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Background: A common polymorphism in the serotonin transporter gene (SLC6A4, 5HTT) has been repeatedly shown to moderate the influence of childhood adversity and stressful life events on the development of psychopathology. Using data from the English and Romanian Adoptee Study, a prospective-longitudinal study of individuals (n = 125) exposed to severe early institutional deprivation (ID), we tested whether the effect of ID on adolescent emotional problems is moderated by 5HTT genotype and stressful life events in adolescence. Methods: Emotional problems were assessed using questionnaire data (age 11), and on the basis of the CAPA diagnostic interview (age 15). Additionally, the number of stressful life events was measured. Results: There was a significant effect for genotype (p = 0.003) and a gene x environment interaction (p = 0.008) that was independent of age at testing. Carriers of the s/l and s/s genotype who experienced severe ID showed the highest emotional problem scores, while l/l homozygotes in the severe ID group showed the lowest overall levels. Furthermore, s/s carriers in the severe ID group who experienced a high number of stressful life events between 11 and 15 years had the largest increases in emotional problem scores, while a low number of stressful life events was associated with the largest decrease (4-way interaction: p = 0.05). Conclusions: The effects of severe early ID on emotional problems in adolescence are moderated by 5HTT genotype, and influenced by stressful life events in adolescence.

There is an abundance of evidence showing relatively strong associations between family characteristics and a child's psychological functioning--both within the normal range and, also, with reference to psychopathology. That has sometimes led to the assumption that equally strong associations should be found within adoptive families. Nevertheless, the available evidence indicates that, to the contrary, the associations tend to be much weaker than those in biological families. In this chapter, the authors sought to determine whether variations in the qualities in the adoptive home might provide the explanation. There was no evidence that postadoption environmental features accounted for the presence of DSPs, but that did not necessarily rule out the possibility of effects on psychopathological features outside of DSPs. The findings certainly do not mean that the huge improvements in functioning following adoption were not a consequence of the adoption. To the contrary, there is ample evidence that this was a causal effect. (Contains 11 tables.)

Whereas metaanalyses of cross-sectional adoption studies have indicated that there is an impact of early deprivation on adoptee's cognitive ability, these effects generally diminish markedly after upbringing in adoptive homes. Outcomes in terms of scholastic attainment were not quite so positive in a cross-sectional metaanalysis, but the Swedish follow-up study of male conscripts did not find that scholastic attainment was impaired relative to IQ. Both initial impairment and catch-up vary as a function of the length and severity of deprivation experienced. Previous analyses of the ERA data patterns of educational attainment at age 11 indicated that these were largely predictable on the basis of cognitive ability, although symptoms of inattention also played a minor role. In this chapter, the authors tackle two key issues: the validity, and the meaning of, a general factor of overall intelligence "g"; and whether these specific cognitive functions are regularly associated with different types of scholastic performance. (Contains 5 tables and 1 figure.)

It has come to be generally accepted that the psychopathological effects of psychosocial stress and adversity are diagnostically nonspecific. There is a good deal of supporting evidence in support of this assumption, even though it may be that the nonspecificity has been exaggerated through a failure to take account of comorbidity. This chapter presents findings on the designation of deprivation-specific psychological patterns (DSPs). These included an early onset (at least by age 6 years, the earliest age at which data were available for the whole sample) and persistence to 11 years of age. The persistence to 11-year requirement was introduced particularly because minor manifestations of DA were so frequent at age 6 years in the pooled comparison group. Without the persistence criterion, the association of DSPs with institutional deprivation would be much weakened. (Contains 5 tables and 8 figures.)

In chapter IV, the authors focused on their findings on the developmental course of deprivation-specific psychological patterns (DSPs). The authors rediscussed the syndrome concept in the light of two main considerations. First, the findings indicated substantial overlap among the four postulated DSPs at 15 years including CI and I/O before requiring cooccurrence with Q-A or DA. Second, they realized that, ordinarily, syndromes are defined on the basis of a unifying pathophysiology rather than a mere clustering together of symptoms. Although they have not identified the nature of such pathophysiology, the strong continuing association with institutional deprivation extending up to at least 6 months of age, plus the findings from the pilot brain imaging study points to the likelihood that there is a unifying pathophysiology. Accordingly, they conclude that, on balance, a coherent syndrome remains a strong possibility. (Contains 6 tables.)

