This article is more than 5 years old. Information may no longer be current.

Deprivation prior to adoption negatively affects later mental health

Adoptees exposed to institutions shortly after birth had increased risk for mental and neurodevelopmental impairment later in life, despite living in supportive families for more than 20 years, according to a study in Romania.

“Being exposed to very severe conditions in childhood can be associated with lasting and deep-seated social, emotional and cognitive problems, which are complex and vary over time,” Edmund Sonuga-Barke, PhD, of King’s College London, said in a press release. “This highlights the importance of assessing patients from deprived backgrounds when providing mental health support and carefully planning care when these patients transfer from child to adult mental health care. Although focused on children adopted from Romanian institutions in the early 1990s, our findings may also be relevant to large numbers of children who are still exposed to abusive or neglectful conditions around the world.”

To assess child-to-adult neurodevelopmental and mental health trajectories after early life deprivation, researchers analyzed data from the English and Romanian Adoptees study, a longitudinal, natural experiment investigation of long-term outcomes of individuals severely deprived from soon after birth to up to 43 months in Romanian institutions before being adopted in the United Kingdom. To determine symptoms of autism, inattention and overactivity, disinhibited social engagement, conduct or emotional problems and cognitive impairment, parents and adoptees completed standard questionnaires, interviews and IQ measures at ages 6, 11 and 15 years and from ages 22 to 25 years.

Symptom levels were similar between Romanian adoptees who experienced less than 6 months in an institution (n = 67 at age 6 years; n = 50 at young adulthood) and controls.

Conversely, Romanian adoptees who experienced more than 6 months in an institution (n = 98 at age 6 years; n = 72 at young adulthood) have higher symptom rates for autism, disinhibited social engagement and inattention and overactivity through young adulthood (P < .0001 for all), compared with controls.

Cognitive impairment was higher among participants exposed to more than 6 months in an institution at ages 6 years (P = .0001) and 11 years (P = .0016), compared with controls. However, these rates remitted to normal rates at young adulthood.

Researchers noted a late-onset pattern with minimal differences vs. controls in self-rated emotional symptoms at ages 11 years (P = .0449) and 15 years (P = .17), followed by significant increases by young adulthood (P = .0005).

Participants exposed to more than 6 months in an institution had lower educational attainment (P = .0195), higher unemployment (P = .0124) and higher mental health service use at ages less than 11 years (P = .012), 11 to 14 years (P = .0032) and 15 to 23 years (P = .0003), compared with controls.

“Whatever the underlying mechanisms, the findings of Sonuga-Barke and colleagues’ study elegantly support the rule of the earlier the better for improving the caregiving environment for young children whose basic needs are profoundly violated,” Frank C. Verhulst, MD, PhD, of Erasmus University, wrote in an accompanying editorial. “This finding is true for millions of children around the world who are exposed to war, terrorism, violence, or mass migration. As a consequence, many young children face trauma, displacement, homelessness, or family disruption. The straightforward implications of the study by Sonuga-Barke and colleagues are in line with Bowlby’s views and should be advanced in an equally determined and passionate way.” – by Amanda Oldt

Disclosure: Sonuga-Barke reports speaker fees, consultancy, research funding, and conference support from Shire Pharma and speaker fees from Janssen Cilag; consultancy fees from Neurotech Solutions, Aarhus University, Copenhagen University and Berhanderling, Skolerne, Copenhagen, Katholieke Universiteit Leuven; book royalties from Oxford University Press and Jessica Kingsley; and honorarium from Wiley for editorship. Verhulst reports receiving compensation for publishing Dutch translations of the Achenbach System of Empirically Based Assessment. Please see the full study for a list of all other researchers’ relevant financial disclosures.