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Original Article and Reviews

Psychological Consequences of Early Global Deprivation

An Overview of Findings From the English & Romanian Adoptees Study

Published Online:https://doi.org/10.1027/1016-9040/a000227

The English & Romanian Adoptees (ERA) study follows children who spent their first years of life in extremely depriving Romanian institutions before they were adopted by families in the UK. The ERA study constitutes a “natural experiment” that allows the examination of the effects of radical environmental change from a profoundly depriving institutional environment to an adoptive family home. The cohort has been assessed at ages 4, 6, 11, and 15 years, and has provided seminal insights into the effects of early global deprivation. The current paper focuses on the long-term psychological sequelae associated with deprivation experiences. These deprivation-specific problems (DSPs) constitute a striking pattern of behavioral impairments, in its core characterized by deficits in social cognition and behavior, as well as quasi-autistic features, often accompanied by cognitive impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD). Possible moderating influences, including variations in family environment, pre-adoption characteristics, and genetic variation, will be discussed to answer the question why some individuals have prospered while others have struggled. Apart from findings on the moderating effect of variation in genes associated with serotonergic and dopaminergic signaling involving specific phenotypes, heterogeneity in outcome is largely unexplained. The review concludes with an outlook on currently ongoing and future research of the ERA study cohort, which involves the investigation of neurobiological and epigenetic mechanisms as possible mediators of the long-term effects of institutional deprivation.

References

  • Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. First citation in articleCrossrefGoogle Scholar

  • Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1, 68–73. First citation in articleCrossrefGoogle Scholar

  • Audet, K., & Le Mare, L. (2011). Mitigating effects of the adoptive caregiving environment on inattention/overactivity in children adopted from Romanian orphanages. International Journal of Behavioral Development, 35, 107–115. First citation in articleCrossrefGoogle Scholar

  • Bakermans-Kranenburg, M. J., Steele, H., Zeanah, C. H., Muhamedrahimov, R. J., Vorria, P., Dobrova-Krol, N. A., … Gunnar, M. R. (2011). Attachment and emotional development in institutional care: Characteristics and catch up. Monographs of the Society for Research in Child Development, 76, 62–91. First citation in articleCrossrefGoogle Scholar

  • Beckett, C., Maughan, B., Rutter, M., Castle, J., Colvert, E., Groothues, C., … Sonuga-Barke, E. J. S. (2006). Do the effects of early severe deprivation on cognition persist into early adolescence? Findings from the English and Romanian adoptees study. Child Development, 77, 696–711. First citation in articleCrossrefGoogle Scholar

  • Behen, M. E., Helder, E., Rothermel, R., Solomon, K., & Chugani, H. T. (2008). Incidence of specific absolute neurocognitive impairment in globally intact children with histories of early severe deprivation. Child Neuropsychology, 14, 453–469. First citation in articleCrossrefGoogle Scholar

  • Bos, K. J., Zeanah, C. H. Jr., Smyke, A. T., Fox, N. A., & Nelson, C. A. 3rd. (2010). Stereotypies in children with a history of early institutional care. Archives of Pediatrics & Adolescent Medicine, 164, 406–411. First citation in articleCrossrefGoogle Scholar

  • Bremner, J. D. (2003). Long-term effects of childhood abuse on brain and neurobiology. Child and Adolescent Psychiatric Clinics of North America, 12, 271–292. First citation in articleCrossrefGoogle Scholar

  • Bruce, J., Tarullo, A. R., & Gunnar, M. R. (2009). Disinhibited social behavior among internationally adopted children. Development and Psychopathology, 21, 157–171. First citation in articleCrossrefGoogle Scholar

  • Canli, T., & Lesch, K. P. (2007). Long story short: The serotonin transporter in emotion regulation and social cognition. Nature Neuroscience, 10, 1103–1109. First citation in articleCrossrefGoogle Scholar

  • Caspi, A., & Moffitt, T. E. (2006). Gene-environment interactions in psychiatry: Joining forces with neuroscience. Nature Reviews Neuroscience, 7, 583–590. First citation in articleCrossrefGoogle Scholar

  • Castle, C., Beckett, C., Rutter, M., & Sonuga-Barke, E. (2010). Post-adoption environmental features. Monographs of the Society for Research in Child Development, 75, 167–186. First citation in articleCrossrefGoogle Scholar

  • Children’s Health Care Collaborative Group . (1992). Romanian health and social care system for children and families: Future directions in health care reform. British Medical Journal, 304, 556–559. First citation in articleCrossrefGoogle Scholar

