Social and Family Relationships of Ex-Institutional …...Social and family relationships of...

J. Child Psychoi Psychiai. Vol. 30, No. 1, pp. 77-97, 1989. 0021-9630/89 $3.00 + 0.00Primed in Great Britain. Pergamon Press pic

© 1989 Association for Child Psychology and Psychiatry.

Social and Family Relationships ofEx-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 2years old. Such maternal deprivation did not necessarily prevent them forming strong andlasting attachments to parents once placed in families, but whether such attachmentsdeveloped depended on the family environment, being much more common in adoptedchildren 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 fewerclose relationships than matched comparison adolescents, indicating some long term effectsof 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 makedeep relationships as particularly endangered. The authors of these studies (Bowlby,1951; Goldfarb, 1945) focused on maternal deprivation as the salient aspect ofinstitutional care leading to this effect. Goldfarb (1944) found that children with earlyinstitutional experience were more often emotionally withdrawn in early adolescence,even after years in a foster family, than children who had been in families throughout.He saw their incapacity for deep human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 yearswhen "strong anchors to specific adults were not established".

A follow-up study of institutional children has allowed us to look at some of thesequestions in detail. Our companion article (Hodges & Tizard, 1989) describes thebackground of the study, details of the groups studied, and reports the fmdings aboutIQ and adjustment, while here we shall consider family and non-familial socialrelationships.

The children in our study spent their early years in residential nurseries. Becausea large number of staff cared for them, and because there was an explicit policy againstallowing too strong an attachment to develop between children and the nurses wholooked after them, the children's attachment behaviour was very unusual. At the ageof 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

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 comparisongroup (Tizard & Tizard, 1971). By the age of 4, 70% of those still in institutional carewere said by the staff "not to care deeply about anyone" (Tizard & Rees, 1975).However, this did not make the nursery children incapable of forming deep attachmentsto parents once placed in families, although whether they did so depended in parton 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 timeand energy into building up a relationship, formed strong attachments. This wastrue, though, of relatively fewer of the children restored to biological parents. Theirparents were often ambivalent about having the child back and also more often hadother children, and material difficulties, competing for their attention.

However, although most formed attachments to their parents, the ex-institutionalchildren showed a number of atypical features in their social development. At age4, they were no longer shy of strangers. About a third of them were markedly attentionseeking, and "over friendly" to strangers, and a few were indiscriminately affectionateto 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 comparisonchildren who had never been in institutional care.

At the age 8, up to 6 years after leaving the institution, "over friendliness" anda 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 afterthe age of 4J/2, had formed strong attachments to their parents. As at age 4, suchattachments were more commonly found between children and adoptive parents thanbetween restored children and biological or step parents.

At 8 years of age, as well as these peculiarities of social behaviour in relation toadults, the ex-institutional children tended to be quarrelsome and unpopular withother 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 willingto share than the home reared comparison group, and a number of them werecompetitive and quarrelsome. However, it was difficult to make a valid comparisonof their peer behaviour, since the home reared 2-year-olds had very limited experiencewith peers.

By the time the young people were 16, it seemed possible that these effects of earlyinstitutionalisation might have disappeared. If long term effects were still to be found,their form was not easy to predict. During adolescence peer group relationships increasein importance and family relationships change as adolescents begin to move towardseventual independence from their parents. Because of the ex-institutional group'searlier difficulties with peers, it seemed important to look at how they were negotiatingthis adolescent task, and how far they had become able to form close friendships andheterosexual relationships with peers, as well as deep attachments to parents.

We felt we should investigate not simply whether peer relationships appearedsatisfactory in general, but more specifically whether there were subtler ways in whichthe ex-institutional group differed from comparison adolescents. Accordingly, weexplored the pattern of the adolescents' peer relationships, as well as whether anyclose friendships had developed, and how far peers had begun to replace parents as

Social and family relationships of ex-institutional adolescents 79

confidants and sources of support. As regards family relationships, besides investigatingthe adolescents' attachment and relationship to parents and siblings, we looked athow far they were still very involved with the family and how far they were takingsteps towards independence. We also looked at the question of assimilation into thefamily; Raynor (1981) found that of the factors she explored, the one most closelylinked to parental satisfaction was the parents' perception of their adopted child asbeing like them in some way, and that adoptees, too, were more satisfied when theycould see themselves as like their families. We tried to find out how far the parentssaw 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 thelatter would be as adults. We also asked the adolescents about the extent to whichthey 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. Occasionallyfathers were also present. The adolescents also completed a self-report questionnaireon social difficulties (Lindsay & Lindsay, 1982). Their teachers completed a postalquestionnaire, focusing on the adolescents' relationships with teachers and peers, andthe Rutter " B " 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 familyAttachment 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. Figure1 shows the proportion of adopted, restored and comparison children said to be attachedto their mother at ages 8 and 16, and also the proportion of those institutional childrensaid to have a close attachment to an adult.

As we have found when the children were aged 8, the great majority (17/21) ofthe adoptive mothers felt that their child was deeply attached to them, and this wastrue 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 relationshipseemed mutually rejecting and hostile. The other three had described their 8-year-old children as closely attached, but now doubted the strength of their attachmentat age 16. One of these mothers saw her son as definitely attached to his father, asat age 8, but was less certain of the strength of his attachment to her. The secondboy's parents disagreed somewhat over his degree of attachment, his mother feelinghe might be happy with anyone who offered him "basic security, affection, food".


Percentage of children attached:

0 50 100

1

11

111

111

111

Comparison

Adopted

Restored

Institutional,care

— Attachments at8 years old

Fig. 1. Attachment to mother at 16 and 8 years.

his father seeing signs of deeper and more specific attachment. The parents nowdoubted how strongly he had been attached to them at 8 years old. The third wasa 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 hadhad their doubts—"I wouldn't be surprised if one day when he was a teenager wewoke up and he was gone."

