Dr. Michael Rutter, a British child psychiatrist whose many transformative studies included one that demonstrated the genetics of autism and another that assessed how poor treatment suffered by Romanian children in orphanages affected them after they were adopted by English families, died Oct. 23 at his home in Dulwich, a suburb of London. He was 88.
The cause was cancer, said Sandra Woodhouse, his personal assistant at King's College London.
In more than a half-century at what is now the Institute of Psychiatry, Psychology and Neuroscience at King's College, Rutter was known for his clinical expertise in treating children with mental health problems and for his ambitious research. In 1973, he was awarded Britain's first professorship in child psychiatry.
"He really created modern child psychiatry by insisting on using data to drive thinking about diagnosis and treatment," Bennett Leventhal, a professor of psychiatry at the University of California, San Francisco, said in a phone interview. "If you go back to the 1950s, '60s and '70s, the focus of psychiatry came out of psychoanalysis, which was built largely on case vignettes. That's not bad -- it's what we had -- but Rutter said we can do better."
In the 1960s and '70s, Rutter and his research team conducted what Leventhal said were the first epidemiological studies in child and adolescent psychiatry. They established that psychiatric problems were fairly common among children on the rural Isle of Wight and an inner borough of London, and that the children's feelings of misery and depression affected, among other things, how well or poorly they did in school.
Rutter also discovered that emotional, behavioral and reading problems were twice as common among the children in London as they were on the Isle of Wight but that children in both areas were affected by family discord, their parents' psychiatric problems and criminality, and overcrowding in their homes.
The studies "played a major role in understanding how biological brain pathology influenced development," Rutter told The Annual Review of Developmental Psychology this year. "It's not that it had not been thought of before, but it was the first time it had been systematically studied."
Rutter challenged the idea that autism was caused by the effect of distant parents -- more specifically, so-called refrigerator mothers -- and the idea that it was a form of schizophrenia.
In a 1977 study, Rutter and Susan Folstein examined why there was a higher incidence of autism between identical twins, who share the same set of genes, than between fraternal twins, who share half of their genes. They concluded that autism was largely genetic. It was a stunning finding at the time, but it has since been validated in molecular studies.
"Before Rutter, the heritability of autism was doubted," Manuel Casanova, a professor of biomedical sciences at the University of South Carolina, said in an email. "Rutter brought it to the forefront and implied that it was larger than previously suspected."
In 1998, when a paper in medical journal The Lancet suggested a link between autism and the measles, mumps and rubella vaccine, Rutter set out to disprove its finding. He looked at the incidence of autism in countries that had stopped using the vaccine, particularly Japan.
"And what our findings showed is that the rate continued going on up -- that the withdrawal of a supposed risk factor had not made a difference, and if anything it had got worse, not better," he said in 2008 in an interview for a video project called "Today's Neuroscience, Tomorrow's History." (The Lancet retracted the paper in 2010.)
Michael Llewellyn Rutter was born Aug. 15, 1933, in Broumana, Lebanon, near Beirut, where his father, Dr. Llewellyn Rutter, worked at a hospital. His mother, Winifred (Barber) Rutter, was a homemaker.
A few years later, Michael and his family moved to Wolverhampton, in the West Midlands, England, where his father worked as a general practitioner.
But in 1940, his parents, fearful that Germany might invade England, sent Michael and his sister, Priscilla, to the United States, where they lived with separate foster families in the same small town.
"My new foster parents were punctilious in not taking over from my parents," he told The Journal of the Canadian Academy of Child and Adolescent Psychiatry in 2010. After four enjoyable years -- his sister, in contrast, had a difficult time, especially after being rejected by her first foster family -- he returned, he said, "as an ebullient American teenager" whose grandmother asked his mother, "Do you think we've got the right ones back?"
He entered the University of Birmingham Medical School in 1950, planning to be a general practitioner and join his father's practice. But he became fascinated by neurology and neurosurgery and then by psychiatry, inspired by a professor, Wilhelm Mayer-Gross, a prominent psychiatrist who had fled Nazi Germany.
Rutter worked at various British hospitals after graduating from medical school in 1955 and was a pediatrics fellow at the Albert Einstein College of Medicine, in New York City, from 1961 to 1962. He joined the social psychiatry research unit at Maudsley Hospital in London in 1962, and the Institute of Psychiatry, also in London, in 1966. He was knighted in 1992.
Rutter wrote or co-wrote more than 400 papers and 40 books, including "Fifteen Thousand Hours: Secondary Schools and Their Effects on Children" (1979), based on a study of the problems faced by London schoolchildren during 12 years of education.
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He also wrote "Maternal Deprivation Reassessed" (1972), which suggested that children can develop strong attachments not just to their mothers but also to other people, both inside and outside their families, who will affect their mental health and development. It was a challenge to the work of John Bowlby, a British psychiatrist whose "attachment theory" argued that a mother's love is absolutely critical to a child and that its deprivation can have dire results.
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Survivors include Rutter's wife, Marjorie (Heys) Rutter, a nurse and the co-author with him of "Developing Minds: Challenge And Continuity Across The Lifespan" (1993); his daughters, Sheila and Christine; his son, Stephen; his sister, Priscilla; and seven grandchildren.
As increasing numbers of Romanian orphans were adopted by families in Britain in the early 1990s, Rutter and several colleagues began a long-term study to determine how well the children recovered from the difficult conditions they had experienced in orphanages.
Many of them, he found, adapted quickly to their new homes, but some who were adopted after they were 6 months old had higher rates of autism spectrum disorder, overactivity and poor personal engagement than a control group of children who had been adopted within Britain. By age 15, some of the Romanian children's emotional, conduct, cognitive and social relationship problems could be traced to their early privations.
"Mike interviewed the children himself," Leventhal said. "He needed to hear their voices."
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Edmund Sonuga-Barke, a professor of developmental psychology, psychiatry and neuroscience at King's College who collaborated on the study, said it had been Rutter's innovative idea to "stratify" the sample of Romanian children into how long each had been in an institution.
"That's really important if you're going to go past a mere correlation to say, 'Yeah, there might be a causal relationship here,' " he said in a video made by King's College to celebrate Rutter's retirement this year. "So you can show what they call in pharmacology the 'dose effect.' Is there an effect of the dose of deprivation on young people's outcomes?"