight.
Reduced height.
Poor muscle development.
Delayed motor skills.
Smaller head circumference.
General developmental delay.
Possible explanations
Physical delay may result from:
Malnutrition.
Illness.
Limited movement.
Poor medical care.
Chronic stress.
Lack of individual physical interaction.
After adoption, many children show substantial physical recovery.
This suggests that at least some physical effects result from environmental conditions rather than permanent biological impairment.
Disinhibited attachment
What is disinhibited attachment?
Disinhibited attachment is a pattern in which a child shows unusually friendly, attention-seeking and affectionate behaviour towards almost any adult.
The child does not display the usual selectivity expected in attachment.
They may behave similarly towards:
A parent.
A familiar caregiver.
An unfamiliar adult.
A complete stranger.
Features of disinhibited attachment
A child may:
Approach unfamiliar adults readily.
Seek physical contact from strangers.
Show little stranger anxiety.
Be willing to leave with an unfamiliar person.
Seek attention indiscriminately.
Treat familiar and unfamiliar adults similarly.
Fail to check back with the caregiver.
Form relationships that appear friendly but lack selectivity.
Selective attachment
A typical attachment is selective.
A securely attached child usually:
Prefers a familiar caregiver.
Seeks that person when distressed.
Is comforted more effectively by them.
Shows some caution around strangers.
Uses the caregiver as a secure base.
These behaviours are assessed through secure and insecure attachment classifications.
In disinhibited attachment, this normal preference is reduced or absent.
Why might disinhibited attachment develop?
In an institution, many caregivers may provide brief periods of care.
No single adult remains consistently available.
The child may therefore learn that the most effective way to receive attention is to approach any available adult.
The process could be:
The child needs care or stimulation.
Care is provided by many changing adults.
Selectivity brings little advantage because one person may soon leave.
The child behaves warmly towards every available caregiver.
Indiscriminate friendliness becomes an established pattern.
Is friendliness always a problem?
Ordinary friendliness is not disinhibited attachment.
The concern is not that a child is sociable.
It is that the child:
Shows little distinction between familiar and unfamiliar adults.
Fails to use a caregiver as a secure base.
Approaches strangers without normal caution.
May place themselves at risk.
The whole pattern must be considered.
Quasi-autistic patterns
Some children who experienced prolonged institutional deprivation showed behaviours described as quasi-autistic patterns.
These could include:
Difficulties with social communication.
Limited interest in reciprocal interaction.
Repetitive behaviour.
Unusual or intense interests.
Problems understanding social situations.
The word quasi means resembling but not necessarily being identical to autism.
Researchers used the term because some children showed autism-like behaviour after severe early deprivation.
It should not be assumed that institutionalisation causes autism generally.
The pattern was identified among some children exposed to extreme early institutional conditions, particularly those adopted later.
Emotional and social effects
Possible emotional and social difficulties include:
Poor emotional regulation.
Difficulty trusting adults.
Limited peer relationships.
Attention-seeking behaviour.
Problems understanding social boundaries.
Difficulty forming close relationships.
Anxiety.
Emotional withdrawal.
Aggressive or disruptive behaviour.
These difficulties may be linked to:
Lack of a stable attachment figure.
An insecure internal working model.
Limited experience of reciprocal interaction.
Continuing developmental delay.
Wider institutional adversity.
The English and Romanian Adoptees project
What was the project?
The English and Romanian Adoptees project, or ERA project, was a longitudinal investigation led by Michael Rutter and colleagues.
It followed children who had experienced severely deprived Romanian institutions and were later adopted by families in the United Kingdom.
The aim was to investigate:
The effects of early institutionalisation.
Whether children could recover after adoption.
Whether age at adoption affected later development.
Which difficulties were most persistent.
Participants
The project followed:
165 Romanian children adopted into British families.
52 British adoptees used as a comparison group.
The British adoptees had not experienced the extreme institutional deprivation experienced by the Romanian group.
Why use British adoptees as a comparison group?
The comparison group helped researchers distinguish between:
Effects associated with adoption generally.
Effects associated with severe Romanian institutional care.
Both groups had experienced adoption.
The major difference was that the Romanian group had usually spent part of early life in severely deprived institutions.
Longitudinal design
The children were assessed repeatedly as they developed.
Assessments took place at ages including:
4 years.
6 years.
11 years.
15 years.
Later follow-up research continued into early adulthood.
A longitudinal study follows the same participants over an extended period.
This allowed the researchers to investigate:
Initial delay.
Later recovery.
