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Vulnerability and resilience after early institutional care: The Greek Metera study

  • Panayiota Vorria (a1), Maria Ntouma (a1) and Michael Rutter (a2)


The aim of the study was to examine possible influences on individual differences in adolescence in response to early institutional care in infancy not involving either generalized privation or subnutrition. Fifty-two adopted adolescents aged 13 years who received institutional care in infancy at the Metera Babies Centre and 36 adolescents of the same age who were raised in their biological families participated in the study. Adolescents' attachment relationships, cognition, behavioral adjustment and use of psychological services were assessed. Marked heterogeneity in outcomes was found. No predictive effects were found for preinstitutional features or for adoptive circumstances. By contrast a large effect was found for institutional care extending beyond the age of 2 years and for quality of institutional care as experienced at an individual level. There was a close association between prolonged institutional care and disorganized attachment while in the institution, but the main institutional effect derived from the length of time in the institution.


Corresponding author

Address correspondence and reprint requests to: Panayiota Vorria, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece; E-mail:


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Bibou-Nakou, I., Kiosseoglou, G., & Stogiannidou, A. (2002). Strengths and Difficulties Questionnaire in the school population. In Roussou, A. (Ed.), Psychometric issues in clinical practice and research (pp. 208220). Athens, Greece: Ellinika Grammata.
Cicchetti, D. (2010). Resilience under conditions of extreme stress: A multilevel perspective. World Psychiatry, 9, 145154.
Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology. Development and Psychopathology, 8, 597600.
Cicchetti, D., Rogosch, F. A., Lynch, M., & Holt, K. D. (1993). Resilience in maltreated children: Processes leading to adaptive outcome. Development and Psychopathology, 5, 629647.
Cicchetti, D., & Toth, S. L. (2009). The past achievements and future promises of developmental psychopathology: The coming of age of a discipline. Journal of Child Psychology and Psychiatry, 50, 1625.
Cohen, S., & Williamson, G. M. (1991). Stress and infectious disease in humans. Psychological Bulletin, 109, 524.
Farran, D., Kasari, C., Comfort, M., & Jay, S. (1986). Parent/Caregiver Interaction Scale. Chapel Hill, NC: University of North Carolina Press.
Georgas, D. D., Paraskevopoulos, I. N., Bezevegis, I. G., & Giannitsas, N. D. (1997). Greek WISC-III: Wechsler Intelligence Scale for Children. Athens, Greece: Ellinika Grammata.
Goldberg, D., & Williams, P. (1988). General Health Questionnaire. Windsor Berkshire: Nfer–Nelson.
Goodman, R. (1994). A modified version of the Rutter Parent Questionnaire including extra items on children's strengths: A research note. Journal of Child Psychology and Psychiatry, 35, 14831494.
Julian, M. M. (2013). Age at adoption from institutional care as a window into the lasting effects of early experiences. Clinical Child & Family Psychology Review, 16, 101145.
Kumsta, R., Rutter, M., Stevens, S., & Sonuga-Barke, E. J. (2010). Risk, causation, mediation, and moderation. Monographs of the Society for Research in Child Development, 75 (1, Serial No. 295), 187211.
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543562.
Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85, 620.
Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491495.
McCall, R. B. (2013). Review: The consequences of early institutionalization: Can institutions be improved? Should they? Child and Adolescent Mental Health, 18, 193201.
National Research Council. (2001). New horizons in health: An integrative approach. Washington, DC: National Academy Press.
Nelson, S., Fox, N. A., & Zeanah, C. H. (2014). Romania's abandoned children: Deprivation, brain development, and the struggle for recovery. Cambridge, MA: Harvard University Press.
Rutter, M. (1972). Maternal deprivation reassessed. Harmondsworth: Penguin Books.
Rutter, M. (2006). Implications of resilience concepts for scientific understanding. Annals of the New York Academy of Sciences, 1094, 112.
Rutter, M. (2012). Resilience as a dynamic concept. Development and Psychopathology, 24, 335344.
Rutter, M. (2013). Annual research review: Resilience—Clinical implications. Journal of Child Psychology and Psychiatry, 54, 474487.
Rutter, M., Kreppner, J., O'Connor, T., & ERA Study Team (2001). Specificity and heterogeneity in children's responses to profound privation. British Journal of Psychiatry, 179, 97103.
Rutter, M., Sonuga-Barke, E. J. S., Beckett, C., Castle, J., Kreppner, J., Kumsta, R., et al. (2010). Deprivation-specific psychological patterns: Effects of institutional deprivation. Monographs of the Society for Research in Child Development, 75(1, Serial No. 295).
Sattler, J. M. (1992). Assessment of Children WISC-III and WPPSI-R supplement. San Diego, CA: Author.
Sheras, P. L., Abidin, R. R., & Konold, T. R. (1998). Stress Index for Parents of Adolescents: Professional manual. Lutz, FL: Psychological Assessment Resources.
St. Petersburg–USA Orphanage Research Team. (2008). The effects of early social-emotional and relationship experience on the development of young orphanage children. Monographs of the Society for Research in Child Development, 73(3, Serial No. 291).
Target, M., Fonagy, P., & Shmueli-Goetz, Y. (2003). Attachment representations in school-age children: The development of the Child Attachment Interview (CAI). Journal of Child Psychotherapy, 29, 171186.
Tizard, J., Sinclair, I., & Clarke, R. V. G. (1975). Varieties of residential experience. London: Routledge & Kegan Paul.
Vaillant, G. E. (2013). Triumphs of experience: The men of the Harvard Grant Study. Cambridge, MA: Harvard University Press.
van IJzendoorn, M. H., Palacios, J., Sonuga-Barke, E. J., Gunnar, M. R., Vorria, P., McCall, R. B., et al. (2011). Children in institutional care: Delayed development and resilience. Monographs of the Society for Research in Child Development, 76(4), 830.
Vorria, P., Ntouma, M., & Rutter, M. (2014a). The cognitive development and school achievement of adopted adolescents. The Greek “Metera” study. European Journal of Developmental Psychology. doi:10.1080/17405629.2014.933703
Vorria, P., Ntouma, M., & Rutter, M. (2014b). The behaviour of adopted adolescents who spent their infancy in residential group care: The Greek “Metera” study. Adoption & Fostering, 38, 271283.
Vorria, P., Ntouma, M., Vairami, M., & Rutter, M. (2015). Attachment relationships of adolescents who spent their infancy in residential group care: The Greek “Metera” study. Manuscript submitted for publication.
Vorria, P., Papaligoura, Z., Dunn, J., van IJzendoorn, M. H., Steele, H., Kontopoulou, A., et al. (2003). Early experience and attachment relationships of Greek infants raised in residential group care. Journal of Child Psychology and Psychiatry, 44, 12081220.
Vorria, P., Papaligoura, Z., Sarafidou, J., Kopakaki, M., Dunn, J., van IJzendoorn, M. H., et al. (2006). The development of adopted children after institutional care: A follow-up study. Journal of Child Psychology and Psychiatry, 47, 12461253.


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