At age 8, four adoptive mothers had felt that their child was not closely attachedto them. Two of these adoptions subsequently broke down, the child being receivedinto care. In the third, as described above, the mother still felt the 16-year-old'sattachment 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 attachedto her adoptive father. At 16, she was still very attached to her adoptive father, andher mother felt that her daughter had now become closely attached to her as well—apicture confirmed by the girl's comments.

In contrast to the adopted adolescents, fewer restored 16-year-olds (five out of thenine 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 attachedto their mother or stepmother. The mother of one of these refused to let us visit at16, and a second mother would not be interviewed herself, although her 16-year-oldwas interviewed. Two of the others were still not seen as closely attached to the motheror stepmother (or to the father), while the remaining two were now said to be definitelyattached to their mother or stepmother. Of the seven who were seen as closely attachedat 8 years old, one was now in a secure unit and her mother was not seen, and anotherfamily refused our visit. Two adolescents were no longer described as closely attachedto their mothers, and three (including the two singleton restored children) had remainedattached.


We asked if the child was easy to love and whether the mother found any of herchildren easier to love than others. In the seven cases where mothers of restoredadolescents 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 "restored"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; twocomparison mothers preferred a sibling to the index child, as did three adoptivemothers. 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 gotolder, or still in the same way as at age 8, more adoptive than "restored" motherssaw their child as equally or more attached to them now. None of the adoptive mothersbut three out of nine of the mothers of restored children felt their child was less attachedto them now than had been the case at age 8 (P< 0.01). One would, of course, expectdevelopmental changes between ages 8 and 16; adoptive parents differed from theircomparisons in that the latter were much likelier to see the child's attachment as beingdifferent, 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 adefinite attachment to an adult at 16.

Adopted adolescents were significantly more often said by their mothers to beattached to their father at age 16 than the restored group (P< 0.01); four out of eightof the restored group were seen as definitely not attached, as compared to only oneout of 20 of the adopted group. The restored group differed similarly from theircomparisons. No adopted or comparison adolescents, but two out of five restoredadolescents, 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 gotolder, they needed help. Adopted and restored adolescents did not differ from theircomparisons, the majority in all groups seeing themselves and their sibs contributingto the care of their parents.

Relations with siblings. Table 1 shows that the comparison adolescents reported fewermarked problems with sibs than the ex-institutional group as a whole (P= 0.03), andthe mothers confirmed this (P= 0.02). The restored group got on particularly badlywith their siblings. This had also been true when they were aged 8. Five out of thenine who had siblings reported having marked difficulties with at least one brotheror sister, and their mothers gave a similar picture. Though those adopted adolescentswith siblings had fewer problems with them, the difference is not significant. Theadopted group had more problems than their comparisons but not significantly so.

Table 1. Relations with siblings

16-year-old interviewNo/slight Markeddifficulties difficulties Group

Parents' interviewNo/slight Markeddifficulties difficulties

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%)


while the restored group and their mothers both reported significantly more problemsthan 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 childwould 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 thechild would probably lose touch, but four of a total of 19 mothers of the ex-institutionalgroup 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 thosestill in institutional care, were the most affectionate and cuddly, and restored childrenstrikingly the least cuddly. When they were 16, we asked the mother if their son ordaughter found it easy to be affectionate to them, for instance to give them a cuddleor a kiss (Table 2).

Table 2. Shows physical affection to parents

Never or rarelyRoutine times onlySome spontaneous "out of the blue"

affection or very affectionate —a lot of cuddles

Adopted

9 (41%)1 (5%)

12 (55%)

Theircomparisons

5 (24%)2 (10%)

14 (67%)

Restored

7 (70%)3 (30%)

0

Theircomparisons

1 (10%)2 (20%)

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 16than their matched comparisons; but the restored group were still strikingly less so—lessthan 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 neveror rarely, but only one comparison; seven out of 10 comparisons showed at least somespontaneous "out of the blue" affection, but not one of the restored group did. Unliketheir comparisons and the adopted group, most restored adolescents were seen asless demonstrative than their siblings.

Table 3.

No difficulty(in showing affection)

Some difficuhyConsiderable difficulty

Mothers' physical

Adopted

10 (46%)6 (27%)6 (27%)

affection to adolescent

Theircomparisons Restored

11 (52%)8 (38%)2 (10%)

2 (22%)2 (22%)5 (56%)

Theircomparisons

3 (30%)5 (50%)2 (20%)

The finding that the adopted adolescents more readily showed affection to theirparents than restored adolescents is paralleled by how readily the parents showedphysical affection to the adolescent (Tables 3 and 4). There was a clear, though notstatistically significant, tendency for adoptive parents to find it easier to show affection

Social and family relationships of ex-institutional adolescents oo

Table 4. Fathers' physical affection to adolescent

Their TheirAdopted 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 especiallymarked as regards the fathers (at least as perceived by the mothers, who were usuallyour sources of information). Fathers of restored adolescents also showed affection lessreadily than their matched controls, although this comparison involves very smallnumbers. Fathers of restored children had also found it more difficult than adoptivefathers to show affection when the child was 8, according to report at 16.

Similarity and assimilationThe 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 satisfactionand the integration of the child into the family. We asked whether the adolescent"took after" 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, 13out of 21 of the adoptive mothers reminded the interviewer in some way that theirchild was not biologically related to them, but eight of these also saw him/her as takingafter someone in the family, and another three also saw resemblances but were moreguarded, saying, for instance, that their child had "picked up mannerisms" fromthem. Most of the restored group and their comparisons were said to "take after"someone in the family.

