Adoptees’ responses to separation from, and reunion with, their adoptive parent at age 4 years is associated with long-term persistence of autism symptoms following early severe institutional deprivation

Abstract

Background: Institutionally deprived young children often display distinctive patterns of attachment - classified as insecure/other (INS/OTH) - with their adoptive parents. The associations between INS/OTH and developmental trajectories of mental health and neuro-developmental symptoms were examined. Methods: Age four attachment status was determined for 97 Romanian adoptees exposed to up to 24 months of deprivation in Romanian orphanages and 49 non-deprived UK adoptees. Autism, inattention/over-activity and disinhibited-social-engagement symptoms, emotional problems and IQ were measured at 4, 6, 11 and 15 years and in young adulthood. Results: Romanian adoptees with over 6 months deprivation (Rom>6) were more often classified as INS/OTH than UK and Romanian adoptees with less than 6 months deprivation combined (LoDep). INS/OTH was associated with cognitive impairment at age 4 years. The interaction between deprivation, attachment status and age for ASD assessment was significant - with greater symptom persistence in Rom>6 INS/OTH(+) than other groups. This effect was reduced when IQ at age 4 was controlled for. Discussion: Age 4 INS/OTH in Rom>6 was associated with worse ASD outcomes up to two decades later. Its association with cognitive impairment at age 4 is consistent with INS/OTH being an early marker of this negative developmental trajectory, rather than its cause.

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Identifiers

ORCID for Dennis Golm: orcid.org/0000-0002-2950-7935

ORCID for Hanna Kovshoff: orcid.org/0000-0001-6041-0376

ORCID for Jana Kreppner: orcid.org/0000-0003-3527-9083

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