Summary Background Time-limited, early-life exposures to institutional deprivation are associated with disorders in childhood, but it is unknown whether effects persist into adulthood. We used data ...from the English and Romanian Adoptees study to assess whether deprivation-associated adverse neurodevelopmental and mental health outcomes persist into young adulthood. Methods The English and Romanian Adoptees study is a longitudinal, natural experiment investigation into the long-term outcomes of individuals who spent from soon after birth to up to 43 months in severe deprivation in Romanian institutions before being adopted into the UK. We used developmentally appropriate standard questionnaires, interviews completed by parents and adoptees, and direct measures of IQ to measure symptoms of autism spectrum disorder, inattention and overactivity, disinhibited social engagement, conduct or emotional problems, and cognitive impairment (IQ score <80) during childhood (ages 6, 11, and 15 years) and in young adulthood (22–25 years). For analysis, Romanian adoptees were split into those who spent less than 6 months in an institution and those who spent more than 6 months in an institution. We used a comparison group of UK adoptees who did not experience deprivation. We used mixed-effects regression models for ordered-categorical outcome variables to compare symptom levels and trends between groups. Findings Romanian adoptees who experienced less than 6 months in an institution (n=67 at ages 6 years; n=50 at young adulthood) and UK controls (n=52 at age 6 years; n=39 at young adulthood) had similarly low levels of symptoms across most ages and outcomes. By contrast, Romanian adoptees exposed to more than 6 months in an institution (n=98 at ages 6 years; n=72 at young adulthood) had persistently higher rates than UK controls of symptoms of autism spectrum disorder, disinhibited social engagement, and inattention and overactivity through to young adulthood (pooled p<0·0001 for all). Cognitive impairment in the group who spent more than 6 months in an institution remitted from markedly higher rates at ages 6 years (p=0·0001) and 11 years (p=0·0016) compared with UK controls, to normal rates at young adulthood (p=0·76). By contrast, self-rated emotional symptoms showed a late-onset pattern with minimal differences versus UK controls at ages 11 years (p=0·0449) and 15 years (p=0·17), and then marked increases by young adulthood (p=0·0005), with similar effects seen for parent ratings. The high deprivation group also had a higher proportion of people with low educational achievement (p=0·0195), unemployment (p=0·0124), and mental health service use (p=0·0120, p=0·0032, and p=0·0003 for use when aged <11 years, 11–14 years, and 15–23 years, respectively) than the UK control group. A fifth (n=15) of individuals who spent more than 6 months in an institution were problem-free at all assessments. Interpretation Notwithstanding the resilience shown by some adoptees and the adult remission of cognitive impairment, extended early deprivation was associated with long-term deleterious effects on wellbeing that seem insusceptible to years of nurturance and support in adoptive families. Funding Economic and Social Research Council, Medical Research Council, Department of Health, Jacobs Foundation, Nuffield Foundation.
Anxiety disorders are highly prevalent worldwide; however, the literature lacks a meta-analytic quantification of the risk posed by fathers’ anxiety for offspring development. This systematic review ...and meta-analysis aimed to provide a comprehensive estimate of the magnitude of the association between paternal anxiety and emotional and behavioral problems of offspring.
In February 2022, Web of Science, Ovid (Embase, MEDLINE, PsycINFO), Trip Database, and ProQuest were searched to identify all quantitative studies that measured anxiety in fathers and emotional and/or behavioral outcomes in offspring. No limits were set for offspring age, publication language, or publication year. Summary estimates were extracted from the primary studies. Meta-analytic random-effects 3-level models were used to calculate correlation coefficients. Quality was assessed using the Newcastle-Ottawa Scale. The study protocol was preregistered with PROSPERO (CRD42022311501) and adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines.
Of 11,746 records identified, 98 were included in the meta-analysis. Small but significant associations were found between paternal anxiety and offspring emotional and behavioral problems overall (r = 0.16, 95% CI 0.13, 0.19) and behavioral (r = 0.19, 95% CI 0.13, 0.24), emotional (r = 0.15, 95% CI 0.12, 0.18), anxiety (r = 0.13, 95% CI 0.11, 0.16), and depression (r = 0.13, 95% CI 0.03, 0.23) problems. Some significant moderators were identified.
Paternal mental health is associated with offspring development, and the offspring of fathers with anxiety symptoms or disorders are at increased risk of negative emotional and behavioral outcomes, in line with the principles of multifinality and pleiotropy. The substantial heterogeneity among studies and the overrepresentation of White European American groups in this literature highlight the need for further research.
While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
Early-life institutional deprivation produces disinhibited social engagement (DSE). Portrayed as a childhood condition, little is known about the persistence of DSE-type behaviours into, presentation ...during, and their impact on, functioning in adulthood.
