Using findings from a study that assessed children adopted from Romanian institutions into families in the United Kingdom, The Lancet reports that deprivation and neglect in early childhood can have a lasting psychological effect into adulthood.

The English and Romanian Adoptees study — conducted by scientists from the University of Southampton, King’s College London, Ruhr University Bochum, The Amy Winehouse Foundation, and the Max Planck Institute for Empirical Aesthetics — began in 1990, following the end of Romania’s communist regime. It analyzed the mental health and cognitive well-being of 165 children between the ages of 2 weeks and 43 months who had endured malnutrition, poor hygiene, little personalized care, and no social or cognitive stimulation and were adopted by families in the United Kingdom deemed to be “socioeconomically advantaged, stable, caring, and supportive.”

The study compared the 165 Romanian children adopted in the United Kingdom with 52 UK children who were adopted in the United Kingdom. Researchers used IQ tests, questionnaires, and interviews with both the children and their adoptive parents at the ages of 6, 11, and 15 to measure symptoms of autism spectrum disorder, inattention and overactivity, disinhibited social engagement, conduct or emotional problems, and cognitive impairment. The Romanian adoptees were further divided into those who had spent less than 6 months (n=67 at age 6 years and n=50 at young adulthood) and those who spent more than 6 months (n=98 at age 6 years and n=72 in young adulthood) in an institution. The researchers then followed both groups of adoptees to ages 22 to 25 years (by that time, approximately 75% of adoptees were still participating in the study: 39 UK adoptees, 50 Romanian adoptees who had spent <6 months in an institution as children, and 72 Romanian adoptees who had spent >6 months in an institution).

Romanian adoptees who had spent <6 months in an institution had similar rates of mental health symptoms as the UK adoptees, but Romanian adoptees who had spent more time in the institutions as children had higher rates of social problems — including autistic features, difficulty engaging with others, and inattention/overactivity — extending from childhood into adulthood. They were also 3- to 4-times more likely to experience emotional problems as adults and had lower educational achievement and employment rates than the other UK and Romanian adoptees.

“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,” explained lead researcher Professor Edmund Sonuga-Barke, King’s College London, who conducted the follow-up study while at the University of Southampton.

While adoptees who lived in Romanian institutions for >6 months had an IQ of less than 80 at 6 years of age, this recovered to within normal levels (90 or above) by early adulthood, suggesting developmental delays but no permanent impact on general cognitive abilities.In addition, 1 in 5 (21%, 15 children) adoptees who spent more than 6 months in Romanian institutions did not experience any mental health problems throughout their lives.

“Although we have not conducted any randomized controlled trials, we have no reason to believe that the neurodevelopmental problems and mental health conditions affected following early deprivation will not be amenable to standard therapies,” Dr Sonuga-Barke told Psychiatry Advisor. “Certainly during their childhood we know that many of the children were satisfactorily treated with standard ADHD pharmacological and nonpharmacological treatments.”

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Sonuga-Barke EJS, Kennedy M, Kumsta R, et al. 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. 2017;