Amounting findings on maternal separation and early disturbed caregiving suggest that this type of early experience negatively influences socioemotional development and may be associated with behavioral and mental health problems in later life. Concerning previously published studies, we have assessed if maternal separation and disrupted caregiving before adoption in infancy could be related to heightened levels of dissociative symptoms and behavioral problems in middle childhood. We involved 30 children (sample S1) who had experienced maternal separation after birth and short-term institutional or foster care prior to adoption before 16.7 months of age. Based on the parents' reports, they had not experienced any other significant adversities by the time of evaluation. These children were compared to a control group of children who have lived with their biological mothers in complete families (sample S2; N = 25). Although the findings are correlational and not causal, they indicate that specific adverse experiences, maternal separation after birth, and relatively short disruptive caregiving prior to successful adoption in infancy could be associated with significantly heightened levels of dissociative symptoms and behavioral problems in school-aged children. Our data also contribute to the literature on child socioemotional development and the etiology of dissociative disorders.

1st Faculty of Medicine Charles University Prague Czechia

Center for Neuropsychiatric Research of Traumatic Stress Department of Psychiatry and UHSL 1st Faculty of Medicine Charles University Prague Czechia

Statistics Department Columbia University New York NY United States

Winnette Lab Natama Institute Prague Czechia

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Bowlby J. Can I leave my baby? London: National Association for Mental Health; (1958).

Bowlby J. By ethology out of psycho-analysis: an experiment in interbreeding. Anim Behav. (1980) 28:649–56. doi: 10.1016/S0003-3472(80)80125-4 PubMed DOI

Le Bas GA, Youssef GJ, Macdonald JA, Rossen L, Teague SJ, Kothe EJ, et al. . The role of antenatal and postnatal maternal bonding in infant development: A systematic review and meta-analysis. Soc Dev. (2020) 29:3–20. doi: 10.1111/sode.12392 DOI

Tottenham N. Risk and developmental heterogeneity in previously institutionalized children. J Adolesc Health. (2012) 51:S29–33. PubMed PMC

Caldji C, Tannenbaum B, Sharma S, Francis D, Plotsky PM, Meaney MJ. Maternal care during infancy regulates the development of neural systems, mediating the expression of fearfulness in the rat. Proc Natl Acad Sci U S A. (1998) 95:5335–40. doi: 10.1073/pnas.95.9.5335 PubMed DOI PMC

Francis D, Diorio J, Liu D, Meaney MJ. Nongenomic transmission across generations of maternal behavior and stress responses in the rat. Science. (1999) 286:1155–8. doi: 10.1126/science.286.5442.1155 PubMed DOI

Sroufe LA, Egeland B, Carlson EA, Collins WA. The development of the person: the Minnesota study of risk and adaptation from birth to adulthood. Guilford Press; (2005).

Vetulani JJ. Early maternal separation: a rodent model of depression and a prevailing human condition. Pharmacol Rep. (2013) 65:1451–61. doi: 10.1016/s1734-1140(13)71505-6 PubMed DOI

Arborelius L, Eklund MB. Both long and brief maternal separation produces persistent changes in tissue levels of brain monoamines in middle-aged female rats. Neuroscience. (2007) 145:738–50. doi: 10.1016/j.neuroscience.2006.12.007 PubMed DOI

Aguggia JP, Suárez MM, Rivarola MA. Early maternal separation: Neurobehavioral consequences in mother rats. Behav Brain Res. (2013) 248:25–31. doi: 10.1016/j.bbr.2013.03.040 PubMed DOI

Wang D, Levine JL, Avila-Quintero V, Bloch M, Kauffman A. Systematic review and meta-analysis: Effects of maternal separation on anxiety-like behavior in rodents. Transl Psychiatry. (2020) 10:174. doi: 10.1038/s41398-020-0856-0 PubMed DOI PMC

Aisa B, Tordera R, Lasheras B, Del Río J, Ramírez MJ. Cognitive impairment associated with HPA axis hyperactivity after maternal separation in rats. Psychoneuroendocrinology. (2007) 32:256–66. doi: 10.1016/j.psyneuen.2006.12.013 PubMed DOI