  • Chisholm, K. (1998). A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Development, 69, 1092–1106. First citation in articleCrossrefGoogle Scholar

  • Chisholm, K., Carter, M. C., Ames, E. W., & Morison, S. J. (1995). Attachment security and indiscriminately friendly behavior in children adopted from Romanian orphanages. Development and Psychopathology, 7, 283–294. First citation in articleCrossrefGoogle Scholar

  • Chugani, H. T., Behen, M. E., Muzik, O., Juhasz, C., Nagy, F., & Chugani, D. C. (2001). Local brain functional activity following early deprivation: A study of postinstitutionalized Romanian orphans. Neuroimage, 14, 1290–1301. First citation in articleCrossrefGoogle Scholar

  • Colvert, E., Rutter, M., Kreppner, J., Beckett, C., Castle, J., Groothues, C., … Sonuga-Barke, E. J. (2008). Do theory of mind and executive function deficits underlie the adverse outcomes associated with profound early deprivation? Findings from the English and Romanian adoptees study. Journal of Abnormal Child Psychology, 36, 1057–1068. First citation in articleCrossrefGoogle Scholar

  • Constantino, J. N., Gruber, C. P., Davis, S., Hayes, S., Passanante, N., & Przybeck, T. (2004). The factor structure of autistic traits. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 45, 719–726. First citation in articleCrossrefGoogle Scholar

  • Cook, E. H. Jr., Stein, M. A., Krasowski, M. D., Cox, N. J., Olkon, D. M., Kieffer, J. E., & Leventhal, B. L. (1995). Association of attention-deficit disorder and the dopamine transporter gene. American Journal of Human Genetics, 56, 993–998. First citation in articleGoogle Scholar

  • Eluvathingal, T. J., Chugani, H. T., Behen, M. E., Juhasz, C., Muzik, O., Maqbool, M., … Makki, M. (2006). Abnormal brain connectivity in children after early severe socioemotional deprivation: A diffusion tensor imaging study. Pediatrics, 117, 2093–2100. First citation in articleCrossrefGoogle Scholar

  • Fisher, L., Ames, E. W., Chisholm, K., & Savoie, L. (1997). Problems reported by parents of Romanian orphans adopted to British Columbia. International Journal of Behavioral Development, 20, 67–82. First citation in articleCrossrefGoogle Scholar

  • Ghera, M. M., Marshall, P. J., Fox, N. A., Zeanah, C. H., Nelson, C. A., Smyke, A. T., & Guthrie, D. (2009). The effects of foster care intervention on socially deprived institutionalized children’s attention and positive affect: Results from the BEIP study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 50, 246–253. First citation in articleCrossrefGoogle Scholar

  • Gleason, M. M., Fox, N. A., Drury, S., Smyke, A., Egger, H. L., Nelson, C. A., … Zeanah, C. H. 3rd. (2011). Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 216–231. First citation in articleCrossrefGoogle Scholar

  • Gunnar, M. R., Van Dulmen, M. H. M., & Team, I. A. P. (2007). Behavior problems in postinstitutionalized internationally adopted children. Development and Psychopathology, 19, 129–148. First citation in articleCrossrefGoogle Scholar

  • Hodges, J., & Tizard, B. (1989). IQ and behavioral adjustment of ex-institutional adolescents. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 30, 53–75. First citation in articleCrossrefGoogle Scholar

  • Hoksbergen, R., ter Laak, J., Rijk, K., van Dijkum, C., & Stoutjesdijk, F. (2005). Post-institutional autistic syndrome in Romanian adoptees. Journal of Autism and Developmental Disorders, 35, 615–623. First citation in articleCrossrefGoogle Scholar

  • Holmes, S. E., Slaughter, J. R., & Kashani, J. (2001). Risk factors in childhood that lead to the development of conduct disorder and antisocial personality disorder. Child Psychiatry and Human Development, 31, 183–193. First citation in articleCrossrefGoogle Scholar

  • Jenkins, J. (2008). Psychosocial adversity and resilience. In M. RutterD. BishopS. PineJ. ScottJ. StevensonE. TaylorA. ThaparEds., Rutter’s child and adolescent psychiatry, Vol. 5, (pp. 377–391). Oxford, UK: Blackwell. First citation in articleCrossrefGoogle Scholar

  • Juffer, F., & van IJzendoorn, M. H. (2005). Behavior problems and mental health referrals of international adoptees: A meta-analysis. JAMA – Journal of the American Medical Association, 293, 2501–2515. First citation in articleCrossrefGoogle Scholar

