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Revealing the lasting effect of neglect

Research carried out by the University of Southampton is shaping future support for children who have suffered deprivation and neglect

Published: 12 May 2017

A groundbreaking study which has revealed the lasting impact of profound deprivation during early childhood could help to inform policy and practice in the future, changing the way that children and young people recover from neglect or hardship in their early years.

The English and Romanian Adoptees (ERA) study – the first large-scale study of its kind – followed a group of children through their lives into early adulthood after experiencing profound early-institutional deprivation. Published in the Lancet, one of the world’s leading medical journals, the ERA study is a collaborative project between the University of Southampton and King’s College London.

“It is the first study of its kind that reports that time-limited periods of early institutional deprivation can have profound effects on development and mental health persisting into young adulthood, despite the positive influence of caring and supportive adoptive families,” says Dr Jana Kreppner, Associate Professor in Developmental Psychopathology and long-standing member of the ERA study team.

The implication is that mental health service providers need to take careful consideration of the needs of individuals with histories of early deprivation

Dr Jana Kreppner - Associate Professor in Developmental Psychopathology

Collaboration over decades

Academics followed the mental health of a group of children adopted from Romanian institutions to UK families in the 1990s. The ERA study, which has been running since the early 1990s, began in response to the large number of UK families adopting Romanian children following the fall of the communist regime there in 1989.

At the beginning of the study, 165 Romanian children – between the ages of two weeks and 43 months – were assessed in terms of their physical, social, emotional, and cognitive development across childhood and adolescence. These adoptees had either spent less than six months or more than six months in an institution, and were compared against 52 children who were adopted as young infants from within the UK.

When the Romanian adoptees were brought over to the UK, they were placed with stable, caring families. The researchers explored whether recovery from such early adversity was possible and what difficulties, if any, would arise for the young people and their families. The study interviewed the parents and children using a range of different assessment methods.

The latter part of the study, which followed each adoptee’s progress to ages 22–25 years old, was led by Professor Edmund Sonuga-Barke while he was at the University of Southampton.

Results show that severe deprivation in early childhood can continue to impact on young adults’ mental health and psychological wellbeing. The children who had been in care in Romania for a longer period of time – over six months – had higher rates of social, emotional and cognitive problems in early adulthood and were more likely to have lower education and employment rates compared to the other adoptees studied. An encouraging finding was that IQ rates which were also lower for this group in childhood, had returned to average levels for many by adulthood.

Neglect and mental health

The study is an important step forward in understanding the role of early experiences in growth and development. However, it is also vital in order to better understand the connection between experiences in early life and mental health.

Despite the caring and positive nature of the adoptive families with which the adoptees were placed, there were clear correlations between neglect in early life and poor mental health and development. A number of findings were important. Many of the children who spent less than six months in Romanian institutions showed remarkable recovery following their adoption. Children who spent more than six months in institutions had higher rates of social, emotional and cognitive problems across childhood, adolescence and in early adulthood.

Just under half of the adoptees who experienced neglect beyond the age of six months had suffered with at least one mental health problem in their young adult life. The kinds of difficulties they experienced include difficulties in social relationships and problems with attention and concentration. They were also more likely to report symptoms of depression and anxiety as young adults. More than 40 per cent of this group had contact with mental health services.

 However, one in five of the children who experienced prolonged deprivation appear unaffected.

This data is important and could be used to inform the approach professionals take in dealing with the mental health issues of adoptees and people who experience trauma during childhood.

“The implication is that mental health service providers need to take careful consideration of the needs of individuals with histories of early deprivation,” Jana explains. “Careful planning is necessary during the transition from child to adult mental health care to ensure the young adults continue to be able to access the specialist services they need.”

But what does this mean for people outside of the demographic studied?

The team has emphasised that caution should be taken when comparing this particular group of institutionally deprived children to other groups of children who experienced early neglect or maltreatment. However, with emerging evidence from other studies highlighting similar developmental difficulties in UK adoptees with more complex care histories, there is potential for the results to be explored further in terms of their implications for children in the UK who experience the care system.

Informing policy and supporting young people

It is clear that the data and information acquired from this study will be put to good use, and the team is now conducting further investigations to better understand why such lasting effects were observed for many, and why others showed remarkable resilience.

The team’s research currently focuses on identifying possible social and biological factors that help explain resilience as well as persistence of difficulties. These efforts include a brain imaging study currently conducted at King’s College London.

Jana says: “Ultimately, we hope our data will help inform policy and practice in terms of how to best identify and support the complex needs of children and young people, and their families, who have experienced early deprivation, maltreatment and neglect.”

More information about Jana's research

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