We found no differences between ex-institutional groups and comparisons in howfar the parents felt that their child's views, on fundamental issues, coincided withtheir own, or in how far they felt the child would, as an adult, resemble them inattitudes, personality or lifestyle. In these respects, the adopted and restored adolescentswere seen as just as much of a piece with their families as other adolescents.

The great majority of adopted adolescents did not refer to being biologicallyunrelated when asked about possible similarities between themselves as adults andtheir parents. About a half of both adopted and restored adolescents thought theywould be like, and a half unlike, their parents. While around 10% thought they wouldbe "very like", around 20% of the adopted and 35% of the restored group thoughtthey would be "very unlike". Study adolescents opted for these extreme categoriessignificantly more often than their matched comparisons (P= 0.03). When we enquiredabout similarity to mother and to father separately, we found this pattern morepronounced in relation to mother than to father, significandy so in the case of restoredadolescents (P=0.02).

Confiding and supportAs Table 5 shows, a majority of all the groups of mothers believed they knew when

their son or daughter was upset; and the adolescents felt the same. Though "restored"

84 J. Hodges and B, Tizard

mothers were less certain than others, their children indicated no such doubts.According to the mothers, around 70% of the adolescents would ask them for supportor advice over some, but not all, problems, and over half of the adolescents themselvesfelt that they would do so. We enquired of the mothers whether the adolescents couldconfide in a parent if anxious. There was no indication that the study adolescentswere less able to turn to their parents than the comparisons who had always beenin their families.

Table 5 . Issues relating to closeness with parent, confiding and support

TheirAdopted comparisons Restored

Theircomparisons

Mother believes adolescent wouldconfide over at least someanxieties

Mother feels she would reaJise ifadolescent upset

Adolescent feels parent wouldrealise if upset, at least sometimes

Parent feels adolescent would askfor support

Adolescent feels s/he could askfor support

17

16

13

13

11

(85%)

(84%)

(65%)

(72%)

(58%)

19

16

15

14

12

(91%)

(76%)

(71%)

(67%)

(57%)

8

5

8

7

5

(80%)

(56%)

(80%)

(78%)

(51%)

8

8

6

7

6

(80%)

(80%)

(60%)

(70%)

(64%)

We asked the mothers if their 16-year-old would confide in anyone if they feltdepressed or miserable. Table 6 again indicates that the adopted and restored groupsdid not differ greatly from their comparison groups in the proportion who would turnto a parent. The table suggests that a higher proportion of adopted and restoredadolescents than their comparisons would not confide in anyone, and that fewer, atleast of the adoptees, would confide in a peer. We shall return to this point in discussingpeer relations. Adopted and restored groups did not differ significantly.

Table 6. Parents' views: who would the adolescent confide in if miserable?

Their TheirConfide in Adopted comparisons Restored comparisons

NobodyParentOther family memberOutside adultPeerN/A—never very unhappy

5120012

(25%)(60%)

(5%)(10%)

191062

(5%)(47%)(5%)

(31%)(11%)

230130

(22%)(33%)

(11%)(33%)

041041

(40%)(10%)

(40%)(10%)

We also asked the 16-year-olds who, if anyone, they would confide in if worriedabout a range of concerns. These were: if they felt very miserable; if anxious abouttheir appearance; if worried that something was wrong with them; if worried aboutnot being liked by the opposite sex; if they felt something was wrong with their body;if they were in severe financial difficulty; if they were unhappy over their girlfriendor boyfriend; if they needed to know about contraception; and if they became pregnant,or made someone pregnant, without wishing to.

Social and family relationships of ex-institutional adolescents 8 5

Different anxieties tended to propel the adolescents towards different confidants.For instance, 75-80% in all groups would turn to a parent over fmancial difficulty.Only one ex-institutioned adolescent and two comparisons, though, would confidein a parent if worried about not being liked by the opposite sex. This was an anxietywhich adolescents kept to themselves, disclaimed, or shared with a peer, the lattermore so for the comparisons than for the ex-institutional group. We pooled theresponses to this range of questions to provide a composite picture of who theadolescents would turn to when anxious (Table 7).

Table 7. Adolescents' views: who would they confide in? (Based on a range of 9 questions)

Their TheirConfide in Adopted comparisons Restored comparisons

NobodyParentOther family memberOutside adultPeerN/A—not worried(Total number of responses)

28%44%)

2%6%

16%3 %

(177)

17%39%

5%5%

30%4%

(191)

23%4 3 %

4 %8%

17%5%

(96)

22%3 5 %

1%6%

3 3 %3 %

(89)

Again, the adopted and restored adolescents were at least as likely to turn to parentsas comparisons who had always lived in their families. They appeared less likely thancomparisons to turn to their peers, and we shall return to this point.

We asked the adolescents who they thought knew them best as a person, and whothey would want to tell first if they had good news. About a half of the adopted andrestored adolescents saw their parents in these roles, and they did not differ significantlyfrom their comparisons.

Disagreements over control and disciplineAccording to both the adolescents and their mothers, disagreements over the

adolescent's style of dress or hairstyle were very rare in all groups—parents eitherapproved of their child's appearance, or at worst "put up with it because it's whathe wants.'' Disagreement over activities—staying out in the evening, getting homeworkdone, helping round the house—or about pocket money was significantly less frequentin adoptive families than in their comparisons, according to the parent (P< 0.01).However, when the 16-year-olds were interviewed, comparison adolescents reportedfewer rows than ex-institutional adolescents, especially so in the the case of the restoredgroup (^< 0.02). The data are summarised in Table 8.

Like the mothers, the adolescents generally described few arguments; over halfof the ex-institutional adolescents recalled no rows or only one in the month priorto interview, though two adopted adolescents described arguments occurring at leastonce in a week, and two restored adolescents described almost daily rows.