  • Kaler, S. R., & Freeman, B. J. (1994). Analysis of environmental deprivation: Cognitive and social development in Romanian orphans. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 35, 769–781. First citation in articleCrossrefGoogle Scholar

  • Karg, K., Burmeister, M., Shedden, K., & Sen, S. (2011). The serotonin transporter promoter variant (5-HTTLPR), stress, and depression meta-analysis revisited: Evidence of genetic moderation. Archives of General Psychiatry, 68, 444–454. First citation in articleCrossrefGoogle Scholar

  • Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis. Archives of General Psychiatry, 57, 953–959. First citation in articleCrossrefGoogle Scholar

  • Kendler, K. S., Kuhn, J. W., & Prescott, C. A. (2004). Childhood sexual abuse, stressful life events and risk for major depression in women. Psychological Medicine, 34, 1475–1482. First citation in articleCrossrefGoogle Scholar

  • Kreppner, J., Kumsta, R., Rutter, M., Beckett, C., Castle, J., Stevens, S., & Sonuga-Barke, E. J. (2010). Developmental course of deprivation-specific psychological patterns: Early manifestations, persistence to age 15, and clinical features. Monographs of the Society for Research in Child Development, 75, 79–101. First citation in articleCrossrefGoogle Scholar

  • Kreppner, J. M., O’Connor, T. G., & Rutter, M. (2001). Can inattention/overactivity be an institutional deprivation syndrome? Journal of Abnormal Child Psychology, 29, 513–528. First citation in articleCrossrefGoogle Scholar

  • Kreppner, J. M., Rutter, M., Beckett, C., Castle, J., Colvert, E., Groothues, C., … Sonuga-Barke, E. J. S. (2007). Normality and impairment following profound early institutional deprivation: A longitudinal follow-up into early adolescence. Developmental Psychology, 43, 931–946. First citation in articleCrossrefGoogle Scholar

  • Kumsta, R., Kreppner, J., Rutter, M., Beckett, C., Castle, J., Stevens, S., & Sonuga-Barke, E. J. (2010). Deprivation-specific psychological patterns. Monographs of the Society for Research in Child Development, 75, 48–78. First citation in articleCrossrefGoogle Scholar

  • Kumsta, R., Rutter, M., Stevens, S., & Sonuga-Barke, E. J. (2010). Risk, causation, mediation, and moderation. Monographs of the Society for Research in Child Development, 75, 187–211. First citation in articleCrossrefGoogle Scholar

  • Lahey, B. B., Moffitt, T. E., & Caspi, A. (2003). Causes of conduct disorder and juvenile delinquency. London, UK: Guilford. First citation in articleGoogle Scholar

  • Lesch, K. P., Bengel, D., Heils, A., Sabol, S. Z., Greenberg, B. D., Petri, S., … Murphy, D. L. (1996). Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science, 274, 1527–1531. First citation in articleCrossrefGoogle Scholar

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2001). Autism Diagnostic Observation Schedule: Manual. Los Angeles, CA: Western Psychological Services. First citation in articleGoogle Scholar

  • MacLean, K. (2003). The impact of institutionalization on child development. Development and Psychopathology, 15, 853–884. First citation in articleCrossrefGoogle Scholar

  • McCall, R., & Grotevant, H. (2011). Children without permanent parental care: Research, practice, and policy, Vol. 76, Boston, MA: Wiley-Blackwell. First citation in articleGoogle Scholar

  • McLaughlin, K. A., Sheridan, M. A., Winter, W., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2014). Widespread reductions in cortical thickness following severe early-life deprivation: A neurodevelopmental pathway to attention-deficit/hyperactivity disorder. Biological Psychiatry, 76, 629–638. doi: 10.1016/j.biopsych.2013.08.016 First citation in articleCrossrefGoogle Scholar

  • McMahon, S. D., Grant, K. E., Compas, B. E., Thurm, A. E., & Ey, S. (2003). Stress and psychopathology in children and adolescents: Is there evidence of specificity? Journal of Child Psychology and Psychiatry, and Allied Disciplines, 44, 107–133. First citation in articleCrossrefGoogle Scholar

  • Mehta, M. A., Golembo, N. I., Nosarti, C., Colvert, E., Mota, A., Williams, S. C., … Sonuga-Barke, E. J. (2009). Amygdala, hippocampal and corpus callosum size following severe early institutional deprivation: The English and Romanian Adoptees study pilot. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 50, 943–951. First citation in articleCrossrefGoogle Scholar

