By the time of their third birthday, many institutionalized children have had as many as 50 or more different caregivers ( The St. Although many institutions provide fairly clean environments, good medical care, and adequate nutrition, the rotating shifts and large number of caregivers (with a ratio of caregivers to children up to 1:12, Zeanah et al., 2005) limit the development of stable relationships between children and caregivers. We conclude that much further study is needed of the development of children’s attachments following adoption out of an institutional setting.ĭisturbances of attachment are among the most pronounced effects of institutionalized care dating from pioneering observations in the 1940s (e.g. We try to delineate infant and caregiver characteristics that are associated with secure attachment in institutional settings, given the inevitable fact that large numbers of infants worldwide are being raised, and will be raised, in contexts of institutional care. In the first case it may reflect a distortion or disruption of early attachment relationships, in the latter case it is likely to result from the lack of expected input in the form of contingent interactions with a stable caregiver in early life. We suggest that the etiology and function of indiscriminate friendly behavior may be different for institutionalized versus not-institutionalized children. Enhanced caregiving quality alone appears to be insufficient to diminish indiscriminate behavior, at least in some children, as evidenced by the persistence of indiscriminate behavior in children adopted out of institutions into adoptive families. In addition, this chapter discusses disinhibited or indiscriminately friendly behavior that is often seen in institutionalized children. Attachment has been assessed in the extreme environment of orphanages, but an important issue to be addressed in this chapter is whether in addition to standard assessment procedures, such as the Strange Situation, the lack of a specific attachment in some institutionalized children should be taken into account given the limits to the development of stable relationships in institutionalized care.

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