Deprivation in early life is associated with childhood psychiatric disorders, but the developmental trajectories of these are not well understood. An intriguing study by Sonuga-Barke et al followed up long-term outcomes (to ages 22–25) of children who had suffered severe deprivation, from birth until 4 years of age, in Romanian institutions before being adopted into the UK. Their plight, including partial starvation and a lack of human contact and care under Ceauşescu's regime has been well reported, as has the fact that many showed a remarkable and rapid improvement in developmental delays upon reaching the UK. Through childhood, those who had spent less than 6 months in such an environment suffered comparatively low levels of psychiatric symptoms, similar to their British counterparts. However, despite well-resourced and loving care from their adoptive UK families, children who had spent more than 6 months in this deprivation had persistently greater rates of autism spectrum disorder (ASD), disinhibited social behaviour, and inattention and hyperactivity symptoms that persisted into adulthood. Although childhood cognitive impairment in this more vulnerable group returned to normal levels by later life, they had lower educational attainments and higher rates of unemployment and increased use of mental health services. The authors praise the resilience of the children, noting how a fifth of those who spent more than 6 months in deprived care still remained problem-free at all points: it also underlines how this was not the case for the other 80% of them. In seemingly introspective political times, it reminds us to look outwards.
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