Michael Rutter’s research while affiliated with The King's College and other places

Background Childhood institutional deprivation is associated with growth stunting in childhood but long-term effects in adulthood remain uncertain. Objective To examine the impact of global institutional deprivation experienced in early childhood on subsequent growth with a special focus on final adult height and puberty timing. Participants & setting The study was originally set in the UK, though some adoptive families lived abroad by the time of the adult follow up. 165 individuals adopted by UK families before 43 months of age from Romanian orphanages after the fall of the Ceaușescu regime in the early 1990's were compared to 51 non-deprived UK adoptees, adopted before the age of 6 months. Methods The English and Romanian Adoptees (ERA) study is a 20-year longitudinal natural experiment on the effects of institutional deprivation on development. Key growth milestones were extracted from growth curve modelling of height data collected at ages 4, 6, 11, 15 and 23 years using a Bayesian approach to fit the JPA2 model. Results Deprivation effects on height were present at the take-off point of accelerating adolescent growth and persisted into adulthood – the largest effects being for individuals who experienced over six months of deprivation. Deprivation was associated with earlier take-off and achievement of peak height velocity of adolescent growth acceleration – an effect driven largely by females' data and correlated with parent ratings of pubertal development. Conclusions Early deprivation appears to reset tempo of growth early in development leading to permanent growth stunting in adulthood and accelerated onset of puberty, specifically in females.

In the last 40 years, there has been a huge increase in autism genetics research and a rapidly growing number of discoveries. We now know autism is one of the most highly heritable disorders with negligible shared environmental contributions. Recent discoveries also show that rare variants of large effect size as well as small effect common gene variants all contribute to autism risk. These discoveries challenge traditional diagnostic boundaries and highlight huge heterogeneity in autism. In this review, we consider some of the key findings that are shaping current understanding of autism and what these discoveries mean for clinicians.

Background: Previous findings suggested that associations between childhood hyperactivity and later criminality were mediated mainly by conduct disorders. Method: Information recorded in case notes was used to predict officially recorded criminal convictions later in life among 148 individuals who were seen as child psychiatric patients between 1948 and 1982. Multiple Poisson and logistic regression were used to examine the independent contributions made by symptom/behaviour counts, diagnosed conduct disorder, and social and family factors to the prediction of recorded criminality during two later periods (ages 17-21 and 22+), taking into account previous recorded criminality in each case. Results: Previous convictions were highly predictive of every offending outcome examined except convictions for violent offenses. Among males, symptoms of hyperactivity were highly predictive of convictions at age 17-21, multiple offending (five or more separate convictions), and having received a custodial sentence. A childhood diagnosis of conduct disorder made little additional contribution to the prediction of later offending over and above the effects of previous convictions. Conclusions: Symptoms of hyperactivity increased the risks of later convictions among boys with behavioural or emotional disturbances in ways that were not mediated by previous convictions or other measures of childhood conduct problems.

Beginning in the 1960s, the Isle of Wight studies were among the first to investigate developmental reading problems in representative, population-based samples, using the tools of epidemiology. In this paper, we provide an overview of the contribution of the Isle of Wight studies to research on reading disabilities. We begin with an account of the surveys of primary school children, then move on to describe the programme of epidemiological and longitudinal research that flowed from them. The early studies provided some of the first systematic evidence on the extent and correlates of severe developmental reading problems, and their overlaps with other childhood difficulties. Subsequent studies documented the persistence of early reading problems into adolescence; provided comparative data on rates of reading problems in an inner city area; and most recently explored the long-term persistence of literacy problems up to mid-life.

Background Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment – the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s –we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Methods Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires. Results Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory. Conclusions These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan – effects that are linked specifically to deprivation-related adult ADHD symptoms.