  • Mehta, M. A., Gore-Langton, E., Golembo, N., Colvert, E., Williams, S. C., & Sonuga-Barke, E. (2010). Hyporesponsive reward anticipation in the basal ganglia following severe institutional deprivation early in life. Journal of Cognitive Neuroscience, 22, 2316–2325. First citation in articleCrossrefGoogle Scholar

  • Murphy, D. L., Lerner, A., Rudnick, G., & Lesch, K. P. (2004). Serotonin transporter: Gene, genetic disorders, and pharmacogenetics. Molecular Interventions, 4, 109–123. First citation in articleCrossrefGoogle Scholar

  • National Authority for the Protection of Child’s Rights Romania . (2006). Child welfare in Romania. Bucharest, Romania: Ministry of Labour, Social Solidarity and Family. First citation in articleGoogle Scholar

  • Nelson, C. A., Zeanah, C. H., Fox, N. A., Marshall, P. J., Smyke, A. T., & Guthrie, D. (2007). Cognitive recovery in socially deprived young children: The Bucharest early intervention project. Science, 318, 1937–1940. First citation in articleCrossrefGoogle Scholar

  • Paolucci, E. O., Genuis, M. L., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135, 17–36. First citation in articleCrossrefGoogle Scholar

  • Pinheiro, P. S. (2006). World report on violence against children. Geneva, Switzerland: United Nations. First citation in articleGoogle Scholar

  • Pliszka, S. R. (2005). The neuropsychopharmacology of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1385–1390. First citation in articleCrossrefGoogle Scholar

  • Rutter, M. (1998). Developmental catch-up, and deficit, following adoption after severe global early privation. English and Romanian Adoptees (ERA) Study Team. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 39, 465–476. First citation in articleCrossrefGoogle Scholar

  • Rutter, M. (2008). Genetic effects on environmental vulnerability to disease: State of the art and future directions. Chichester, UK: Wiley. First citation in articleCrossrefGoogle Scholar

  • Rutter, M., Andersen-Wood, L., Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., … Team, E. R. A. S. (1999). Quasi-autistic patterns following severe early global privation. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 40, 537–549. First citation in articleCrossrefGoogle Scholar

  • Rutter, M., Bailey, A., & Lord, C. (2003). The Social Communication Questionnaire. Los Angeles, CA: Western Psychological Services. First citation in articleGoogle Scholar

  • Rutter, M., Beckett, C., Castle, J., Kreppner, J., Stevens, S., & Sonuga-Barke, E. (2009). Policy and practice implications from the English and Romanian Adoptees (ERA) Study: Forty Two Key Questions. London, UK: BAAF. First citation in articleGoogle Scholar

  • Rutter, M., Kumsta, R., Schlotz, W., & Sonuga-Barke, E. (2012). Longitudinal studies using a “natural experiment” design: The case of adoptees from Romanian institutions. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 762–770. First citation in articleCrossrefGoogle Scholar

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism Diagnostic Interview – Revised: Manual. Los Angeles, CA: Western Psychological Services. First citation in articleGoogle Scholar

  • Rutter, M., Sonuga-Barke, E., Beckett, C., Castle, J., Kreppner, J., Kumsta, R., … Stevens, S. (2010). Deprivation-specific psychological patterns. Effects of institutional deprivation. New York, NY: Wiley. First citation in articleGoogle Scholar

  • Rutter, M., Sonuga-Barke, E., & Castle, J. (2010). Investigating the impact of early institutional deprivation on development: Background and research strategy of the English and Romanian Adoptees (ERA) study. Monographs of the Society for Research in Child Development, 75, 21–47. First citation in articleCrossrefGoogle Scholar

  • Rutter, M., Tizard, J., & Whitmore, K. (1970). Education, health, and behaviour. London, UK: Longmans. First citation in articleGoogle Scholar

  • Rutter, M. L., Kreppner, J. M., & O’Connor, T. G. (2001). Specificity and heterogeneity in children’s responses to profound institutional privation. British Journal of Psychiatry, 179, 97–103. First citation in articleCrossrefGoogle Scholar

  • Sanberg, S., & Rutter, M. (2008). Rutter’s child and adolescent psychiatry. In M. RutterD. BishopS. PineJ. ScottJ. StevensonE. TaylorA. ThaparEds., Rutter’s child and adolescent psychiatry, Vol. 5, (pp. 392–406). Oxford, UK: Blackwell. First citation in articleGoogle Scholar

