Abuse/neglect, Treatment complex trauma

Recovery from severe privation: What the research shows

This is the second blog post concerning influential child psychiatrist, Michael Rutter, particularly his work on the English and Romanian Adoptee (ERA) study. Last week’s post provided the background to the ERA study. Today, we look at the bad news and the good news, i.e. recovery is achievable with good care. Firstly, more about Michael Rutter and why he is important to the field.

Michael Rutter and autism

Prior to the 1970s, autism was thought to be caused by environmental factors. The ‘discoverer’ of autism, Leo Kanner and psychoanalyst,  Bruno Bettelheim, stated that a lack of parental warmth was the cause autism (i.e. the so-called  refrigerator mother syndrome). Rutter’s research demonstrated that autism was most likely caused by biological factors independent of parental warmth.

Bruno Bettelheim

Bruno Bettelheim is also an interesting figure in his own right as he, in my view, set up one of the first residential treatment facilities in the world, called the Orthogenic School for Disturbed Children, in Chicago in 1944.

The front door of the Orthogenic School’s former building, with the iconic “yellow door” that has become a trademark of the school

Quasi-Autistic Symptoms

There is a link between Rutter’s work on autism and the ERA study. Practitioners will understand that many children in OoHC present with some autism symptoms but do not meet the DSM-5 criteria for Autism Spectrum Disorder. One the key findings of the ERA study was that privation (ie  trauma or extreme abuse/neglect) can cause quasi-autistic symptoms including difficulties in making and maintaining eye contact, underdeveloped social skills, difficulties in managing transitions and change, or unwillingness to engage in reciprocal or shared play, a sense of being persecuted, and the sudden triggering of extreme behaviours.


Summary of outcomes from the ERA study

The aim of the study was to examine the extent to which children could recover when extreme deprivation in early life is followed by a middle childhood within a safe family environment. This following summary comes from the Nuffield Foundation:

The study has shown that children who experience extreme institutional deprivation will usually make a huge improvement in psychological functioning following successful adoption. However, a substantial minority of those adopted after the age of six months will continue to experience significant problems.

The Romanian children adopted by UK families before the age of three-and-a-half, were studied at ages four, six and eleven and fifteen. As a control group, 52 adopted children from the UK who had not lived in institutions were also studied.

  • The developmental improvements made by the Romanian children were rapid and often continued over a period of several years.
  • A proportion of the Romanian children adopted after the age of six months experienced difficulties that were very uncommon in the group of domestic adoptees. These were autistic-like qualities, problems with forming appropriate attachments and social functioning, inattention, overactivity and poor mental functioning.
  • One third of the Romanian children placed for adoption after the age of six months experienced problems that warranted the intervention of professional educational, psychological or psychiatric services.
  • A substantial minority of the Romanian children seemed to be functioning normally in all respects at age eleven in spite of their adverse early experiences.
  • The degree to which the Romanian children were under-nourished had only a minor effect on their psychological outcomes.
  • Romanian children with even a very low level of language at the time of adoption had a higher average IQ at age eleven than those with no language skills.
  • The follow-ups at 15 years of age, and into young adulthood, have revealed unusual patterns of persisting, specific patters of deficits and problems that appear to be deprivation-specific, out of which arise a number of emotional, conduct and peer-relationship problems.

Wider context

The evidence suggests that wider, more flexible criteria are possible for successful adoption within the UK. The vast majority of families made a success of the adoptions from Romania despite many of them being considered unacceptable for domestic adoption.

Furthermore, the significant benefit to children following adoption in the UK indicates that there is considerable potential in Romania and other countries if the right conditions outside institutions can be provided.


About graemembaird

I am a psychologist with a special interest in improving the outcomes of families, children and young people in the Out of Home Care and Juvenile Justice systems.
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