Summary Fifty‐one children who had spent their first 2–7 years in institutions, and who had been previously visited at the age of 41/2 years, were reassessed at the age of 8. Seven children had never left the institutions, the rest had been adopted, fostered, or restored to their biological parent. The children's behaviour during psychological testing was assessed, and information was obtained from their parents and teachers. According to the parents’ reports, the ex‐institutional children did not present any more problems than the comparison groups. The teachers, however, found many differences between the ex‐institutional children and their classmates. Despite very frequent staff changes, the institutional children were not retarded. The adopted children had the highest mean I. Q, and reading achievements; this finding appears to be related to the higher social class of the adoptive parents and the poorer emotional adjustment of the children restored to their biological families.

The adolescents described in the preceding companion article (J. Child Psychol. Psychiat. 30, 53-75, 1989) had experienced multiple changing caregivers until at least 2 years old. Such maternal deprivation did not necessarily prevent them forming strong and lasting attachments to parents once placed in families, but whether such attachments developed depended on the family environment, being much more common in adopted children than in those restored to a biological parent. Both these groups alike, however, were more oriented towards adult attention, and had more difficulties with peers and fewer close relationships than matched comparison adolescents, indicating some long term effects of their early institutional experience.

IT IS known to every student of child development that serious personality defects are said to follow early institutional rearing. The evidence on which this assertion is based is now very out-dated and in need of review. Most English residential nurseries for young children have enormously improved in response to criticisms and bear little resemblance to the grim institutions described by earlier writers. In the nurseries studied by the authors and colleagues the children lived in small mixed age groups, the staff-child ratio was high, the provision of books and toys generous and considerable efforts were made to broaden the children's experience. By the age of three the cognitive development of these children was at least average (Tizard et al., 1972). However, those aspects of the institutional environment which Bowlby (1951) considered most inimical to mental health remained unchanged; large numbers of different staff cared for the children and close personal relationships were discouraged. There is thus a need to assess (a) whether, despite the other improvements, serious personality disturbance results from this atypical rearing; (b) whether institutional rearing in the earliest years leaves persisting effects on the development of children who subsequently leave the institutions.Suitable children to study are not easy to find, because of the current reluctance to place infants in residential nurseries and the tendency to discharge them as soon as possible, even if only for short periods. Hence the great majority of children in institutions are admitted after the first year oflife, and/or have had several admissions or re-admissions. The undoubtedly high rate of psychiatric disturbance in older institutional children (Yule and Raynes, 1972;Wolkind, 1971) can therefore rarely be attributed to early institutional rearing patterns.This study concerns a group of 26 children aged 4| yr who had been continuously reared since early infancy in institutions which were in many respects of high quality. Their behaviour difficulties and affectional bonds with adults were contrasted with those of a group of London working-class children living at home. In order to assess how far the effects of early institutional care are reversible comparisons were also with 39 children either adopted or restored to their natural mothers after spending their first 2-4 yr in a residential nursery. The cognitive assessment of the children is reported elsewhere (Tizard and Rees, 1974). The mean Full-scale WIPPSI I.Q. (Wechsler, 1967) of all groups was at least 100.

A group of children raised in institutions until at least 2 years of age, then adopted or restored to a biological parent, have been followed longitudinally into mid-adolescence. No effect of early institutionalisation was found on IQ which depended largely on the type of family placement. Behavioural and emotional difficulties were more common in the ex-institutional group than in a matched comparison group, according to teacher questionnaires and interviews with the adolescents and their parents. The findings are discussed in relation to placement policy and the question of the long-term effects of early experience.