The deprivation to which the adoptees were exposed has been described as ‘global’, in the sense it included extremely poor diet, poor sanitation, minimal social and cognitive stimulation and a lack of individualised care, all of which meant they had no real opportunity to form close, selective attachments with caregivers.
As children in the institutions, those who would go on to be adopted lacked the most basic things developmental psychologists believe a child needs for healthy development.
The impacts of their experiences have been documented across multiple outcomes at different ages in a large body of literature (Links to key papers here: 1, 2, 3). In this blog, we describe a recent study exploring in detail one area of challenge faced by some of the adoptees – autism.
Quasi-autism in people who suffered childhood institutional deprivation
In the early ERA years, it soon became clear that a quarter of adoptees who spent more than six months in the institutions displayed marked autistic features. This was very much unexpected based on what was known at the time about the effects of early maltreatment.
Initially, Michael Rutter described this as ‘quasi-autism’ partly because autism was known to be genetic in origin rather than due to environmental effects and partly because of apparent differences in symptom profile when compared to the sorts of autistic children he typically met in his clinic – compared to these the adoptees exhibited especially intense and circumscribed interests and odd preoccupations, only limited communication problems and unusually sociable behaviour.
Michael Rutter also reported that these autistic features had reduced somewhat between ages four and six, perhaps with the expectation that they would continue to reduce as the children grew older.
Quasi-Autistic people in adulthood
We recently published two articles reporting the adult outcomes of the adoptees identified as having quasi-autism as children. In the first article, we reported that, following the initial reductions, the autistic features of the group had persisted from childhood through adolescence and into adulthood, largely unabated (Rodriguez-Perez et al., 2023). The young people still displayed significant levels of social and communication difficulties and repetitive behaviours.
Importantly, these behaviours were associated with a range of functional and mental health challenges—unemployment, lower educational attainment, more anxiety and depression and high levels of clinical service use. Despite these challenges, the positive findings were that the young quasi-autistic adoptees had positive self-concepts, high life satisfaction and good relationships with their parents.
Quasi-Autism or just Autism
On the face of it, the outcomes for adoptees with quasi-autism in ERA looked very similar to the outcomes for autistic people more generally. Perhaps the term ‘quasi-autism’ isn’t warranted.
To address this question in more detail, we conducted a second study. In it, we compared the group of people with quasi-autism in the ERA study with a separate group of people who had received an early diagnosis of autism but, to the best of our knowledge, had not experienced deprivation. The core question was; in what ways were they similar, and in what ways were they different (Rodriguez-Perez et al., 2025)?
Additionally, resolving the issue of the use of the term quai-autism is important as the answer may have implications for the sorts of care and support they need. It turned out that the two groups were mostly similar - with difficulties in social interactions and communication and elevated levels of repetitive and stereotyped behaviours. Levels of emotional and behavioural problems were also similar.
However, we found some, perhaps quite subtle, differences between the groups. Compared to the classic autism profile seen in the non-deprived group, the autistic people in the deprived group’s communication domain mainly included abnormalities of linguistic expression. They also displayed less severe problems with social interaction.
Should we drop the term “Quasi-Autism”?
Since Michael Rutter observed the high prevalence of autism in the Romanian orphans from the Communist institutions over 25 years ago, we have used the term ‘quasi-autism’ to describe this neuro-developmental variant.
Our results cause us to question whether this term is appropriate– especially given what we now know about the similarities with classical autism in terms of symptom profiles, associated impairment and difficulties and the broadening of the autism definition to encompass a wider range of presentations.
One concern is that that sticking with the ‘quasi-autism’ term might downplay the clinical significance and impact of the condition for those children with autism who also have histories of neglect or deprivation.
This could be harmful to affected individuals, perhaps restricting access to services when we now know that the clinical needs linked to deprivation-related autism are comparable to those of many other autistic people. Perhaps the phrase autism following severe neglect might be a better description.
References
Rodriguez‐Perez, M., Kennedy, M., Barker, E. D., Kreppner, J., Solerdelcoll, M., & Sonuga‐Barke, E. J. (2023). The adult outcome of childhood quasi‐autism arising following extreme institutional deprivation. Journal of Child Psychology and Psychiatry, 64(9), 1292-1302.
Rodriguez‐Perez, M., Chandler, S., Kennedy, M., Charman, T., Simonoff, E., & Sonuga‐Barke, E. (2025). What Is Distinctive About Autism Arising Following Severe Institutional Deprivation? A Direct Comparison With a Community Sample of Early Diagnosed Autistic People. Autism Research