This monograph is concerned with the mid adolescent follow-up of a group of adoptees from Romania and from within the United Kingdom who were first assessed at the age of 4 years (or 6 years in the case of the oldest children). Chapter I provides the background as it applied at the time that the study began, and then goes on to outline the overall research strategy and the measures relevant for the first assessment at age 4 years. It then goes on to summarize, briefly, some of the key findings from the follow-ups undertaken up to the age of 11 years. In the authors' published papers on the age 4-, 6-, and 11-year assessments, they mainly dealt with findings in relation to key outcome variables. In this monograph, they have adopted a different strategy that capitalizes on the unique features of their study. Their study is the only investigation with detailed interview and observation measures, together with psychometric assessments, spanning a 10-year follow-up period. Most especially, their study is unique in having systematic, standardized measurements of key behavioral patterns that seem to be specific to institutional deprivation. Accordingly, the authors have been able to focus on the crucial issue of the extent to which these patterns account for the deficits and problems that have persisted to age 15 years. In order to do that, it was first necessary both to determine which patterns met criteria for specificity to institutional deprivation and to determine their boundaries. This topic is tackled in Chapter III, after outlining the methods and measures in Chapter II. Chapter IV builds on the authors' prospective data over the course of a decade in order to describe the developmental course of the deprivation-specific psychological patterns (DSPs) defined in Chapter III. To facilitate this, the several apparently DSPs are pooled, having noted the major overlap among them. Chapter V considers disturbances of emotion, conduct and peer relations--that is, the three major domains of psychopathology that, up to age 11 years, appeared "not" to follow a DSPs. Chapter VI takes as its starting point the major catch-up found in cognitive functioning following adoption and goes on to ask how far cognitive findings vary according to specific cognitive function and how far cognitive gains up to age 11 have been translated into meaningful educational attainments at age 15-16 years. Chapter VII reevaluates these findings in the light of the age 15 results and examines the physical growth and maturational effects of institutional deprivation. It considers how far the findings differ according to the presence/absence of institutional deprivation-specific features. Chapter VIII reexamines the issue of possible postadoption environmental mediators, paying attention to key methodological challenges. Throughout their study, there has been abundant evidence of heterogeneity in outcome. Chapter IX seeks to pull together the relevant findings with respect to possible biological moderators and mediators. There is reexamination of the apparently protective role of minimal language skills, of genetic influences on environmental susceptibility, of possible effects of social cognitive features, of the role of subnutrition, and of impaired head growth. Finally, Chapter X provides an overview of the findings at age 15, together with the theoretical and practical implications of these findings. (Contains 48 tables and 21 figures.)

Theory of Mind (ToM) and Executive Function (EF) have been associated with autism and with attention-deficit hyperactivity disorder (ADHD), and hence might play a role in similar syndromes found following profound early institutional deprivation. In order to examine this possibility the current study included a group of 165 Romanian adoptees, of whom 144 were adopted into the UK from deprived institutional settings before 43 months of age, and a group of 52 within-UK adoptees, all adopted before 6 months of age. Both groups were assessed at 6 and 11 years. The Strange Stories task was used to assess ToM and the Stroop task was used to assess EF, both at age 11. The Romanian adoptees displayed deficits in both ToM and EF compared with the within-UK adoptee group. The degree of deficit was greater for children who had experienced more than 6 months of institutional deprivation. Deficits in both domains (ToM and EF) were associated with each of the three apparently deprivation-specific problems, namely quasi-autism, disinhibited attachment and inattention/overactivity. Statistical analyses indicated a mediating role for both ToM and EF with respect to quasi-autism; possibly a partial mediating role for EF with respect to inattention/overactivity; and probably no mediating role for either ToM or EF in the case of disinhibited attachment. In conclusion, there is evidence for a possible mediating role for ToM and EF in the development of some apparently deprivation-specific difficulties in institution-reared Romanian adoptees, but neither accounts for the overall pattern of deprivation-related difficulties.