Continuing difficulties.
Changes across childhood and adolescence.
The AQA June 2024 mark scheme identifies the 165 Romanian adoptees, 52 British controls and assessments at ages 4, 6, 11 and 15 as central features of the project.
Initial condition of the Romanian adoptees
When first adopted, many Romanian children showed substantial developmental delay.
Possible difficulties included:
Low weight.
Poor physical growth.
Delayed language.
Low intellectual functioning.
Limited social behaviour.
Unusual emotional responses.
At age four, approximately half showed intellectual delay.
However, there were major differences according to the age at which the child had left institutional care.
Age of adoption
Adoption before six months
Children adopted before approximately six months tended to show substantial recovery.
By later assessments, many had intellectual and social development similar to the British adoptees.
This suggests that:
Early effects were not necessarily permanent.
High-quality family care supported recovery.
There may be an early sensitive period.
Duration of institutional care is important.
Adoption after six months
Children adopted after six months were more likely to show continuing difficulties.
These included:
Lower intellectual development.
Delayed language.
Poorer physical growth.
Disinhibited attachment.
Quasi-autistic patterns.
Difficulties with attention and social relationships.
The longer children remained in deprived institutions, the greater the risk of persistent effects.
Why is six months important?
Six months should not be treated as a magical boundary at which damage suddenly becomes inevitable.
The finding indicates that outcomes were generally better among children adopted earlier.
Age of adoption also represents:
Length of exposure to deprivation.
Length of time without stable family care.
Opportunity for earlier intervention.
The relationship is therefore graded rather than completely all-or-nothing.
Findings at age four
At age four:
Many Romanian children had made considerable physical progress.
Some had caught up intellectually.
Approximately half still showed intellectual delay.
Earlier-adopted children generally showed better development.
Later-adopted children were more likely to display continuing difficulties.
This shows both recovery and persistence.
Institutionalisation did not affect all children in the same way.
Findings at age eleven
By age eleven, recovery remained strongly related to age at adoption.
Children adopted before six months generally showed outcomes closer to the British adoptees.
Children adopted later were more likely to show:
Lower IQ.
Disinhibited attachment.
Social difficulties.
Quasi-autistic patterns.
Continuing developmental delay.
The findings suggest that supportive family care can produce major improvement, but prolonged early deprivation may leave persistent effects.
Findings during adolescence and adulthood
Later follow-ups found that some difficulties continued beyond childhood, particularly among those who had experienced longer institutional deprivation.
Persistent effects could include:
Disinhibited social behaviour.
Difficulties with peer relationships.
Attention problems.
Quasi-autistic patterns.
Educational difficulties.
However, outcomes varied.
Many adopted children developed successfully and showed considerable recovery.
This variability is important because it prevents an overly deterministic conclusion.
What did the ERA project conclude?
The main conclusions were:
Severe institutionalisation can delay development.
Many effects are reversible after supportive adoption.
Earlier adoption is associated with better outcomes.
Longer institutional care increases the risk of persistent difficulties.
Disinhibited attachment can continue after physical and intellectual recovery.
Development remains influenced by later care.
Summary table
Length of institutional care | Typical pattern found |
Adopted before six months | Substantial recovery; outcomes often similar to British adoptees |
Adopted after six months | Greater risk of intellectual delay and disinhibited attachment |
Longest institutional exposure | Greater likelihood of persistent social, cognitive and developmental difficulties |
How does the ERA project relate to Bowlby?
Support for an important early period
The better outcomes among children adopted before six months support the idea that early attachment opportunities are especially important.
This is broadly consistent with Bowlby’s early critical period.
Sensitive rather than critical period
The findings do not support a completely rigid critical period.
Children adopted after six months could still improve.
Even children with substantial initial delay sometimes made progress after receiving:
Stable family relationships.
Emotional support.
Education.
Nutrition.
Cognitive stimulation.
The evidence therefore supports a sensitive period more strongly than an absolute critical period.
Internal working model
Children raised by changing caregivers may not develop an internal working model based on one dependable relationship.
They may learn that:
Adults are interchangeable.
Attention must be gained from whoever is available.
Relationships are temporary.
Selective attachment is not useful.
This could help explain disinhibited attachment.
After adoption, a stable family may allow new expectations to develop, although earlier patterns may persist.
The English and Romanian Adoptees project as a natural experiment
Researchers could not ethically allocate children to deprived institutions.
The ERA project therefore studied a naturally occurring difference.
The Romanian children had experienced institutional deprivation before adoption, while the researchers observed their later development.
