Celia Beckett

The Effects of Global Severe Privation on Cognitive Competence: Extension and Longitudinal Follow-Up.

The current study extends previous research on a sample of children adopted into the United Kingdom following severe early deprivation and a comparison sample of nondeprived, within-country, early adoptees. We assessed 165 children adopted from Romania and 52 U.K. adoptees at age 6 years. Longitudinal data (at age 4 and 6 years) were available on 111 Romanian adoptees placed into U.K. homes before 24 months of age and on all U.K. adoptees. Results indicated that there was considerable catch-up among late-placed Romanian children from entry into the United Kingdom to age 6, but as a group they exhibited lower cognitive scores and general developmental impairment compared with earlier adopted Romanian children. In addition, the resilience suggested at the assessment at age 4 years was maintained longitudinally, but there was no further evidence of catch-up or recovery.

Effects of Profound Early Institutional Deprivation: An Overview of Findings from a UK Longitudinal Study of Romanian Adoptees

A randomly selected sample of 165 children from Romania (of whom 144 had been reared in institutions) who were adopted by UK families, with placement before the age of 42 months, was studied at 4, 6, and 11 years of age. Comparisons were made with a sample of 52 non-institutionalized UK children adopted before the age of 6 months, who were studied in the same way. The paper briefly summarizes circumstances at the time of adoption and then reports findings at age 11, focusing on changes between 6 and 11. Marked catch-up in psychological functioning was evident following adoption, but significant problems continued in a substantial minority of the children placed after the age of 6 months. The theoretical implications of the findings are considered, and the policy implications are noted.

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.

Behavior patterns associated with institutional deprivation: A study of children adopted from Romania

ABSTRACT. This study examined the prevalence and persistence of behaviors associated with institutional rearing in a sample of 144 children from Romania adopted by UK families. Patterns of rocking, self-injury, unusual sensory interests, and eating problems were assessed in children aged between a few weeks and 43 months who were adopted from institutional care. Forty-seven percent of the institutionally reared children rocked at the time of UK entry and 24% engaged in self-injurious behavior. By age 6 years, the percentages were 18% and 13%, respectively. Eleven percent of the children were displaying unusual sensory interests at the time of arrival, and at 6 years 13% of the children did so. Fifteen percent of the children were still experiencing difficulties with chewing and swallowing solid food at age 6 years. The primary factor affecting the prevalence and persistence of the behaviors was the length of time the children had spent in institutional deprivation.

5HTT genotype moderates the influence of early institutional deprivation on emotional problems in adolescence: evidence from the English and Romanian Adoptee (ERA) study

BACKGROUND A common polymorphism in the serotonin transporter gene (SLC6A4, 5HTT) has been repeatedly shown to moderate the influence of childhood adversity and stressful life events on the development of psychopathology. Using data from the English and Romanian Adoptee Study, a prospective-longitudinal study of individuals (n = 125) exposed to severe early institutional deprivation (ID), we tested whether the effect of ID on adolescent emotional problems is moderated by 5HTT genotype and stressful life events in adolescence. METHODS Emotional problems were assessed using questionnaire data (age 11), and on the basis of the CAPA diagnostic interview (age 15). Additionally, the number of stressful life events was measured. RESULTS There was a significant effect for genotype (p = .003) and a gene x environment interaction (p = .008) that was independent of age at testing. Carriers of the s/l and s/s genotype who experienced severe ID showed the highest emotional problem scores, while l/l homozygotes in the severe ID group showed the lowest overall levels. Furthermore, s/s carriers in the severe ID group who experienced a high number of stressful life events between 11 and 15 years had the largest increases in emotional problem scores, while a low number of stressful life events was associated with the largest decrease (4-way interaction: p = .05). CONCLUSIONS The effects of severe early ID on emotional problems in adolescence are moderated by 5HTT genotype, and influenced by stressful life events in adolescence.

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.

iv. Developmental course of deprivation-specific psychological patterns: early manifestations, persistence to age 15, and clinical features

Chapter III (Kumsta et al.) presented findings on the designation of deprivation-specific psychological patterns (DSPs) and on the testing of the internal and external validity of the concept of a DSP. The starting point was the meeting of particular criteria at age 6 and persistence of impairment to age 11. In this chapter, we turn to our findings on the developmental course of DSPs. Because the postulate was that the DSP resulted from profound institutional deprivation, it is necessary to begin with findings on what the children were like at the time of leaving institutional care. The evidence is relevant to scientific question about continuities and discontinuities in individual differences in the children’s functioning in the institutions and the manifestation of DSPs that persisted at least up to age 11Fsome 71 years after adoption. It is also relevant to the practical question of whether prospective adoptive parents could identify children in the institutions who were likely, or unlikely, to show persisting DSPs postadoption. We next turn to the features of the four postulated DSPs between the ages of 6 and 11 yearsFstarting with quasi-autism (Q-A). The features as shown at age 6 were described in chapter III (Kumsta et al.) and will not, therefore, be repeated here. The emphasis is on both continuities and discontinuities (including change of pattern) over this age period. Chapter III (Kumsta et al.) indicated the criteria used for persistence to age 11, and here, by contrast, we focus on a qualitative description of what the children were like. In the case of the children with Q-A, we were able to use the detailed clinical assessments undertaken by M. R. together with the systematic ADOS and ADI-R findings. In addition, we have detailed findings on mental health and special educational service usage. In order to focus on MONOGRAPHS OF THE SOCIETY FOR RESEARCH IN CHILD DEVELOPMENT

iii. Deprivation-specific psychological patterns

It has come to be generally accepted that the psychopathological effects of psychosocial stress and adversity are diagnostically nonspecific (McMahon, Grant, Compas, Thurm, & Ey, 2003). There is a good deal of supporting evidence in support of this assumption, even though it may be that the nonspecificity has been exaggerated through a failure to take account of comorbidity (Shanahan, Copeland, Costello, & Angold, 2008). Thus, although ‘‘natural experiments’’ have confirmed the reality of environmental mediation of causation, in the case of sexual abuse in childhood (Kendler, Kuhn, & Prescott, 2004), its risk effects span a range of diagnoses. In other words, knowing that someone has experienced sexual abuse does not enable a confident prediction at an individual level as to what psychopathology will be evident (see Glaser, 2008). Conversely, there is not a pattern of psychopathology that tells one that the disorder must have been due to sexual abuse. Much the same applies to other acute and chronic psychosocial stresses and adversities, such as physical abuse, exposure to family violence, exposure to severe family discord and conflict, and the experience of multiple negative life events carrying long-term threat. Accordingly, at the time that we started the study, our expectation, like those of other researchers, was that we would find the same with respect to institutional deprivation. It came very much as a surprise, therefore, that we found at age 6 no evident increase in the common varieties of emotional and behavioral problems that constitute the majority of mental health clinic referrals (Kreppner et al., 2007; Rutter et al., 1999). In sharp contrast, what we did find were four patterns that were strongly associated with institutional deprivation and that rarely occurred in other children within our sample. These comprised quasi-autism (Q-A; Rutter et al., 1999; Rutter, Kreppner et al., 2007), disinhibited attachment (DA; O’Connor, Bredenkamp, Rutter, MONOGRAPHS OF THE SOCIETY FOR RESEARCH IN CHILD DEVELOPMENT

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.