Roughly a third of the study 16-year-olds saw their parents as less strict than average,another third saw them as about average, and a third thought they were stricter inat least some ways. They did not differ significantly from their comparison groups.

As regards their attitude to parental rules and level of control, it is perhapsunsurprising that no 16-year-old felt there was too little control. Thirteen out of 19


Table 8. Disagreements over child

Adolescents' interview: Altercations in last month

0 1 2/3

8 (44%)13 (62%)4 (44%)9 (90%)

Parents' interview: Altercations

0-215 (79%)6 (29%)4 (50%)5 (50%)

4 (22%)1 (5%)1 (11%)1 (10%)

4 (22%)3 (14%)2 (22%)0

in last 3 monthsWeekly or

3-11 more often

2 (11%)3 (14%)1 (13%)3 (30%)

2 (11%)12 (57%)3 (38%)2 (20%)

's activities

Weekly ormore often

2 (11%)4 (19%)2 (22%)0

AdoptedTheir comparisonsRestoredTheir comparisons


adopted adolescents felt the level of control was about right, and they did not differfrom their comparisons. Six out of 11 restored adolescents felt the same, but five felttheir parents were too strict in at least some areas. This represents significantly moredissatisfaction than among their comparisons (P=0.05).

Involvement in the familyWe asked how much the 16-year-old spent time with the family as opposed, for

instance, to staying out of the house a lot or withdrawing to his or her room for longperiods. The adoptive mothers saw their 16-year-old as more involved in the familythan did mothers of restored adolescents, but neither group differed significantly fromtheir matched comparisons.

Table 9. Adolescent's involvement in family activities (parent'sinterview)


Very muchinvolved

5 (28%)5 (24%)1 (11%)0

Sometimeswithdraws,

appropriately

11 (61%)12 (57%)4 (44%)8 (80%)

Withdrawsconsiderably

2 (11%)4 (19%)4 (44%)2 (20%)

According to the ex-institutional 16-year-olds, about 40% of them very rarely wentout together with parents, and the adopted and restored groups did not differ fromeach other. Comparison adolescents went out together with their parents more thanthe ex-institutional adolescents (P< 0.01). This was true for both the adopted andthe restored groups, especially so for the latter, although separately the differencesbetween these groups and their comparisons were not significant.

Most 16-year-olds said they felt consulted "enough" about family decisions; buthow much is "enough" depends of course on how much the adolescent wants to beconsulted, and adopted adolescents wanted more consultation than restored ones—14out of 19 adopted adolescents, versus two out of nine restored, definitely wanted to


Table 10. Going out with parents (adolescents' interview)


No/veryrarely

8 (42%)4 (19%)4 (50%)1 (10%)

Yes, not inlast month

3 (16%)4 (19%)2 (25%)2 (20%)

In lastmonth, less

/ than weekly

5 (26%)12 (57%)1 (13%)7 (70%)

At leastI/week in

last month

3 (16%)1 (5%)1 (13%)0

One restored adolescent had been living away from his parents over the past month.

be consulted (P=0.01). Only one out of 20 adopted, but four out of 10 restoredadolescents, maintained that they definitely did not want to be consulted about decisionslike where the family should go for an outing or a holiday. Comparison adolescentswanted even more definitely to be consulted; the difference was not significant forthe adopted group and their comparisons, but was very marked for the restored group.Two out of nine of them, but seven out of 10 comparisons, definitely wanted to beconsulted (P=0.04).

Peer relationshipsOverall ratings. On the basis of the account given by the mothers in answers to five

open-ended exploratory questions, plus questions about specific difficulties, a ratingwas made of the 16-year-olds' peer relationships over the last year. Another ratingwas made on the basis of the interview with the 16-year-olds, who also completeda 46-item self-report questionnaire on social difficulty (Lindsay & Lindsay, i982).The questionnaire sent to teachers also asked them to rate whether, in comparisonto classmates, the adolescents were more popular than average with peers, aboutaverage, or less popular. We dichotomised the rating scales from the parents' and16-year-olds' interviews to compare the proportion of adolescents with average andbetter-than-average peer relationships with the proportion who had some significantproblems or worse. The adopted group did not differ from the restored, but as a groupthe ex-institutional adolescents were more often rated as having difficulty in theirpeer relationships than their matched comparisons, both according to the mother'sinterview and according to the 16-year-old's interview. Rather fewer 16-year-oldswere seen as experiencing difficulties on the basis of their own account of their peerrelations (12 out of 31 of the ex-institutional group and four out of 31 of their matchedcomparisons) {P< 0.02) than on the basis of their mothers' perception (17 out of 31of the ex-institutional group and seven out of 31 comparisons) {P< 0.02).

No significant differences between groups were apparent on the self-report socialdifficulty questionnaire as regards overall problems or problems specifically with peers.

The teachers' assessments also indicated that the adopted and restored adolescentsdid not differ from each other, but the ex-institutional children did differ as a groupfrom their matched comparisons (Table 11). Considerably more ex-institutionaladolescents were rated "less popular than average with peers" although slightly morewere also rated as "more popular". There is a similar but not statistically significantdifference between the ex-institutional group and their school comparisons. Theteacher's questionnaire also indicated that the ex-institutioneJ group tended significantlymore often then their matched comparisons to be left till near the end when their

J. Hodges and B. Tizard

Table 11. Teachers' assessment of popularity with peers

Ex-inst.Matched

compsSchool

comps

Less popularthan average

12 (39%)

4(15%)

6(21%)

Average

12 (39%)

20 (74%)

18 (64%)

More popularthan average

7 (23%)

3 (11%)

4 (14%)

Total

31

27

28

(Ex-inst. vs matched comparisons P < 0.025)

classmates were choosing teams or groups, or to be objected to as partners if pairedwith classmates by the teacher for a task or activity (P=0.04).