Strength
The research involved genuine early experiences rather than an artificial laboratory manipulation.
This gives the findings high real-world relevance.
Limitation
Because the researchers did not create or control the original conditions, the Romanian and British groups may have differed in several ways.
This makes causal conclusions more difficult.
Evaluating institutionalisation research
Strength: longitudinal evidence
The ERA project followed the same children over many years.
This allowed researchers to examine:
Whether developmental delay continued.
Whether recovery occurred.
Which effects were persistent.
How age of adoption affected later outcomes.
A short study could show only one moment in development.
The longitudinal design revealed developmental change.
Limitation: participant attrition
In long-term research, some participants may stop taking part.
This is known as attrition.
Participants who remain may differ from those who withdraw.
For example, families experiencing greater difficulties might be:
More motivated to remain because they want support.
Less able to continue because participation is demanding.
If withdrawal is systematic, the final sample may be biased.
Strength: a comparison group
The British adoptees provided a useful comparison.
Because both groups had been adopted, differences were less likely to result simply from adoption.
The design allowed researchers to compare:
Romanian institutional deprivation followed by adoption.
British adoption without the same extreme institutional history.
Limitation: the groups were not randomly allocated
Children were not randomly assigned to:
Romanian institutional care.
British family care.
Different ages of adoption.
Random allocation would have been unethical and impossible.
This means the groups may have differed before adoption.
For example:
Healthier children may have been adopted sooner.
More sociable children may have attracted adoptive parents earlier.
Children with greater difficulties may have remained in institutions longer.
Age of adoption may therefore be partly confounded with the child’s initial condition.
The AQA specimen mark scheme specifically identifies the lack of random assignment and the possibility that more sociable children were selected for adoption as evaluation issues.
Limitation: Romanian institutions were unusually deprived
The Romanian children experienced exceptionally poor care.
The findings may not generalise to institutions that provide:
Adequate food.
Education.
Stable key workers.
Emotional warmth.
Smaller groups.
Greater individual attention.
The research demonstrates the risk of extreme institutional deprivation.
It does not prove that every form of residential care produces the same outcomes.
Limitation: several forms of deprivation occurred together
The Romanian institutions differed from family homes in many ways.
Children may have experienced:
Attachment disruption.
Malnutrition.
Illness.
Limited movement.
Cognitive understimulation.
Poor medical care.
Lack of language interaction.
This makes it difficult to identify which factor caused each outcome.
For example:
Low IQ may reflect understimulation rather than attachment disruption alone.
Poor growth may reflect malnutrition.
Social difficulties may reflect a lack of stable relationships.
Most outcomes may reflect several interacting conditions.
Limitation: prenatal factors
Researchers could not control the children’s experiences before birth.
Some children may have been affected by:
Poor prenatal nutrition.
Maternal illness.
Substance exposure.
Genetic factors.
Complications during pregnancy or birth.
These factors could contribute to developmental difficulties independently of institutional care.
Strength: less confounding from prior family trauma
Many earlier studies of institutionalised children included participants who had experienced:
Abuse.
Family conflict.
Parental mental illness.
Repeated separations.
It was therefore difficult to determine whether later problems came from the institution or earlier family experiences.
Many Romanian children entered institutions very early.
This reduced, although did not eliminate, the confounding effect of prolonged harmful family experiences before institutionalisation.
Strength: consistent findings across development
The relationship between later adoption and poorer outcomes appeared across several assessments.
This consistency strengthens the conclusion that prolonged exposure was associated with increased developmental risk.
However, an association still does not prove that institutionalisation alone caused the difficulties.
Zeanah and the Bucharest Early Intervention Project
Zeanah and colleagues also investigated children living in Romanian institutional care.
The Bucharest Early Intervention Project compared children who:
Remained in institutional care.
Were placed in foster care.
Attachment was assessed using a version of Ainsworth’s procedure.
The research found evidence of:
Disinhibited attachment.
Disorganised attachment behaviour.
Better outcomes among some children placed in foster care.
Why this research is useful
It provides additional evidence that:
Institutional care can affect attachment.
Stable substitute family care may support recovery.
Quality and timing of later care matter.
Random allocation
Children were assigned to institutional or foster-care conditions through random allocation.
This improved control because pre-existing differences should have been distributed more evenly between the groups.
The AQA June 2024 mark scheme recognises the project as a randomised controlled trial that found disinhibited and disorganised attachment.
Ethical issue
Randomly allocating some children to remain in institutional care creates a serious ethical concern.
