The impact of childhood deprivation on adult neuropsychological functioning is associated with ADHD symptom persistence

Abstract

Background Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment – the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s –we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Methods Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires. Results Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory. Conclusions These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan – effects that are linked specifically to deprivation-related adult ADHD symptoms.

Sensitive periods in executive function development

“…Two recent studies from a different cohort, the English and Romanian Adoptees (ERA) cohort, report the long-term psychopathology and neuropsychological outcomes of early institutionalisation [ 52 •• , 55 ]. Sonuga-Barke et al [ 52 •• ] report that children adopted before 6 months were indistinguishable from peers in adulthood on a range of clinical measures, whereas those that spent greater than 6 months in an institution presented with increased rates of ‘quasi’ autism spectrum disorder, disinhibited social engagement and inattention/over-activity in adulthood.…”

“…A further study from the same cohort investigating neuropsychological functioning in adulthood did not report the same 6 month ‘step change’ – rather, even institutionalisation experienced at 3 months was associated with neuropsychological impairments at age 25, including in pro-active inhibitory control, which was accounted for by impairments in IQ [ 55 ]. The authors highlight that together these findings point towards a complex relationship between neuropsychological functioning and clinical outcomes, since individuals in the group adopted before 6 months may, in adulthood, have presented with lower inhibitory control and IQ [ 55 ] but not ADHD symptoms [ 52 •• ], whereas deprivation for longer than 6 months appears to be a key for developing clinical symptoms.…”

Are Mental Health, Family and Childhood Adversity, Substance Use and Conduct Problems Risk Factors for Offending in Autism?

“…Family violence, physical abuse, sexual abuse and neglect have also been reported to be experienced more frequently by autistic offenders compared to both autistic non-offenders and TD offenders (Kawakami et al 2012 ; Kumagami and Matsuura 2009 ). Whilst early childhood deprivation and trauma can be associated with ADHD symptomology in adulthood, this is not the case for ASD symptomology (Golm et al 2020 ). Neglect and physical abuse alone have been reported to increase the likelihood of offending by 6.3 and 3.1 times respectively within a sample of autistic offenders (Kawakami et al 2012 ).…”

Sensitive periods in executive function development

“…A further study from the same cohort investigating neuropsychological functioning in adulthood did not report the same 6 month 'step change' -rather, even institutionalisation experienced at 3 months was associated with neuropsychological impairments at age 25, including in pro-active inhibitory control, which was accounted for by impairments in IQ [55]. The authors highlight that together these findings point towards a complex relationship between neuropsychological functioning and clinical outcomes, since individuals in the group adopted before 6 months may, in adulthood, have presented with lower inhibitory control and IQ [55] but not ADHD symptoms [52 ], whereas deprivation for longer than 6 months appears to be a key for developing clinical symptoms.…”