  • Smyke, A. T., Zeanah, C. H., Gleason, M. M., Drury, S. S., Fox, N. A., Nelson, C. A., & Guthrie, D. (2012). A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder. American Journal of Psychiatry, 169, 508–514. First citation in articleCrossrefGoogle Scholar

  • Sonuga-Barke, E., Schlotz, W., & Kreppner, J. (2010). Differentiating developmental trajectories for conduct, emotion, and peer problems following early deprivation. Monographs of the Society for Research in Child Development, 75, 102–124. doi: 10.1111/j.1540-5834.2010.00552.x First citation in articleCrossrefGoogle Scholar

  • Sonuga-Barke, E. J., Beckett, C., Kreppner, J., Castle, J., Colvert, E., Stevens, S., … Rutter, M. (2008). Is sub-nutrition necessary for a poor outcome following early institutional deprivation? Developmental Medicine and Child Neurology, 50, 664–671. First citation in articleCrossrefGoogle Scholar

  • Sonuga-Barke, E. J., & Rubia, K. (2008). Inattentive/overactive children with histories of profound institutional deprivation compared with standard ADHD cases: A brief report. Child: Care, Health and Development, 34, 596–602. First citation in articleCrossrefGoogle Scholar

  • Stevens, S. E., Kumsta, R., Kreppner, J. M., Brookes, K. J., Rutter, M., & Sonuga-Barke, E. J. (2009). Dopamine transporter gene polymorphism moderates the effects of severe deprivation on ADHD symptoms: Developmental continuities in gene-environment interplay. American Journal of Medical Genetics. Part B: Neuropsychiatric Genetics, 150B, 753–761. First citation in articleCrossrefGoogle Scholar

  • Stevens, S. E., Sonuga-Barke, E. J. S., Kreppner, J. M., Beckett, C., Castle, J., Colvert, E., … Rutter, M. (2008). Inattention/overactivity following early severe institutional deprivation: Presentation and associations in early adolescence. Journal of Abnormal Child Psychology, 36, 385–398. First citation in articleCrossrefGoogle Scholar

  • Thapar, A., O’Donovan, M., & Owen, M. J. (2005). The genetics of attention deficit hyperactivity disorder. Human Molecular Genetics, 14, R275–R282. doi: 10.1093/hmg/ddi263 First citation in articleCrossrefGoogle Scholar

  • Tottenham, N., Hare, T. A., Quinn, B. T., McCarry, T. W., Nurse, M., Gilhooly, T., … Casey, B. J. (2010). Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation. Developmental Science, 13, 46–61. First citation in articleCrossrefGoogle Scholar

  • Uher, R. (2008). The implications of gene-environment interactions in depression: Will cause inform cure? Molecular Psychiatry, 13, 1070–1078. First citation in articleCrossrefGoogle Scholar

  • van Ijzendoorn, M. H., Juffer, F., & Poelhuis, C. W. (2005). Adoption and cognitive development: A meta-analytic comparison of adopted and nonadopted children’s IQ and school performance. Psychological Bulletin, 131, 301–316. First citation in articleCrossrefGoogle Scholar

  • van Ijzendoorn, M. H., Luijk, M. P. C. M., & Juffer, F. (2008). IQ of children growing up in children’s homes: A meta-analysis on IQ delays in orphanages. Merrill-Palmer Quarterly – Journal of Developmental Psychology, 54, 341–366. First citation in articleCrossrefGoogle Scholar

  • Wegman, H. L., & Stetler, C. (2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosomatic Medicine, 71, 805–812. First citation in articleCrossrefGoogle Scholar

  • Young, E. A., Abelson, J. L., Curtis, G. C., & Nesse, R. M. (1997). Childhood adversity and vulnerability to mood and anxiety disorders. Depression and Anxiety, 5, 66–72. First citation in articleCrossrefGoogle Scholar

  • Zeanah, C. H., & Smyke, A. T. (2008). Attachment disorders in family and social context. Infant Mental Health Journal, 29, 219–233. First citation in articleCrossrefGoogle Scholar

  • Zeanah, C. H., Smyke, A. T., & Dumitrescu, A. (2002). Disturbances of attachment in young children: Indiscriminate behavior and institutional care. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 983–989. First citation in articleCrossrefGoogle Scholar

  • Zeanah, C. H., Smyke, A. T., Koga, S. F., & Carlson, E. (2005). Attachment in institutionalized and community children in Romania. Child Development, 76, 1015–1028. First citation in articleCrossrefGoogle Scholar