If researchers believed foster care might be better, children remaining in institutions could continue experiencing harmful conditions.
This creates a conflict between:
Gaining strong causal evidence.
Protecting vulnerable children.
Validity of attachment measures
Using the Strange Situation
Attachment research may use the separation and reunion procedure developed by Ainsworth.
This provides:
A standardised method.
Observable behavioural categories.
Comparisons between children.
The possibility of checking observer agreement.
Limitations
The Strange Situation was designed to classify:
Secure attachment.
Insecure-avoidant attachment.
Insecure-resistant attachment.
Institutionalised children may display patterns that do not fit neatly into these categories.
For example, a child might:
Show indiscriminate friendliness.
Lack a clear preferred attachment figure.
Behave inconsistently towards all adults.
The original categories may therefore be insufficient for understanding severe institutional privation.
Cultural and experiential validity
The procedure may also be affected by the child’s previous experience.
A child accustomed to many caregivers may respond to a stranger very differently from a child raised in one family.
Low stranger anxiety may reflect:
Disinhibited attachment.
Extensive experience of unfamiliar adults.
Both factors together.
Correlation and causation
The ERA project found a relationship between:
Longer institutional care.
Greater developmental difficulties.
This does not by itself prove that one caused the other.
Possible alternative explanations include:
More impaired children were adopted later.
Later-adopted children had poorer physical health before adoption.
Prenatal factors affected both development and adoption timing.
Institutions differed in quality.
Adoptive families differed in the support they could provide.
The most justified conclusion is:
Longer exposure to severe institutional conditions was associated with a greater risk of continuing developmental difficulties.
Individual differences and resilience
Not every child exposed to prolonged institutional care developed the same difficulties.
Possible protective factors include:
Individual temperament.
Physical health.
Genetic differences.
Early adoption.
A particularly responsive adoptive family.
Educational support.
Stable peer relationships.
Access to professional intervention.
Resilience means positive development despite substantial adversity.
The presence of resilience shows that institutionalisation increases risk rather than determining a child’s future.
Recovery after adoption
Physical recovery
Many Romanian children gained weight and improved physically after adoption.
This suggests that some growth problems were environmentally caused and reversible.
Intellectual recovery
Children adopted earlier often made substantial gains in intellectual development.
This demonstrates the importance of:
Stimulation.
Education.
Language interaction.
Individual attention.
Good nutrition.
Emotional and social recovery
Recovery in emotional and attachment development was sometimes slower.
Disinhibited attachment could continue even after improvements in:
Physical growth.
IQ.
Language.
This suggests that different areas of development may have different sensitive periods or recovery patterns.
Adoption is not an instant cure
A supportive family provides an improved environment, but children may still need:
Time.
Consistent caregiving.
Help developing boundaries.
Educational support.
Psychological intervention.
Understanding from caregivers and teachers.
Practical applications
Early adoption
The findings support placing children in stable families as early as possible when adoption is appropriate.
Earlier placement reduces the duration of institutional exposure and increases opportunities to form attachments.
Foster care
Family-based foster care may provide:
A smaller social environment.
One or two stable caregivers.
Individual attention.
Opportunities for selective attachment.
Greater cognitive stimulation.
Key workers
Where institutional care is necessary, assigning a stable key worker can help provide continuity.
The key worker should:
Spend regular time with the child.
Respond to distress.
Learn the child’s signals.
Provide comfort.
Encourage exploration.
Remain consistently involved.
Smaller caregiver-child ratios
Reducing the number of children assigned to each caregiver allows more:
Conversation.
Play.
Emotional interaction.
Individual care.
Recognition of each child’s needs.
Stable placements
Repeated movement between institutions or foster homes may disrupt developing attachments.
Research supports:
Avoiding unnecessary placement changes.
Preparing children carefully for transitions.
Maintaining contact with important caregivers where appropriate.
Supporting adoptive and foster families.
Intervention for disinhibited attachment
Children showing disinhibited behaviour may need support in learning:
Safe boundaries.
Differences between familiar adults and strangers.
How to use a caregiver as a secure base.
How to form selective, reciprocal relationships.
Social sensitivity
Institutionalisation research concerns highly vulnerable children.
Poorly communicated findings could lead to:
Children being labelled as permanently damaged.
Adoptive parents expecting inevitable problems.
Stigma towards people who have experienced care.
Institutions or countries being judged without context.
Children’s histories becoming public.
Researchers must protect:
Confidentiality.
Dignity.
