A number of investigators have studied in great detail the adverse effects of institutional care, especially on infants and young children. They clearly show that the continuity of a warm relationship with a mother or mother-substitute is essential for mental health. Prolonged deprivation of maternal care during a young child's first three years may leave permanent damage to his personality - the first year of life seems to be of critical importance. Observations of pre-school and school-age children reveal that their adjustment is very poor in many respects. In particular there is marked inability to form interpersonal relationships: they have no capacity to care for people or to make friends. They show no real feelings and no emotional response in normal conditions. They seem inaccessible and exasperating to those trying to help. They show a curious lack of concern. They are often aggressive and destructive. Running away, stealing and lying are also frequently encountered. They have very poor performance at school, lacking interest and concentration. Their capacity for abstract thinking seems to be affected. Institutionalization during the first year of life affects language and social development most severely, and the longer the institutionalization the greater the damage.
It is clear that most children who enter public care are underprivileged from birth. If the effects of institutional care are added to this, with its high rate of emotional disturbance and educational retardation, the picture is grim indeed. Children placed in foster homes seem to suffer less ill effects, but research on the rate and after-effects of foster-home breakdown is so sketchy that no firm statement can be made. Only adoption at an early age appears to reverse the unfavourable factors. Finally, the financial cost of caring for children apart from their parents is extremely high.