Amanda Hawkins

Do Theory of Mind and Executive Function Deficits Underlie the Adverse Outcomes Associated with Profound Early Deprivation?: Findings from the English and Romanian Adoptees Study

Theory of Mind (ToM) and Executive Function (EF) have been associated with autism and with attention-deficit hyperactivity disorder (ADHD), and hence might play a role in similar syndromes found following profound early institutional deprivation. In order to examine this possibility the current study included a group of 165 Romanian adoptees, of whom 144 were adopted into the UK from deprived institutional settings before 43months of age, and a group of 52 within-UK adoptees, all adopted before 6months of age. Both groups were assessed at 6 and 11years. The Strange Stories task was used to assess ToM and the Stroop task was used to assess EF, both at age 11. The Romanian adoptees displayed deficits in both ToM and EF compared with the within-UK adoptee group. The degree of deficit was greater for children who had experienced more than 6months of institutional deprivation. Deficits in both domains (ToM and EF) were associated with each of the three apparently deprivation-specific problems, namely quasi-autism, disinhibited attachment and inattention/overactivity. Statistical analyses indicated a mediating role for both ToM and EF with respect to quasi-autism; possibly a partial mediating role for EF with respect to inattention/overactivity; and probably no mediating role for either ToM or EF in the case of disinhibited attachment. In conclusion, there is evidence for a possible mediating role for ToM and EF in the development of some apparently deprivation-specific difficulties in institution-reared Romanian adoptees, but neither accounts for the overall pattern of deprivation-related difficulties.

Emotional difficulties in early adolescence following severe early deprivation: Findings from the English and Romanian adoptees study

The study assessed conduct and emotional difficulties in a group of Romanian adoptees at age 11, and serves as a follow-up to assessments made when the children were 6 years old. It was found that there was a significant increase in emotional difficulties, but not conduct problems, for the Romanian sample since age 6. It was also found that emotional difficulty was significantly more prevalent at age 11 in the Romanian group than in a within-UK adoptee group. Emotional difficulties in the Romanian adoptee group were found to be significantly and strongly related to previous deprivation-specific problems (disinhibited attachment, cognitive impairment, inattention/overactivity and quasi-autism); however, the presence of such early problems did not account fully for the onset of later emotional problems. Five contrasting hypotheses concerning possible mediators for later onset of emotional difficulties for the Romanian group were examined. No links were found to duration of deprivation or other deprivation-related indices, stresses/difficulties in the postadoption family environment, or educational attainment and self-esteem. There was some evidence that emotion recognition might play a role in the emergence of these problems, but other measures of social competence and theory of mind showed no associations with the onset of emotional problems.

Is sub-nutrition necessary for a poor outcome following early institutional deprivation?

Institutional deprivation is multifaceted and includes adverse psychosocial and nutrition‐related components. In this study we partitioned these risks in relation to cognitive impairment and mental ill health, and explored the mediating role of reduced head/brain size. There were 138 participants (61 males, 77 females) in the study. Participants were Romanian adoptees who had experienced at least 2 weeks of early institutional deprivation. The sample was stratified on the basis of duration of deprivation (high risk >6mo in institutions) and sub‐nutrition (i.e. 1.5 SD below UK age‐related norms for weight at UK entry). UK children adopted before 6 months of age and a group of non‐institutionally deprived Romanian children constituted the comparison groups. Duration of deprivation was associated with smaller head circumference, lowered IQ, and increased mental heath problems, independently of effects found for sub‐nutrition on head circumference and IQ. The mediating role of head circumference was limited to either sub‐nourished (IQ) or non‐sub‐nourished (inattention/overactivity and disinhibited attachment) subgroups. Many negative effects of early deprivation, including stunted brain growth, occur without sub‐nutrition: psychosocial deprivation plays a major role in neurodevelopmental effects of deprivation. Further studies of functional and structural neuroanatomy following institutional deprivation are required to delineate the role of brain development in its effects.