The child’s right not to be defined by early adversity.
The evidence should be described probabilistically.
Early institutionalisation may increase risk, but it does not determine every outcome.
Ethical strengths of natural research
Researchers did not deliberately create the Romanian orphanage conditions.
They studied naturally occurring circumstances after the children had been adopted.
This avoided intentionally exposing children to severe deprivation.
However, ethical responsibilities remained, including:
Protecting confidential information.
Avoiding intrusive assessments.
Gaining consent from adoptive parents.
Gaining assent from children when appropriate.
Providing support if assessments caused distress.
Avoiding harmful labels.
Evaluating theoretical conclusions
Support for Bowlby
The research supports several aspects of Bowlby’s theory:
Early attachments are important.
Lack of stable care can affect development.
Earlier placement is associated with better outcomes.
The internal working model may influence social behaviour.
Prolonged early disruption can have continuing consequences.
Challenge to strict determinism
The considerable recovery shown by many children challenges the claim that early damage must be permanent.
Later high-quality care can improve:
Physical growth.
Intellectual development.
Social relationships.
Emotional functioning.
The evidence therefore supports developmental flexibility.
Sensitive period
The age-of-adoption findings support a sensitive period.
Development appears most vulnerable during early infancy, but recovery remains possible later.
This is more balanced than saying:
Missing one exact critical deadline causes irreversible damage.
Institutionalisation and later relationships
A child who has not experienced one stable caregiver may develop expectations that relationships are:
Temporary.
Non-selective.
Unreliable.
Based on gaining attention from any available adult.
These expectations may influence later behaviour.
For example, the child may:
Approach strangers too readily.
Struggle with friendship boundaries.
Seek constant adult attention.
Find reciprocal relationships difficult.
This connects with the influence of early attachment on later relationships.
However, later experiences can alter these expectations.
A stable adoptive relationship may gradually provide a different model of how relationships work.
Applying institutionalisation research
Scenario 1: early adoption
A child spent four months in a deprived institution before being adopted into a stable family.
The ERA findings suggest that:
The child experienced some early adversity.
Adoption occurred before prolonged institutional exposure.
Substantial developmental recovery is likely.
The child’s outcome may become similar to children without prolonged institutionalisation.
A good answer should avoid guaranteeing a completely typical outcome.
Scenario 2: later adoption
A child remained in a deprived institution until age three.
At age eight, they approach unfamiliar adults, seek physical contact and show little preference for their adoptive parents.
This behaviour is consistent with disinhibited attachment because:
The child is indiscriminately friendly.
They show limited stranger anxiety.
Their behaviour lacks normal selectivity.
Prolonged care by many changing adults may have prevented a selective attachment from developing.
Scenario 3: intellectual recovery
A child had delayed language and low IQ when adopted but made rapid progress after receiving family care and education.
This suggests that:
Some intellectual delay was environmentally caused.
Greater stimulation supported recovery.
Institutional effects are not necessarily irreversible.
Later care can alter developmental outcomes.
Scenario 4: mixed outcomes
A child catches up in physical growth and schoolwork but remains unusually friendly towards strangers.
This pattern is consistent with the ERA findings because:
Different developmental areas may recover at different rates.
Physical and intellectual improvement can occur.
Disinhibited attachment may be more persistent.
Scenario 5: a high-quality institution
A child lives in a small residential home with stable key workers, good education and warm individual care.
It would be inaccurate to assume severe institutional effects solely because the child lives in residential care.
The quality and continuity of care must be considered.
Analysing research data
Imagine the following results:
Age at adoption | Mean IQ at age 11 | Percentage showing disinhibited attachment |
Before 6 months | 102 | 6% |
6 to 24 months | 91 | 24% |
After 24 months | 82 | 43% |
A strong analysis would state:
Earlier adoption is associated with higher mean IQ.
Disinhibited attachment becomes more common as age at adoption increases.
The results suggest that longer institutional exposure is associated with poorer outcomes.
The findings do not prove causation because children were not randomly allocated to adoption ages.
Pre-existing differences could affect both adoption timing and later development.
Planning an extended answer
A strong 16-mark answer could follow this structure:
Define institutionalisation.
Explain possible physical and intellectual effects.
Explain disinhibited attachment.
Describe the ERA project’s participants and longitudinal design.
Explain age-of-adoption findings.
Discuss recovery and sensitive periods.
Evaluate the comparison group and longitudinal method.
Discuss the lack of random allocation.
Explain the unusually severe Romanian conditions.
Consider confounding variables.