Specific difficulties with peer relations. Given that peer relationships were more commonlyrated as poor among the ex-institutional adolescents, the next question is whetherparticular difficulties can be identified which led to these poorer overall ratings. Wefound few indicators by asking parents about specific difficulties. One difference whichdid emerge between ex-institutional and matched comparison groups was that unlikeany of the comparisons, six out of 30 ex-institutional adolescents were definitely saidto be "friendly with anyone who's friendly towards him/her" in relation to peers,as opposed to "choosing his/her friends", and another seven parents were uncertainif this was so (Kendall's tau C= -0.4333, P < 0.001).

We found no significant differences between groups in how often they had seenfriends over the previous week, how many different friends they had seen, or thenumber of visits to or from friends. There were no differences either in contacts withopposite sex friends or in whether or not the 16-year-old currently had a boy- orgirlfriend. According to the parents, 30% of the ex-institutional adolescents and 24%of comparisons definitely had a current boy- or girlfriend; similar figures, about 5%higher, emerged from interviews with the 16-year-olds themselves. Ex-institutionaladolescents reported themselves less often than their matched comparisons as belongingto a "crowd" of young people who generally went around together (P< 0.02). Thisdifference was more marked between the adopted group and their matched comparisonsthan between the restored group and theirs, and was statistically significant only inthe former (P< 0.01).

The Rutter " B " scale and our teachers' questionnaires gave some indications ofspecific kinds of peer difficulties. Teachers rated the ex-institutional adolescentssignificantly more often as quarrelsome (Kendalls tau C= 0.28, P= 0.01), and as lessoften liked by other children (tau C = 0.21, P<0.05) , as against their schoolcomparisons, and also as against their matched comparisons (tau C = 0.35, P < 0.002and tau C = 0.28, P < 0.02, respectively). Teachers zdso saw the ex-institutional groupas bullying other children more than the matched comparison group (tau C = 0.24,P<0.01).

Special friends. One major dimension of difference emerged when we asked whetherthe adolescent had a special friend of the same sex. According to the mothers (Fig.2a), the ex-institutional adolescents were markedly less likely to have a definite special


friend than their comparisons {P< 0.002). Eleven out of 31 of the ex-institutionaladolescents and 24 out of 31 of their matched comparisons definitely had a specizilfriend. Adopted and restored groups each differed significantly from their respectivematched comparison groups when compared separately (^=0.04 and P=0.02,respectively) but they did not differ from each other. When the 16-year-olds wereinterviewed, the same pattern emerged but to a less marked extent (Fig. 2b). Abouthalf of them felt definitely that they had a special friend. They did not differ significandyfrom their comparisons, although more comparison adolescents felt they definitelyhad a special friend, and more ex-institutional adolescents felt they definitely did not.

I I Adopted and restored (n = 3l)

I I Comparison adoLescents (n= 31)

20

•S 15

10

25 r

20

15

(p<0.003)

No special friend ordoubtful

Definite speciolfriend

(a) According to parents

(n.s)

No special friend ordoubtful

Definite specialfriend

(b) According to adolescents

Fig. 2. Number of adolescents with special same-sex friend.

One way in which a friendship can be defined as "special" is in its degree ofcloseness, and one measure of this is how readily the adolescent confides in the friend.As described above, we found that ex-institutional adolescents were less likely to confidein peers thcin their matched comparisons were. As indicated earlier (Table 7), 16-17%of ex-institutional adolescents, but 30-33% of their matched comparisons, said theywould confide in peers, when we enquired about a range of nine issues. Taking theseissues individually, ex-institutional adolescents were significantly less likely than their

90 J- Hodges and B. Tizard

comparisons to turn to peers for the examples of feeling miserable or unhappy (13%of ex-institutional adolescents and 43% of comparisons, P< 0.01), being worried thatsomething was wrong with them (3% of ex-institutional adolescents and 19% ofcomparisons, P<0.05), and being concerned about contraception (14% of ex-institutional and 39% of comparisons, P<0.04).

Thus in respect of confiding, the ex-institutional adolescents did not look to theirpeer group for support to the same extent as the comparison adolescents. Since theex-institutional group were less likely to have a special friend, the question whicharises is whether comparison adolescents confide more in peers because, as a group,more have special friends in whom to confide.

If this were so, no differences between ex-institutional and comparison groups shouldbe apparent if we look only at those adolescents who did have a definite special friend.However, this was not the case; taking first the adolescents said by their parents tohave a definite special friend, a significantly greater proportion of comparison ratherthan ex-institutional adolescents said that they turned or would turn to peers if feelingmiserable, instead of saying nothing or turning to someone other than a peer{P< 0.02). This pattern was consistent for eight of the nine situations we gave asinstances. Taking all those adolescents who described themselves as having a specialfriend, comparisons would turn more to peers than the ex-institutional children inseven of the nine instances, significantly more so if they felt miserable {P< 0.002)or were concerned about contraception (/ '<0.05).

The questionnaire to teachers asked whether or not the 16-year-old had one ortwo particular friends. At this level, teachers are less likely to know than at primarylevel, and indeed, between 15% and 20% of teachers did not respond to this questionor indicated that they did not know. Of those for whom answers were given, themajority of adolescents were reported to have such a friend, and there were nosignificant differences between the ex-institutional and comparison groups.

Relationships between attachment and peer relationsThe ratings of the 16-year-old's current peer relationships were not related to

attachment to the mother at 16. However, ex-institutional children who at eight hadbeen described as closely attached to their mothers had better peer relationships at16 than those who had not been attached at eight, significantly so according to thepeer rating from the interview with the 16-year-old (tau C = 0.32, P< 0.04), but notsignificantly so according to the rating from the parents' interview.

