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1. J. Child Psychoi Psychiai. Vol. 30, No. 1, pp. 77-97, 1989. 0021-9630/89 $3.00 + 0.00 Primed in Great Britain. Pergamon Press pic © 1989 Association for Child…
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  • 1. J. Child Psychoi Psychiai. Vol. 30, No. 1, pp. 77-97, 1989. 0021-9630/89 $3.00 + 0.00 Primed in Great Britain. Pergamon Press pic © 1989 Association for Child Psychology and Psychiatry. Social and Family Relationships of Ex-Institutional Adolescents Jill Hodges* and Barbara Tizard^ Abstract—The adolescents described in the preceding companion article (/. 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. Keywords: Ex-institutional, adolescents, social relationships, adoption Introduction The classic studies of the effects of early institutionalisation saw the ability to make deep relationships as particularly endangered. The authors of these studies (Bowlby, 1951; Goldfarb, 1945) focused on maternal deprivation as the salient aspect of institutional care leading to this effect. Goldfarb (1944) found that children with early institutional experience were more often emotionally withdrawn in early adolescence, even after years in a foster family, than children who had been in families throughout. He saw their incapacity for deep human relationships as related to their early years when quot;strong anchors to specific adults were not establishedquot;. A follow-up study of institutional children has allowed us to look at some of these questions in detail. Our companion article (Hodges & Tizard, 1989) describes the background of the study, details of the groups studied, and reports the fmdings about I Q and adjustment, while here we shall consider family and non-familial social relationships. The children in our study spent their early years in residential nurseries. Because a large number of staff cared for them, and because there was an explicit policy against allowing too strong an attachment to develop between children and the nurses who looked after them, the children's attachment behaviour was very unusual. At the age of 2, they seemed to be attached to a large number of adults. That is, they would Accepted manuscript received 19 May 1988 •Department of Psychological Medicine, Hospital for Sick Children, Great Ormond Street, London, U.K. ^Thomas Coram Research Unit, 41 Brunswick Square, London, U.K. Requests for reprints to: Professor Barbara Tizard, Thomas Coram Research Unit, 41 Brunswick Square, London WCIN lAZ, U.K. 77
  • 2. 78 J. Hodges and B. Tizard run to be picked up when anyone familiar entered the room, and cry when they left. At the same time, they were more fearful of strangers than a home reared comparison group (Tizard & Tizard, 1971). By the age of 4, 70% of those still in institutional care were said by the staff quot;not to care deeply about anyonequot; (Tizard & Rees, 1975). However, this did not make the nursery children incapable of forming deep attachments to parents once placed in families, although whether they did so depended in part on the family setting which they entered. The great majority of adopted children, who went to parents who had very much wanted a child and who put a lot of time and energy into building up a relationship, formed strong attachments. This was true, though, of relatively fewer of the children restored to biological parents. Their parents were often ambivalent about having the child back and also more often had other children, and material difficulties, competing for their attention. However, although most formed attachments to their parents, the ex-institutional children showed a number of atypical features in their social development. At age 4, they were no longer shy of strangers. About a third of them were markedly attention seeking, and quot;over friendlyquot; to strangers, and a few were indiscriminately affectionate to all adults. Though these traits were shown by only a minority of the children, nonetheless they set the ex-institutional children off as a group from comparison children who had never been in institutional care. At the age 8, up to 6 years after leaving the institution, quot;over friendlinessquot; and a great desire for adult attention were still common among the ex-institutional group. This was despite the fact that most children, including several placed in families after the age of 4J/2, had formed strong attachments to their parents. As at age 4, such attachments were more commonly found between children and adoptive parents than between restored children and biological or step parents. At 8 years of age, as well as these