Does the type of care matter? : a study of the effect of early substitute care
'Looked after' children have high rates of emotional/behavioural disturbance, but it remains uncertain whether this derives from genetic risk, adverse experiences before reception into care, or from risks associated with substitute care experiences. Methods: The study was a 'natural experiment' comparing two different patterns of rearing after breakdown in early parenting, using teacher and parent questionnaires, interviews, systematic observations and standardised cognitive testing. 19 primary school children raised in institutional care from before the age of 1 year were compared with 19 children, matched for age and gender and comparable in biological background, who had experienced uninterrupted family foster care from that age. Both groups were compared with classroom controls. Results: The combined group of 'looked after' children differed from their classroom controls in showing a high level of inattention/overactivity. The teacher questionnaire and observational measures showed, however, that the increased rate was substantially higher in the institutional group than the family foster group. This difference was not explained by cognitive deficits. Also, the heightened level of inattention/overactivity was associated with a marked lack of selectivity in social relationships. This profile was found only in the institutional group, characterising about a third of them, all boys. At school, this elevated level of inattention was a specific response to cognitively demanding tasks, and partially accounted for the lower reading attainment of the institutional group compared with the family foster care group, whereas variation in IQ accounted for the lower reading scores of the family foster care group compared with their matched classroom controls. Out of school, the children in institutional care were rated by carers as having more emotional and unsociable difficulties; help with homework was associated with higher reading attainment in the family foster care group only. Conclusions: Against a background of genetic and early environmental risk, the type of care does matter. Institutional rearing was associated with a pattern of inattention/overactivity that for a significant minority included a marked lack of selectivity in social relationships. Further institutional upbringing was related to poorer reading attainment both directly and indirectly through this heightened inattention. Possible reasons, and implications for social policy and future research, are discussed.