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

Background:  Some young children reared in profoundly depriving institutions have been found to show autistic‐like patterns, but the developmental significance of these features is unknown. Methods:  A randomly selected, age‐stratified, sample of 144 children who had experienced an institutional upbringing in Romania and who were adopted by UK families was studied at 4, 6, and 11 years, and compared with a non‐institutionalised sample of 52 domestic adoptees. Twenty‐eight children, all from Romanian institutions, for whom the possibility of quasi‐autism had been raised, were assessed using the Autism Diagnostic Interview‐Revised (ADI‐R) and the Autism Diagnostic Observation Schedule (ADOS) at the age of 12 years. Results:  Sixteen children were found to have a quasi‐autistic pattern; a rate of 9.2% in the Romanian institution‐reared adoptees with an IQ of at least 50 as compared with 0% in the domestic adoptees. There were a further 12 children with some autistic‐like features, but for whom the quasi‐autism designation was not confirmed. The follow‐up of the children showed that a quarter of the children lost their autistic‐like features by 11. Disinhibited attachment and poor peer relationships were also present in over half of the children with quasi‐autism. Conclusions:  The findings at age 11/12 years confirmed the reality and clinical significance of the quasi‐autistic patterns seen in over 1 in 10 of the children who experienced profound institutional deprivation. Although there were important similarities with ‘ordinary’ autism, the dissimilarities suggest a different meaning.