MacLean K. The impact of institutionalization on child development. Dev Psychopathol. (2003) 15:853–84. doi: 10.1017/s0954579403000415 PubMed DOI

Pollak SD, Nelson CA, Schlaak MF, Roeber BJ, Wewerka SS, Wiik KL, et al. . Neurodevelopmental effects of early deprivation in postinstitutionalized children. Child Dev. (2010) 81:224–36. doi: 10.1111/j.1467-8624.2009.01391.x PubMed DOI PMC

Čater M, Majdič G. How early maternal deprivation changes the brain and behavior? Eur J Neurosci. (2022) 55:2058–75. doi: 10.1111/ejn.15238 PubMed DOI

Nelson CA, Gabard-Durnam LJ. Early adversity and critical periods: Neurodevelopmental consequences of violating the expectable environment. Trends Neurosci. (2020) 43:133–43. doi: 10.1016/j.tins.2020.01.002 PubMed DOI PMC

Maccari S, Krugers HJ, Morley-Fletcher S, Szyf M, Brunton PJ. The consequences of early life adversity: Neurobiological, behavioural and epigenetic adaptations. J Neuroendocrinol. (2014) 26:707–23. doi: 10.1111/jne.12175 PubMed DOI

Ho TC, King LS. Mechanisms of neuroplasticity linking early adversity to depression: Developmental considerations. Transl Psychiatry. (2021) 11:517. doi: 10.1038/s41398-021-01639-6 PubMed DOI PMC

Winnette P, Abramson L. Behavioral problems, dissociative symptoms, and empathic behaviors in children adopted in infancy from institutional and foster care in the Czech Republic. Attach Hum Dev. (2024). doi: 10.1080/14616734.2024.2444722 PubMed DOI

Peñarrubia M, Palacios J, Román M. Executive function and early adversity in internationally adopted children. Child Youth Serv Rev. (2020) 108:104587. doi: 10.1016/j.childyouth.2019.104587 DOI

Rafiq S, Campodonico C, Varese F. The relationship between childhood adversities and dissociation in severe mental illness: a meta-analytic review. Acta Psychiatr Scand. (2018) 138:509–25. doi: 10.1111/acps.12969 PubMed DOI

Schalinski I, Teicher MH, Nischk D, Hinderer E, Müller O, Rockstroh B. Type and timing of adverse childhood experiences differentially affect severity of PTSD, dissociative and depressive symptoms in adult inpatients. BMC Psychiatry. (2016) 16:295. doi: 10.1186/s12888-016-1004-5 PubMed DOI PMC

Spiegel D, Loewenstein RJ, Lewis-Fernández RJ, Sar V, Simeon D, Vermetten E, et al. . Erratum: Dissociative disorders in DSM-5. Depress Anxiety. (2011) 28:1119. doi: 10.1002/da.20920 PubMed DOI

Hesse E, Main M. Disorganized infant, child, and adult attachment: Collapse in behavioral and attentional strategies. J Am Psychoanal Assoc. (2000) 48:1097–127. doi: 10.1177/00030651000480041101 PubMed DOI

Harding L, Murray K, Shakespeare-Finch J, Frey R. High stress experienced in the foster and kin carer role: Understanding the complexities of the carer and child in context. Child Youth Serv Rev. (2018) 95:316–26. doi: 10.1016/j.childyouth.2018.11.004 DOI

Groh AM, Fearon RM, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Roisman GI. Attachment in the early life course: Meta-analytic evidence for its role in socioemotional development. Child Dev Perspect. (2017) 11:70–6. doi: 10.1111/cdep.12213 DOI

Stams GJ, Juffer F, Rispens J, Hoksbergen RA. The development and adjustment of 7-year-old children adopted in infancy. J Child Psychol Psychiatry. (2000) 41:1025–37. doi: 10.1111/1469-7610.00690 PubMed DOI

Úzis ČChecktae. . Act. Coll (2012) 401/2012.

Schneiberg F. Dětská centra–moderní forma komplexní péče o ohrožené děti. Pediatr Praxi. (2011) 12:136–7.

