Jenny Castle

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.

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 (1)* A Study of Intercountry and Domestic Adoption from the child's point of view

Amanda Hawkins, Celia Beckett, Jenny Castle, Christine Groothues, Edmund Sonuga-Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter compared views about adoption for two groups of 11-year-old children (n = 180). The teams analyses compared the views of children according to their pre-adoption background: UK domestic adoptees placed before the age of six months versus intercountry adoptees who had experienced extreme deprivation for up to three-and-a-half years in Romania prior to placement (the Romanian group was further broken down by age at placement). Remarkably few differences were found between these groups, with the exception of two areas. Older-placed adopted children from Romania were significantly more likely to find it difficult to talk about adoption than domestic adoptees, and to feel different from their adoptive families. However, supplementary analyses suggested that these differences were due to increased levels of difficulties within the older-placed Romanian group, rather than whether they were adopted internationally or domestically. The implications of the similarities and differences between these groups for policy and practice are discussed.

The Role of Social Workers in Intercountry Adoption: An Analysis of the Experience of Adopters from Romania

People who adopted children from Romania between 1990 and 1992 experienced considerable difficulties arranging the adoptions, both in Romania and the UK. It is not known how many more potential adopters were unsuccessful. Based on a study of 148 families adopting 165 children, Celia Beckett, Diana Bredenkamp, Jenny Castle, Christine Groothues and the English and Romanian Adoptees (ERA) study team shed light on the difficulties encountered in England and implications of agency and non-agency practice in relation to these adopters. The placements are progressing well, but there is some evidence that those applicants who were approved by specialist local authority social workers have a more sustained sense of the importance for the child of issues concerning their background and identity.