Discuss practical applications.
Reach a balanced conclusion.
A balanced conclusion
Research into Romanian adoptees shows that severe early institutional care can be associated with:
Intellectual delay.
Poor physical growth.
Disinhibited attachment.
Quasi-autistic patterns.
Continuing social difficulties.
However, the research also demonstrates substantial recovery.
The most justified conclusion is:
Institutionalisation is a serious developmental risk when care is severely deprived and prolonged, but outcomes depend strongly on duration, age of adoption, quality of later care and individual resilience.
Hints from the Examiner Reports 💡
Examiner hint: Learn the ERA procedure accurately. Rutter and colleagues followed 165 Romanian adoptees and compared them with 52 British adoptees.
Examiner hint: Include the longitudinal nature of the project. The children were assessed repeatedly at ages including 4, 6, 11 and 15.
Examiner hint: Link findings to age at adoption. Earlier-adopted children generally showed greater recovery, while adoption after six months was associated with a greater risk of persistent difficulties.
Examiner hint: Do not describe disinhibited attachment merely as “being friendly”. Explain the lack of selectivity and limited preference between familiar caregivers and strangers.
Examiner hint: Distinguish intellectual recovery from attachment recovery. A child may catch up physically or intellectually but continue to display disinhibited social behaviour.
Examiner hint: Keep background concise. Conditions in Romanian institutions provide useful context, but lengthy political history will not replace psychological knowledge.
Examiner hint: Make methodological evaluation specific. Do not simply write that the study lacked control. Identify a particular confounding variable and explain how it affects the conclusions.
Examiner hint: Avoid generic ecological-validity points. The research involved genuine adopted children and real developmental outcomes, so any criticism must accurately reflect its method.
The June 2024 examiner report noted that effective answers used detailed knowledge of Rutter and Zeanah. Weaker discussion relied on generic claims about ecological validity or extraneous variables without explaining their relevance to Romanian orphan research.
Common Mistakes ⚠️
Mistake: Saying institutionalisation means being adopted
Why this is incorrect:
Institutionalisation concerns living in institutional care. Adoption is often the improved environment that follows it.
How to improve:
Distinguish early institutional experience from later family placement.
Mistake: Treating institutionalisation as identical to maternal deprivation
Why this is incorrect:
Institutionalisation may include privation, deprivation, understimulation and physical adversity.
How to improve:
Identify the child’s exact early experience.
Mistake: Saying all institutions produce developmental damage
Why this is incorrect:
Effects depend on care quality, stability, stimulation and caregiver relationships.
How to improve:
Refer specifically to severely deprived institutional care.
Mistake: Describing disinhibited attachment as secure sociability
Why this is incorrect:
Disinhibited attachment involves a lack of normal selectivity and unsafe approach behaviour towards strangers.
How to improve:
Mention limited stranger anxiety and equal treatment of familiar and unfamiliar adults.
Mistake: Saying disinhibited children have no social interest
Why this is incorrect:
They may be highly attention-seeking and sociable.
How to improve:
Explain that the problem is indiscriminate rather than absent social behaviour.
Mistake: Saying every Romanian child had a low IQ permanently
Why this is incorrect:
Many showed substantial recovery, especially after early adoption.
How to improve:
Use age of adoption and individual differences.
Mistake: Saying adoption before six months guarantees normal development
Why this is too absolute:
Earlier adoption was associated with better average outcomes, but individual differences remained.
How to improve:
Use phrases such as “greater likelihood of recovery”.
Mistake: Saying six months was a strict deadline
Why this is inaccurate:
The findings show a general relationship between duration and outcome rather than an instant change at one exact age.
How to improve:
Describe a sensitive period and graded risk.
Mistake: Forgetting the British comparison group
Why this matters:
The comparison helped separate effects of institutional deprivation from effects of adoption generally.
How to improve:
Include the 52 British adoptees when describing the method.
Mistake: Calling the ERA project a laboratory experiment
Why this is incorrect:
Researchers did not manipulate institutional deprivation or randomly allocate children.
How to improve:
Describe it as a longitudinal investigation of naturally occurring groups.
Mistake: Claiming the study proves causation
Why this is incorrect:
Adoption timing was not randomly allocated, and several variables differed between groups.
How to improve:
State that longer institutionalisation was associated with poorer outcomes.
Mistake: Giving a vague confounding-variable criticism
Why this is incomplete:
The alternative factor must be identified.
How to improve:
Discuss nutrition, prenatal health, institutional stimulation or selection for early adoption.
