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Childhood deprivation linked to neurodevelopmental, mental health disorders in adulthood
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Adopted children who underwent extended social and emotional deprivation in early childhood experienced a range of mental health problems in early adulthood, despite influence from positive experiences with adoptive families, according to a recent study.
Following the fall of the Communist government in 1989, Romania came under control of Nicolae Ceauşescu, whose regime focused on stimulating economic growth through population growth. Banning both abortions and contraceptives, as well as increased taxes for citizens who remained childless, the regime saw a significant increase in unwanted children; by the end of the regime, there were approximately 100,000 children in state-run orphanages in Romania.
“In the institutions, most children experienced extremely poor hygiene, insufficient food, little personalized care, and social and cognitive understimulation,” Edmund J. S. Sonuga-Bark, PhD, from King’s College London, and colleagues wrote. “By contrast, following their arrival in the U.K., the children joined socioeconomically advantaged, stable, caring and supportive families.”
Although research in the past has demonstrated a correlation between time-limited, early-life deprivation and disorders during childhood, no research currently investigates whether these symptoms continue into adulthood.
“Although other studies have examined the adult outcomes of groups of international adoptees, the recent completion of the English and Romanian Adoptees young adult follow-up – age 22 to 25 years – allows us, for the first time, to chart childhood-to-adult developmental trajectories in a large group of individuals affected by early profound global institutional deprivation,” the researchers wrote.
Children who resided in Romanian institutions between the ages of 2 weeks and 43 months were given multiple forms of analysis at varying ages, including developmentally appropriate standard questionnaires, measures of IQ and interviews with both adoptive parents and children. These were used to evaluate possible symptoms of autism spectrum disorder, inattention and overactivity, disinhibited social engagement, behavioral or emotional problems and cognitive impairment (defined as an IQ score less than 80). Each symptom was assessed during childhood (ages 6, 11 and 15) and in young adulthood (ages 22 to 25).
Participants were then separated into two groups: those who spent less than 6 months in an institution and those who spent over 6 months in an institution. Researchers compared responses and symptoms of the Romanian children to a control group of children who were adopted and not deprived as children.
To analyze the ranging severity of symptoms and trends between adopted children who were deprived and were not deprived, the researchers used mixed-effects regression models for ordered-categorical outcome variables.
According to study results, children who spent less than 6 months in an institution had low chances of being symptomatic, and results were comparable to the control group of children from the U.K. This held true at all ages; however, children who had spent more than 6 months in a Romanian institution were more likely to have more severe symptoms at all ages of testing.
The predominant symptoms correlated with autism spectrum disorder, inattention and overactivity as well as disinhibited social engagement, all of which continued into young adulthood. The group that spent more than six months in an institution also showed higher cognitive impairment in childhood than they did in young adulthood; in contrast, self-rated emotional symptoms between the two groups demonstrated a noticeable increase in young adulthood. Parental interviews confirmed this increase.
In addition to emotional symptoms, Romanian children who spent more than 6 months in an institution demonstrated lower academic achievement and higher levels of unemployment, and sought mental health services more frequently. Few children (one-fifth of those who spent over 6 months) were asymptomatic at all assessments.
“The presence of multiple neurodevelopmental and mental health problems, with characteristic developmental trajectories, creates a distinctive, complex and heterogeneous clinical picture; any two affected children rarely presented with the same clinical profile over time,” Sonuga-Bark and colleagues wrote. “Nevertheless, taking the group as a whole, three outcome domains – autism spectrum disorder, disinhibited social engagement and inattention and overactivity – followed similar, somewhat overlapping, developmental trajectories and appear to form an early-onset, highly persistent, impairing and clinically significant deprivation-specific core of characteristics.” — by Katherine Bortz
Disclosure: Funding for this research was provided by the Economic and Social Research Council, Medical Research Council, Department of Health, the Jacobs Foundation and the Nuffield Foundation.
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