Type of Paper: Original Article; Prospective Study
Purpose: To describe the degree of developmental catch-up in Romanian adoptees following adoption.
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores for height and weight were calculated using U. K. standards.
Participants: 111 children adopted from Romania into the U. K. before the age of 2 years. The majority had lived in institutional care prior to adoption (18 of the 111 lived in a family setting and spent less than 2 weeks in institutional care). There was also a comparison group of 52 within-country adopted children who were adopted before 6 months of age.
Methods: Physical growth measurements were taken at arrival into the U. K. and at age 4 years. The measurements at arrival were based on the review of medical records at entry into the U. K. and were not available for all of the children.
Nutrition Results: Physical growth:
- There was severe growth delay at arrival.
- Average z scores were:
- Height for age (HAZ): -1. 95
- Weight for age (WAZ): -2. 37
- Head circumference for age (OFCZ): -2. 14
- Many children were below the third percentile for growth:
- HAZ: 34%
- WAZ: 51%
- OFCZ: 38%
- Children who spent less time in institutional care had better average weight status at arrival (those who spent less than 2 weeks in institutional care: -1. 28 z scores; those who spent the majority of their pre-adoption time in institutional care: -2. 38 z scores). Age at arrival, however, was not correlated with physical growth.
- There was significant catch-up in physical growth at age 4 years. However, the Romanian adoptees were slightly smaller in all areas of physical growth compared to the within-country adopted group.
- Approximate average z scores at 4 years of age were:
- HAZ: -0. 3
- WAZ: 0. 0
- OFCZ: -1. 3
- Fewer children were below the third percentile for growth at 4 years of age compared to entry:
- HAZ: 1%
- WAZ: 2%
- OFCZ: 13%
- There was little association between physical growth and developmental functioning.
- All areas of physical growth at arrival (HAZ, WAZ, OFCZ) were correlated with developmental functioning at arrival, but did not predict developmental functioning at age 4 years.
- Weight at arrival (being below the third percentile) was associated with poorer developmental functioning at age 4 years, but only in those who had been adopted before the age of six months. For those who were adopted after 6 months of age, weight did not predict developmental functioning.
- Age at adoption was the strongest predictor of developmental functioning at 4 years of age.
Conclusions & Clinical Implications: Children adopted from Romania experience sever growth failure at the time of adoption followed by significant catch-up growth. Just over half of the children had a weight below the third percentile. There was very little association between the degree of growth failure (or malnutrition) with later developmental functioning. The authors conclude form their data that malnutrition did not have a lasting effect on cognitive functioning in these children. However, they suggest that the duration of malnutrition rather than the severity of malnutrition could have affected cognitive performance. This is consistent with their findings that older age at adoption (a longer period of deprivation) predicted poorer cognitive functioning, but weight did not in children who older than six months at adoption. However, it is difficult from this study to distinguish the effects of the duration of nutritional deprivation from the duration of other types of deprivation (physical and psychological).
Limitations of the Nutritional Results: The authors suggest that the degree of malnutrition has little or no effect on cognitive functioning. However, other studies have found an association between physical growth at arrival and developmental functioning in international adoptees. Also, malnutrition may have negative consequences on other areas of developmental functioning that were not addressed in the current study. This study only examined general cognitive functioning.
Reference: Rutter M. Developmental catch-up, and deficit, following adoption after severe global early privation. English and Romanian Adoptees (ERA) Study Team. J Child Psychol Psychiatry. 1998; 39 (4): 465-476. http://www.ncbi.nlm.nih.gov/pubmed/9599775