Neurodivergence

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• A comparison between a Neuro-Physiological Psychotherapy (NPP) treatment group and a control group for children adopted from care: Support for a neurodevelopmentally informed approach to therapeutic intervention with maltreated children

  2019 · England

  The study compared adopted children receiving Neuro-Physiological Psychotherapy with children assessed by the service whose families did not take up the recommended treatment. Analyses adjusting for group differences found better reported outcomes in the treatment group in regulation, executive functioning and some mental-health and behavioural measures.

• A Comparison of the effects of preterm birth and institutional deprivation on child temperament

  2020 · United Kingdom; Romania (origin); Germany (comparison cohort)

  Researchers compared parent-rated temperament at age six in the ERA study and a German preterm-birth cohort, each with comparison groups. Children exposed to institutional deprivation and those born very preterm both had lower effortful control. Higher activity was observed in the deprivation group, while lower shyness was observed in the preterm group.

• ADHD in international adoptees: a national cohort study

  2010 · Sweden

  This Swedish national cohort compared 16,134 international adoptees with more than 1.3 million people with Swedish-born parents, using prescribed ADHD medication as the measured outcome. ADHD medication use was higher among international adoptees, with particularly high rates in some regions of origin, and risk increased with older age at adoption. The study reports a population-level association; medication use is not the same thing as a direct measure of ADHD prevalence or neurodivergence.

• Adolescent inattention/overactivity/impulsivity as an outcome of early institutional deprivation: the role of genetic factors

  2009 · United Kingdom

  The ERA doctoral study followed attention, activity and impulsivity outcomes at ages six, 11 and 15 among Romanian and UK adoptees. Longer institutional deprivation was associated with greater and persistent difficulties, with variation between individuals. A genetic subsample examined whether DAT1 variation moderated this association.

• Adopted children’s mental health needs beyond attachment and trauma: A comparison of social work and mental health conceptualisations

  2026 · England

  Researchers compared 153 consecutive social-worker referral letters with diagnoses following specialist mental-health assessment of adopted children. Assessments commonly identified behavioural and neurodevelopmental conditions. Agreement between referral descriptions and clinical diagnoses was low, suggesting that the two services described children’s difficulties differently.

• 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

  2020 · United Kingdom; Romania (origin)

  Researchers related attachment responses at age four in 97 Romanian adoptees and 49 UK adoptees to symptoms followed into young adulthood. In the more deprived group, an insecure/other attachment classification was associated with more persistent autism symptoms. The association weakened after accounting for early IQ, suggesting a possible marker rather than proof of a causal attachment effect.

• Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation

  2017 · UK; Romania

  ERA follow-up examined disinhibited social engagement from childhood into adulthood alongside neurodevelopmental and mental-health outcomes.

• Amygdala, hippocampal and corpus callosum size following severe early institutional deprivation: the English and Romanian Adoptees study pilot

  2009 · United Kingdom; Romania (origin)

  An MRI pilot compared 14 adolescent adoptees exposed to Romanian institutional deprivation with 11 non-adopted UK controls. The exposed group had smaller total grey and white matter volumes. After adjustment for overall brain volume, amygdala volumes differed, while hippocampal volume and corpus callosum area did not.

• An Evaluation of Neuro-Physiological Psychotherapy for Adopted Children and Young People with Neurodevelopmental Trauma and Prenatal Alcohol Exposure Who May Meet Criteria for Foetal Alcohol Syndrome Disorder

  2026 · England

  This evaluation extends earlier Family Futures research to a larger treatment group and examines prenatal alcohol exposure. Parent and teacher ratings indicated differences favouring treated children on selected executive-function and behavioural measures compared with a non-equivalent control group. Improvements in behavioural regulation were also observed among children with prenatal alcohol exposure.

• Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees

  2004 · United Kingdom; Romania (origin)

  Using Romanian-born and UK domestic adoptees, researchers examined whether early deprivation might leave persistent developmental effects after children entered families. Assessments at age six showed substantial recovery in cognition and social functioning alongside continuing difficulties for some children. The authors interpreted this pattern as consistent with lasting developmental changes, while noting variation between children.