The current study examined the persistence and phenotypic presentation of inattention/overactivity (I/O) into early adolescence, in a sample of institution reared (IR) children adopted from Romania before the age of 43 months. Total sample comprised 144 IR and 21 non-IR Romanian adoptees, and a comparison group of 52 within-UK adoptees, assessed at ages 6 and 11 years. I/O was rated using Rutter Scales completed by parents and teachers. I/O continued to be strongly associated with institutional deprivation, with continuities between ages 6 and 11 outcomes. There were higher rates of deprivation-related I/O in boys than girls, and I/O was strongly associated with conduct problems, disinhibited attachment and executive function but not IQ more generally, independently of gender. Deprivation-related I/O shares many common features with ADHD, despite its different etiology and putative developmental mechanisms. I/O is a persistent domain of impairment following early institutional deprivation of 6 months or more, suggesting there may be a possible pathway to impairment through some form of neuro-developmental programming during critical periods of early development.

The relationship between severe early institutional deprivation and scholastic attainment at age 11 in 127 children (68 girls and 59 boys) adopted from institutions in Romania was compared to the attainment of 49 children (17 girls and 32 boys) adopted within the UK from a non-institutional background. Overall, children adopted from Romania had significantly lower attainment scores than those adopted within the UK; the children within the Romanian sample who had spent 6 months or more in an institution had significantly lower attainment scores than those who had spent less than 6 months in an institution, but there was no additional risk of low attainment associated with longer institutional care after 6 months. The lower scholastic attainment in the children adopted from Romanian institutions, as compared with domestic adoptees, was mediated by IQ, and to a lesser degree, inattention/overactivity. When these factors were taken into account, only small between-group differences in attainment remained.

Background: Some young children reared in profoundly depriving institutions have been found to show autistic-like patterns, but the developmental significance of these features is unknown. Methods: A randomly selected, age-stratified, sample of 144 children who had experienced an institutional upbringing in Romania and who were adopted by UK families was studied at 4, 6, and 11 years, and compared with a non-institutionalised sample of 52 domestic adoptees. Twenty-eight children, all from Romanian institutions, for whom the possibility of quasi-autism had been raised, were assessed using the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) at the age of 12 years. Results: Sixteen children were found to have a quasi-autistic pattern; a rate of 9.2% in the Romanian institution-reared adoptees with an IQ of at least 50 as compared with 0% in the domestic adoptees. There were a further 12 children with some autistic-like features, but for whom the quasi-autism designation was not confirmed. The follow-up of the children showed that a quarter of the children lost their autistic-like features by 11. Disinhibited attachment and poor peer relationships were also present in over half of the children with quasi-autism. Conclusions: The findings at age 11/12 years confirmed the reality and clinical significance of the quasi-autistic patterns seen in over 1 in 10 of the children who experienced profound institutional deprivation. Although there were important similarities with "ordinary" autism, the dissimilarities suggest a different meaning.

Longitudinal analyses on normal versus impaired functioning across 7 domains were conducted in children who had experienced profound institutional deprivation up to the age of 42 months and were adopted from Romania into U.K. families. Comparisons were made with noninstitutionalized children adopted from Romania and with nondeprived within-U.K. adoptees placed before the age of 6 months. Specifically, the validity of the assessment, the degree of continuity and change in levels of functioning from 6 to 11 years, and the factors in the pre- and postadoption environment accounting for heterogeneity in outcome were examined. Pervasive impairment was significantly raised in children experiencing institutional deprivation for =6 months of life, with a minority within this group showing no impairment. There was no additional significant effect of duration of deprivation beyond the 6-month cutoff, and few other predictors explained outcome. The pattern of normality/impairment was mainly established by 6 years of age, with considerable continuity at the individual level between 6 and 11 years. The findings are discussed in terms of the possibility of a sensitive period for development.