We examine these issues in the young adult follow-up of the English and Romanian Adoptees study.
A total of 122 of the original 165 Romanian adoptees who had spent up to 43 months as children in Ceauşescu's Romanian orphanages and 42 UK adoptees were assessed for DSE behaviours, neurodevelopmental and mental health problems, and impairment between ages 2 and 25 years.
Young adult DSE behaviour was strongly associated with early childhood deprivation, with a sixfold increase for those who spent more than 6 months in institutions. However, although DSE overlapped with autism spectrum disorder and attention-deficit hyperactivity disorder symptoms it was not, in itself, related to broader patterns of mental health problems or impairments in daily functioning in young adulthood.
DSE behaviour remained a prominent, but largely clinically benign, young adult feature of some adoptees who experienced early deprivation.
Severe, prolonged early deprivation is associated with later neurodevelopmental difficulties. Despite elevated levels of contact with service providers, these problems often persist into adult life ...and are associated with impairment in adulthood (e.g., unemployment, higher rates of depression and anxiety symptoms and poorer subjective wellbeing). Here, we aimed to explore the ongoing service needs and experiences of adoptees and their parents from the English and Romanian Adoptees (ERA) study, in those with a history of early deprivation and neurodevelopmental problems. Our descriptive thematic analysis highlighted difficulties with independent living, particularly financial management and problems with decision-making. Where specific forms of support had been accessed (e.g., medication for attention-deficit/hyperactivity disorder) they were often helpful, although there was some ambivalence towards taking medication due to side effects. However, the neurodevelopmental problems were not well understood and were often overlooked by service providers. There is a need for greater awareness among frontline service providers of the neurodevelopmental impact of early adversity. Participants also identified that their support needs were largely unmet and that their parents were having to fill this gap. Similarities and differences between the experiences highlighted here and those identified with idiopathic neurodevelopmental disorders are discussed, as are several recommendations for educational improvements for service providers.
Plain Language Summary
People who have experienced severe, prolonged institutional deprivation are at increased risk of neurodevelopmental disorders. Despite spending many years in warm, loving families, the English and Romanian Adoptees (ERA) study has shown that these problems often persist into adulthood and are associated with a range of negative outcomes. Importantly, these poorer outcomes seem to occur despite contact with support/service providers. In this study, we interviewed the adoptees and their parents about their support needs, and experiences with trying to obtain support and communicate with service providers. Support needs included help with independent living and support with managing finances. Our participants described a range of difficulties with obtaining support, including a lack of understanding of the link between early adversity and later mental health, and that neurodevelopmental problems were often overlooked. Consequently, the adoptive parents had largely been left to fill this gap in unmet needs. However, where support had been accessed, it was often described as helpful.
Sensitive Periods Zeanah, Charles H; Gunnar, Megan R; McCall, Robert B ...
Monographs of the Society for Research in Child Development,
12/2011, Volume:
76, Issue:
4
Journal Article
Peer reviewed
Open access
This chapter reviews sensitive periods in human brain development based on the literature on children raised in institutions. Sensitive experiences occur when experiences are uniquely influential for ...the development of neural circuitry. Because in humans, we make inferences about sensitive periods from evaluations of complex behaviors, we underestimate the occurrence of sensitive periods at the level of neural circuitry. Although we are most interested in complex behaviors, such as IQ or attachment or externalizing problems, many different sensitive periods at the level of circuits probably underlie these complex behaviors. Results from a number of studies suggest that across most, but not all, domains of development, institutional rearing limited to the first 4-6 months of life is associated with no significant increase risk for long-term adverse effects relative to non-institutionalized children. Beyond that, evidence for sensitive periods is less compelling, meaning that "the earlier the better" rule for enhanced caregiving is a reasonable conclusion at the current state of the science.
VI. SENSITIVE PERIODS Zeanah, Charles H.; Gunnar, Megan R.; McCall, Robert B. ...
Monographs of the Society for Research in Child Development,
December 2011, Volume:
76, Issue:
4
Journal Article
Peer reviewed
Open access
This chapter reviews sensitive periods in human brain development based on the literature on children raised in institutions. Sensitive experiences occur when experiences are uniquely influential for ...the development of neural circuitry. Because in humans, we make inferences about sensitive periods from evaluations of complex behaviors, we underestimate the occurrence of sensitive periods at the level of neural circuitry. Although we are most interested in complex behaviors, such as IQ or attachment or externalizing problems, many different sensitive periods at the level of circuits probably underlie these complex behaviors. Results from a number of studies suggest that across most, but not all, domains of development, institutional rearing limited to the first 4-6 months of life is associated with no significant increase risk for long-term adverse effects relative to noninstitutionalized children. Beyond that, evidence for sensitive periods is less compelling, meaning that "the earlier the better" rule for enhanced caregiving is a reasonable conclusion at the current state of the science.