One aspect of peer relationships at 16 was related to attachment to mother. Sixteen-year-olds who were closely attached to the mother at 16 were less likely to be seenas "friendly to anyone who's friendly towards him" as far as peers were concerned(tau C= .247, P< 0.04). Close attachment at 8 was similarly related (tau C= .504,P< .002)

Relationships between current and earlier peer relationsWhether the adolescent had a same-sex special friend seem to bear no overall

relationship to the pattern of peer relationships at age 8.Young people who at age 8 had been seen as "solitary through choice'' were enjoying

generally good peer relationships at 16, according to the ratings from both the 16-year-olds' and the parents' interviews. Those who at 8 had seemed to want to be friends


but whom other children would not befriend had rather more difficulties at 16. Theseven young people seen as having a small group of special friends at age 8 weredoing less well, especially according to the parents. Three of this latter group werealso among the five adopted and restored adolescents described as friendly towardsany peers who were friendly towards them. The one child described at age 8 as havinga large diffuse group of friends had very severe difficulties in peer relationships at 16.

Overfriendly behaviourAt age 4, indiscriminately friendly behaviour towards adults had characterised the

behaviour of some institutional children. This was much attenuated by age 8, but stillpresent in some children. Because the natural history of this "overfriendliness" isof interest, we looked at all the young people rated "overfriendly" at age 8 for whomwe had information at 16—a total of 11—to see what had happened to thischaracteristic. We asked the parents of the 16-year-olds to describe how their childwould usually react if an adult whom they did not know came to the house—someonewhom the parents might know, but whom their child had not met before. Of the11 young people who had been rated "overfriendly" at the age of 8, two were stillseen as exceptionally friendly and keen to get attention from an adult at 16, and sowere two who had not been seen as "overfriendly" at age 8. However, their behaviourwas socially acceptable and did not worry the parents as it usually had done at age8. Of the remaining nine adolescents who had been "overfriendly" 8-year-olds, fivewere described as being neither shy nor overfriendly, but polite or friendly. Two weresaid to be "not interested", tending to ignore the stranger, though not especiallyshy. Two more were now described as being shy or reserved with a stranger andtaking a long while to become friendly. All in all we found no relationship betweenwhether or not the children were "overfriendly" at age 8, and how friendly theywere towards strangers at 16.

However, there was a clear tendency for "overfriendliness" to adults at age 8 tobe associated with a rating of behaviour towards peers at 16, based on the parents'judgement, that the 16-year-old was friendly with any peer who was friendly towardsthem, rather than choosing their friends (Table 12). One should note that this latterfeature of behaviour, more common in the ex-institutional group, was not in generalseen as a problem by the parents.

Table 12. Relationships between indiscriminate overfriendliness towardsadults at 8 and selectivity towards peers at 16

Not overfriendlyto adults at 8

Overfriendly toadults at 8

All ex-institutional adolescentsGenerally

chooses friendsat 16

16 (70%)

2 (20%)

Ratingdubious

6 (26%)

3 (30%)

Friendlyto anypeer

1 (4%)

5 (50%)

Total

23

10

(Kendall's tau C = 0.5179, P < 0.002)


Relationships to teachersAs 8-year-olds, the ex-institutional children were seen by their teachers as trying

more than most children to get attention both from their teachers and from a strangerentering the classroom. They differed both from their classmate comparisons andfrom the then comparison group.

According to the teachers, the ex-institutional group at 16 was still seen as "tryingto get a lot of attention from adults" more often than the school comparison group(P< 0.05), but not significantly more than their matched comparisons. About halfthe ex-institutional adolescents were also said to have marked likes or dislikes ofparticular teachers, compared to about 20% of the school comparisons {P< 0.02),and 10% of the matched comparisons (P< 0.001). Adult approval was seen asespecially important for half the ex-institutional adolescents and under a fifth of theirmatched comparisons (P<0.03). As regards their relationships with teachers, theadopted and restored groups differed significandy only in how often they were seenas aggressive; the restored 16-year-olds were more often aggressive than the adopted(P< 0.03), and than either their matched comparisons (P< 0.01), or their schoolcomparisons (P<0.04).

An ex-institutional "syndrome"?The preceding sections indicate that as a group the ex-institutional adolescents show

a pattern of social relationships which differs from that of matched comparisons. Theyare: (1) more often adult-oriented; (2) more likely to have difficulties in peer relations;(3) less likely to have a special friend; (4) less likely to turn to peers for emotionalsupport if anxious; and (5) less likely to be selective in choosing friends. Does thispattern emerge at the individual as well as the group level, forming a characteristic"syndrome"?

Summarising the data from adolescents, parents and teachers, a score wasconstructed for each adolescent in each of the five areas listed, indicating the presenceor absence of the behaviour characteristic of the ex-institutional group. Table 13indicates how many individuals in the ex-institutional and comparison groups showedthese characteristics. Very few ex-institutional adolescents, and no comparisons, showall five. However, jilmost half of the ex-institutionad adolescents, but only onecomparison child, show four out of five characteristics.

Table 13.Number of characteristics0 1 2 3 4 5 A

Ex-institutional 0 5(19%) 3(12%) 5 (19%) 11 (42%) 2(8%) 26Matched comparisons 8(33%) 6(25%) 5(21%) 4(16%) 1 (4%) 0 2 ^

Tau C= -0.65, / '< 0.0001

The constructed scores revealed no new differences between adopted and restoredadolescents.

In so far as these ex-institutional characteristics do form a "syndrome", how faris this related to more generail behavioural and emotional disturbance?


