Is sub-nutrition necessary for a poor outcome following early institutional deprivation?

Authors

  • Edmund J S Sonuga-Barke PhD,

    Corresponding author
    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London
      * Correspondence to first author at School of Psychology, University of Southampton, Southampton SO17 1BJ, UK.
      E-mail: ejb3@soton.ac.uk
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  • Celia Beckett PhD,

    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London
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  • Jana Kreppner PhD,

    1. School of Psychology, University of Southampton
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  • Jenny Castle BSc,

    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London, London, UK.
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  • Emma Colvert PhD,

    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London, London, UK.
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  • Suzanne Stevens BSc,

    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London, London, UK.
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  • Amanda Hawkins BSc,

    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London, London, UK.
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  • Michael Rutter MD

    1. Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, University of London, London, UK.
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* Correspondence to first author at School of Psychology, University of Southampton, Southampton SO17 1BJ, UK.
E-mail: ejb3@soton.ac.uk

Abstract

Institutional deprivation is multifaceted and includes adverse psychosocial and nutrition-related components. In this study we partitioned these risks in relation to cognitive impairment and mental ill health, and explored the mediating role of reduced head/brain size. There were 138 participants (61 males, 77 females) in the study. Participants were Romanian adoptees who had experienced at least 2 weeks of early institutional deprivation. The sample was stratified on the basis of duration of deprivation (high risk >6mo in institutions) and sub-nutrition (i.e. 1.5 SD below UK age-related norms for weight at UK entry). UK children adopted before 6 months of age and a group of non-institutionally deprived Romanian children constituted the comparison groups. Duration of deprivation was associated with smaller head circumference, lowered IQ, and increased mental heath problems, independently of effects found for sub-nutrition on head circumference and IQ. The mediating role of head circumference was limited to either sub-nourished (IQ) or non-sub-nourished (inattention/overactivity and disinhibited attachment) subgroups. Many negative effects of early deprivation, including stunted brain growth, occur without sub-nutrition: psychosocial deprivation plays a major role in neurodevelopmental effects of deprivation. Further studies of functional and structural neuroanatomy following institutional deprivation are required to delineate the role of brain development in its effects.

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