The English and Romanian Adoptees Study: Understanding development following early severe deprivation
Millions of children are estimated to grow up in institutional care around the world which is often described as not sufficiently meeting the needs of children. Research by staff at Southampton’s School of Psychology has provided important evidence which has enhanced our understanding of the development of children with complex histories of deprivation and neglect. This research has influenced clinical and social work and international policy recommendations to replace institutional care for children with good quality alternative family-based care. In addition, the English and Romanian Adoptees Study is featured in many educational resources as a case study to teach students about development following early adversity.
Overview
Image credit: Anna Kolosyuk
Research challenge
The English and Romanian Adoptees study (ERA) is the first comprehensive prospective longitudinal study of the long-term effects of time-limited early severe deprivation on development. The study follows a cohort of Romanian children who were raised in the state-run institutions of the Ceaușescu regime during infancy and early childhood before they were adopted by families living in the UK.
At the time of adoption, most of the children were significantly delayed in their development and growth, and many presented with significant health problems.
At 6 years old, substantial developmental recovery was noted but a significant minority presented with a surprisingly specific set of psychological difficulties including attention problems, autistic-like features, cognitive impairment, and socially disinhibited behaviour. These difficulties persisted for many across childhood and adolescence into young adulthood and were associated with experiencing prolonged deprivation lasting beyond the first 6 months of life.
Importantly, most of the children adopted from institutions before 6 months of age appeared to have ‘caught up’ by the time they were 6 years old. Across a range of developmental measures, they were indistinguishable in childhood, adolescence, and early adulthood from a non-deprived comparison group of domestic adoptees who were all placed with their families before 6 months of age.
Changing our understanding of attachment and attachment-related disorder in children with histories of severe early deprivation
ERA’s findings provided crucial evidence to inform a shift in our understanding of attachment following severe early deprivation and neglect. Specifically, our data contributed to the understanding that variations in attachment security and insecurity are distinct from attachment-related disorders. This knowledge informed diagnostic and treatment guidelines used internationally by experts in all areas of mental health including the re-classification of attachment disorders in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, the NICE guidelines on attachment in children in care, and the Practice Parameters for the American Academy of Child and Adolescent Psychiatry.
Influencing campaigns to end institutional care for children world-wide
ERA findings have informed several high-profile campaigns which contributed to global progress to better the lives of children without parental care:
ERA’s evidence of the developmental consequences associated with institutional care was featured in a highly influential review on the impact of institutional care on vulnerable children. This review was used as key evidence by the Better Care Network (BCN, an international network of organisations and agencies committed to supporting children without adequate family care around the world), for their recommendations to the 2019 UN General Assembly Resolution on the Rights of the Child.
The Resolution on the Rights of the Child was formally adopted by the UN on 18 December 2019, including a recommendation and commitment to put an end to child institutionalisation.
LUMOS, a UK and US foundation created by author J.K. Rowling, actively campaigns for ending institutionalisation of children across the world. ERA’s evidence is used in their 2019 report ‘A Goal Within Reach: Ending the institutionalization of children to ensure that no one is left behind’.
UNICEF and BCN’s 2015 paper ‘Making Decisions For The Better Care of Children: The role of gatekeeping and strengthening the family-based care and reforming alternative care systems’ also includes the evidence from the ERA study.
Impact in Education
The ERA study has become one of the most influential studies in developmental psychology and child psychiatry.
The most recent version of the AQA A-level psychology syllabus specifically requires students to learn about ‘Romanian orphanage’ studies as an example of the effects of institutional care and caregiver deprivation.
ERA’s importance in the field of developmental psychology is further reflected in its inclusion as a case study in many higher education-level textbooks nationally and internationally.