Baumeister H, Merkel E, Bengel J. Development of an anamnestic questionnaire for psychotherapeutic patients with comorbid somatic diseases. Psychother Psychosom Med Psychol. (2011) 61:38–41. doi: 10.1055/s-0030-1265214 PubMed DOI

Goemans A, Tarren-Sweeney M, van Geel M, Vedder P. Psychosocial screening and monitoring for children in foster care: Psychometric properties of the Brief Assessment Checklist in a Dutch population study. Clin Child Psychol Psychiatry. (2018) 23:9–24. doi: 10.1177/1359104517706527 PubMed DOI PMC

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. (2006) 166:1092–7. doi: 10.1001/archinte.166.10.1092 PubMed DOI

Piper BJ, Gray HM, Raber J, Birkett MA. Reliability and validity of brief problem monitor, an abbreviated form of the child behavior checklist. Psychiatry Clin Neurosci. (2014) 68:759–67. doi: 10.1111/pcn.12188 PubMed DOI PMC

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. (2001) 16:606–13. doi: 10.1046/j.1525-1497.2001.016009606.x PubMed DOI PMC

Tarren-Sweeney M. An investigation of complex attachment- and trauma-related symptomatology among children in foster and kinship care. Child Psychiatry Hum Dev. (2013) 44:727–41. doi: 10.1007/s10578-013-0366-x PubMed DOI

Pedersen ML, Jozefiak T, Sund AM, Holen S, Neumer SP, Martinsen KD, et al. . Psychometric properties of the brief problem monitor (BPM) in children with internalizing symptoms: Examining baseline data from a national randomized controlled intervention study. BMC Psychol. (2021) 9:185. doi: 10.1186/s40359-021-00689-1 PubMed DOI PMC

Fenn J, Tan CS, George S. Development, validation and translation of psychological tests. BJPsych Adv. (2020) 26:306–15. doi: 10.1192/bja.2020.33 DOI

Penelo E, de la Osa N, Navarro JB, Domènech JM, Ezpeleta L. The Brief Problem Monitor-Parent form (BPM-P), a short version of the Child Behavior Checklist: Psychometric properties in Spanish 6- to 8-year-old children. Psychol Assess. (2017) 29:1309–20. doi: 10.1037/pas0000428 PubMed DOI

Rognstad K, Helland SS, Neumer SP, Baardstu S, Kjøbli J. Short measures of youth psychopathology: Psychometric properties of the brief problem monitor (BPM) and the behavior and feelings survey (BFS) in a Norwegian clinical sample. BMC Psychol. (2022) 10:182. doi: 10.1186/s40359-022-00894-6 PubMed DOI PMC

Putnam FW. Child dissociative checklist. Bethesda; (1988).

Putnam FW, Helmers K, Trickett PK. Development, reliability, and validity of a child dissociation scale. Child Abuse Negl. (1993) 17:731–41. doi: 10.1016/s0145-2134(08)80004-x PubMed DOI

Achenbach system of empirically based assessment (2024). Available online at: https://aseba.org/aseba-overview (Accessed January 1, 2025).

Putnam FW, Peterson G. Further validation child dissociative checklist dissociation. Dissociation: Progress in the Dissociative Disorders (1994) 7:204–11.

Bailey TD, Brand BL. Traumatic dissociation: Theory, research, and treatment. Clin Psychol Sci Pract. (2017) 24:170–85.

Macfie J, Cicchetti D, Toth SL. The development of dissociation in maltreated preschool-aged children. Dev Psychopathol. (2001) 13:233–54. doi: 10.1017/s0954579401002036 PubMed DOI

Soukup J, Papežová H, Kuběna AA, Mikolajová V. Dissociation in non-clinical and clinical sample of Czech adolescents. Reliability and validity of the Czech version of the Adolescent Dissociative Experiences Scale. Eur Psychiatry. (2010) 25:390–5. doi: 10.1016/j.eurpsy.2010.03.011 PubMed DOI

Guérin-Marion C, Sezlik S, Bureau JF. Developmental and attachment-based perspectives on dissociation: Beyond the effects of maltreatment. Eur J Psychotraumatol. (2020) 11:1802908. doi: 10.1080/20008198.2020.1802908 PubMed DOI PMC

Soukup J, Papežová H. Disociace v dětství: Klinické projevy a Diagnostika. Dotazník disociace v dětství. Česká Slov Psychiatr. (2008) 104:236–40.

