Romanian Orphan Studies and Institutional Care

The fall of the Romanian communist regime in 1989 revealed thousands of children living in severely deprived conditions in state-run orphanages. Many of these children had experienced extreme privation — they had never formed any attachment bond and had received minimal physical, emotional, or intellectual stimulation. The adoption of many of these children by families in the UK and other countries provided a unique natural experiment to investigate the effects of early institutional deprivation and the extent to which recovery is possible.

Key Definition: Institutional care refers to the raising of children in residential settings (such as orphanages) rather than in family homes. Institutionalised children often experience privation — the absence of any attachment bond — as well as physical and cognitive deprivation.

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The English and Romanian Adoptees (ERA) Study

The most important longitudinal study of Romanian orphans is Rutter's English and Romanian Adoptees (ERA) study. This began in 1998 and has followed the children into adulthood.

Procedure

Rutter and his colleagues (Rutter et al., 1998, 2011) studied 165 Romanian orphans who had been adopted by British families. These children were assessed at ages 4, 6, 11, 15, and 22 years. Their development was compared with a control group of 52 British children who had been adopted within the UK before the age of six months and who had not experienced institutional deprivation.

The Romanian children were divided into groups based on their age at adoption:

Group	Age at Adoption	Typical Condition on Arrival
Early adopted	Before 6 months	Variable — some showed signs of deprivation
Middle adopted	Between 6 months and 2 years	More signs of deprivation
Late adopted	After 2 years	Severe deprivation — many were underweight, cognitively delayed, and showed abnormal social behaviour

Conditions in Romanian Orphanages

The conditions in many Romanian orphanages were extremely poor:

• Physical deprivation: Children were malnourished, underweight, and physically underdeveloped.
• Cognitive deprivation: There was minimal stimulation — no toys, limited interaction with adults, and no educational activities.
• Emotional deprivation (privation): Staff-to-child ratios were very poor (often one carer for 30+ children). There was no opportunity to form a consistent attachment with any adult.
• Many children spent most of their time lying in cots with no human interaction.

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Key Findings of the ERA Study

Physical Development

On arrival in the UK, many Romanian adoptees were severely underweight and physically underdeveloped. However, most children showed remarkable physical catch-up:

• By age 4, the majority of early-adopted children had reached normal weight and height.
• Late-adopted children also showed physical improvement but were more likely to remain below average.

Cognitive Development

Age at Adoption	Average IQ on Arrival	Average IQ at Age 4	Average IQ at Age 11
Before 6 months	Variable	~102 (normal range)	~105
Between 6 months and 2 years	Below average	~86	~90
After 2 years	Often 50–60	~77	~80

• Children adopted before 6 months showed near-normal cognitive development by age 4 and maintained this into adolescence.
• Children adopted after 6 months showed significant improvement but often remained below the UK average.
• The later the adoption, the greater the cognitive deficit that persisted.

Social and Emotional Development

The most significant and persistent effects of institutional deprivation were in the domain of social and emotional development.

Disinhibited attachment was one of the most distinctive and concerning outcomes:

Key Definition: Disinhibited attachment is a pattern of behaviour in which a child shows indiscriminate friendliness towards strangers — they may approach, cling to, or be willing to go off with any adult, without the wariness that typically developing children show. It reflects a failure to form selective attachments.

Behaviour	Description
Indiscriminate friendliness	Willingness to approach and interact with any adult, including strangers
Lack of stranger anxiety	No wariness or caution around unfamiliar adults
Attention-seeking	Clingy, demanding behaviour with any available adult
Difficulty with peer relationships	Poor social skills and difficulty forming normal friendships

The ERA study found that disinhibited attachment was strongly associated with the duration of institutional care:

• Children adopted before 6 months showed rates of disinhibited attachment similar to non-deprived UK adoptees.
• Children adopted after 6 months were significantly more likely to show disinhibited attachment, and this persisted into adolescence and early adulthood.

Long-Term Outcomes (Sonuga-Barke et al., 2017)

Sonuga-Barke et al. (2017) followed up the ERA sample at age 22–25. They found:

1. Persistent deficits in some late-adopted individuals: higher rates of disinhibited attachment, emotional difficulties, ADHD-like symptoms, and cognitive impairment.
2. Significant recovery in many individuals, particularly those adopted early: by adulthood, many early-adopted children showed no significant differences from the UK control group.
3. Individual variation was substantial: some late-adopted children showed remarkable recovery, while others continued to experience significant difficulties. This challenges the idea that institutional deprivation inevitably causes permanent damage.

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Other Research on Institutional Care

Zeanah et al. (2005) — The Bucharest Early Intervention Project

Zeanah et al. (2005) compared 95 children (aged 12–31 months) who had spent most of their lives in Romanian institutions with 50 children who had never been institutionalised.