peculiarities of social behaviour in relation to adults, the ex-institutional children tended to be quarrelsome and unpopular with other children. This had also been true of the institutionalised children at age 4 (Tizard & Rees, 1975). At the age of 2, the nursery children had been described as less willing to share than the home reared comparison group, and a number of them were competitive and quarrelsome. However, it was difficult to make a valid comparison of their peer behaviour, since the home reared 2-year-olds had very limited experience with peers. By the time the young people were 16, it seemed possible that these effects of early institutionalisation might have disappeared. If long term effects were still to be found, their form was not easy to predict. During adolescence peer group relationships increase in importance and family relationships change as adolescents begin to move towards eventual independence from their parents. Because of the ex-institutional group's earlier difficulties with peers, it seemed important to look at how they were negotiating this adolescent task, and how far they had become able to form close friendships and heterosexual relationships with peers, as well as deep attachments to parents. We felt we should investigate not simply whether peer relationships appeared satisfactory in general, but more specifically whether there were subtler ways in which the ex-institutional group differed from comparison adolescents. Accordingly, we explored the pattern of the adolescents' peer relationships, as well as whether any close friendships had developed, and how far peers had begun to replace parents as^
  • 3. 79 Social and family relationships of ex-institutional adolescents confidants and sources of support. As regards family relationships, besides investigating the adolescents' attachment and relationship to parents and siblings, we looked at how far they were still very involved with the family and how far they were taking steps towards independence. We also looked at the question of assimilation into the family; Raynor (1981) found that of the factors she explored, the one most closely linked to parental satisfaction was the parents' perception of their adopted child as being like them in some way, and that adoptees, too, were more satisfied when they could see themselves as like their families. We tried to find out how far the parents saw the adolescents as like other family members, as generally accepting the parents' values, and how like the parents both the parents and the adolescents thought the latter would be as adults. We also asked the adolescents about the extent to which they wanted to have a voice, and had one, in family decisions. Assessment Procedure The data were obtained during the assessment described in our companion article. Interviews were carried out with the adolescents and with their mothers. Occasionally fathers were also present. The adolescents also completed a self-report questionnaire on social difficulties (Lindsay & Lindsay, 1982). Their teachers completed a postal questionnaire, focusing on the adolescents' relationships with teachers and peers, and the Rutter quot; B quot; Scale. Results Though we regard percentages as somewhat incongruous with such srnall numbers, we include them where they facilitate comparison, as the groups differ in size. Relationships within the family Attachment to parents. We asked whether the mother felt that her 16-year-old was deeply attached to her now, and whether this had changed since childhood. Figure 1 shows the proportion of adopted, restored and comparison children said to be attached to their mother at ages 8 and 16, and also the proportion of those institutional children said to have a close attachment to an adult. As we have found when the children were aged 8, the great majority (17/21) of the adoptive mothers felt that their child was deeply attached to them, and this was true for all their comparisons. Of the four mothers who felt that their child was not closely attached to them, at 16, one had taken the same view when the child was 8. At 16, the parent-child relationship seemed mutually rejecting and hostile. The other three had described their 8-year- old children as closely attached, but now doubted the strength of their attachment at age 16. One of these mothers saw her son as definitely attached to his father, as at age 8, but was less certain of the strength of his attachment to her. The second boy's parents disagreed somewhat over his degree of attachment, his mother feeling he might be happy with anyone who offered him quot;basic security, affection, foodquot;.
