Inattention/Overactivity Following Early Severe Institutional Deprivation: Presentation and Associations in Early Adolescence

Abstract

The current study examined the persistence and phenotypic presentation of inattention/overactivity (I/O) into early adolescence, in a sample of institution reared (IR) children adopted from Romania before the age of 43 months. Total sample comprised 144 IR and 21 non-IR Romanian adoptees, and a comparison group of 52 within-UK adoptees, assessed at ages 6 and 11 years. I/O was rated using Rutter Scales completed by parents and teachers. I/O continued to be strongly associated with institutional deprivation, with continuities between ages 6 and 11 outcomes. There were higher rates of deprivation-related I/O in boys than girls, and I/O was strongly associated with conduct problems, disinhibited attachment and executive function but not IQ more generally, independently of gender. Deprivation-related I/O shares many common features with ADHD, despite its different etiology and putative developmental mechanisms. I/O is a persistent domain of impairment following early institutional deprivation of 6 months or more, suggesting there may be a possible pathway to impairment through some form of neuro-developmental programming during critical periods of early development.

Serotonin transporter polymorphism moderates the effects of caregiver intrusiveness on ADHD symptoms among institutionalized preschoolers

“…It proved surprising, however, that these institutional features did not predict ADHD symptoms, especially given results of related investigations [8,9]. We are not the first to fail to document such seemingly anticipated associations, however, thereby calling attention to methodological differences across inquiries that could account for variation in results.…”

“…We are not the first to fail to document such seemingly anticipated associations, however, thereby calling attention to methodological differences across inquiries that could account for variation in results. Recall that in our own and in Zeanah and colleagues' [6] work, the focus was on children still institutionalized, whereas other research focused on previously institutionalized children, living with their adoptive families [8,9]. Another factor to consider in entertaining reasons for divergent results across studies is that the absence of an effect of duration of deprivation on ADHD may be attributable to the fact that all children from the current study were institutionalized for no less than 6 months and this was by no means the case in other work.…”

“…In fact, recent work indicates that institution-reared children, relative to their family-raised peers, have a higher incidence of ADHD symptoms of inattention and hyperactivity [4][5][6], with problems persisting years after they have departed the institution, often due to adoption [7][8][9][10]. Such high prevalence and resistance to intervention led some to argue that these difficulties represent a persistent impairment and constitute a specific deprivation syndrome associated with institutional rearing [11,12].…”

“…Thus, not all children exposed to institutional care, even for 6 months or more, evince signs of attention problems and hyperactivity [8,9]. This certainly calls attention to the need to consider non-institutional factors as contributors to the development of attention problems and hyperactivity.…”

Associations between early life adversity and executive function in children adopted internationally from orphanages

“…Previous laboratory studies with older PI children have shown reduced performance on each of these components: cognitive flexibility (11), working memory performance (11,12,15), and inhibitory control (13,15,31). Additionally, there are extensive reports that PI children show attention deficits and hyperactivity symptoms that persist into adolescence (32,33), which could signal long-term difficulties with EF.…”