Nurturing neglected minds

Unpublished research suggests that adopted Romanian orphans can make up lost intellectual ground.Michael Rutter tells Julia Hinde how his findings shed light on the interplay of nature and nurture

Child psychiatrist Michael Rutter has some good news for the new year. He is about to publish "spectacular" research that will give comfort to anyone who has rescued a child from the horrendous conditions of a Romanian orphanage.

Having followed, for the past five years, the progress of 165 Romanian orphans adopted into British families, Rutter can show that, even though these children were imprisoned in cots, starved of toys and conversation, many are not damaged for life. Given loving and stimulating environments, their intellectual catch-up is "huge".

When the children came to the UK, says Rutter, "over half were functioning in the mentally retarded range. Whether you looked at them physically or developmentally, they were in bad shape." But, by their fourth birthday, most of their IQs were within the normal range. Many received no special teaching or counselling, just the support and love of parents who very much wanted to adopt them. "It shows how resilient children really are," he comments happily.

The slight hiccup in this otherwise cheerful tale is that the orphans have not all progressed at the same rate. Their recovery appears to depend on how long they spent in East European orphanages. The longer the confinement, the worse the prognosis. It is this, rather than the length of time they have lived with UK families, that affects their IQ development.

Rada (not her real name) was brought to England when she was three. "Rada is about three years behind academically," says the nine-year-old's mother."Children who came over at birth are developing relatively normally." Rada, who did not speak until she was four, does well, says her mother, at language and in social situations. But her maths is years behind. "A lot (of the orphans) seem to have maths problems I There was no one to show you there were ten fingers. They didn't leave their cots, there was no concept of distance, or of night or day."

So, what do these findings say about the relationship between nurture and nature - between the environmental influences on a child's intellect and the child's inherent, genetic ability? Well, says Rutter, "even the severe environmental conditions (found in Romanian orphanages) do not lead to homogeneous outcomes. Presumably genetic factors are involved too."

Teasing out the relationship between nature and nurture has consumed much of Michael Rutter's working life. The first psychiatrist since Sigmund Freud to be made a fellow of the Royal Society, Rutter has tried to understand all the influences that bear upon the developing child, en route steering child psychiatry away from the fanciful psychoanalytic approaches that previously dominated the field in favour of hard empirical research.

Why are some children able to come through the most trying problems, developing into normal adults, while others go under when things get difficult? In trying to answer this key question Rutter has danced between environmental and genetic influences and the effect the two may have on each other.

Fifteen Thousand Hours, his 1979 study of a dozen inner London comprehensives, revealed how much difference the environment of a good school can make to a child's future. Even when IQ and parental factors were allowed for, Rutter's research highlighted huge disparities between the 12 schools in terms of pupils' behaviour and academic achievements. It pinpointed the key characteristics of schools associated with success, proving empirically, for the first time, that well-organised schools could have a positive effect even in disadvantaged areas and it led to 20 years of research into what makes a school effective.

At the other end of the scale, Rutter's studies have also shone light on the importance of genes in autism - a condition characterised by abnormal self-absorption and a tragic inability to understand other people.

So, after a lifetime's research, what is Rutter's verdict - is it nature or nurture that has the strongest influence on the development of a child? His conclusion, says this father of three, is that trying to separate the influence of genes and environment, in all but a tiny proportion of conditions, is absurd. "Both are important. Asking how much is one and how much another is not a sensible question." Genes may predispose someone to a certain condition and may have some influence on a child's intelligence, but the environment within which that person lives will be hugely significant as well. Rutter adds that genetic effects are not all direct: genes influence the kind of interaction a person has with his or her environment, therefore indirectly shaping that environment and its influence. When pushed, though, he points to studies that suggest that about 40-70 per cent of variation in an individual's intelligence is genetic. In other words, that nature and nurture have about equal effect on a person's intelligence. "The real question is not how much is environmental or genetic, but how the interplay between the two works."

