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Early life deprivation and the ERA study

Geoff Ferguson - February 28th 2017

We know that institutional deprivation at a very early age can lead to disorders in the child’s neurodevelopment and mental health. What is less clear is how these problems might continue into later life. The latest report1 from the English and Romanian Adoptees study follows into young adulthood adoptees who experienced severe early global deprivation.

The fate of the Romanian orphans is often given as an example of the effects of early institutional deprivation. These were children who were kept in terrible conditions in orphanages during the Communist regime that ended in 1989. A harsh austerity programme during the 1980s created food and energy shortages, and eventually contributed to the end of the regime. This austerity programme, along with a policy to encourage a high birth rate, led to overcrowded and poorly resourced orphanages, with poorly trained staff.

Conditions in many of the orphanages were truly terrible. Children were often kept naked, were underfed and without proper medical care. In many cases children were tied to their beds and received little emotional or other stimulation. Beatings and physical abuse was common, both from members of staff and from older children.

With the downfall of Ceaușescu the fate of these orphans became widely known and several were adopted by English families. It is the progress of these orphans which is the subject of the English and Romanian Adoptees study. The study recruited 165 Romanian orphans who had been adopted into English families, along with 52 UK adoptees to act as a comparison sample. The study has now been following these adoptees for over 20 years and provides important insights into the long-term effects of early deprivation.

Earlier assessments of the children’s development had been made at ages 6, 11 and 15. These studies had shown that many of the Romanian children with a profound developmental delay had made significant progress after adoption. Children who had spent less than 6 months in a Romanian orphanage were largely indistinguishable from the non-deprived UK adoptees. However, the Romanian children who had been in the orphanage for more than 6 months showed a significant impairment of their social and cognitive functioning that persisted through to adolescence. These impairments included symptoms of disinhibited social engagement, autistic behaviours such as communication and obsessional problems, inattention and overactivity, and cognitive impairment.

The study has now been able to track these issues into young adulthood. Again, the study found that in their early 20s Romanian adoptees who had spent less than 6 months in an orphanage before being adopted were indistinguishable from their UK counterparts.

However, compared to the UK adoptees, Romanian adoptees who had spent more than 6 months in an institution continued to have problems into young adulthood in most of the areas identified in the earlier assessments. These included symptoms of autism spectrum disorder, disinhibited social engagement, and inattention and overactivity.

In striking contrast, these adoptee’s earlier cognitive impairment had generally normalised by early adulthood.

Emotional problems, such as depression and anxiety, seemed to follow a very different trajectory to these other difficulties. At age 6 rates of emotional problems amongst the more deprived Romanian adoptees were almost the same as amongst the less deprived Romanian and UK adoptees. However, the rate of these problems began to increase amongst the more deprived adoptees during their adolescence, until by young adulthood these adoptees had a rate of emotional problems that was three to four times higher than amongst other adoptees.

This is a significant finding, given the relative absence of emotional problems in the earlier assessments. This perhaps says something about the way in which the individual's early experiences had failed to prepare them for the developmental challenges of adolescence and early adulthood. Even so, there was a significant proportion of the more deprived Romanian adoptees who still showed no mental health problems in young adulthood. The report’s authors note the importance of working to understand the origins of this resilience in these children.

The English and Romanian Adoptees study provides a unique insight into the long-term effects of early deprivation. As the authors of its latest report conclude: 

Our finding that early institutional deprivation is associated with a pervasive pattern of long-term impairment and burden is relevant to the health and wellbeing of the very large numbers of children worldwide still exposed to depriving and neglectful conditions.

1Sonuga-Barke, Edmund J S et al. (2017) Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet. Open Access http://dx.doi.org/10.1016/S0140-6736(17)30045-4


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Welcome to ourNews, where we keep up-to-date with research and other news related to infant mental health. These articles can be of interest to both parents and professionals.
We are keen to know your views and so please do comment on our articles.
Is there a topic that you would like us to write about? Just send us a message via 'Contact us'.

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