{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T19:53:02Z","timestamp":1789069982846,"version":"build-2803163510"},"reference-count":54,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,6,4]],"date-time":"2013-06-04T00:00:00Z","timestamp":1370304000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acamh.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Child Adoles Ment Health"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and scope<\/jats:title>\n                    <jats:p>The focus of this review is on institutionalized children, one of the most inequitably and severely treated groups of children. Although institutions vary, many share some common characteristics, including large groups, high children:caregiver ratios, many and changing caregivers and caregiver\u2010child interactions that lack warm, sensitive, contingently\u2010responsive and child\u2010directed behaviours. Resident children develop poorly physically, mentally and social\u2010emotionally, but those adopted from institutions display substantial catch\u2010up growth in many domains of development. If they are adopted at an early age, there have been no long\u2010term consequences of institutionalization yet measured; but if institutionalization is prolonged, they display higher rates of long\u2010term deficiencies and problems in many domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This review is based on a database search of the literature, focusing on the development of children while residents, and the development of post\u2010institutionalized children who have been transitioned from institutions to family care. It also draws on the reports and findings of the St. Petersburg\u2013\n                      <jats:styled-content style=\"fixed-case\">USA<\/jats:styled-content>\n                      Orphanage intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>A combination of theories pertaining to attachment (especially caregiver attachment to the infant\u2013toddler), chronic stress and genetics may explain these outcomes. It appears that caregiver\u2013child interactions are a major contributor to children's outcomes and interventions in institutions that improve such interactions produce substantial increases in children's physical, mental and social\u2010emotional development, including for children with disabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Deinstitutionalization and the creation of comprehensive professional child welfare systems emphasizing family care alternatives is a preferred goal, but this is likely to take many low\u2010resource countries decades to develop. If substantial numbers of children remain in institutions despite best efforts to find families for them, improving the institutions might help to provide all the children with the best care possible under the circumstances.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/camh.12025","type":"journal-article","created":{"date-parts":[[2013,6,4]],"date-time":"2013-06-04T02:10:46Z","timestamp":1370311846000},"page":"193-201","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Review: The consequences of early institutionalization: can institutions be improved? \u2013 should they?"],"prefix":"10.1111","volume":"18","author":[{"given":"Robert B.","family":"McCall","sequence":"first","affiliation":[{"name":"University of Pittsburgh Office of Child Development 400 Lexington street Pittsburgh PA 15208 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