Macfie J, Cicchetti D, Toth SL. Dissociation in maltreated versus nonmaltreated preschool-aged children. Child Abuse Negl. (2001) 25:1253–67. doi: 10.1016/s0145-2134(01)00266-6 PubMed DOI

Hulette AC, Freyd JJ, Fisher PA. Dissociation in middle childhood among foster children with early maltreatment experiences. Child Abuse Negl. (2011) 35:123–6. doi: 10.1016/j.chiabu.2010.10.002 PubMed DOI PMC

Farina B, Liotti G. Does Dissociative Psychopathol Dimension Exist? A review on dissociative processes and symptoms in developmental trauma spectrum disorders. Clin Neuropsychiatry. (2013) 10:11–8.

Berardelli I, Sarubbi S, Rogante E, Erbuto D, Giuliani C, Lamis DA, et al. . Association between childhood maltreatment and suicidal ideation: A path analysis study. J Clin Med. (2022) 11:2179. doi: 10.3390/jcm11082179 PubMed DOI PMC

Cay M, Gonzalez-Heydrich J, Teicher MH, van der Heijden H, Ongur D, Shinn AK, et al. . Childhood maltreatment and its role in the development of pain and psychopathology. Lancet Child Adolesc Health. (2022) 6:195–206. doi: 10.1016/S2352-4642(21)00339-4 PubMed DOI PMC

Cook A, Spinazzola J, Ford J, Lanktree C, Blaustein M, Cloitre M, et al. . Complex trauma in children and adolescents. Psychiatr Ann. (2005) 35:390–8. doi: 10.3928/00485713-20050501-05 DOI

van der Kolk BA, Courtois CA. Editorial comments: Complex developmental trauma. J Trauma Stress. (2005) 18:385–8. doi: 10.1002/jts.20046 PubMed DOI

Modestin J, Lötscher K, Erni T. Dissociative experiences and their correlates in young non-patients. Psychol Psychother. (2002) 75:53–64. PubMed

Blihar D, Delgado E, Buryak M, Gonzalez M, Waechter R. A systematic review of the neuroanatomy of dissociative identity disorder. Eur J Trauma Dissociation. (2020) 4. doi: 10.1016/j.ejtd.2020.100148 PubMed DOI

Mann BJ, Sanders S, Sanders S. Child dissociation and the family context. J Abnorm Child Psychol. (1994) 22:373–88. doi: 10.1007/BF02168080 PubMed DOI

Brodzinsky D, Gunnar M, Palacios J. Adoption and trauma: Risks, recovery, and the lived experience of adoption. Child Abuse Negl. (2022) 130:105309. doi: 10.1016/j.chiabu.2021.105309 PubMed DOI PMC

van den Dries L, van Juffer F, van Ijzendoorn MH, Bakermans-Kranenburg MJ. Fostering security? A meta-analysis of attachment in adopted children. Child Youth Serv Rev. (2009) 31:410–21. doi: 10.1016/j.childyouth.2008.09.008 DOI

Lyons-Ruth K, Yarger HA. Developmental costs associated with early maternal withdrawal. Child Dev Perspect. (2022) 16:10–7. doi: 10.1111/cdep.12442 PubMed DOI PMC

Hulette AC, Freyd JJ, Pears KC, Kim HK, Fisher PA, Becker-Blease KA. Dissociation and posttraumatic symptoms in maltreated preschool children. J Child Adolesc Trauma. (2008) 1:93–108. doi: 10.1080/19361520802083980 PubMed DOI PMC

Juffer F, van Ijzendoorn MH. Behavior problems and mental health referrals of international adoptees: A meta-analysis. Jama. (2005) 293:2501–15. doi: 10.1001/jama.293.20.2501 PubMed DOI

Vannucci A, Fields A, Heleniak C, Bloom PA, Harmon C, Nikolaidis A, et al. . Machine learning for identifying caregiving adversities associated with greatest risk for mental health problems in children. Nat Ment Health. (2025) 3:71–82.

Bowlby J. Attachment and loss. In: Separation: Anxiety and anger. Basic Books, vol. II. (1973).

