Behavior Problems and Mental Health Referrals of International Adoptees: A Meta-analysis

Centre for Child and Family Studies, Leiden University, Leiden, The Netherlands.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2005; 293(20):2501-15. DOI: 10.1001/jama.293.20.2501
Source: PubMed


International adoption involves more than 40,000 children a year moving among more than 100 countries. Before adoption, international adoptees often experience insufficient medical care, malnutrition, maternal separation, and neglect and abuse in orphanages.
To estimate the effects of international adoption on behavioral problems and mental health referrals.
We searched MEDLINE, PsychLit, and ERIC from 1950 to January 2005 using the terms adopt* combined with (behavior) problem, disorder, (mal)adjustment, (behavioral) development, clinical or psychiatric (referral), or mental health; conducted a manual search of the references of articles, books, book chapters, and reports; and consulted experts for relevant studies. The search was not limited to English-language publications.
Studies that provided sufficient data to compute differences between adoptees (in all age ranges) and nonadopted controls were selected, resulting in 34 articles on mental health referrals and 64 articles on behavior problems.
Data on international adoption, preadoption adversity, and other moderators were extracted from each study and inserted in the program Comprehensive Meta-analysis (CMA). Effect sizes (d) for the overall differences between adoptees and controls regarding internalizing, externalizing, total behavior problems, and use of mental health services were computed. Homogeneity across studies was tested with the Q statistic.
Among 25,281 cases and 80,260 controls, adoptees (both within and between countries) presented more behavior problems, but effect sizes were small (d, 0.16-0.24). Adoptees (5092 cases) were overrepresented in mental health services and this effect size was large (d, 0.72). Among 15,790 cases and 30,450 controls, international adoptees showed more behavior problems than nonadopted controls, but effect sizes were small (d, 0.07-0.11). International adoptees showed fewer total, externalizing and internalizing behavior problems than domestic adoptees. Also, international adoptees were less often referred to mental health services (d, 0.37) than domestic adoptees (d, 0.81). International adoptees with preadoption adversity showed more total problems and externalizing problems than international adoptees without evidence of extreme deprivation.
Most international adoptees are well-adjusted although they are referred to mental health services more often than nonadopted controls. However, international adoptees present fewer behavior problems and are less often referred to mental health services than domestic adoptees.

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    • "Nous avons choisi d'aborder le développement des adolescents adoptés pour de nombreuses raisons. Avant tout, la recherche sur l'attachement et l'adoption concerne surtout les enfants, tandis que l'adolescence est en général une période critique dans le développement des adoptés [10] [11] [12]. En outre, si les relations dans la nouvelle famille sont le facteur le plus important pour l'adaptation de l'enfant adopté [13], les adolescents ont eu le temps d'expérimenter cette relation pendant des années, donc nous pouvons mieux étudier l'articulation des facteurs en jeu : cet approche de recherche, qui sollicite l'analyse de l'expérience adoptive en soi, pas simplement en comparant enfants adoptés et biologiques, est une importante suggestion de la recherche récente dans ce domaine [14]. "
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    ABSTRACT: The role of attachment in the development of adoptee has been investigated extensively, especially considering mother–child relationships. Nevertheless, adoptive fathers are generally very present in the care and education of their children: therefore, our study aims at exploring the relationships between attachment representations of adopted adolescents and those of their parents, analyzing also any possible difference between fathers and mothers.
    Neuropsychiatrie de l Enfance et de l Adolescence 05/2015; DOI:10.1016/j.neurenf.2015.04.004
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    • "The maximum likelihood with robust standard errors estimator was used to account for the non-normal distribution of the dependent variable (AAB). We included as covariates age, sex, and adoptive status as these variables have been shown to relate to externalizing disorders in prior research on this sample [32] and in others [33]. "
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    ABSTRACT: Life course-persistent antisocial behavior manifests as a display of aggressive and antisocial behavior beginning in childhood (conduct disorder [CD]) and lasting through adulthood (adult antisocial personality disorder). This study aimed to build on prior research by evaluating whether involvement in high school sports helped attenuate the association between CD and subsequent adult antisocial behavior (AAB). A prospective sample of 967 male and female adolescents (56% adopted) was used. Structured interviews were used to assess CD (symptoms before the age of 15 years), involvement in sports during high school, and past-year adult antisocial personality disorder symptoms in young adulthood (M age = 22.4 years). As expected, the association between CD and AAB was significantly less for those involved in sports (β = .28; p < .001) compared with those not involved in sports (β = .49; p < .001), χ(2)(1) = 4.13; p = .04. This difference remained after including known covariates of antisocial behavior in the model (age, gender, adoption status), and results were consistent across males and females. Involvement in other extracurricular activities (e.g., student government, plays, clubs) did not significantly moderate the relationship between CD and AAB. Although selection effects were evident (those with more CD symptoms were less likely to be involved in sports), findings nevertheless suggest high school sports involvement may be a notable factor related to disrupting persistent antisocial behavior beginning in childhood and adolescence and lasting through young adulthood. Implications are discussed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of Adolescent Health 04/2015; 57(1). DOI:10.1016/j.jadohealth.2015.03.009 · 3.61 Impact Factor
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    • "Also, in comparison studies in which significant differences to the disadvantage of adoptees were found in behavioral adaptation, the effect sizes were low (Bimmel, Juffer, van Ijzendoorn, & Bakermans- Kranenburg, 2003; Juffer & van IJzendoorn, 2005), suggesting first that variations in behavioral adjustment stay in the normal range (Dalen & Rygvold, 2006), and second that although adoptees display more behavior problems than their non-adopted counterparts, this concerns a minority of adoptees. The large majority function well, and much better than might be expected based on their background of deprivation (Juffer & van IJzendoorn, 2005). It is therefore assumed that the effects of adoptive status can be modified by a favorable post-adoption environment (Goldman & Ryan, 2011; Kriebel & Wentzel, 2011; Lindblad, Weitoft, & Hjern, 2010; Whitten & Weaver, 2010). "
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    ABSTRACT: The main purpose of the research was to test whether cumulative effects represent a common pathway to behavioral maladjustment for internationally adopted adolescents and controls. The findings of previous comparison and follow-up studies have been contradictory. The hypothesis was tested in an original multi-informant study with 74 adolescents: 40 adoptees and 34 controls. The analyses of the data provided arguments in favor of the existence of a common pathway for adoptees and controls. The accumulation of risk factors in the current characteristics of the adolescents and their family was significantly associated with behavioral outcomes of both adoptees and controls. Implications for research, policy and practice are discussed.
    Journal of Applied Developmental Psychology 05/2014; 35(3). DOI:10.1016/j.appdev.2013.12.005 · 1.85 Impact Factor
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