• Association of Exposure to Diethylstilbestrol During Pregnancy With Multigenerational Neurodevelopmental Deficits

  2018 · United States

  In data from 47,540 Nurses’ Health Study II participants, reported ADHD diagnoses affected 7.7% of grandchildren of women who used DES during the relevant pregnancy, versus 5.2% without that exposure. The adjusted odds ratio was 1.36 (95% CI 1.10–1.67).

• Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up. English and Romanian Adoptees Study Team

  2000 · United Kingdom; Romania (origin)

  Researchers assessed attachment-related behaviours at age six in 165 Romanian adoptees and 52 UK domestic adoptees, with age-four data for part of the sample. Parent interviews showed an association between longer deprivation and more attachment-related difficulties. These behaviours overlapped with attention, conduct and cognitive difficulties but also formed a distinct pattern. Individual differences were relatively stable between ages four and six.

• Attachment disorders versus more common problems in looked after and adopted children: comparing community and expert assessments

  2015 · England

  A review of 100 consecutive specialist-service referrals compared community descriptions with expert assessments of looked-after and adopted children. Attachment disorders were identified substantially more often in community referrals, while common neurodevelopmental and conduct problems were identified less often. The study examines differences in diagnostic descriptions across services.

• Behavior patterns associated with institutional deprivation: a study of children adopted from Romania

  2002 · United Kingdom (regional breakdown not specified)

  Researchers studied rocking, self-injury, unusual sensory interests and eating difficulties in 144 children adopted from Romania into UK families. Rocking and self-injury became less common between arrival and age 6, while some sensory and eating difficulties remained. Time spent in institutional deprivation was the main factor associated with how common and persistent these behaviours were.

• Can inattention/overactivity be an institutional deprivation syndrome?

  2001 · United Kingdom; Romania (origin)

  Parents and teachers rated attention, overactivity, conduct and emotional difficulties in 165 Romanian-born adoptees and 52 UK domestic adoptees. Longer deprivation was associated with attention and overactivity problems at age six, with persistence from age four in the earlier-assessed subgroup. The association was not explained by the measured birth-weight, nutritional or cognitive differences and overlapped with attachment difficulties.

• Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation

  2017 · UK; Romania

  The English and Romanian Adoptees study found prolonged early institutional deprivation remained associated with autism-related, attention/overactivity and disinhibited-social-engagement symptoms into young adulthood. Some cognitive difficulties improved while emotional difficulties became more prominent later.

• Childhood post-adoption experiences and long-term neurodevelopmental trajectories

  2026 · UK; Romania

  ERA data examined trajectories of autism, ADHD, disinhibited social engagement, cognition and mental health into young adulthood.

• Children after adoption: Exploring their psychological needs

  2016 · United Kingdom

  Researchers assessed children placed for adoption by one UK local authority using parent interviews and questionnaires. Of 106 families approached, partial data were obtained for 47 children; 34 had complete assessment data. In the complete-data group, approximately three quarters met criteria for at least one neurodevelopmental or mental-health diagnosis, and fewer than half of those with a mental-health diagnosis had a previous diagnosis.

• Disinhibited Attachment Disorder in UK Adopted Children During Middle Childhood: Prevalence, Validity and Possible Developmental Origin

  2016 · United Kingdom (regional breakdown not specified)

  Researchers compared 60 children adopted from UK care with 26 children referred for behavioural difficulties and 55 lower-risk comparison children. They used parent and teacher reports and researcher observations to assess behaviour then described as disinhibited attachment disorder. It was identified more often in the adopted group and was associated with first entering care between 7 and 24 months. Its association with ADHD did not account for the difference between groups.

• Do children adopted from British foster care show difficulties in executive functioning and social communication?