Service use by families with children adopted from Romania

Service use between six and 11 years of age is reported for children adopted from Romania into UK families, and compared with that for children adopted within the UK before six months of age. Between six and 11, there had been only one adoption breakdown, and about one in ten couples experienced a marital breakdown. Apart from continuing concerns over hepatitis B carrier status in a small number of children, physical health problems were not a prominent feature. By contrast, nearly one‐third of the children from Romania placed in UK families after the age of six months received mental health services provision ‐ a rate far higher than the 11 to 15% in the groups adopted before the age of six months. Such provision was strongly related to research assessments of mental health problems and largely concerned syndromes that were relatively specific to institutional deprivation (quasi‐autism, disinhibited attachment and inattention/overactivity). There were similar differences between the UK adoptees and the adoptees from Romania entering the UK after six months of age in major special educational provision and, again, the findings showed that the provision was in accord with research assessments of scholastic achievement. The between group differences for lesser special educational provision were much smaller and there was some tendency for the early adopted groups to receive such provision for lesser degrees of scholastic problems than the children adopted from Romania who entered the UK after six months of age. The policy and practice implications of the findings are briefly discussed.

Communicative Openness About Adoption and Interest in Contact in a Sample of Domestic and Intercountry Adolescent Adoptees

ABSTRACT Adolescent intercountry (n = 122) and domestic (n = 40) adoptees and their adoptive parents were asked about their views on communicative openness. The adoptees were also asked for their thoughts on birth parents and contact. A modest association between communicative openness and feelings about adoptive status and self-esteem was found. Girls were more interested in many aspects of their adoptions than boys. Compared with the situation at 11 years of age, there was greater parent-child agreement on whether the child had difficulties talking about adoption. Nevertheless, at age 15, children were still nearly twice as likely to report difficulties talking about adoption issues than their adoptive parents realized. At the age of 15, the majority of the adoptees expressed a desire for contact with birth relatives, but this was a reduction from the numbers at age 11. They also reported finding it easier to talk about adoption issues than they did at the age of 11. The implications for policy and practice are discussed.

The Experience of Adoption (2): The Association between Communicative Openness and Self-Esteem in Adoption:

A study of the views of two groups of 11-year-old adopted children (one adopted as babies within the UK, n = 47, the other adopted from Romania, aged between two and 43 months, n = 133) indicates that parents underestimate the difficulty that their children have in talking about adoption. Children who found this harder experienced lower self-esteem at age 11 and were also more likely to feel different from their adoptive families, and both these factors were related to the individual childs level of behavioural or cognitive difficulties. Children in the Romanian sample who had another adopted sibling found it easier to talk about their adoption. In summary, the ease with which children can talk about adoption does appear to be associated with higher self-esteem and the individual childs difficulties, as well as family composition. This article by Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Edmund Sonuga-Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter follows ‘The experience of adoption (1)’ (Hawkins et al, 2007), which explored intercountry and domestic adoption from the childs point of view.

The importance of cultural identity in adoption: A study of young people adopted from Romania

This article by Celia Beckett, Amanda Hawkins, Michael Rutter, Jenny Castle, Emma Colvert, Christine Groothues, Jana Kreppner, Suzanne Stevens and Edmund Sonuga-Barke examines attitudes regarding cultural and national identity in a group of 165 young people adopted from Romania. The attitudes of their adoptive parents are also explored. The adoptive parents were interviewed over three or four time periods, when their children were 4/6, 11 and 15 years, and the adopted young people at the age of 11 and 15. The majority of the adopted young people had an interest in Romania and expressed a wish to visit their country of origin. However, there was no association between this interest in Romanian identity and levels of self-esteem. The majority of the adoptees saw themselves as English or Anglo-Romanian. A small minority saw themselves as Romanian; these adoptees had both lower self-esteem and a higher level of deprivation-specific problems. The degree of sustained interest shown by adoptive parents in the importance of Romanian identity was associated with the adopted young peoples interest in Romania. However, parental interest in this issue had significantly declined by the time the children were 11 years old, by which time fewer adoptive parents than young people had plans to visit Romania in the future.