  • 4. 80 J. Hodges and B. Tizard Percentage of children attached: 0 50 100 1 1 Comparison 1 1 Adopted 1 1 1 1 Restored 1 1 Institutional, 1 care 1 — Attachments at 8 years old Fig. 1. Attachment to mother at 16 and 8 years. his father seeing signs of deeper and more specific attachment. The parents now doubted how strongly he had been attached to them at 8 years old. The third was a child whose parents had had very mixed feelings about his placement with them. At age 8, although they had felt on balance that he was attached to them, they had had their doubts—quot;I wouldn't be surprised if one day when he was a teenager we woke up and he was gone.quot; At age 8, four adoptive mothers had felt that their child was not closely attached to them. Two of these adoptions subsequently broke down, the child being received into care. In the third, as described above, the mother still felt the 16-year-old's attachment to her, and to her husband, was doubtful. The fourth was a girl who, though not closely attached to her adoptive mother at age 8, had been very attached to her adoptive father. At 16, she was still very attached to her adoptive father, and her mother felt that her daughter had now become closely attached to her as well—a picture confirmed by the girl's comments. In contrast to the adopted adolescents, fewer restored 16-year-olds (five out of the nine on whom we had information) were said to be deeply attached to their mother. At 8 years old, six out of 13 restored children were described as not closely attached to their mother or stepmother. The mother of one of these refused to let us visit at 16, and a second mother would not be interviewed herself, although her 16-year-old was interviewed. Two of the others were still not seen as closely attached to the mother or stepmother (or to the father), while the remaining two were now said to be definitely attached to their mother or stepmother. Of the seven who were seen as closely attached at 8 years old, one was now in a secure unit and her mother was not seen, and another family refused our visit. Two adolescents were no longer described as closely attached to their mothers, and three (including the two singleton restored children) had remained attached.
  • 5. 81 Social and family relationships of ex-institutional adolescents We asked if the child was easy to love and whether the mother found any of her children easier to love than others. In the seven cases where mothers of restored adolescents also had other children, only one mother, but six of eight comparisons, felt they loved each child as much as the others. Five of the other six quot;restoredquot; mothers preferred a sibling to the restored child. Nine out of 14 adoptive parents, and 13 out of 16 of their comparisons, felt they loved their children equally; two comparison mothers preferred a sibling to the index child, as did three adoptive mothers. In one of the latter cases, the sibling was also adopted. Asked whether their child was fond of them in any different way as s/he had got older, or still in the same way as at age 8, more adoptive than quot;restoredquot; mothers saw their child as equally or more attached to them now. None of the adoptive mothers but three out of nine of the mothers of restored children felt their child was less attached to them now than had been the case at age 8 ( P < 0.01). One would, of course, expect developmental changes between ages 8 and 16; adoptive parents differed from their comparisons in that the latter were much likelier to see the child's attachment as being different, with age, than as having stayed the same or increased (P=0.01). None of the five adolescents whom we had seen in residential care aged 8 had a definite attachment to an adult at 16. Adopted adolescents were significantly more often said by their mothers to be attached to their father at age 16 than the restored group ( P < 0.01); four out of eight of the restored group were seen as definitely not attached, as compared to only one out of 20 of the adopted group. The restored group differed similarly from their comparisons. No adopted or comparison adolescents, but two out of five restored adolescents, were said to have become less attached to their father as they grew older. We asked the adolescents who would look after their parents if, as the latter got older, they needed help. Adopted and restored adolescents did not differ from their comparisons, the majority in all groups seeing themselves and their sibs contributing to the care of their parents. Relations with siblings. Table 1 shows that the comparison adolescents reported fewer marked problems with sibs than the ex-institutional group as a whole (P= 0.03), and the mothers confirmed this (P= 0.02). The restored group got on particularly badly with their siblings. This had also been true when they were aged 8. Five out of the nine who had siblings reported having marked difficulties with at least one brother or sister, and their mothers gave a similar picture. Though those adopted adolescents with siblings had fewer problems with them, the difference is not significant. The adopted group had more problems than their comparisons but not significantly so. Table 1. Relations with siblings 16-year-old interview Parents' interview No/slight Marked No/slight Marked difficulties difficulties difficulties difficulties Group 9 (75%) 3 (25%) Adopted 9 (64%) 5 (36%) 15(94%) 1 (6%) Their comparisons 14(88%) 2(13%) 4(44%) 5(56%) Restored 3(45%) 4(57%) 8 (100%) 0 Their comparisons 8 (100%) 0 13 (62%) 8 (38%) Ad. and Restd. 12 (57%) 9 (43%) 23 (96%) 1 (4%) All comparisons 22 (92%) 2 (8%)
