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The English and Romania Adoptees (ERA) study sought to capitalize on an invaluable "natural experiment" in which there was a rapid, easily timed, transition from a profoundly depriving environment in Romanian institutions of the 1980s and early 1990s to a generally well-functioning adoptive family in England. Moreover, the transition was not accompanied by the usual selective biases associated with admission to, and discharge from, the institution. Earlier reports considered findings on the cohort at 4, 6, and 11 years of age; here we extend the findings to age 15 years. Throughout the follow-up, we have been fortunate in having very low attrition, and we have endeavored to have multimodal methods of assessments. Thus, the measures have included detailed standardized interviews with both parents and their adopted offspring, questionnaires completed by parents, teachers, and the young people themselves. In addition, there was systematic standardized psychometric testing of the young people, together with anthropometric measurements of height, weight, and head circumference. DNA samples were obtained on the great majority of the adoptees, and a pilot brain imaging study was also undertaken.
Our early findings indicated that the main outcomes that were strongly associated with institutional deprivation were unusual and distinctive: namely, quasi-autism, disinhibited attachment, inattention/overactivity, and cognitive impairment. We postulated that these might constitute possible deprivation-specific patterns. Accordingly, this monograph is focused on these postulated deprivation-specific patterns and their association with more general patterns of functioning and impairment. We began with a rigorous testing of the causal inference that these were truly due to institutional deprivation; the weight of evidence suggested that they were (albeit there were important changes in patterns and substantial improvement). Our findings showed a high degree of persistence to 16+ years of age, a remarkable persistence of the strong association with institutional deprivation, and pointers to the likelihood that there was coherence across the four separate deprivation-specific patterns. Moreover, the findings showed that psychosocial deprivation in the absence of subnutrition was accompanied by a major impairment in head growth (implying stunted brain growth) when the institutional deprivation lasted beyond the age of 6 months. Unlike height and weight, the head circumference continued to increase up to age 15 years but still remained well below normal limits.
Special attention was paid to the relationship between postulated deprivation-specific patterns and more ordinary and common disturbances of conduct, emotions, and peer relationships. Indeed the findings showed that all three of these patterns were associated with, and appeared to derive from earlier deprivation-specific features. However, the developmental course of the three features was markedly different. Emotional problems were unremarkable at 6 years but increased over the 6–15-year age period. Insofar as could be judged, (usually) it was not that there was a late onset of them but rather that its manifestations probably depended on a greater degree of maturation to become properly apparent. By contrast, an increase in conduct problems was beginning to be evident at 6 years, was clearly manifest at 11, and remained elevated at 15 years of age. It was most strongly associated with inattention/overactivity. The pattern for peer relationship problems was different yet again in that it was increased in frequency relative to the pooled comparison group and was strongly associated with all four postulated deprivation-specific patterns. It was concluded that peer relationship problems constitute a sensitive index of social relationship problems and, therefore, are likely to be associated to some degree with any severe form of psychopathology, especially with disorders in which difficulties in social relationships constitute such a prominent feature. Both conduct and emotional problems also showed associations with deprivation-specific features, but the developmental course of the two are strikingly different. Longitudinal data were crucial in identifying this difference.
On the basis of cross-sectional findings, it had been claimed by others that the recovery of scholastic achievement lagged behind that of other cognitive functions. We did not find that, but, again, the longitudinal analysis of within-individual change was essential in order to assess the possibility. Our results showed substantial heterogeneity in the specifics of cognitive patterns, but there was no single pattern that was specifically associated with institutional deprivation.
Prior cross-sectional studies have typically reported complete catch-up in height and weight within 2 or 3 years after adoption. Our within-individual growth curves suggest that it is necessary to modify that conclusion. In keeping with previous research, we too found major catch-up in height and weight. What was different, however, was that we found a relative deceleration of growth between 11 and 15 years. The overall pattern of findings suggest that a significantly earlier puberty (found also in other studies of abuse and neglect) is likely to play a role in both bringing about an earlier growth spurt and curtailing its duration. We had inadequate statistical power to test this in the way that we would have wished, but the possibility clearly warrants further research. Once again, the growth trajectory for head circumference was different, a deceleration was not evident, and the catch-up to age 15 fell well short of population norms.
Our measures of possible biological concomitants of deprivation-specific patterns were necessarily limited; however, two findings stood out. First, psychosocial deprivation, in the absence of overall subnutrition, had a major effect in constraining head growth (imaging data suggest that this was a reasonable index of brain growth) provided the deprivation continued beyond 6 months of age. Second, mediation analyses indicated that head circumference had a significant indirect role in the connection between institutional deprivation and deprivation-specific patterns.
Because of the complexities of person–environment interplay, we finally sought to pull together findings on risk, causation, mediation, and moderation. We concluded that, following a series of rigorous methodological checks, there was strong evidence for both the validity of deprivation-specific patterns, and their causation by institutional deprivation. However, our leads on possible moderating influences were necessarily more tentative. We see this as a high priority area and one that will require a broader range of measures (on genetic variations and also on coping styles) than we were able to employ. Variations in the adoptive home environment did not seem to provide much of an effect, but something of a rethink is needed on how to conceptualize the measurement of relevant features.
