Timing Matters in the Effects of Neglect on Development
New research tracks the effect of early neglect from childhood through adulthood
Posted Jul 18, 2017
What are the consequences of deprivation on the developing child? How long-lasting are the effects of early neglect on a child’s emotional well-being and developing intellect later in life? The answer is: it depends, and one of the factors it depends on is timing. As shown by a recent study of young adults who had spent time as children in Romanian orphanages, severe neglect in early life can have different consequences depending on the time window of deprivation, and also depending on the person’s age when skills and well-being are later assessed. Research findings related to the developmental timing of neglect can have implications for child-welfare policies and can also help adoptive families better understand how effects of neglect may play out later in life.
One key finding of the study (published earlier this year in the medical journal Lancet) is that severe early-life deprivation lasting more than 6 months led to more serious consequences. Over a period spanning from early childhood through adulthood, the study followed 165 people adopted in infancy from severely depriving Romanian orphanages. All the children were adopted by British families in the 1990’s, after the fall of Romania’s dictator Nicolai Ceausescu brought to light the shocking conditions of Romanian orphanages. During their time in the orphanages, children were exposed to inadequate food, hygiene, and medical care, combined with a severe lack of nurturance and cognitive stimulation. Since the time of adoption, the children had been raised in British homes. Because the child’s age at the time of adoption varied— between 2 weeks and 43 months of age—researchers could examine how the duration of deprivation affected development. For purposes of comparison, children were placed into two groups: those who had spent less than 6 months in the Romanian orphanages, and those who has spent more than 6 months there.
Researchers compared both of these groups of Romanian-born children to a sample of children adopted domestically within the U.K., who had not experienced institutional care and were adopted before the age of 6 months. The comparison between Romanian-born and U.K.-born adoptees controls for the effects of some aspects of adoption, such as the experience of separation from birth parents (which all adoptees experience), while allowing a contrast between adoptees who experienced severe neglect in institutions versus those who did not.
The good news from the study is that those Romanian adoptees who spent less than 6 months institutionalized were generally indistinguishable from the U.K. adoptees across a range of measures of cognitive and emotional well-being. This implies that children have the resilience to rebound from severe deprivation when placed into stable and nurturing homes at a young age. However, children who endured more than 6 months of deprivation did not rebound quite so well. Across a range of measures, including autistic-like behavior, disinhibited social behavior, and hyperactivity, those who experienced longer durations of deprivation tended to show worse outcomes compared to the other groups. Although these results may not seem surprising—logically, it makes sense that longer deprivation would be more harmful—the results have direct implications for child welfare policy. In short, children are harmed when they are placed in institutions for longer than 6 months.
A more surprising finding of the study was that some negative consequences of neglect got better over the child’s life, whereas others got worse. Researchers assessed the participants at ages 6, 11, 15, and young adulthood (22-25 years old), and therefore could track the trajectory of developmental change over many years following adoption. One bright spot in the findings was that for the measures of cognitive ability (IQ), significant improvement over developmental time emerged. Romanian children deprived for more than 6 months showed cognitive impairments compared to the other two groups during childhood and adolescence, but not in adulthood. In other words, eventual catch-up in cognitive skills was evident even for the most severely-deprived group.
On the other hand, emotional well-being showed a pattern of worsening over developmental time among the severely-deprived group. Emotional problems were similarly low for all groups in childhood, but the severely-deprived group showed a significant increase in emotional problems in adulthood. That is, in young adulthood (but not at earlier ages), the group who had been severely deprived for more than 6 months as infants had higher rates of emotional problems, both as reported by themselves and as reported by their parents, compared to the other groups. For example, 43 percent of those in the most-deprived group reported using mental health services between the ages of 15 and 23, compared to 23 percent in the less-deprived Romanian group and 10 percent in the group of U.K. domestic adoptees. These findings demonstrate that some negative consequences of early neglect do not become fully evident until later during development. The transition from adolescence to young adulthood may raise new psychological challenges that are more difficult for those with a history of severe deprivation.
In sum, the results of this study offer reasons for both optimism and pessimism. Placement into nurturing homes led to developmental catch-up in cognitive abilities, even among those who experienced longer durations of institutionalization before placement. At the same time, the children who were institutionalized for a longer time during infancy tended to show greater emotional problems in young adulthood, compared to adoptees who were institutionalized for shorter periods or who did not experience institutionalization at all. Thus, while time (and nurturance) may heal wounds, it does not heal all of them completely.
Of course, these results should not be taken as deterministic for any individual child who experienced early neglect. The study focused on children exposed to some of the harshest orphanage conditions yet reported, and may not generalize to less severe experiences of neglect. Furthermore, the researchers reported that even among those children who lived in Romanian institutions for more than 6 months, a significant minority (about 20 percent) reported no problems at any of the time-points measured, raising interesting questions about the causes of individual differences in resilience. Yet, from a public policy standpoint, the implication is clear: children’s interests are best served by placement in stable family homes, rather than harmful institutional care, as early in life as possible.
Sonuga-Barke, E. J., Kennedy, M., Kumsta, R., Knights, N., Golm, D., Rutter, M., ... & Kreppner, J. (2017). Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet, 389(10078), 1539-1548.