Early Literature On Institutionalization
Research interest in the developmental consequences of extreme deprivation in infancy began in the early 1940s and 1950s with the work of researchers such as Rene Spitz (1945a; 1945b), William Goldfarb (1945; 1955), and John Bowlby (1953). Researchers became interested in this topic as a result of the high infant mortality rate in institutions from no known physical cause (Spitz 1945a; 1945b). Rene Spitz coined the term hospitalism to describe the physical and psychological characteristics of infants housed in institutions. He described conditions in the institution as dire. For example, children spent most of their days in cubicles with drab walls wherein sheets often hung over the sides of the infants' cribs, obstructing their view. Spitz suggested that this lack of stimulation explained the rapid deterioration in children's intellectual development. He found a drastic drop in infants' developmental quotients (DQ) over the first few months of life in institutions, and by the end of the second year Spitz reported that infants' DQs had dropped to a low of 45, where an average DQ is 100. Spitz concluded from his study that the damage inflicted on children during their first year of life was irreparable.
William Goldfarb (1955) studied fifteen children who had been reared in an institutions for the first three years of their lives and were subsequently placed in foster care. He compared these children to a group of children who had been in foster care since early infancy. Goldfarb found that the institution group, even in adolescence, were delayed intellectually relative to the foster care group, displayed significantly greater problem behaviors, were socially less mature and appeared emotionally removed in terms of their capacity to form relationships. Goldfarb claimed that early institutional rearing resulted in developmental deficits that were not overcome once children were placed in more stimulating and loving environments. He clearly stated that, given his findings, "babies should be kept out of institutions" (Goldfarb 1947, p. 457).
Clearly, this early work suggested that institutionalized children would be irreparably damaged as a result of such experience. This work has been criticized, however, largely because of methodological limitations (Longstreth 1981; Pinneau 1955). Critics reported that much of this early literature provided scant details regarding not only conditions in orphanages but also the assessments used to evaluate children. The number of children who were tested, the ages at which they were tested, and how often assessments were carried out was often unclear. These limitations made it difficult for later researchers to have strong confidence in the early data on institutionalized children.
Not all early studies, however, predicted such dire outcomes for institutionalized children. In many parts of the world researchers conducted intervention studies attempting to ascertain the kinds of interventions that might prevent poor developmental outcomes. Researchers began demonstrating that many of the cognitive and social deficits among these children were ameliorated after improvements in their environment (Broussard and DeCarie 1971; Dennis 1960; Hunt et al. 1976; see Rosenblith and Sims-Knight 1985 for a review; Skodak and Skeels 1945, 1949). Such interventions included placing infants as houseguests with older children (Skodak and Skeels 1945, 1949), improving child-to-caregiver ratios (Hunt et al. 1976), and early-adoption (Dennis 1973). All of these studies showed that simple changes, even within the orphanage environment (e.g., lowering child-caregiver ratios, providing perceptual stimulation), resulted in increases in children's intelligence quotient (IQ) scores. More importantly, this research showed that the effects of deprivation were not irreparable, although the length of institutionalization could make a difference in developmental outcomes.
Further support for the idea that institutionalized children were not destined for developmental compromise came from the work of Barbara Tizard and her colleagues with children who had spent the first two years of their lives in high-quality institutions in the United Kingdom (Tizard 1977). In these institutions child-to-caregivers ratios were 3:1 and the children experienced adequate social interaction, were taken on outings, and fed well. The caregivers, however, were discouraged from forming intimate relationships with the children. This was the major way in which orphanage children's lives differed from the lives of home-reared children. Tizard first assessed these children at two years of age and compared them to a sample of home-reared children from a working-class background. She found that at this time the institution children's IQs were slightly lower than the IQs of the working class children, and their language was slightly delayed, but their social development was normal. Tizard followed her sample of children up to sixteen years of age and found that the majority of parents claimed their children had developed a deep attachment toward them. These data were in contrast to Goldfarb's earlier work in which he claimed that previously institutionalized children would be unable to form subsequent attachment relationships. As noted previously, however, the children in Tizard's sample had not experienced the extreme deprivation that the children in Gold-farb's sample had. Therefore Tizard's more positive outcomes may be partially the result of less severe deprivation.
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