Mistake: Ignoring recovery
Why this creates an unbalanced answer:
The ERA project found both persistent difficulties and considerable developmental improvement.
How to improve:
Explain how later family care changed outcomes.
Mistake: Saying institutionalised children are permanently damaged
Why this is deterministic and socially sensitive:
Children showed varied outcomes and many made substantial progress.
How to improve:
Describe institutionalisation as a risk factor rather than a fixed destiny.
Exam-Style Questions ✍️
Question 1
Which one of the following best describes disinhibited attachment?
A. Avoiding every adult, including familiar caregivers
B. Showing an unusually strong preference for one caregiver
C. Displaying indiscriminate friendliness towards familiar and unfamiliar adults
D. Becoming distressed whenever a stranger leaves
[1 mark]
reveal mark scheme and indicative content
Answer: C. Displaying indiscriminate friendliness towards familiar and unfamiliar adults
Question 2
Define institutionalisation.
[2 marks]
reveal mark scheme and indicative content
Mark scheme
AO1 = 2
2 marks: Clear definition referring to spending a prolonged period living in institutional care, typically with limited opportunities to form stable attachments.
1 mark: Limited or partial definition.
Indicative content
Living in an institution such as an orphanage or children's home.
Care may involve many different carers and limited consistent emotional interaction.
Example answer
Institutionalisation is the experience of living for a prolonged period in institutional care, where children may receive care from many adults and have limited opportunities to form stable attachments.
Question 3
Explain one difference between institutionalisation and privation.
[3 marks]
reveal mark scheme and indicative content
Mark scheme
AO1 = 3
1 mark: Institutionalisation refers to being raised or cared for in an institution.
1 mark: Privation refers to failing to form an attachment in the first place.
1 mark: Clear distinction explaining that institutionalisation may lead to privation but does not automatically mean that privation has occurred.
Example answer
Institutionalisation describes the experience of being raised in institutional care, whereas privation means that a child has never formed an attachment. Institutionalisation can create conditions that make privation more likely, but the two terms do not mean the same thing.
Question 4
Outline two possible effects of institutionalisation.
[4 marks]
reveal mark scheme and indicative content
Mark scheme
AO1 = 4
Award up to 2 marks for each effect.
Indicative content
Credit any two:
Disinhibited attachment, indiscriminate friendliness and attention seeking towards unfamiliar adults.
Intellectual delay, including lower IQ.
Delayed language development.
Impaired social skills.
Poor physical growth.
Quasi-autistic symptoms.
Reduced empathy or pretend play.
Disorganised attachment.
AQA explicitly identifies these as possible outcomes in research on Romanian orphans.
Example answer
One possible effect is disinhibited attachment, where a child shows indiscriminate friendliness towards unfamiliar adults rather than a clear preference for a particular caregiver. Another is intellectual delay, with institutionalised children sometimes showing lower IQ and delayed cognitive development.
Question 5
A child approaches unfamiliar adults, seeks physical contact and is willing to leave with people they have never met.
Use your knowledge of institutionalisation to explain this behaviour.
[4 marks]
reveal mark scheme and indicative content
Mark scheme
AO2 = 4
Award 1 mark each for:
Identifying disinhibited attachment.
The child shows indiscriminate friendliness towards unfamiliar adults.
Seeking physical contact with strangers demonstrates a lack of normal selectivity between familiar and unfamiliar people.
Such behaviour has been associated with institutional care where children have had limited opportunities to form stable, selective attachments.
Example answer
The child is showing disinhibited attachment. They do not show the usual preference for familiar caregivers and instead approach and seek contact with unfamiliar adults. Institutional care involving many changing carers may make it difficult to develop a selective attachment, which could explain this indiscriminate friendliness.
Question 6
Outline the procedure and participants used in the English and Romanian Adoptees project.
[4 marks]
reveal mark scheme and indicative content
Mark scheme
AO1 = 4
Award 1 mark for each relevant point, up to 4 marks.
Indicative content
Rutter and the ERA team followed 165 Romanian children adopted into British families.
They were compared with 52 British adoptees.
The children's emotional, social, cognitive and physical development was assessed.
Assessments took place at several ages, including 4, 6, 11 and 15 years.
Later follow-up research continued into early adulthood.
Outcomes were considered in relation to factors such as age at adoption.
AQA's 2024 mark scheme gives 165 Romanian adoptees, 52 British controls and assessments at ages 4, 6, 11 and 15, with later follow-up at 22 to 25.