  • 6. 82 J. Hodges and B. Tizard while the restored group and their mothers both reported significantly more problems than their comparisons [P=0.01 (16-year-olds), P=0.03 (parents)]. We asked the mothers of children who had sibs whether they felt the study child would remain in touch with their sibs when they had all grown up and left home. To this hypothetical question, none of the comparison mothers responded that the child would probably lose touch, but four of a total of 19 mothers of the ex-institutional group did—two out of 14 adopted and two out of five restored. Showing affection When the children were 8, we had found that adopted children, alongside those still in institutional care, were the most affectionate and cuddly, and restored children strikingly the least cuddly. When they were 16, we asked the mother if their son or daughter found it easy to be affectionate to them, for instance to give them a cuddle or a kiss (Table 2). Table 2. Shows physical affection to parents Their Their Adopted comparisons Restored comparisons Never or rarely 9 (41%) 5 (24%) 7 (70%) 1 (10%) Routine times only 1 (5%) 2 (10%) 3 (30%) 2 (20%) Some spontaneous quot;out of the bluequot; affection or very affectionate — a lot of cuddles 12 (55%) 14 (67%) 0 7 (70%) As they grew older, 10 of the 22 adopted children had become less demonstrative, and as a group they were not significantly more demonstratively affectionate at 16 than their matched comparisons; but the restored group were still strikingly less so—less than the adopted group (P<0.01) and less than their own matched comparisons ( P < 0.01). Seven out of 10 restored adolescents were said to show affection never or rarely, but only one comparison; seven out of 10 comparisons showed at least some spontaneous quot;out of the bluequot; affection, but not one of the restored group did. Unlike their comparisons and the adopted group, most restored adolescents were seen as less demonstrative than their siblings. Table 3. Mothers' physical affection to adolescent Their Their Adopted comparisons Restored comparisons No difficulty (in showing affection) 10 (46%) 11 (52%) 2 (22%) 3 (30%) Some difficuhy 6 (27%) 8 (38%) 2 (22%) 5 (50%) 6 (27%) Considerable difficulty 2 (10%) 5 (56%) 2 (20%) The finding that the adopted adolescents more readily showed affection to their parents than restored adolescents is paralleled by how readily the parents showed physical affection to the adolescent (Tables 3 and 4). There was a clear, though not statistically significant, tendency for adoptive parents to find it easier to show affection
  • 7. Social and family relationships of ex-institutional adolescents oo Table 4. Fathers' physical affection to adolescent Their Their Adopted comparisons Restored comparisons No difiicuhy ,,.„ s (in showing affection) 6(30%) 10(48%) 0 4(44% Some difficulty 8(40%) 5(24%) 2(29%) 3(33% Considerable difficulty 6(30%) 6 (2%) 5(71%) 2(22%) to their 16-year-old than parents of restored adolescents. This difference was especially marked as regards the fathers (at least as perceived by the mothers, who were usually our sources of information). Fathers of restored adolescents also showed affection less readily than their matched controls, although this comparison involves very small numbers. Fathers of restored children had also found it more difficult than adoptive fathers to show affection when the child was 8, according to report at 16. Similarity and assimilation The extent to which the adopted child is seen as resembling other family members has been considered (e.g. Raynor, 1981) an important element in parental satisfaction and the integration of the child into the family. We asked whether the adolescent quot;took afterquot; anyone in the family. Six out of 21 (29%) adoptive mothers said no, compared with three out of 20 (15%) comparisons. When asked this question, 13 out of 21 of the adoptive mothers reminded the interviewer in some way that their child was not biologically related to them, but eight of these also saw him/her as taking after someone in the family, and another three also saw resemblances but were more guarded, saying, for instance, that their child had quot;picked up mannerismsquot; from them. Most of the restored group and their comparisons were said to quot;take afterquot; someone in the family. We found no differences between ex-institutional groups and comparisons in how far the parents felt that their child's views, on fundamental issues, coincided with their ow
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