Policy and Practice Implications from the English and Romanian Adoptee (ERA) Study: Forty-five key questions.

Parker, Roy

Policy and Practice Implications from the English and Romanian Adoptee (ERA) Study: Forty-five key questions Michael Rutter, Celia Beckett, Jennifer Castle, Jana Kreppner, Suzanne Stevens and Edmund Sonuga-Barke BAAF 2009 48 pages 6.95 [pounds sterling]

The English and Romanian adoptee study was launched under Michael Rutter's direction in 1992. Its aim was to discover what happened when children who had been living in profoundly depriving circumstances in Romanian institutions were adopted by families in the UK. In order to provide some basis for comparison a group of English adoptions was also included. It has been possible to follow both groups of children as far as their 15th birthdays, a wide range of information having been collected at intervals from the age of four until then.

A multitude of papers have been published on different aspects of this ambitious study (many listed in the references), but this one is different because it is produced as a series of answers to some of the more commonly asked questions about what was found. Altogether the sample comprised 165 of the adoptions from Romania and was restricted to those who were no more than 42 months old when they entered the UK. However, this particular account focuses almost wholly upon the 98 children who had lived in institutions until at least the age of six months.

Although the publication's question and answer format is inventive, it makes it difficult to read as one would a book. There are too many discontinuities for that. Instead, it will be much more useful if it is approached with specific questions in mind and with the idea of 'looking up' the answers. Even so, caution is called for in drawing quick conclusions from the answers, for they contain a good many qualifications.

It emerges that the number of breakdowns (or disruptions) was remarkably small--just two of the 165 during the 15 years. But, as we know, the survival rates of any placements are only one way of looking at outcomes. Nonetheless, the study shows that the children made 'a remarkable degree of recovery' from their harrowing early lives, albeit not immediately. However, not all was plain sailing as one might have expected. In particular, half of the children who had spent more than their first six months in these institutions 'experienced continuing impairments or difficulties'. These were largely psychological in nature. In particular, the study identified four what were termed 'deprivation-specific' patterns: disinhibited attachment, quasi-autism, inattention/overactivity and cognitive impairment. A variety of questions follow. For example: did the findings on 'disinhibited attachment' mean that the young people showing this behaviour could not develop secure attachments to their parents? The answer is that it did not. The answer was the same to the companion question of whether the persistence of these problems meant that they could not be ameliorated.

Some of the 45 questions that are posed will be of particular interest to non-clinical practitioners. One is whether there were factors in these placements that helped to predict what was likely to happen, particularly in terms of psychological problems. The answer is that there were more nonpredictive factors than there were predictors. Among the first group it was found that the adoptive parents' age, their household composition, whether they sought these adoptions from altruistic motives or because of infertility, or whether they adopted one or two children made no difference to the outcomes. What did help to discriminate between those children who did and who did not show later problems was, as we have seen, the child's age at leaving the institution, the level of their language acquisition (the more the better) and the parents' commitment, which is described as 'crucially important'.

In terms of the first of these factors it would be interesting to know whether it was the child's age that made the difference or the shorter duration of the depriving experience. As far as one can tell both were important, but it would be illuminating to see their effect disentangled. With respect to the second it would be interesting to discover how far this reflected even a slightly better degree of personal attention in the institutions (as is suggested) or, perhaps, slightly better feeding. Presumably the language in question was Romanian, but how, one wonders did this relate to the subsequent acquisition of English? When it comes to the adopters' contribution we are given some indication of how this manifested itself; for example, in their determined negotiation for the services that their children needed. But, for the practitioner, it is also relevant to know whether, and if so how, such attributes might be recognised beforehand. Doubtless some of these issues are explored in the teams' other more detailed papers. In that respect, one of the virtues of this selection of questions is that the reader is prompted to pose additional queries, some of which may not have occurred to them before.

Certainly, they would want to know how far what is learned about the effects and recuperative possibilities when children have been exposed to deeply depriving institutional care hold good when children are adopted from less extreme conditions. Obviously that is a matter of degree; but clearly it is of considerable importance to have some idea of any differential effects of a graduation in severe depriving experiences. The authors do pose the question whether the study has messages for nonclinical practitioners dealing with these more usual adoptions and fostering, but their answers take us only so far. For example, they tell us that their findings are likely to be relevant to other intercountry adoptions but warn that there will be important differences in the children's experiences prior to adoption. They also emphasise that the young people in their sample had mixed attitudes to making contact with their biological families and argue, therefore, that adoptees' preferences in this matter should be respected and not influenced by 'ideological grounds'.

Nonetheless, it may be tempting to conclude that the prior circumstances of these Romanian children were so extreme that few lessons can be drawn about current practice. That, I feel, would be too hasty a conclusion, and for at least three reasons. First, there are a few children in this country who, although not having lived in such depriving institutions, will have suffered from some of the severest forms of deprivation and abuse. In these cases the results of the study may well be relevant. Second, the findings of this research are heartwarmingly optimistic and suggest that at least comparable success is possible (albeit not denying ongoing problems) in the placement of children who are adopted or fostered from significantly less depriving backgrounds. But that takes us back to the question of what it is that distinguishes one outcome from another. As we have seen, there were some indicators but, as the authors explain, one of their 'most striking findings' was that however long their institutional deprivation, the children's responses were surprisingly varied. 'Some children', they say, 'remained markedly impaired whereas others showed no evidence of problems', even when, in some cases, they had suffered as much as three-and-a-half years of institutional deprivation. One possible explanation for this, it is suggested, is that 'there are some normal genetic variations that play a part in making some people more resistant to stress and adversity than others', but with the proviso that further work is needed in order for this to be confirmed.

My final point follows. Even a sophisticated longitudinal study like this leaves much unanswered; many conclusions are tentative and acknowledged to demand further research. Yet it is only by small steps that our understanding of the difficult problems that have to be grappled with advances. One study builds on another and the resulting accumulation may be particularly fruitful to social workers when it has drawn on the research of different but related disciplines, in this case mainly psychiatry.

Roy Parker is Professor Emeritus of Social Policy, University of Bristol