  2017 · United Kingdom

  Thirty primary-school-aged UK children adopted from foster care completed cognitive and executive-function assessments; parents completed behaviour, executive-function and social-communication questionnaires. The children performed below age comparisons on two of three computerised executive tasks, and parents reported elevated behavioural and executive difficulties. All scored below the autism-screening threshold.

• Do theory of mind and executive function deficits underlie the adverse outcomes associated with profound early deprivation?: findings from the English and Romanian adoptees study

  2008 · United Kingdom; Romania (origin)

  Researchers assessed theory of mind and executive function at age 11 within a cohort of 165 Romanian and 52 UK adoptees. Longer deprivation was associated with difficulties on both tasks. Statistical analyses suggested possible mediation of some autism-related difficulties, but these functions did not explain the whole pattern of deprivation-related problems.

• Dopamine transporter gene polymorphism moderates the effects of severe deprivation on ADHD symptoms: developmental continuities in gene-environment interplay

  2009 · United Kingdom

  The ERA study examined whether variation in DAT1 and DRD4 genes moderated associations between early institutional deprivation and attention-deficit/hyperactivity symptoms at ages six, 11 and 15. DAT1 variation moderated the association from early adolescence into mid-adolescence; the equivalent DRD4 interaction was not found.

• Early adolescent outcomes of institutionally deprived and non-deprived adoptees. III. Quasi-autism

  2007 · United Kingdom; Romania (origin)

  Researchers followed Romanian institution-reared adoptees and UK domestic adoptees through ages four, six and eleven. Children with suspected autistic-like patterns underwent further diagnostic assessment at twelve. Sixteen Romanian adoptees met the study’s quasi-autism designation, while none of the domestic comparison adoptees did. Some earlier autistic-like features diminished; disinhibited attachment and difficulties with peers often co-occurred.

• Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment

  2020 · UK; Romania

  MRI data from Romanian adoptees with severe early deprivation were compared with non-deprived UK adoptees. The deprived group had smaller total brain volume on average and regional structural differences, with duration of deprivation associated with brain volume.

• Early severe institutional deprivation is associated with a persistent variant of adult ADHD

  2016 · UK; Romania

  An ERA follow-up found those exposed to more than six months' institutional deprivation had much higher ADHD rates into ages 22–25 than a low-deprivation comparison group, with links to education and employment difficulties.

• Emotional difficulties in early adolescence following severe early deprivation: findings from the English and Romanian adoptees study

  2008 · United Kingdom; Romania (origin)

  This follow-up compared emotional and conduct difficulties at ages six and eleven among Romanian-born adoptees and UK domestic adoptees. Emotional difficulties increased in the Romanian group and were more common at eleven than among domestic adoptees; conduct problems did not show the same increase. Earlier neurodevelopmental difficulties were associated with later emotional problems but did not fully account for their emergence.

• Facial emotion recognition in adopted children

  2022 · Wales

  Forty-two adopted children completed a facial-emotion recognition task as part of neurodevelopmental assessment.

• Health Problems in Children Adopted from Romania: Association with Duration of Deprivation and Behavioural Problems

  2003 · United Kingdom

  Parents reported health problems in 165 Romanian adoptees and 52 UK comparison adoptees at entry and age six. Malnutrition and infections were common on arrival from Romania; some hearing, eye, skin and hepatitis B problems persisted. Health risks were associated with later attention and activity difficulties, but not with cognitive or attachment outcomes in the reported analyses.

• II. Methods and measures used for follow-up at 15 years of the English and Romanian Adoptee (ERA) study

  2010 · England / Romania (adopted into UK families)

  This methods chapter describes the ERA follow-up at age 15, including participation, earlier assessments, cognitive tests, assessments of deprivation-related difficulties, genotyping and statistical analysis. It also describes assessments relevant to possible autism at ages 18–20. It documents how the cohort was investigated rather than presenting a separate study with a new participant sample.

• III. Deprivation-specific psychological patterns

  2010 · United Kingdom; Romania (origin)

  This separately indexed empirical research chapter forms part of the ERA adolescent follow-up monograph. Its title identifies the research topic, but the indexed record supplies no abstract. Findings are not summarised because the underlying chapter was not reviewed.

