Name:______Block:______
Rutter et al (2007) Romanian Orphanage Study
Investigating the Impact of Early Institutional Deprivation on Development: Background and Research Strategy of the English and Romanian Adoptees (era) Study
Directions: Read the abridged study and then answer the questions which follow
The work by Michael Rutter, Edmund J. Sonuga-Barke, and Jennifer Castile followed the development of a group of adoptees from Romania and from within the United Kingdom. After being adopted from a neglectful orphanage in Romania, they were adopted by Russian and British parents. The children were first assessed at the age of 4 years, 6 years, and 11 years old to see how they had developed after adoption. The researchers assessed the children’s developmental ages as well as their physical developments right after leaving the orphanage and then at 4, 6, and 11 years of age.
This study deals with the relationship between deprivation and development later in life. It focuses on the crucial issue of the extent to which deprivation patters account for deficits and problems which appear in children as old as 15 years old. In order to do that, it was first necessary both to determine which patterns met criteria for specificity to institutional deprivation. Before beginning the study, researchers determined and described the deprivation specific psychological patterns they would be looking for. They also developed a scale to rate the level of disturbances of emotion witnessed later in life.
The “natural experiment”
Participants
The situation with respect to the adoption of children from Romania was an invaluable ‘‘natural experiment’.” The key features that made this a natural experiment were as follows. First, the great majority of the children had been placed in institutions in infancy. One hundred twenty-three of the 144 (i.e., 85%) received institutional care from before 2 weeks of age (probably from birth in the great majority of cases). Eight children entered an institution around the age of 1 month, another 10 before the age of 12 months, and only 3 after that age. This meant that it was very unlikely that the children had been admitted because of identifiable problems (mental retardation) of anykind. Second,very few (if any at all) of the children returned to their biological families, and, as far as could be determined, there had been no previous adoptions from the institutions. Third, in the great majority of cases, there was only a very short period of time between leaving the institution and entering the United Kingdom. Accordingly, the timing of the move out of the depriving institutions could be readily established. The prospective adoptive parents had only a limited choice on which child they would adopt because the Romanian authoritiesdecided which institutions and which children in those institutions were available for adoption.
The sample was drawn from the 324 children adopted from Romania into families resident in England between February 1990 and September 1992, who were age 42 months or younger, at the time of entry to the United Kingdom. Stratified, random sampling was employed with the aim of obtaining a target number of 13 boys and 13 girls placed between the ages of 0 and 3 months, 13 of each gender placed between 3 and 6 months, and 10 boys and 10 girls for each of the subsequent 6-month age bands up to the age of 42 months. There were 21 children who had not experienced institutional care, although they did come from a very deprived background. This group provided a useful contrast between noninstitutional and institutional deprivation. 85% (123 of the 144 institutional children) had spent the whole of their life in the institution, and nearly all (a further 15 making a total of 138) had spent at least half of their life in an institution. Because the proportion of children who had spent rather short periods in institutional care was so tiny (5%).
Background
The degree of deprivation in the institutions was quite unusually extreme. Some of the residential institutions were officially labeled as ‘‘hospitals’’ and some ‘‘orphanages,’’ but in practice there were few major differences between them; both provided long-term care for children whose parents had ceased to look after them for one reason or another. Conditions in these institutions varied from poor to appalling. In most instances, the children were confined to cots; there were few, if any, toys or play things; very little talk from caregivers; no personalized caregiving; feeding of gruel by bottles with large teats, often left propped up; and an environment that was frequently physically harsh. Thus, washing often consisted of being hosed down with cold water. Most of the children who entered institutions in the neonatal period remained there.
After careful consideration, we decided that the most appropriate comparison group would be children adopted within the United Kingdom who had not experienced institutional care or other known forms of severe
abuse or neglect and who were adopted before the age of 6 months. In other words, they constituted, in effect, a ‘‘best scenario’’ adoptee group because of the extensive evidence that early adopted children, without handicaps, ordinarily fare well. Such a group had the advantage of controlling for the experience of adoption and also had the advantage of the adoption having taken place at a time when ‘‘closed’’ adoption was the norm. This group was chosen through volunteer, rather than random sampling.
Procedure:
The overall strategy of the study consisted of a dual approach. First, there was an examination of recovery following the move to the United Kingdom, which involved a radical change in circumstances, allowing an assessment of the degree to which the initial deficits or retardation at the time of entry to the United Kingdom was a result of a prior depriving environment. Second, the strategy involved determination of the extent to
which the continuation of a deficit, or unusual pattern, could be related to some plausible mediating variable (such as duration of institutional deprivation or degree of malnutrition) providing a means of inferring
causal inferences on longer term outcomes.There were then correlations made between the amount of time spent in the deprived environment, and the ability for the child to make developmental recoveries after being adopted.
