Research into the effects of institutionalisation was conducted as natural experiment, meaning that there was no control over extraneous variables. In Hodges & Tizard's study, there was high levels of participant attrition which decreases the validity of results. Research was unable to determine the quality of care from adopted families which questions the findings that good quality care leads to recovery from MD. All ppts in the studies were Romanian which is not representative of the population, cant be generalised.