Significance Millions of children worldwide live in nonfamilial institutions. We studied impact on adult brain structure of a particularly severe but time-limited form of institutional deprivation in early life experienced by children who were subsequently adopted into nurturing families. Institutional deprivation was associated with lower total brain volume in a dose-dependent way. Regionally specific effects were seen in medial prefrontal, inferior frontal, and inferior temporal areas. Deprivation-related alterations in total brain volume were associated with lower intelligence quotient and more attention deficit/hyperactivity disorder symptoms; alterations in temporal volume seemed compensatory, as they were associated with fewer attention deficit/hyperactivity disorder symptoms. We provide evidence that early childhood deprivation is related to alterations in adult brain structure, despite environmental enrichment in intervening years.

Background: Using data from the English & Romanian Adoptees (ERA) study, we recently reported that early time-limited exposure to severe institutional deprivation is associated with early-onset and persistent neurodevelopmental problems and later-onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. Methods: The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships. Results: The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive. Conclusions: Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model.

There is an enormous interest in identifying the causes of psychiatric disorders but there are considerable challenges in identifying which risks are genuinely causal. Traditionally risk factors have been inferred from observational designs. However, association with psychiatric outcome does not equate to causation. There are a number of threats that clinicians and researchers face in making causal inferences from traditional observational designs because adversities or exposures are not randomly allocated to individuals. Natural experiments provide an alternative strategy to randomized controlled trials as they take advantage of situations whereby links between exposure and other variables are separated by naturally occurring events or situations. In this review, we describe a growing range of different types of natural experiment and highlight that there is a greater confidence about findings where there is a convergence of findings across different designs. For example, exposure to hostile parenting is consistently found to be associated with conduct problems using different natural experiment designs providing support for this being a causal risk factor. Different genetically informative designs have repeatedly found that exposure to negative life events and being bullied are linked to later depression. However, for exposure to prenatal cigarette smoking, while findings from natural experiment designs are consistent with a causal effect on offspring lower birth weight, they do not support the hypothesis that intra-uterine cigarette smoking has a causal effect on attention-deficit/hyperactivity disorder and conduct problems and emerging findings highlight caution about inferring causal effects on bipolar disorder and schizophrenia.

Hypothalamic-pituitary-adrenal (HPA) axis function is disrupted in institutionally-deprived children - reduced morning cortisol, flattened diurnal slope and blunted reactivity persist even after successful adoption into positive family environments. Here we test whether such effects persist into adulthood. Cortisol release across the day (sampled at awakening, 30 and 45min later, and at four points across the day) was investigated in young adult adoptees who had lived in severe deprivation for up to 43 months in early childhood in Ceaușescu's Romanian orphanages and a comparison group of non-deprived UK adoptees (Total N=57; mean age=24±0.9years). The mediating role of cortisol levels on adult mental health was examined using data from standardized clinical assessments. Cortisol profiles were disrupted in the Romanian adoptees who experienced more than 6 months deprivation marked by a striking absence of the cortisol awakening response (CAR) and a significantly flatter cortisol curve until 1h 15min after awakening. Whereas institutional deprivation was associated with both cortisol secretion and emergence of emotional problems in young adulthood, path analysis revealed no evidence for a mediating role of CAR disruption in the sub-sample studied here. The results are in line with findings of HPA axis hypo-functionality following early adverse experience and provide strong evidence for long-term programming effects of HPA axis function through experience of institutional deprivation.

Background: early life institutional deprivation produces disinhibited social engagement (DSE). Portrayed as a childhood condition, little is known about the persistence of DSE-type behaviours into, presentation during, and impact on, functioning in adulthood. Aims: we examine these issues in the young adult follow-up of the English and Romanian Adoptees study. Method: 122 of the original 165 Romanian adoptees who had spent up to 43 months as children in Ceaușescu’s Romanian orphanages and 42 UK adoptees were assessed for DSE behaviours, neuro-developmental and mental health problems, and impairment between ages 22-25 years. Results: young adult DSE behaviour was strongly associated with early childhood deprivation, with a six-fold increase for those who spent more than 6 months in institutions. However, while DSE overlapped with autistic spectrum disorder and ADHD symptoms it was not, in itself, related to broader patterns of mental health problems or impairments in daily functioning in young adulthood. Conclusion: DSE behaviour remained a prominent, but largely clinically benign, young-adult feature of some adoptees who experienced early deprivation.