April 18, 2017

It is generally thought that early social and emotional deprivation have pernicious and persistent negative effects on mental health . Strong supporting evidence comes from animal studies (Mela V, 2015). Studying this in children is not at all easy. Observational studies have serious limitations. RCTs are impossible and unethical.

Sonuga-Barke and team from the brain behaviour lab at Southampton University, UK report the results of a unique study. The English and Romanian Adoptees study  is so unique in that it is a very rare natural experiment of early life severe deprivation.  165 children were adopted from depriving institutions in Romania in 1990s (immediately after the fall and execution of Nicolae Ceaușescu) to stable, supporting families in UK.  Deprivation was extreme and global. There were two subgroups in the adopted children, those who spent less than 6 months in an institution and those who spent more than 6 months ( up to 43 months).  The comparison group was of UK adoptees who did not experience any such deprivation. Over the years, the participants were comprehensively assessed at ages 6,11,15 and between 22-25 years. A wide range of behavioural , social and cognitive measures were studied.

Results: Children severely deprived up to 6 months and non deprived  UK adoptees had similarly low levels of problems. The group that suffered more than 6 months of deprivation had multiple problems:- autism spectrum disorder, disinhibited social engagement, inattention and overactivity, and this was seen in adult hood. Compared with UK adoptees group, they also had more  low educational achievement, unemployment, and mental health service use. Interestingly, the higher rates of cognitive impairment in high deprivation group ( at age 6 and 11) remitted to normal by adult age. Emotional problems showed a late on set pattern and an increase over time in  the prolonged deprivation group.

Disappearance of deprivation related cognitive problems  suggest neuroplasticity / remediation possibility even in prolonged early deprivation . Emotional problems emerged later and in young adulthood this was 3-4 times higher than other groups. This may be due to stress induced vulnerability that expresses only later. This could also be a direct developmental consequence of deprivation. Inappropriate social engagement with strangers , considered usually as a childhood limited feature, continued to manifest in to adulthood. The aberrant social communication and obsessive behaviours ( quasi autism) , also continued to adulthood.


Not much information is available on pre institutional risk factors.  However, It is unlikely that children who spent more time in institutions were exposed more to such factors than those who spent less time.


The problems seen in this deprived group, could they be adaptive behaviours? (i.e.  disinhibited social engagement could be adaptive where caregiver continuity is absent). The fact that emotional problems have emerged later, suggest that at least some  such behaviours/ outcomes are not adaptive ? A positive finding: A fifth of adoptees with longer period of deprivation were problem free after age 6, suggesting high degree of resilience as well. We don’t know what that constitutes in biological/ psychological terms from this study.

Earlier this group has reported very high prevalence of ADHD in high deprived group, this was 4 times higher in adolescence ( age 15) and 7 times higher in adult hood(22-25 yrs). The ADHD types was complex with distinctive features. It was equally common in men and women , was predominantly inattentive type.This was comorbid with features of Autistic SD, Conduct D and Emotional callousness. ( Kennedy et al 2016).


Early life years are crucial in adult mental health. Supportive , caring family environments can offset some of the effects of early social emotional deprivation. High risk for adult mental health problems ( emotional and social engagement related problems)  remain in those who were deprived for longer periods. One way to reduce the burden of  mental health problems is to ensure  safe and supportive early years for every child.

In the accompanying comment  Frank C Verhulst reminds us of how John Bowlby warned the UK Govt in 1939 ( in BMJ) about the practice of evacuating children ti unfamiliar families ( for safety reasons) during world war 2:: “Sir—The evacuation of small children between the ages of 2 and 5 introduces major psychological problems.”

Common sense? But then these separations are continuing to happen worldwide. Orphanages are still around us!

Summary of the article

Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adultfollow-up of the longitudinal English and Romanian Adoptees study.

Sonuga-Barke EJ, Kennedy M, Kumsta R, Knights N, Golm D, Rutter M, Maughan B, Schlotz W, Kreppner J.Lancet. 2017 Feb 22. pii: S0140-6736(17)30045-4. doi: 10.1016/S0140-6736(17)30045-4. [Epub ahead of print]


Mela V, Diaz F, Borcel E, Argente J, Chowen JA, Viveros MP.
Long term hippocampal and cortical changes induced by maternal deprivation and neonatal leptin treatment in male and female rats. PLoS One 2015; 10: 1–25

Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and RomanianAdoptees study.

Kennedy M, Kreppner J, Knights N, Kumsta R, Maughan B, Golm D, Rutter M, Schlotz W, Sonuga-Barke EJ. J Child Psychol Psychiatry. 2016 Oct;57(10):1113-25. doi: 10.1111/jcpp.12576.

Manoj Kumar MD FRCPsych, Inmind, Thrissur, Kerala.


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