Example answer
Rutter and colleagues followed 165 Romanian children who had been adopted by British families and compared them with 52 British adoptees. Their physical, intellectual, emotional and social development was assessed repeatedly at ages including 4, 6, 11 and 15 years, allowing development to be related to age at adoption.
Question 7
Explain what Rutter and colleagues found about the relationship between age of adoption and later development.
[6 marks]
reveal mark scheme and indicative content
Mark scheme
AO1 = 6
Award credit for a clear account of the relationship between duration of institutional care and developmental outcome.
Indicative content
Many Romanian children showed developmental delays when first adopted.
Recovery was strongly related to the age at which they were adopted.
Children adopted before approximately 6 months generally showed substantial recovery.
Their later development was much closer to that of British adoptees.
Children adopted after 6 months were more likely to show persistent difficulties.
These included disinhibited attachment, intellectual and language delay, poor physical growth and quasi-autistic symptoms.
Longer institutionalisation was therefore generally associated with poorer later outcomes.
AQA specifically states that recovery at age 11 was related to age of adoption and that children adopted after six months displayed more persistent difficulties.
Example answer
Rutter and colleagues found that later development depended strongly on the age at which the Romanian children were adopted. Children adopted before about six months generally showed substantial developmental recovery. Those adopted after six months were more likely to show persistent effects such as lower intellectual development, disinhibited attachment and delayed language development. This suggests that longer exposure to institutional care was associated with poorer outcomes.
Question 8
The following results were obtained from children adopted from institutional care:
Age at adoption | Mean IQ at age 11 | Percentage showing disinhibited attachment |
Before 6 months | 103 | 5% |
6 to 24 months | 92 | 21% |
After 24 months | 81 | 46% |
Describe the pattern shown in the results. Explain one conclusion that could be drawn.
[6 marks]
reveal mark scheme and indicative content
Mark scheme
AO2/AO3 = 6
Award up to 3 marks for describing the pattern and 3 marks for explaining a conclusion.
Indicative content
Pattern
Mean IQ decreases as age at adoption increases.
Children adopted before 6 months have the highest mean IQ, 103.
This falls to 92 for adoption between 6 and 24 months and 81 after 24 months.
Disinhibited attachment increases with age at adoption, from 5% to 21% to 46%.
Conclusion
Longer periods in institutional care are associated with poorer cognitive development.
Longer institutionalisation is also associated with greater risk of disinhibited attachment.
Earlier adoption into stable family care appears to reduce or reverse some adverse effects.
The results suggest the effects are not necessarily irreversible.
Example answer
As age at adoption increases, IQ decreases and disinhibited attachment becomes more common. Children adopted before six months have a mean IQ of 103 and only 5% show disinhibited attachment. For those adopted after 24 months, mean IQ falls to 81 and disinhibited attachment rises to 46%. The researcher could conclude that longer exposure to institutional care is associated with greater developmental difficulties, while early adoption may protect against some of these effects.
This is consistent with AQA's emphasis on the importance of age of adoption and evidence that adverse effects can sometimes be overcome by adequate substitute care.
Question 9
Explain one strength and one limitation of the English and Romanian Adoptees project.
[6 marks]
reveal mark scheme and indicative content
Mark scheme
AO3 = 6
Award up to 3 marks for the strength and 3 marks for the limitation.
Indicative content
Strength
The ERA project was longitudinal, following children's development across many years.
The same children could be assessed repeatedly at different ages.
This allowed researchers to investigate recovery and whether effects of institutionalisation persisted over development.
Limitation
Conditions in Romanian institutions were exceptionally poor.
Children experienced severe deprivation, limited emotional care and high child-to-staff ratios.
Findings may therefore not generalise to children raised in less deprived institutional settings.
Alternatively credit:
Children were not randomly assigned to adoption conditions.
More sociable or healthier children might have been adopted earlier.
This creates possible confounding variables and makes causal conclusions difficult.
AQA explicitly credits both the unusually severe conditions in Romanian institutions as a generalisability issue and the absence of random allocation as a methodological limitation.
Example answer
One strength is that the ERA project was longitudinal. Researchers followed the same children over many years, allowing them to see whether early developmental problems persisted or whether children recovered after adoption.
One limitation is that the Romanian institutions involved exceptionally severe deprivation. These conditions may not represent institutional care more generally, so the findings may not generalise to children raised in institutions providing better-quality care.
Question 10
Discuss research into the effects of institutionalisation. Refer to the English and Romanian Adoptees project in your answer.
[16 marks]
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