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Inclusive education for children with attention deficit hyperactivity disorder (ADHD) presents challenges for school staff and professional development is lacking. Training is not always available when needed, strategies suggested by external experts can be impractical and staff lack autonomy in choosing the best way of being resourced. Additionally, the experience and knowledge of the range of school staff is not utilised. A collaborative working group of school staff and a researcher explored an alternative method of ADHD resourcing. Co-construction of knowledge defines how the group discursively identified actionable knowledge from the different perspectives and knowledge brought by individual group members. A systemic framework was used to critically reflect on the collaboration. The framework enabled reflection on four areas to understand how and why the collaboration led to a published web-based school staff ADHD resource. Firstly, starting conditions and assumptions were considered to identify and articulate the rationale for the resource. Secondly, the context and system dynamics enabled consideration of the socio-cultural and political landscape of the project and the impact of COVID-19. Thirdly, the different voices of participants and power dynamics were reflected on. Finally, emergence was a frame in which to elucidate knowledge production and changes in practice. The collaborative working group addressed the research--practice gap and the need for diversity of voices to be heard across the school. Knowledge co-construction positions staff as knowledge bearers and, together with different forms of knowledge, they can be empowered to create new, contextualised evidence-based knowledge.

Traditional in-school approaches focus on using consequences for managing pupil behaviour. Within published literature, concerns have been raised about the effectiveness and negative impact of punitive approaches. This systematic synthesis explores the perspectives of children and young people (CYP) in secondary schools on in-school punitive behaviour management policies and practices. Papers are evaluated using an adapted version of the Critical Appraisal Skills Programme (2019) and study findings are analysed using thematic synthesis. The findings highlight CYP's thoughts on the fairness and consistency of punitive consequences, the impact of these on academic development and emotional wellbeing, and the limited long-term effectiveness of such approaches. CYP explain their need to feel listened to, understood and supported with their behaviour and emotions. Implications of these views for school staff, educational professionals and education policy makers are outlined.

Teachers report feeling ill-equipped to meet the needs of ADHD children. Previous studies on ADHD teacher training have been largely quantitative, focused on measured gains in ADHD knowledge and use of behavioural strategies. Traditional training shows initial improvements which deteriorate over time necessitating a new approach. Staff perspectives identifying important factors in teaching children with ADHD and staff training are largely missing from the literature. Semi-structured interviews were conducted with 19 primary staff in England. Interviews were analysed using a reflexive thematic approach. Five themes are reported: being equipped to provide for the individual needs of children with ADHD; a joined-up team approach which draws on the knowledge of others; creating the opportunity for every child to succeed; supporting all children in the classroom; training and support which meets the needs of all school staff. Findings will enable ADHD training to be better tailored to meet school staff's needs.

Research examining the effects of severe, prolonged early deprivation has shown elevated rates of neurodevelopmental symptoms, which frequently persist into adulthood and are associated with functional and social relationship difficulties, as well as elevated rates of mental health problems. The behavioural manifestations of these symptoms closely resemble those of ADHD and also ASD. Here, we used qualitative methods to explore and characterise the social experiences and difficulties encountered by young adults exposed to profound early deprivation, in part to highlight any apparent parallels between the experiences in this group and those identified in typically developing samples with ADHD or ASD. To do so, we interviewed young adults and their adoptive parents (N = 18) from the English and Romanian Adoptees study, about their social lives. Participants were keen to describe not only the challenges they faced but also adaptive responses. A semantic/descriptive thematic analysis revealed that the young adults strongly desired social relationships but struggled to navigate social norms, resulting in frustration and frequent loss of relationships. This was accompanied by strong feelings of loss and rejection, all of which were perceived to have a negative impact upon self-esteem and mental health. Adaptive strategies included the fostering of casual friendships with older individuals and seeking employment with strong social components. Similarities and differences between our findings and the social difficulties experienced by typically developing groups with neurodevelopmental problems, and adopted individuals more generally, are discussed. [ABSTRACT FROM AUTHOR]

Nurture Groups (NGs) are a short term, psychotherapeutic intervention aiming to provide reparative attachment experiences for children within an educational setting. The social skills of 16 children (aged between 6.0 and 9.75 years) were assessed through teacher ratings and children's self-report to hypothetical and challenging social situations. Thematic analysis was also used to explore six children's experiences and perceptions of NG intervention on their social skills. Over time, children attending NGs used significantly more socially appropriate responses. Teachers' ratings of children's social skills also improved, although did not reach statistical significance. In their interviews, children suggested that they enjoyed attending NGs and that this had helped them improve their social skills. However, they reported challenges engaging with peers outside of the NG, particularly in the playground. Implications for practice include the need to identify how practitioners can help to facilitate the generalisation of children's developing social skills beyond the NG context.

