Prevalence of the Autism Phenotype in Children Adopted After Early Neglect and Maltreatment

Background:   The finding that 6% of 111 children adopted into U.K. families from Romanian institutions following severe early social deprivation showed ‘quasi-autistic’ patterns of social impairment in early childhood, with a further 6% showing isolated autistic features (Rutter et al 1999), had significant impact in suggesting a possible environment-related aetiology for an autism phenotype. An important question has remained – with both theoretical and practical implications - as to whether such autistic-like impairments might also be found in children adopted after early severe maltreatment or neglect in countries not using institutional care.

Objectives:   To make a systematic and rigorous investigation into the presence of the autism spectrum disorder (ASD) phenotype in children after maltreatment.

Methods:   Fifty-nine domestically adopted children (mean age 102 months (SD 20); 47% male) were recruited via a UK national charity (Adoption-UK). Seventy-three percent had experienced severe maltreatment with a mean of 1.6 (SD 1.2) of different maltreatment categories (emotional, physical, sexual abuse and neglect). Mean age at admission to out-of-home care was 11 months (SD 15); mean age at adoption was 35 months (SD 27); mean number of previous placements was 2.5 (SD 1.8).  Initial screening for ASD symptoms and other psychopathology used the Development and Wellbeing Assessment (DAWBA; Goodman et al 2000), a detailed online parent symptom report used in national UK (Meltzer et al, 2000) and other large-scale epidemiological studies (Green et al, 2005, Ford et al, 2007). The DAWBA uses symptom report plus expert clinician review (blind to study hypotheses) to generate algorithm probabilities for DSM-IV diagnostic criteria. Individuals screening positively for ASD on the DAWBA were invited to a second phase detailed assessment including: i) Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule; ii) clinical diagnostic assessment; iii) biometrics and rating of minor physical anomalies (associated with neurodevelopmental risk such as fetal alcohol syndrome); iv) interview data on birth family history of ASD, psychopathology, and substance or alcohol misuse in pregnancy.

Results:  Screening data analysed to date on 54/59 children suggests a high prevalence of autistic symptomatology. Three (5%) meet DAWBA criteria for >70% probability of ASD diagnosis and a further twelve (22%) for possible ASD criteria (>3% probability). These 15 adoptees are being assessed in detail as above during the second phase. Three of the first 10 of these phase 2 cases show ASD, with a further 7 showing ‘Broad ASD’ (partial features) using the Collaborative Program of Excellence in Autism (CPEA) criteria (Lainhart et al. 2006).

Data available for the IMFAR presentation will include; i) Complete ADI-R, ADOS and clinical examination data for autism and ‘quasi-autism’ symptoms; ii) complete maltreatment indices and data on physical phenotype, including evidence for fetal alcohol syndrome or other biological vulnerability; iii) birth family history.

Conclusions:   This data will give to our knowledge the first rigorous data on the presence of ASD in a high-risk adoption sample from non-institutionalized care in a high-income country. It has potentially substantial theoretical and clinical implications.