At the Institute of Psychiatry's social, genetic and developmental psychiatry research unit at London's Maudsley Hospital, Rutter is gathering around him some of the best brains in related fields to better understand how genes and the environment influence child development. "We want to understand the mechanisms, and that involves genetic mechanisms, environmental risk mechanisms and most especially how the two come together. I am not a geneticist. But on the other hand, it has become obvious that genetic research strategies are very important. So in recent years I have used these more."

Among the top-name recruits is behavioural geneticist Robert Plomin, whose work involves examining the role of heredity and environment in early language delay. Rutter says he sees nothing unsettling about Professor Plomin's studies of twins at the institute, although Plomin has run into considerable controversy with research he is undertaking in the United States which involves comparing DNA patterns of people with high and medium intelligence in a bid to detect the relevant genes.

Rutter refuses to be drawn on the US study, but says he understands people's concerns about research which attempts to link genes with either intelligence or with psychiatric disorders such as schizophrenia.

"There is no doubt that genetic information has been misused," he says, citing the eugenics movement and Nazi Germany. "These are real worries that I take seriously. But people tend to think that genetics research leads to a deterministic view. That is not how it works. The sort of disorders we are concerned with are multifactorial and the genes have a probabilistic effect. Many different genes are involved. "We all have genes that predispose us to something. The notion of using genes to label people is a nonsense."

Rutter is personally involved in several of the unit's projects. At one extreme, he is on a hunt for the genes that predispose a child to autism. He suggests there are between two and ten such genes, as opposed to the dozens likely to be involved in intelligence. DNA samples are being taken from families where at least two children have autism to see the extent to which they share particular genes more than would be expected. He is also involved in two studies of 15,000 twin pairs born in the UK over a three-year period in a bid to determine whether we all have psychological and language problems to varying degrees, or whether the problems are qualitatively different in different individuals.

For someone who has devoted his life to child development, Rutter's own childhood was far from standard, but he describes it as "good". He was born in 1933 into a Quaker family living in the Lebanon, where his father was a doctor. They moved to England when he was three, and, at seven, he was evacuated to the United States where he lived with a Quaker family during the second world war. Though not a regular churchgoer, he believes his Quaker roots have been influential. "Concern for the disadvantaged is what Quakerism is all about," he suggests.

After studying medicine at Birmingham University he planned to be a GP. But, during his undergraduate years he chose an elective where he met the German psychiatrist Mayer Gross. Stints in neurology and paediatrics followed, before he was advised to consider a career in child psychiatry. "I was taken aback, but said I would give it a go. It quickly became an engaging interest."

David Skuse, professor of the behavioural sciences at the Institute of Child Health, says: "Rutter put child psychiatry on the map. When he started it was dominated by psychoanalysis, there was no empirical research basis for the subject. He added rigour. Now it is based on empirical work, not airy-fairy things."

Rutter, 64, will stand down as director of the research unit later this year but plans to carry on with his work. He is hopeful that, by bringing together the different strands of research, a better understanding of how genes and the environment interact to affect child development will emerge,in a way that will influence clinical work. "I think that is a realistic aspiration given that our understanding, and our recognition of the complexity (of the interaction) is clearer."

TESSY (CENTRE) IS TEN. She came to England from a Romanian orphanage seven years ago, unable to talk and barely able to walk. The three-year-old was like "a slightly large baby" rather than a toddler, says her adoptive father Peter O'Curry. But Tessy has flourished. She attended a mainstream nursery and is now in a middle school. She's not significantly behind her friends in her work and, according to her father, is ahead in some areas.

Her biological sisters Eva (right), nine, and Claudia, eight, are less fortunate. They were brought to England only two years ago from the squalor of a Romanian orphanage. Having learnt of Tessy's sisters, Peter and his wife Jackie battled for over two years to bring the girls to England. But despite two years in the UK, neither can talk.

The fate of the sisters follows the pattern of development described by Michael Rutter's research, namely, the longer spent in Romanian institutions, the greater the long-term damage. "Eva and Claudia compare very poorly with their sister," says their father. The girls only spend a few afternoons a week in school. Years of deprivation mean the connections in their ears have not properly formed and even though they can hear, they cannot distinguish between different voices.