There was some tendency for adolescents who showed more ex-institutionalcharacteristics to have higher " B " scale scores (ex-institutional adolescents, TauC= 0.37, P= 0.01; comparisons, Tau C = 0.39, P= 0.01), but " A " scale scores wereunrelated. Ex-institutional adolescents with more of these characteristics were morelikely than those with fewer to have been referred to child psychiatric or psychologicalservices (Tau C = 0.4, F=0.03), but were no more likely to have been in troublewith the police.

Discussion

There is an interesting asymmetry about the findings reported here. While thewhole ex-institutional group differs from comparison adolescents in their relationshipswith peers and with adults outside the family, only the restored group differs fromcomparisons in their family relationships.

The family relationships of most of the adopted 16-year-olds seemed satisfactoryfor them and for their parents, and differed little from non-adopted comparisons,who had never been in care. In contrast, the restored group still suffered difficultiesand poor family relationships much more frequently than either the adoptees or theirown comparison group. They and their parents were less often attached to each otherthan adoptees or comparisons, and where there were siblings their mothers tendedto prefer them to the restored child. Restored 16-year-olds still showed less affectionto their parents than did any other group, as had been the case when they were 8-year-olds, and their parents, equally, found difficulty in showing affection to them. Therewere also indications that they wanted less involvement in family discussions thanother groups, and identified themselves less with their parents. Though both ex-institutional groups tended to have more difficulty with siblings than their comparisons,the restored group had particularly great difficulty. It seems likely that these difficultiesarose because most of the restored children had entered their families to find youngersiblings already there; the difficulties to which this situation had given rise had notbeen overcome by mid-adolescence.

Although good relationships were not universal in the adoptive families, thesefamilies differed very little from their comparison group, while contrasting greatlywith the restored group. Early institutional care with a lack of close attachments hadnot necessarily led to a later inability to make a close attachment to parents and tobecome as much part of a family as any other child. Rather, it is clear that somecircumstances—most fundamentally that the parent wanted the child and was ableto put a lot into the relationship—encouraged attachments to develop, while othershindered them. This seemed true of the adoption successes as against the breakdowns;it also characterised the adopted/restored difference. Further, it seemed evident withirithe restored group. For example, one restored boy was doing particularly well onour various measures of adjustment and attachment. His mother had always beencertain that she wanted him home when her circumstances allowed it, and had visitedhim to spend time with him every week while he was in the nursery. She had nohusband or cohabitee, but supportive links with her family. She had quite a goodjob, no other children, and was older than other mothers of restored children. Inmost of these respects, as well as in apparently not having had a struggle over whether


she really wanted to have her child with her, she resembled the group of adoptiveparents more than she resembled other parents of restored children.

No explanation of these differences between the adopted and restored groups interms of differences in the children before family placement seems likely (Tizard,1977). Rather, the differences seem most probably to be due to differences in thefamily settings offered to the child by the adoptive and "restored" families. Theadoptive parents, who had very much wanted a child, put a lot of time and effortinto building a relationship with the child and were often ready to accept verydependent behaviour initially. They differed as a group from the parents of the restoredchildren, who more often had fewer resources, more other children, had been moreambivalent about the child living with them and often expected great independenceof their young child (Tizard & Hodges, 1978).

In the three adoptions where a strong attachment had not developed to either parentby the time the chiid was aged 8, the outlook was poor. As described in our companionarticle, two of these adoptions subsequently broke down, and in the third, thoughthe adolescent was still living in the home, relationships between the adolescent andthe rest of the family were angry and rejecting in the extreme.

In contrast to the differences in family relationships between the two ex-institutionalgroups are the similarities they showed in relationships to peers and to adults outsidethe family. Although the indiscriminate "overfriendliness" shown by some ex-institutional children at 8 years no longer seemed to be a problem at 16, the ex-institutional adolescents were still more often oriented towards adult attention andapproval than comparison adolescents. They were likelier to have difficulties in peerrelations, and less likely than comparisons to have a special friend, at an age whenpeer relationships are usually seen as more important than before. They were lesslikely to see peers as a source of emotional support, in that even where they did havea special friend, they were less likely to turn to a peer as someone to confide in ifthey were anxious. A fifth of them were seen as being friendly to any peer, ratherthan choosing their friends.

If we consider these five characteristics together, ex-institutional adolescents arevery much more likely to show four to five of them than comparison adolescents.In this sense, one can speak of an ex-institutional "syndrome", which does not appearto be merely a reflection of general behavioural and emotional disturbance. However,despite being much more common in the ex-institutional adolescents, this "syndrome"still occurs in only half of their number; and we would also emphasise that in generalthe behaviour characteristics represented by the "syndrome" are differences from thecomparison group, and do not all imply difficulties.

The pattern of differences found resembled the picture when the children were8 years old. This raises the question of whether the "syndrome" may be permanent,or whether in time these adolescents' social relationships will come to resemble moreclosely those of people who have always lived in their families. If permanent, furtherquestions present themselves about the extent to which they will be able to make closeemotional attachments and sustain love relationships and marriage as they enteradulthood.

There are a number of possible explanations for our findings, ranging from thosethat stress the enduring impact of institutional experience, and attribute less significance


to later events, to those that place most weight on post-institutional circumstances.In the latter category is the hypothesis that families who took their "own'' or an adoptedchild after a period in institutional care might be characterised by particular patternsof child rearing, different from families raising their "own" children from birth, andthe behaviour of the ex-institutional children might be a response to this. The difficultywith this hypothesis is the extreme difference in the attitudes and childrearing patternsof the "restored" and adoptive parents, as opposed to the similarity of many of theways in which both groups of children differed from their comparison groups. Forinstance, adoptive parents spent more time playing with their children than "restored''parents, spent more time with them in "educative" pursuits, and involved them morein joint household activities. These differences were greater than a simple classdifference; adoptive parents spent more time in these activities with their childrenthan a middle-class comparison group, and "restored" parents spent less time thanworking-class comparisons. Greater independence was expected of the restoredchildren; at age 8, a third of them put themselves to bed, or put their lights out,compared to only one adopted child.

