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Specificity and Heterogeneity in Children's Responses to Profound BRITISH JOURNAL OF PSYCHIATRY !2001), 179, 97^103 Specificity and heterogeneity in children's selected at random from within bands stratified according to age of entry to the responses to profound institutional privation{{ UK, and a comparison group of 52 non- deprived within-UK adoptees placed before the age of 6 months for details see Rutter MICHAEL L. RUTTER, JANA M. KREPPNER and THOMAS G. O'CONNOR et aletal, 1998,1998).). Of these, 156 children from on behalf of the English and Romanian Adoptees $ERA) study team* Romania and 50 within-UK adoptees had complete data-sets and were used for analyses where these were required. Four- fifths of the Romanian adoptees had been reared in institutions for most of their life and nearly all had been admitted to Background The sequelae of Studies of children suffering profound institutions in the neonatal period mean profound early privation are varied. institutional privation in infancy and early age of admission was 0.34 months). The childhood have shown that it results in major conditions in the Romanian institutions Aims Todelineate the behavioural developmental impairment, that there is were generally extremely bad see Kaler & patterns that are specifically associated considerable developmental catch-up follow- Freeman, 1994;Castle et aletal, 1999;Johnson, ingingadoption into well-functioning families, 2001);and the condition of most of the with institutional privation. and that there are clinically significantficantsigni children on arrival in the UK was also very MethodMethod A group of165 children sequelae in some of the children Chisholm poor. Their mean weight was 2.4 standard et aletal, 1995;Ames, 1997;Fisher et aletal, 1997;,1997; deviations below the mean with over half adopted from Romania before the age Chisholm, 1998;Rutter et aletal, 1998, 2001; below the third percentile) and the retro- of 42 months were compared at 4 years O'ConnorO'Connor et aletal, 2000). However, the studies spectively administered) Denver scale and 6 years with 52 non-deprived UK also show that, at least in relation to specific produced a mean quotient of 63, with children adoptedininfancy.Dysfunctionadoptedin infancy.Dysfunction outcomes, there is considerable hetero- three-fifths functioning in the severely retarded range. By the time the children was assessed for seven domains of geneity in response. Thus, in our own study, for children who experienced at least 2 years reached the age of 4 years substantial functioning.The groups were compared of institutional privation in infancy, the catch-upcatch-uphadhad occurred, with the mean on which, and how many, domains were measured IQ scores at 6 years ranged from weight and Denver quotient both being impaired.impaired. the severely retarded range to high superior nearnearnormalnormal for UK children Rutter et aletal,, O'ConnorO'Connor et aletal, 2000). Because the pub- 1998). Eighty-one per cent of the adoptive ResultsResults Attachment problems, lished reports all consider outcomes in re- parents of Romanian children who were inattention/overactivity, quasi-autistic lation to specific impairments, it is not approached to participate in the study features and cognitive impairment known whether thechildren who fare well agreed to do so. on one type of outcome also fare well on were associated withinstitutionalwith institutional others. It is necessaryto determine the privation, but emotional difficulties, poor extent to which impairments tend to be peer relationships and conduct problems pervasive across domains and to ask what MeasuresMeasures were not.Nevertheless, one-fifth of proportion of profoundly deprived children The assessments at age 6 years comprised a achieves generally normalpsychological children who spentthe longesttime in standardised investigator-based interview functioning. Equally, it is not knownknown that included among other things) institutions showed normal functioning. whether profound institutional privation systematic questions on attachment dis- results in a general increase in all forms of order behaviours O'Connor et aletal, 1999,,1999, Conclusions Attachment disorder psychopathology or whether there are cer- 2001), completion of parent and teacher behaviours, inattention/overactivity and tain behavioural patterns or syndromes that versions of the Rutter behavioural scales quasi-autistic behaviour constitute are particularly strongly associated with early Elander & Rutter, 1996;Hogg et aletal,, institutional privation patterns. privation. The aim of this investigation was 1997) and individually administered to use findings from a follow-up study to McCarthy Scales of Children's Abilities Declaration of interest The age 6 years) of institution-reared Romanian McCarthy, 1972). In order to assess poss- research was supported by funds from children who were adopted into UK ible autistic features, the parents completed the Department of Health, the Medical families to answer these questions on speci- the Autism Screening Questionnaire ASQ; ficity and heterogeneity in children's re- BerumentBerument et aletal, 