Castle · The American journal of orthopsychiatry 1999 · cohort study (natural experiment) · n=?

Effects of qualities of early institutional care on cognitive attainment. E.R.A. Study Team. English and Romanian Adoptees.

Level 3 - non-randomized controlled study

Non-randomized observational cohort study (natural experiment) comparing cognitive outcomes based on early institutional exposure.

PubMed 10553454 · doi:10.1037/h0080391 · record verified 2026-08-26

What was done

Children reared in poor-quality Romanian institutions who were subsequently adopted were followed to determine whether early psychological privation caused later cognitive deficits. Cognitive outcome (IQ) was evaluated at six years of age in relation to duration of institutional care, malnutrition, and the quality of individualized care.

What was found

The abstract reports no numerical values, effect sizes, or confidence intervals. It states that low IQ at six years was strongly related to the duration of institutional care, that malnutrition had a weaker effect, and that a marked lack of individualized care had an additional negative effect after adjusting for duration and malnutrition.

Why it matters

The findings indicate that psychological privation and absence of individualized care in early childhood contribute to enduring cognitive deficits independently of nutritional status.

Limits

The abstract does not report the sample size, specific IQ scores, effect sizes, or statistical metrics. Because it relies on a natural experiment/observational cohort design, residual confounding from prenatal factors, genetic vulnerability, or pre-adoption health status cannot be ruled out.