However, despite these differences, both adoptive and "restored" parents werealike in that they had missed their child's early years, and it is possible that in someway this loss affected their handling of the child. Lambert and Streather (1980), intheir study of adopted children, suggest that relatively poorer social adjustment ofadoptees at 11 years compared to non-adopted children may have been based on anuncertainty on the part of the adoptive parents about their own reactions and responses,which had communicated itself to the children and made relationships harder for them.If such uncertainty did occur in our study, how it could have operated to producethe differences we found is another question.

Clarke and Clarke (1979) have suggested a transactional explanation for our findings,stressing later experience, with the emphasis on the responses of others to the child.They point out that while the adoptive parents in our study made great efforts tofoster close attachments in the children placed with them, they did not put the samesort of effort into helping their children get on with peers or with teachers, so thedifficulties remained in these areas. We would add further that unlike the highlymotivated parents, there was no reason for the ex-institutional children's peers totolerate or make special efforts towards children who could not already relate reasonablywell. Such difficulties would thus be likely to perpetuate themselves. In relationshipswith non-family adults, the ex-institutional children's attention seeking behaviourmay have been perpetuated similarly, through the responses of teachers and others.

Another possible transactional hypothesis puts less stress on the particular natureof post-institutional experiences and more on the longlasting impact of the earlyexperience on development. In effect, the emphasis is less on what the environmentoffers, and more on what the child has become able to elicit from it. The outstandingfeature of our ex-institutional children's early social life was that they were caredfor by a rapidly changing series of nurses. When the children were first assessed withinthe institutions at the age of 24 months they were strikingly insecure in theirrelationships with the nurses, running to be picked up when staff entered the room,and crying when they left it.

There are some parallels between this early insecurity, followed later by poor peer


relationships, and the findings of Sroufe and his co-workers (LaFreniere & Sroufe,1985; Waters, Wippman & Sroufe, 1979). Sroufe and his co-workers view socialrelationships with peers as an aspect of development particularly vulnerable todifficulties in early attachment. They found that children who as infants had beenseen as having secure attachments to the mother—assessed via Ainsworth's (1978)Strange Situation procedure—managed peer relationships better at 3 Vi and at 5 yearsold than children who had not been securely attached, as well as coping better inother respects. They stress the ways in which the experience of the insecure infantor child differs from that of the more confident child who can engage more freelywith the environment and with peers. "Once constitution and early experience haveinteracted to produce the emergent personality, the child is an active force in his orher own development" (Sroufe, 1979).

However, other authors have offered alternative interpretations of the link betweenthe strange situation behaviour and other behaviour, including the effect on bothof underlying temperamental variables, or of cultural influences on socialisation(Kagan^ 1984; Campos, Barrett, Lamb, Goldsmith & Steinberg, 1983).

A related hypothesis that also stresses the direct impact of the children's earlyexperiences on their development invokes the concept of developmental delay. AnnaFreud (1966) outlines a detailed "developmental line", a sequence in which adequatedevelopment of the child's relation to parents forms a precondition for normal laterrelationships with peers and others outside the family. The ex-institutional childrenhad their first opportunity to develop these close exclusive attachments around anage when most children, in their families from birth, have already done so. Theymay continue to lag somewhat behind these children in the broadening of their socialhorizons beyond the family and the increase in the emotional importance of peersrelative to parents. There is some support for this in indications that children whowere parent-oriented and not particularly peer-oriented at age 8 were more likely thanothers to make good peer relationships later on. Close attachment to a parent at age8 was related to good peer relationships at 16, while attachment at 16 was not sorelated; close attachment at age 8 was more strongly linked than attachment at 16to selectivity in choosing friends; and children described as "solitary through choice"at age 8, suggesting less peer involvement (and possibly more with parents) than usualat that age, seemed to have the most satisfactory peer relationships at 16.

We do not have sufficiently detailed evidence, especially about the children's post-institutional experiences, to decide between these theories, and indeed more thanone theory may be needed to account for the findings. However, the issue is oneof importance, not only for our study, but for the general issue of the relationshipbetween the quality of young children's attachments to adults and the developmentof their peer relationships (Tizard, 1986). If this matter were better understood, itwould help us to understand our findings.

In conclusion, the study gives evidence that children who in their first years oflife are deprived of close and lasting attachments to adults can make such attachmentslater. But these do not arise automatically if the child is placed in a family. Theydepend rather on the adults concerned and how much they nurture such attachments.Yet despite these attachments, certain differences and difficulties in social relationshipsare found over 12 years after the child has joined a family. These are not related

Social and Family Relationships of Ex-Institutional Adolescents 97

to the kind of family, and appear to have their origins in the children's early experiencein institutional care. Since they affect relationships with peers, as well as with adultsoutside the family, they may have implications for the future adult relationships ofthese 16-year-olds. Whether these differences are now permanent, or furthermodifiable, we do not know.

Acknowledgements—This research was supported by grants from the Joseph Rowntree Memorial Trustand the Research Fund of the Institute of Education, London, It was dependent on the generouscooperation of the children and parents concerned, as well as the help of many local authority socialworkers, and the staff of Dr, Barnardo's Society and the Church of England Children's Society. Thanksare due to Mary Baginsky, Judith Cook, Barbara Reid and Olwen Rowlands, who assembled andinterviewed the matched comparison group.

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