III. ATTACHMENT AND EMOTIONAL DEVELOPMENT IN INSTITUTIONAL CARE: CHARACTERISTICS AND CATCH UP

Disturbances of attachment are among the most pronounced effects of institutionalized care dating from pioneering observations in the 1940s (e.g. Burlingham & Freud, 1944). 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. By the time of their third birthday, many institutionalized children have had as many as 50 or more different caregivers (The St. Petersburg-USA Orphanage Research Team, 2008; see also Chapter 1), and they have often not been able to establish a personal relationship with any of them. Attachment theory has been developed on the basis of research in typical child rearing environments, specifically in particular families. In some cases the limits of the concept and theory of attachment seem to be reached, for example in pervasively disturbed clinical groups (Down’s Syndrome, Autism), in atypical care settings (e.g., the communal kibbutz), and -- as this chapter considers – children living in institutions where opportunities for developing a selective enduring attachment are extremely limited if not impossible. Yet when care approaches the average expectable environment or where children are gifted with a propensity to seek out and make use of care available, whether they be institutionalized children, children with Down syndrome or autism, or those living in a communal care setting, relationships akin to secure organized attachments are observed with concomitant links to better outcomes than for children without this fundamental social advantage. This chapter is organized around three conceptual and methodological issues: When attachment is assessed in children reared in extreme institutional environments as opposed to in children reared in families, is the same construct being measured, and do the problems encountered in applying the standard assessment procedures, such as the Strange Situation Procedure with the Ainsworth coding system (and the Cassidy-Marvin coding system for children over two years of age), force us to reconsider attachment measures and/or theory? What is the role of attachment and indiscriminate friendliness in adapting to the institutional environment of structural neglect? Specifically, what components in institutional care are responsible for attachment insecurity and disorganization? What caregiver and child characteristics are associated with secure attachment? How can institutional care be enhanced to promote more secure attachments? How fast do attachments develop after adoption or fostering, how can we assess progress and problems in the development of attachments, and what can parents and professionals do to facilitate post-institutionalized children in creating their secure base and regulating their emotions in acceptable ways? How might attachments emerging in the institutional setting help or hinder the adaptation of post-institutionalized children to a life in adoptive families or foster care? And last but not least, is complete recovery of attachment and emotion regulation possible, or do scars remain that limit recovery? An obvious critical variable is the age at which a child enters and leaves institutional care.