• Inattention/overactivity following early severe institutional deprivation: presentation and associations in early adolescence

  2008 · United Kingdom; Romania (origin)

  Researchers followed inattention and overactivity from ages six to eleven in Romanian adoptees and UK adoptee controls using parent and teacher ratings. These difficulties remained associated with longer institutional deprivation and overlapped with conduct problems, disinhibited attachment and executive-function difficulties.

• Inattentive/overactive children with histories of profound institutional deprivation compared with standard ADHD cases: a brief report

  2008 · United Kingdom; Romania (origin)

  Researchers compared 13 deprivation-exposed children with inattention/overactivity, 20 clinical ADHD cases and 22 ERA comparison children around age 13. Boys in the deprivation group had symptom profiles resembling clinical ADHD; girls showed more symptom remission. Neuropsychological difficulties were greater in the deprivation-related group.

• Is it That They Won't Do it, or is it That They Can't?: Executive Functioning and Children Who Have been Fostered and Adopted

  2007 · United Kingdom (regional recruitment not established)

  An analysis of 86 children referred to Family Futures identified difficulties consistent with impaired executive functioning in every child assessed. The authors related the assessment data to their therapeutic approach for fostered and adopted children and proposed explanations for the difficulties.

• IV. Developmental course of deprivation-specific psychological patterns: early manifestations, persistence to age 15, and clinical features

  2010 · United Kingdom; Romania (origin)

  This separately indexed empirical research chapter forms part of the ERA adolescent follow-up monograph. Its title identifies the research topic, but the indexed record supplies no abstract. Findings are not summarised because the underlying chapter was not reviewed.

• Neurodevelopmental problems in adulthood following severe early deprivation: A qualitative analysis of clinical needs and service user experiences

  2024 · United Kingdom; Romania

  Interviews with adult adoptees and parents from the English and Romanian Adoptees study explored neurodevelopmental difficulties and service needs after severe early deprivation. Accounts described difficulties with independent living, money management and decisions, alongside unmet needs and problems obtaining recognition of neurodevelopmental conditions. Some described helpful support, while medication experiences varied.

• Normality and impairment following profound early institutional deprivation: a longitudinal follow-up into early adolescence

  2007 · United Kingdom (regional breakdown not specified)

  Researchers followed adopted children from ages 6 to 11, assessing functioning across seven areas. Children who had experienced at least six months of severe institutional deprivation were more likely to have difficulties across several areas, although some had no identified impairment. Individual patterns were often already evident at age 6 and continued at age 11. Few measured background factors explained the differences between children.

• Post adoption support needs and implications for future practice – a systematic review

  2026 · International (UK-led review)

  A systematic review examined 76 English-language primary studies published during 2002–2025 about adoptees’ and families’ post-adoption support needs. Recurring subjects included attachment, identity, neurodevelopment, mental health, trauma, education, loss and birth-family contact. The synthesis described barriers to obtaining support and understanding adoptees’ earlier adversity and neurodevelopmental needs.

• Quasi-autistic patterns following severe early global privation. English and Romanian Adoptees (ERA) Study Team

  1999 · United Kingdom; Romania (origin)

  Assessments at ages four and six compared 111 children adopted into UK families from Romania with 52 UK domestic adoptees. Some Romanian adoptees showed autistic-like patterns, and others showed milder features; these patterns were absent in the comparison sample. Autistic-like features were associated with longer deprivation and greater cognitive impairment, although some features improved by age six.

• Scholastic attainment following severe early institutional deprivation: a study of children adopted from Romania

  2007 · United Kingdom; Romania (origin)

  Researchers compared school attainment at age eleven in 127 Romanian institution-reared adoptees and 49 UK domestic adoptees. Attainment was lower on average in the Romanian group, particularly among those with at least six months of institutional care. Statistical analyses linked much of the difference to IQ and, to a lesser extent, attention and overactivity.