Main M, Solomon J. “Procedures for identifying infants as disorganised/disoriented during the Ainsworth Strange Situation”. In: Greenberg MT, Cicchetti D, Cummings EM. (Eds.) Attachment in the Preschool Years. Chicago, IL: University of Chicago Press; (1990), pp. 121–60.

Liotti M, Tucker DM. Right hemisphere sensitivity to arousal and depression. Brain Cognit. (1992) 18:138–51. PubMed

Van Ijzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ. Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Dev Psychopathol. (1999) 11:225–49. PubMed

Collins FE. Dissociation, coping and control: A cognitive model of dissociation in nonclinical populations. Melbourne, Australia: Monash University; (2004).

Ogawa JR, Sroufe LA, Weinfield NS, Carlson EA, Egeland B. Development and the fragmented self: Longitudinal study of dissociative symptomatology in a nonclinical sample. Dev Psychopathol. (1997) 9:855–79. PubMed

Kihlstrom JF. Dissociative disorders. Annu Rev Clin Psychol. (2005) 1:227–53. PubMed

Dutra L, Bureau JF, Holmes B, Lyubchik A, Lyons-Ruth K. Quality of early care and childhood trauma: A prospective study of developmental pathways to dissociation. J Nerv Ment Dis. (2009) 197:383–90. PubMed PMC

Császár-Nagy N, Bókkon I. Mother-newborn separation at birth in hospitals: a possible risk for neurodevelopmental disorders? Neurosci Biobehav Rev. (2018) 84:337–51. PubMed

Schimmenti A. The relationship between attachment and dissociation. In: Dorahy MJ, Gold SN, O’Neil JA, editors. Dissociation and the dissociative disorders: past, present, future. Taylor & Francis; (2022). p. 161–76. doi: 10.4324/9781003057314-14 DOI

Sullivan RM, Perry RE. Mechanisms and functional implications of social buffering in infants: Lessons from animal models. Soc Neurosci. (2015) 10:500–11. doi: 10.1080/17470919.2015.1087425 PubMed DOI PMC

Aisa B, Tordera R, Lasheras B, Del Río J, Ramírez MJ. Effects of maternal separation on hypothalamic-pituitary-adrenal responses, cognition and vulnerability to stress in adult female rats. Neuroscience. (2008) 154:1218–26. doi: 10.1016/j.neuroscience.2008.05.011 PubMed DOI

Diehl LA, Alvares LO, Noschang C, Engelke D, Andreazza AC, Gonçalves AC, et al. . Long-lasting effects of maternal separation on an animal model of post-traumatic stress disorder: Effects on memory and hippocampal oxidative stress. Neurochem Res. (2012) 37:700–7. doi: 10.1007/s11064-011-0660-6 PubMed DOI

Zhao X, Zhang A, Liu W, Tao F, Sun Y. Childhood separation from parents with cognitive and psychopathological outcomes in adolescence. Dev Sci. (2023) 26:e13324. doi: 10.1111/desc.13324 PubMed DOI

Mundorf A, Bölükbas I, Freund N. Maternal separation: Does it hold the potential to model consequences of postpartum depression? Dev Psychobiol. (2022) 64:e22219. doi: 10.1002/dev.22219 PubMed DOI

Liotti G. A model of dissociation based on attachment theory and research. J Trauma Dissociation. (2006) 7:55–73. doi: 10.1300/J229v07n04_04 PubMed DOI

Rutter M. Developmental catch-up, and deficit, following adoption after severe global early privation. J Child Psychol Psychiatry Allied Disciplines. (1998) 39:465–76. PubMed

Avinun R, Knafo-Noam A, Israel S. The general psychopathology factor from early to middle childhood: Longitudinal genetic and risk analyses. J Psychopathol Clin Sci. (2022) 131:705–15. doi: 10.1037/abn0000780 PubMed DOI

Ainsworth MD. Patterns of attachment behavior shown by the infant in interaction with his mother. Merrill-Palmer Q Behav Dev. (1964) 10:51–8.

Ainsworth MD. Attachments across the life span. Bull New York Acad Med. (1985) 61:792. PubMed PMC