Severe, prolonged early deprivation is associated with later neurodevelopmental difficulties. Despite elevated levels of contact with service providers, these problems often persist into adult life and are associated with impairment in adulthood (e.g., unemployment, higher rates of depression and anxiety symptoms and poorer subjective wellbeing). Here, we aimed to explore the ongoing service needs and experiences of adoptees and their parents from the English and Romanian Adoptees (ERA) study, in those with a history of early deprivation and neurodevelopmental problems. Our descriptive thematic analysis highlighted difficulties with independent living, particularly financial management and problems with decision-making. Where specific forms of support had been accessed (e.g., medication for attention-deficit/hyperactivity disorder) they were often helpful, although there was some ambivalence towards taking medication due to side effects. However, the neurodevelopmental problems were not well understood and were often overlooked by service providers. There is a need for greater awareness among frontline service providers of the neurodevelopmental impact of early adversity. Participants also identified that their support needs were largely unmet and that their parents were having to fill this gap. Similarities and differences between the experiences highlighted here and those identified with idiopathic neurodevelopmental disorders are discussed, as are several recommendations for educational improvements for service providers. Plain Language Summary: People who have experienced severe, prolonged institutional deprivation are at increased risk of neurodevelopmental disorders. Despite spending many years in warm, loving families, the English and Romanian Adoptees (ERA) study has shown that these problems often persist into adulthood and are associated with a range of negative outcomes. Importantly, these poorer outcomes seem to occur despite contact with support/service providers. In this study, we interviewed the adoptees and their parents about their support needs, and experiences with trying to obtain support and communicate with service providers. Support needs included help with independent living and support with managing finances. Our participants described a range of difficulties with obtaining support, including a lack of understanding of the link between early adversity and later mental health, and that neurodevelopmental problems were often overlooked. Consequently, the adoptive parents had largely been left to fill this gap in unmet needs. However, where support had been accessed, it was often described as helpful. [ABSTRACT FROM AUTHOR]

Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22–25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence. [ABSTRACT FROM AUTHOR]

Background: Rutter and colleagues' seminal observation that extended early life exposure to extreme institutional deprivation can result in what he termed quasi‐autism (QA), informed both our understanding of the effects of adversity on development and the nature of autism. Here we provide the first detailed analysis of the adult outcomes of the group of institutionally deprived‐then‐adopted children identified as displaying QA. Methods: Twenty‐six adult adoptees identified with QA in childhood (Childhood QA+) were compared to 75 adoptees who experienced extended institutional deprivation (>6 months) but no QA (Childhood QA−), and 116 adoptees exposed to Low/No institutional deprivation. The outcomes were child‐to‐adult developmental trajectories of neuro‐developmental symptoms (autism, attention‐deficit/hyperactivity disorder (ADHD), disinhibited social engagement (DSE) and cognitive impairment), adult functioning, life satisfaction and mental health. Results: Childhood QA+ was associated with elevated and persistent trajectories of broad‐based autism‐related difficulties, ADHD and DSE symptoms and low IQ, as well as adult mental health difficulties and functional impairment, including high rates of low educational attainment and unemployment. Life satisfaction and self‐esteem were unaffected. Autism‐related communication problems, in particular, predicted negative adult outcomes. Childhood QA+ was still associated with poor outcomes even when ADHD, DSE and IQ were controlled. Conclusions: Early and time‐limited institutional deprivation has a critical impact on adult functioning, in part via its association with an early established and persistent variant of autism, especially related to communication difficulties. Apparent similarities and differences to non‐deprivation related autism are discussed. [ABSTRACT FROM AUTHOR]

We set out to explore the meaning of the attachment categories in the Cassidy/Marvin strange situation procedure, as employed in the home, using data from a longitudinal study of children adopted into UK families up to the age of 42 months from Romanian institutions, and of adopted children without the experience of institutional care--both groups being assessed at 4 and 6 years of age. Inter-rater reliability was found to be good. Security (meaning the use of the parent as a secure base and no negative behavior on reunion) was the modal categorical rating in both the institution-reared and comparison groups, but the category of anomalous non-normative behavior (meaning a lack of any ordered attachment behavior as covered by the standard ratings), previously labeled "insecure-other", was more common in the institution-reared children. Because this was unassociated with the usual manifestations of insecurity (such as avoidance or resistance) and because it was largely evident in interactions with the stranger, it is concluded that the adjective "insecure" was not appropriate. Although this "insecure-other" category was associated with disinhibited attachment as reported by parents (meaning a lack of differentiation among adults, a willingness to go off with strangers and a lack of checking back with parents in anxiety-provoking situations), it did not prove to be a good index of disinhibited attachment because changes over time in the "insecure-other" category were not associated with changes in the rate of disinhibited attachment. Also, whereas the rate of "insecure-other" fell markedly in the institution-reared group between 4 and 6 years of age, it rose in the comparison group, raising queries over its meaning. (Contains 4 tables and 1 figure.)

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.

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.)

The development of conduct and emotional problems involves a complex interplay between environmental and genetic factors. The child-rearing environment contributes to this process. Gross deviations, such as those seen in abusive or neglectful homes, or where the parent has serious mental health problems, have been shown to contribute to the initial onset and persistence of emotional and conduct problems during childhood and adolescence. In this chapter, the authors consider whether, in their sample, conduct, emotional, and peer-relationship problems are in fact truly independent of institutional deprivation. They find that they are not. (Contains 5 tables and 4 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.)

Background: Despite the evidence on anomalous attachment patterns, there has been a tendency to interpret most of these as reflecting differences in security/insecurity. Methods: Empirical research findings are reviewed in relation to attachment/insecurity as evident in both infancy and later childhood, disorganised attachment, inhibited attachment disorder, and disinhibited attachment disorder. Findings: Substantial differences are found in the correlates and meaning of these different features, as well as in the patterns associated with conditions such as autism, psychopathy, and Williams syndrome. Conclusions: It is seriously misleading to view all of these patterns through the lens of security/insecurity. This heterogeneity in social relationship features necessarily has implications for the assessment measures for social relationships that need to be used.

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.