• Specificity and heterogeneity in children's responses to profound institutional privation

  2001 · United Kingdom; Romania (origin)

  Researchers compared seven areas of functioning at ages four and six in 165 Romanian adoptees and 52 UK domestic adoptees. Institutional deprivation was associated with attachment-related behaviours, attention and overactivity problems, autistic-like features and cognitive impairment. Emotional difficulties, peer problems and conduct problems did not show the same association at these ages. Outcomes varied, including children with longer institutional exposure who showed no measured impairment.

• The adult outcome of childhood quasi-autism arising following extreme institutional deprivation

  2023 · England / Romania (adopted into UK families)

  Researchers followed adoptees identified in childhood with the ERA study’s “quasi-autism” pattern into adulthood. They compared 26 such participants with 75 adoptees exposed to extended deprivation without that pattern and 116 adoptees with low or no institutional deprivation. The childhood pattern was associated with persistent autism-related difficulties, ADHD and disinhibited social engagement symptoms, mental health difficulties and poorer educational and employment outcomes. Life satisfaction and self-esteem were not affected in the reported comparisons. Communication difficulties predicted poorer adult outcomes.

• The Impact of a Neurocollaborative Theraplay-informed Intervention on the Presentations of Developmental Trauma and Attachment Difficulties in Attention Deficit Hyperactivity Disorder Children: A Pilot Study

  2026 · England

  Fourteen care-experienced children with diagnosed or suspected ADHD were compared with 14 children without ADHD after both groups received a 30-hour therapy package. Parent/carer ratings in the ADHD group improved on selected behavioural and anxiety scales. Adjusted comparisons found no statistically significant difference in changes between groups.

• The Impact of a Neurocollaborative Theraplay®-Informed Intervention on the Presentations of Developmental Trauma and Attachment Difficulties in a Sub-Group of Autistic Looked after Children: a Retrospective Service Evaluation

  2026 · England

  Researchers compared parent/carer ratings before and after a 30-hour therapy package for 35 autistic and 172 non-autistic care-experienced children. Most children in both groups were adopted. The full sample and non-autistic group improved on some measures. Changes in the smaller autistic group were not statistically significant, and adjusted comparisons found no difference between groups.

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

  2020 · UK; Romania

  Previously institutionalised adoptees showed adult difficulties across several cognitive domains, related particularly to persistent ADHD symptoms. It links behavioural findings with adult cognitive functioning.

• Understanding the prospective associations between neuro-developmental problems, bullying victimization, and mental health: Lessons from a longitudinal study of institutional deprivation

  2024 · United Kingdom (regional breakdown not specified)

  Using assessments from ages 6, 11 and 15 and young adulthood, researchers examined neurodevelopmental difficulties, bullying and later mental health in 165 Romanian adoptees and 52 UK adoptees. Severe early deprivation was associated with more bullying and neurodevelopmental symptoms. Statistical models suggested a pathway in which earlier neurodevelopmental difficulties were followed by bullying and then adult depression or anxiety.

• What Is Distinctive About Autism Arising Following Severe Institutional Deprivation? A Direct Comparison With a Community Sample of Early Diagnosed Autistic People

  2025 · United Kingdom; Romania (origin)

  Researchers compared autism-related questionnaire profiles in 26 ERA adoptees with deprivation-associated autistic characteristics, UK adoptee controls and community samples of autistic young people. Many features overlapped with community autism, while some communication and repetitive behaviours persisted and social reciprocity difficulties declined over time.

• Why does early childhood deprivation increase the risk for depression and anxiety in adulthood? A developmental cascade model

  2020 · United Kingdom; Romania (origin)

  The ERA study examined pathways from early deprivation to depression and anxiety in young adulthood, using childhood parent reports and later parent and adoptee reports. Statistical modelling linked early neurodevelopmental difficulties to adult emotional problems through unemployment and difficulties with friendships during the transition to adulthood. Results concerning later stress reactivity were inconclusive.