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Adoptees’ responses to separation from, and reunion with, their adoptive parent at age 4 years is associated with long-term persistence of autism symptoms following early severe institutional deprivation

  • Edmund Sonuga-Barke (a1), Mark Kennedy (a1), Dennis Golm (a1), Nicky Knights (a2), Hanna Kovshoff (a3), Jana Kreppner (a3), Robert Kumsta (a4), Barbara Maughan (a5), Thomas G. O'Connor (a6) and Wolff Schlotz (a7)...


Institutionally deprived young children often display distinctive patterns of attachment, classified as insecure/other (INS/OTH), with their adoptive parents. The associations between INS/OTH and developmental trajectories of mental health and neurodevelopmental symptoms were examined. Age 4 attachment status was determined for 97 Romanian adoptees exposed to up to 24 months of deprivation in Romanian orphanages and 49 nondeprived UK adoptees. Autism, inattention/overactivity and disinhibited-social-engagement symptoms, emotional problems, and IQ were measured at 4, 6, 11, and 15 years and in young adulthood. Romanian adoptees with over 6 months deprivation (Rom>6) were more often classified as INS/OTH than UK and Romanian adoptees with less than 6 months deprivation combined. INS/OTH was associated with cognitive impairment at age 4 years. The interaction between deprivation, attachment status, and age for autism spectrum disorder assessment was significant, with greater symptom persistence in Rom>6 INS/OTH(+) than other groups. This effect was reduced when IQ at age 4 was controlled for. Age 4 INS/OTH in Rom>6 was associated with worse autism spectrum disorder outcomes up to two decades later. Its association with cognitive impairment at age 4 is consistent with INS/OTH being an early marker of this negative developmental trajectory, rather than its cause.


Corresponding author

Author for Correspondence: Edmund J. S. Sonuga-Barke, Department of Child & Adolescent Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, 16 DeCrespigny Park London SE5 8AF, United Kingdom; E-mail:


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