Risk for autism increases for abandoned children placed in institutions

As part of the Bucharest Early Intervention Project, 136 children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to either continued care as usual in the institution, or high quality foster care created and maintained by the investigators. The children averaged 23 months of age at the time of randomization.

At 10 years of age, 117 children were assessed. Each child's primary caregiver filled out the Social Communication Questionnaire (SCQ), which assesses for symptoms associated with autism, including social communication skills. Children with concern for possible autism were then referred for a full neurodevelopmental evaluation to determine whether they met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for autism.

Five children with a history of institutional care (three in the institutional care as usual group and two in the foster care group) met the DSM diagnostic criteria for autism spectrum disorder. In a comparison group of 100 age-matched, never-institutionalized children living in Bucharest, Romania, no child met criteria for autism spectrum disorder. Based on SCQ scores, children in the foster care group were identified as having more typical social behaviors compared to children in the institutional care as usual group.

These findings suggest that children with a history of institutional care are at increased risk for behaviors associated with autism, including social communication difficulties. These behaviors improved with an early intervention of quality foster care.

The authors strongly emphasize that in the vast majority of autism cases in the general population, children are raised in caring families, and psychosocial deprivation plays no role. "Although the institutionalized children with autism resemble children with autism in the general population, the origins of their symptoms are very different," says Charles A. Nelson PhD of Boston Children's Hospital and Harvard Medical School, who is senior author on the paper. "We believe that both groups suffer deprivation, but of different types: In institutionalized children, the deprivation comes from their environment, while in the general population, the autism itself causes a kind of deprivation, making it harder for children to perceive and understand social cues."