1999). In addition, the Research Council and the Helmut Horten sponses to profound institutional privation. Autism Diagnostic Interview ± Revised Foundation.Foundation. ADI±R;Le Couteur et aletal, 1989;Lord etet alal, 1994) was given by a researcher experi- METHOD enced in its use M.L.R.) when parental interview reports suggested the possibility Subjects *Celia Beckett,Jenny Castle,Carla Croft,Judy Dunn and of autistic features see Rutter et aletal, 1999).,1999). Christine Groothues. The sample comprised 165 children adopted In order to obtain a categorical measure {{See editorial, pp.93^94, thisissue. from Romania before the age of 42 months, of probable dysfunction in each of seven 97 Downloaded from https://www.cambridge.org/core. 27 Sep 2021 at 04:26:11, subject to the Cambridge Core terms of use. RUT TER ET AL specific domains of functioning, the data and often complains of aches and pains Conduct problems were dealt with as follows. see HoggseeHogg et aletal, 1997). These were dealt The scores on the Rutter parents' and with according to the distribution of scores teachers' scales were standardised as for Attachment problems in the within-UK adoptees sample. Children hyperactivity and emotional difficulties. with scores in the top 5% on either or both The conduct items were: often destroys Three items from the parental interview ± of the parents' and teachers' scales were own or others' property;frequently fights definite lack of differentiation between treated as having emotional difficulties. or is extremely quarrelsome with other adults;clear indication that the child would children;is often disobedient;often tells readily go off with a stranger;and definite lies;has stolen thingsthings on on one one or or more more lack of checking back with the parent in Autistic features occasions in the past 12 months;disturbs anxiety-provoking situations ± were scored other children;bullies other children; as 0 for `no abnormality', 1 for `probable Using the ASQ and the ADI±R, 20 children blames others for things;is inconsiderate problem' and 2 for `definite problem'. were diagnosed as showing quasi-autistic of others;kicks, bites other children see These were summated to produce a com- features Rutter et aletal, 1999). As this HoggHogg et aletal, 1997).,1997).Children who scored posite score ranging from 0 to 6, and a provided the combination of total screening in the top 5% of scores in the UK sample cut-off of 4 or more was used to indicate coverage of both groups and individual distribution on either scale were categorised dysfunction. diagnoses, this categorisation was used. as showing conduct problems. Inattention/overactivity Cognitive impairment The Rutter scales completed by mothers The general cognitive index GCI) of the and fathers were standardised and then McCarthy Scales was used as the measure. averaged to produce a single parent score Children who scored at least 2 standard Statistical analysis see Kreppner et aletal, 2001). The teachers' deviations below the UK sample's mean Between-group differences in the pro- scale was similarly standardised. The were treated as showing cognitive impair- inattention/overactivity items on the portion of children showing dysfunction ment. The UK sample mean was 117, with on each of the seven domains were examined parents' scale were: very restless, has a standard deviation of 18. Twice the difficulty staying seated for long;squirmy, using Fisher's two-tailed exact test and one standard deviation 36) subtracted from degree of freedom. Within-group differ- fidgety child;cannot settle to anything for 117 equated to a score of 81;accordingly more than a few moments and inattentive; ences according to age of entry to the UK all children with an IQ of 81 or less were were examined for a linear trend on a chi and easily distracted. The teachers' scale included in this domain of dysfunction. included all the preceding items plus: square comparing entry at under 6 months, excessive demands for teacher's attention; 6±24 months, and over 24 months nn58,58, 59 and 48 respectively). Polychoric corre- and fails to finish things started ± short Peer difficulties attention span. Using the distribution of lations were used to examine the associ- scores in the within-UK adoptees sample, Peer difficulties were assessed through a ation among the binary domains of three categories were created for the combination of the Rutter parents' and dysfunction variables. parents' and teachers' scales separately with teachers' scales, together with nine items Cluster analysis was used to examine a score of 0 for a score below the median, 1 from the parental interview. The three the ways in which children in the Romanian for a score between the median and the top items in the parents' scale were `not much adoptees sample showed similarities in their 10% cut-off, and 2 for a score in the top liked by other children', `tends to be patterns of dysfunction. The technique is 10% of the range. Pervasive inattention/ solitary' and `does not get on well with valuable for grouping individuals according overactivity required a score of 2 on either other children'.
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