Background: Disinhibited attachment is an important sequel of an institutional rearing, but questions remain regarding its measurement, its persistence, the specificity of the association with institutional rearing and on whether or not it constitutes a meaningful disorder. Method: Children initially reared in profoundly depriving institutions in Romania and subsequently adopted into UK families were compared with respect to findings at 11 years with children who had not experienced institutional deprivation and who had been adopted within the UK before the age of 6 months. Measures included parental reports, a Strange Situation procedure modified for use in the home and systematic standardised investigator ratings of the children's behaviour. Results: Disinhibited attachment, as reported by parents, showed a high degree of persistence from 6 to 11, but also a reduction over time in its frequency. Investigator ratings validated the parental reports but suggested that much of the fall in rate of disinhibited attachment was a function of the parental measure being less developmentally appropriate at 11 than it had been at 6. Disinhibited attachment was strongly associated with institutional rearing but there was not a significant increase in relation to duration of institutional deprivation beyond the age of 6 months. Mild, but not marked, disinhibited attachment was quite frequent in non-institutionalised adopted children but both the course and correlates indicated that its meaning was probably quite different. In the institution-reared children, disinhibited attachment was associated with a marked increase in service usage and associations with other forms of psychopathology. Conclusions: Disinhibited attachment constitutes a valid, and handicapping, clinical pattern that is strongly associated with an institutional rearing.

Background: There is uncertainty about the extent to which language skills are part of general intelligence and even more uncertainty on whether deprivation has differential effects on language and non-language skills. Methods: Language and cognitive outcomes at 6 and 11 years of age were compared between a sample of 132 institution-reared Romanian children adopted into UK families under the age of 42 months, and a sample of 49 children adopted within the UK under the age of 6 months who had not experienced either institutional rearing or profound deprivation. Results: The effects of institutional deprivation were basically similar for language and cognitive outcomes at age 6; in both there were few negative effects of deprivation if it ended before the age of 6 months and there was no linear association with duration of deprivation within the 6 to 42 month range. For the children over 18 months on arrival (range 18-42 months), the presence of even very minimal language skills (imitation of speech sounds) at the time of arrival was a strong beneficial prognostic factor for language and cognitive outcomes, but not for social/emotional/behavioural outcomes. Individual variations in adoptive parent characteristics were unrelated to differences in language or cognitive outcomes, possibly as a consequence of the limited variability in the adoptive family group. Conclusions: Minimal language probably indexes some form of cognitive reserve that, in turn, indexes the degree of institutional deprivation.

Cognitive outcomes at age 11 of 131 Romanian adoptees from institutions were compared with 50 U.K. adopted children. Key findings were of both continuity and change: (1) marked adverse effects persisted at age 11 for many of the children who were over 6 months on arrival; (2) there was some catch-up between ages 6 and 11 for the bottom 15%; (3) there was a decrease of 15 points for those over 6 months on arrival, but no differentiation within the 6-42-month range; (4) there was marked heterogeneity of outcome but this was not associated with the educational background of the adoptive families. The findings draw attention to the psychological as well as physical risks of institutional deprivation.

An extended longitudinal study compared cognitive development in children adopted from Romania before 24 months and in United Kingdom adoptees with an additional sample of Romanian children adopted after 24 months. Findings indicated that there was considerable catch-up among late-placed Romanian children but they exhibited lower cognitive scores and general developmental impairment compared with earlier adopted Romanian children. (Author/KB)

The article focuses on the findings of the English and Romanian Adoptees (ERA) study carried out to investigate the effects of early institutional deprivation on cognitive functions and academic achievement of children adopted from Romania. It states that the degree of initial impairment and cognitive development could influence the academic attainment. It mentions the association of intelligent quotient (IQ) with genetic and environmental influences. It states that the study focused on determining the association of cognitive gains between 11 and 15 years with deprivation-specific psychological patterns (DSPs). It concludes that cognitive gains with disabilities at 11 sustained up to the age of 15 years.

The article focuses on a study done to detect the postadoption influences on children in Romania and Great Britain. It states that the study focused on family factors that might distinguish children with or without assumed deprivation-specific psychological patterns (DSPs). It discusses the measure Child and Adolescent Psychiatric Analysis (CAPA) in which children upto age 15 years were interviewed. It presents a table in which group comparisons are made using the family risk (FARIS) scale. It further discusses the associations with non-DSP psychopathology in the pooled comparison group. It concludes that there was functional variation in the postadoption environment in children who were adopted after institutional deprivation.

