The science of early adversity: is there a role for large institutions in the care of vulnerable children?

Lancet. 2015 Jul 25;386(9991):388-98. doi: 10.1016/S0140-6736(14)61131-4. Epub 2015 Jan 29.


It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Brain / growth & development
  • Child
  • Child Development
  • Child Welfare*
  • Child, Institutionalized / psychology*
  • Deinstitutionalization
  • Developmental Disabilities / etiology
  • Developmental Disabilities / prevention & control*
  • Humans
  • Institutionalization
  • Orphanages
  • Social Support