Trauma-informed (T-I) approaches to working with vulnerable people have gained popularity in practice but are rarely used in academic research and little is known about the challenges of conducting a ...T-I approach to participatory research. This paper reflects on our experiences of a participatory peer research project involving unaccompanied young people seeking asylum (16–25 years) during the Covid-19 pandemic. Whilst the project adhered to a robust ethical framework, it became apparent at an early stage in the empirical phase that our methods needed to acknowledge and accommodate the trauma of those involved in the project much more thoughtfully and effectively than our ethical framework suggested. With this in mind, we set about identifying the key elements of a T-I approach to research and how these might add value to research with vulnerable and marginalised populations. Our model of a T-I approach to peer research is framed around five core principles: working reflectively with those with lived experience; contextualising trauma; nurturing trust; showing care; and empowering those involved in and affected by the research.
The sequelae of profound early privation are varied.
To delineate the behavioural patterns that are specifically associated with institutional privation.
A group of 165 children adopted from Romania ...before the age of 42 months were compared at 4 years and 6 years with 52 non-deprived UK children adopted in infancy. Dysfunction was assessed for seven domains of functioning. The groups were compared on which, and how many, domains were impaired.
Attachment problems, inattention/overactivity, quasi-autistic features and cognitive impairment were associated with institutional privation, but emotional difficulties, poor peer relationships and conduct problems were not. Nevertheless, one-fifth of children who spent the longest time in institutions showed normal functioning.
Attachment disorder behaviours, inattention/overactivity and quasi-autistic behaviour constitute institutional privation patterns.
It has been reported that adult adoptees with histories of maltreatment face particular challenges when they become parents. Here we explore this issue using a qualitative analysis of the views of 14 ...adoptee mothers, who suffered severe institutional deprivation in the Romanian orphanages of the late 1980s before being adopted into the UK, and their adoptive parents. Following a thematic analysis, we report several perceived benefits of becoming a parent, as well as co-occurring difficulties and challenges. Benefits included a sense of accomplishment and fulfilment, feeling more motivated personally and professionally and the positive experience of having a relationship with a biological relative. Challenges related, in particular, to some adoptee parents’ abilities to appraise risk relating to their children and to difficulties in organising day-to-day activities. Practical and emotional support from adoptive grandparents was very often crucial for adoptee parents’ success and wellbeing. Implications for research and practice are discussed, emphasising that deprivation-related difficulties expand into adulthood and for some can impact their ability to parent.
Plain Language Summary
Care-experienced individuals are at an increased risk of having their own children taken into care. The reasons for this are currently not clear, but questions have been raised about the importance of early adversity versus a continuation of adversity, unfortunately commonly experienced by care leavers. The English and Romanian Adoptees (ERA) study has followed the progress of individuals who were adopted into high functioning homes following a period of early deprivation. Last assessed in young adulthood, 20% have become parents and in the current study, these parents, and their adoptive (grand)parents, were interviewed. Most parents reported no areas of difficulty and for them, becoming a parent had been a globally positive experience, which included a closer sense of connectivity, a sense of fulfilment and a greater sense of motivation. However, significant difficulties in providing childcare were experienced by around a fifth of the group, often resulting in care proceedings. Areas of difficulties appeared to revolve around appraising and responding to risk. Consequently, the adoptive grandparents were an important source of day-to-day support. Implications for practice and future research are discussed.
Background: Some young children reared in profoundly depriving institutions have been found to show autistic‐like patterns, but the developmental significance of these features is unknown.
Methods: ...A randomly selected, age‐stratified, sample of 144 children who had experienced an institutional upbringing in Romania and who were adopted by UK families was studied at 4, 6, and 11 years, and compared with a non‐institutionalised sample of 52 domestic adoptees. Twenty‐eight children, all from Romanian institutions, for whom the possibility of quasi‐autism had been raised, were assessed using the Autism Diagnostic Interview‐Revised (ADI‐R) and the Autism Diagnostic Observation Schedule (ADOS) at the age of 12 years.
Results: Sixteen children were found to have a quasi‐autistic pattern; a rate of 9.2% in the Romanian institution‐reared adoptees with an IQ of at least 50 as compared with 0% in the domestic adoptees. There were a further 12 children with some autistic‐like features, but for whom the quasi‐autism designation was not confirmed. The follow‐up of the children showed that a quarter of the children lost their autistic‐like features by 11. Disinhibited attachment and poor peer relationships were also present in over half of the children with quasi‐autism.
Conclusions: The findings at age 11/12 years confirmed the reality and clinical significance of the quasi‐autistic patterns seen in over 1 in 10 of the children who experienced profound institutional deprivation. Although there were important similarities with ‘ordinary’ autism, the dissimilarities suggest a different meaning.
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