This article by Celia Beckett, Amanda Hawkins, Michael Rutter, Jenny Castle, Emma Colvert, Christine Groothues, Jana Kreppner, Suzanne Stevens and Edmund Sonuga-Barke examines attitudes regarding cultural and national identity in a group of 165 young people adopted from Romania. The attitudes of their adoptive parents are also explored. The adoptive parents were interviewed over three or four time periods, when their children were 4/6, 11 and 15 years, and the adopted young people at the age of 11 and 15. The majority of the adopted young people had an interest in Romania and expressed a wish to visit their country of origin. However, there was no association between this interest in Romanian identity and levels of self-esteem. The majority of the adoptees saw themselves as English or Anglo-Romanian. A small minority saw themselves as Romanian; these adoptees had both lower self-esteem and a higher level of deprivation-specific problems. The degree of sustained interest shown by adoptive parents in the importance of Romanian identity was associated with the adopted young people's interest in Romania. However, parental interest in this issue had significantly declined by the time the children were 11 years old, by which time fewer adoptive parents than young people had plans to visit Romania in the future. [ABSTRACT FROM AUTHOR]

The study assessed conduct and emotional difficulties in a group of Romanian adoptees at age 11, and serves as a follow-up to assessments made when the children were 6 years old. It was found that there was a significant increase in emotional difficulties, but not conduct problems, for the Romanian sample since age 6. It was also found that emotional difficulty was significantly more prevalent at age 11 in the Romanian group than in a within-UK adoptee group. Emotional difficulties in the Romanian adoptee group were found to be significantly and strongly related to previous deprivation-specific problems (disinhibited attachment, cognitive impairment, inattention/overactivity and quasi-autism); however, the presence of such early problems did not account fully for the onset of later emotional problems. Five contrasting hypotheses concerning possible mediators for later onset of emotional difficulties for the Romanian group were examined. No links were found to duration of deprivation or other deprivation-related indices, stresses/difficulties in the postadoption family environment, or educational attainment and self-esteem. There was some evidence that emotion recognition might play a role in the emergence of these problems, but other measures of social competence and theory of mind showed no associations with the onset of emotional problems. [ABSTRACT FROM PUBLISHER]

A study of the views of two groups of 11-year-old adopted children (one adopted as babies within the UK, n = 47, the other adopted from Romania, aged between two and 43 months, n = 133) indicates that parents underestimate the difficulty that their children have in talking about adoption. Children who found this harder experienced lower self-esteem at age 11 and were also more likely to feel different from their adoptive families, and both these factors were related to the individual child's level of behavioural or cognitive difficulties. Children in the Romanian sample who had another adopted sibling found it easier to talk about their adoption. In summary, the ease with which children can talk about adoption does appear to be associated with higher self-esteem and the individual child's difficulties, as well as family composition. This article by Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Edmund Sonuga-Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter follows 'The experience of adoption (1)' (Hawkins et al, 2007), which explored intercountry and domestic adoption from the child's point of view. [ABSTRACT FROM AUTHOR]

Amanda Hawkins, Celia Beckett, Jenny Castle, Christine Groothues, Edmund Sonuga- Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter compared views about adoption for two groups of 11-year-old children (n = 180). The team's analyses compared the views of children according to their pre-adoption background: UK domestic adoptees placed before the age of six months versus intercountry adoptees who had experienced extreme deprivation for up to three-and-a-half years in Romania prior to placement (the Romanian group was further broken down by age at placement). Remarkably few differences were found between these groups, with the exception of two areas. Older-placed adopted children from Romania were significantly more likely to find it difficult to talk about adoption than domestic adoptees, and to feel different from their adoptive families. However, supplementary analyses suggested that these differences were due to increased levels of difficulties within the older-placed Romanian group, rather than whether they were adopted internationally or domestically. The implications of the similarities and differences between these groups for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

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Adoption outcomes need to be assessed from both child and parental perspectives. This paper represents part of a wider study of 165 children, adopted into the UK from Romania, and a comparison group of 52 domestic adoptions. It focuses on outcome from the parents' point of view, in particular, the level of parental satisfaction, and considers possible risk factors for poor outcome. The level of satisfaction in both groups is very high and the main factors associated with less good outcome are child behaviour problems. The positive picture at age 6 is very similar to that found when the children were seen two years earlier. [ABSTRACT FROM AUTHOR]

The adoption of children reared in poor quality Romanian institutions provided a "natural experiment" to determine whether psychological privation is the cause of later deficits. Low IQ at six years was strongly related to the duration of institutional care, with malnutrition having a weaker effect. After taking both into account, there was an additional effect of a particularly marked lack of individualized care. [ABSTRACT FROM AUTHOR]