What Is Distinctive About Autism Arising Following Severe Institutional Deprivation? A Direct Comparison With a Community Sample of Early Diagnosed Autistic People

Abstract

In the English and Romanian Adoptees study, a substantial proportion of adoptees who suffered extended severe deprivation (26 of 101) displayed autistic characteristics termed quasi-autism (QA). Here we directly compare this group with a community sample of early diagnosed autistic individuals (community autism; CA). First, we characterized the QA autism symptom profile (61.5% females) by calculating which of the 32 Social Communication Questionnaire (SCQ) items were statistically more common in the QA group than in a control group of 52 non-deprived UK adoptees (UK Control, 34.6% females) at ages 11, 15, and/or 23 years of age. The latent structure of these QA-characteristic items was explored using confirmatory factor analyses. Second, we compared the QA symptom profiles with CA profiles using a sample from the QUEST study (Salazar et al. 2015). To do this, we identified two QUEST groups, one aged 11 years on average (n = 21) and one aged 15 years (n = 24). The former were compared to ERA SCQ scores at age 11, and the latter at age 15. Nineteen SCQ items were statistically significantly more common in the QA group than in the ERA UK control group at ages 11 and 15. Ten differences persisted into adulthood. These QA-characteristic items ranged across and mapped onto all three standard SCQ domains (social reciprocity, communication, repetitive and stereotyped behaviors). The age 11 CA group scored higher than QA at 11 years across each subscale when all items were considered. However, when only QA-characteristic items were included, only scores for the Repetitive and Stereotyped subscale differentiated QA and CA. When the age 15 comparison was made, no differences were found between CA and QA subscales. QA and CA were associated with similar levels of emotional and conduct problems and overactivity/inattention levels. QA shared many features with CA. QA difficulties extended across all autism domains and were associated to a similar degree with emotional and behavioral problems. However, there were some distinctive elements. Compared to the classic autism profile, the communication domain mainly comprised persistent abnormalities of linguistic expression. In contrast, social reciprocity problems were diffuse, less severe, and declined over time. QA-characteristic repetitive and stereotyped behaviors are broadly expressed and endure into adulthood.

Keywords: Romanian adoptees; autism; early adversity; institutional deprivation; longitudinal.