ASSESSMENTS OF THE CHILDREN’S STATE AT TIME OF U.K. ENTRY
Some of the assessments made on the children included anthropometric measurements, such as height, weight, and head circumference. This measure provides a continuous measure of physical developmentthat is not confounded by age. Extremely low anthropometric measures are likely to index serious nutritional privation. Developmental assessments were also recorded, although this was difficult for the older children because records had not been kept at the institutions. Developmental assessments marked when children hit developmental milestones, like walking and talking. The Denver Scales were used by parents to record their children’s developmental levels at the time of entry in the United Kingdom. The Denver Scales are designed to be used by parents to focus on attainments (such as lifting the head, standing while holding on to a support, making meaningful ‘‘mama’’ or ‘‘dada’’ sounds) that are readily available. The scores were transformed into developmental quotients by allocating each child a developmental age as compared to their actual age. Especially with babies who are severely delayed in their development, such scores can either give a zeroquotient because the child is unable to do anything.There were a large number of children (n=70) with scores in the severely retarded range, and few (n=8) with unusually high scores.
When comparing the data taken from the Denver Scales, the children from the Romanian Institution scored a mean developmental mental age of 9.5 months, and a mean chronological age of 35 months. Of the 25 children studied, 20 were functioning at a level that was less than half their chronological age. Only 10% of the children older than 12 months at the time of adoption were judged to be developmentally normal.
SUMMARY OF KEY FINDINGS UP TO THE AGE OF 11 YEARS
Physical Health
At the time of U.K. entry, many of the children from Romanian institutions had both skin lesions and intestinal infections (Beckett et al., 2003). In the great majority of cases, these physical disorders were both treatable and transient. At the time of U.K. entry, many of the children also showed behaviors typical of children living in institutions (Beckett et al., 2002). They had low mental ages, and were physically behind other children. However, the developmental catch-up for the children from Romania following U.K. entry was spectacular. For example, the mean Denver developmental quotient at time of U.K. entry was approximately 50 (at age 4), whereas the mean Intelligence Scale score for Children at age 11 had grown to over 90. Most of the catch-up was already apparent by age 6 years, but in those who were most impaired at 6, there were significant, albeit slight, further gains between 6 and 11.
By age 6 years, there had been virtually complete catch-up in the children’sweight and height as judged by U.K. population norms, but althoughthere had been a similar major catch-up in head circumference, a reasonable index of brain size; it was much lesscomplete at 6 years of age. By age 11, head circumference was still 1 SD or sobelow normal population means, but the recovery process had continuedbetween ages 6 and 11. This raised the question as to how far the gainsin head circumference served to mediate psychological outcomes. Rathersurprisingly, the analyses at age 11 suggested that there was little mediationof this kind.
Possible Effects of Deprivation
Despite the major catch-up in psychological functioning in the first few years after adoption, cognitive deficits were still evident in a substantial amount of the children at ages 4, 6, and 11. Strikingly, the differences applied to four rather unusual patterns (quasi-autism, disinhibited attachment, inattention/over activity, and cognitive impairment). It should be noted, that these four apparently specific patterns were associated with institutional deprivation and not deprivation as a whole. These behaviors were much less marked and less specific in the children adopted from Romania who had not experienced institutional care.
A striking finding at all ages was the heterogeneity in outcome. Thus, even with the children who had the most prolonged experience of institutional care, there were some who at age 11 showed no indication of abnormal functioning on any of the domains that we assessed. Conversely, there was a substantial proportion of children who showed impairments in multiple domains of functioning.Of the children with multiple domains of impairment at 11, nearly 90% had used professional education or psychological/psychiatric services, compared
with about 1 in 10 of those showing apparently normal functioning. Findings show that at 6 and 11 years that no measurable deficits were evident in those children whose institutional deprivation came to an end before the age of 6 months. It appears that negative effects were worse for children who were in the institution after the age of 6 months. Those who were adopted before that age seemed to have made the most striking developmental gains.
In the follow-ups at ages 6 and 11, particular attention was paid to the validation of quasi-autism and disinhibited attachment. In the case of quasi-autism, the standardized parental Autism Diagnostic Interview and the standardized Autism Diagnostic Observation Schedule were used. In the case of disinhibited attachment, we used ratings based on investigator observations and blindly rated ratings of a modified Strange Situation Procedure in the home. Children who were adopted after 6 months of age also had difficulty with their attention, and were very overactive in their play, and found it hard to calm themselves.
Conclusions:
At the end of this study we have concluded that deprivation can have long term negative developmental effects. These effects include: disinhibited styles of attachment, tendency to be over active, cognitive impairments, and Autism. Children who had been adopted before reaching 6 months in age were able to recover, and by age 11 were in line with children who had not been in the deprived environment. It did not matter how long they were in the institution. However, children who were adopted after 6 months hold had less recovery from the deprivation. We conclude that the effects of deprivation can be overcome if attachment is formed within the first 6 months of life. After 8 months, however, negative effects tend to be more permanent.