Dr Mark Kennedy
In the early 1990s, the collapse of the Ceausescu regime in Romania revealed the harsh realities of institutional care for children. Images of overcrowded orphanages with minimal stimulation and care prompted a wave of international adoptions—and an opportunity to better understand the long term outcomes of severe, prolonged early neglect. The English and Romanian Adoptees (ERA) study followed 165 children adopted from Romanian institutions and 52 UK adoptees over three decades, offering profound insights into how early deprivation shapes development.
The study revealed significant impacts on brain development, which persisted well into adulthood. Children who experienced prolonged deprivation had reduced head circumference—a proxy for brain growth—and lower total brain volume. While some areas of the brain showed signs of recovery, others remained affected, particularly those linked to executive function (and notably we didn't find associations with the threat response regions of the brain). Interestingly, certain regions appeared “spared,” suggesting the brain may prioritise growth in critical areas even under adversity.
Four key psychological outcomes emerged: cognitive impairment (i.e., lower IQs), ADHD, elevated symptoms of autism, and disinhibited social engagement disorder (DSED; historically referred to as disinhibited attachment disorder). Encouragingly, cognitive impairment showed promising recovery over time, especially between ages 6–11 and again in young adulthood. ADHD, however, persisted and even worsened for some, with a predominance of inattentive symptoms. There were some signs that pharmaceutical treatment for ADHD helped, whilst others experienced side effects. Similarly, symptoms of autism often persisted into adulthood and like ADHD, were associated with higher rates of mental health problems and problems with day-to-day functioning. DSED, while persistent, did not appear to cause impairment, raising questions about whether it should be classified as a disorder.
Mental health outcomes were complex. Emotional problems like depression and anxiety spiked in adulthood, often linked to earlier neurodevelopmental challenges and social difficulties such as unemployment and bullying. Attachment theory also played a role. Contrary to early assumptions, many children formed secure attachments with adoptive parents, even after prolonged deprivation. However, those who hadn’t formed selective attachments early on were more likely to show signs of autism later, suggesting that attachment difficulties may reflect underlying neurodevelopmental issues rather than cause them.
Qualitative interviews during adulthood with adoptees and their parents added depth to these findings. We focused on 3 important outstanding questions - 1) what happened when those who experienced early adversity became parents themselves? 2) given relatively high levels of professional support and high levels of poorer outcomes, what had the experience of seeking help been like and how did the group describe their own needs, and 3) given the important role of social difficulties in predicting mental health increases, what were the challenges faced by the group and what can be done to help? In brief, our work highlighted challenges in challenged being recognised by service providers, a lack of understanding/ knowing how to navigate social relationships, and for around a fifth, significant challenges with providing adequate parenting. Despite these struggles, many participants demonstrated resilience, with parenthood emerging as a particular source of pride and motivation.
In conclusion, the ERA study underscores the long-term impact of early deprivation—and the importance of sustained support across the lifespan. There are broad implications for those working in education, healthcare, social services, or policy, particularly in bridging gaps in understanding and providing support for those affected by early adversity. Whether through improved diagnostic pathways, tailored interventions, or inclusive service design, what we do can make a meaningful difference.
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Dr Mark Kennedy, Senior Lecturer in Psychology and Neuroscience of Mental Health, King’s College London
Dr Mark Kennedy is a Senior Lecturer in the Psychology and Neuroscience of Mental Health at King’s College London, where he also serves as Programme Lead for the MSc in Psychology and Neuroscience of Mental Health. His research focuses on the developmental outcomes of extreme early adversity, including institutional deprivation, neurodevelopmental disorders such as ADHD, and attachment-related mental health challenges.
Dr Kennedy is a researcher on the English and Romanian Adoptees (ERA) study—one of the most significant longitudinal investigations into the long-term effects of early deprivation. His postdoctoral work has contributed to understanding how early adversity shapes cognitive, emotional, and social development across the lifespan. With a background in mixed methods research, Dr Kennedy has published extensively on topics including ADHD, quasi-autism, disinhibited social engagement, and links between early adversity and mental health. His doctoral research explored the application of attachment theory in diverse family contexts, including single-parent and non-nuclear families.
Dr Kennedy is actively engaged in public scholarship and outreach, contributing to national discussions on adoption, child development, and mental health. He has also led online education initiatives, including courses on ADHD and developmental psychology.
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