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.

59 Reads
    • "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]. "
    [Show abstract] [Hide abstract]
    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 10/2015; 63(6):376-384. DOI:10.1016/j.neurenf.2015.04.004
  • Source
    • "On the one hand, late-adoption represents a window for the investigation of the impact of children's negative pre-adoption experiences on the development of insecuredisorganized IWMs of attachment (Steele et al., 2007; Pace et al., 2015b). On the other hand, late adoption embodies the opportunity for children's schemas to be revised and reprocessed based on the " new " relationships with adoptive caregivers (Steele et al., 2003, 2008; Juffer and van IJzendoorn, 2005). Some studies highlighted that previously maltreated and neglected children placed after 4 years of age and assessed both through a behavioral procedure and narrative tasks (Pace and Zavattini, 2011; Pace et al., 2012) showed increasing attachment security over 2 years after adoption. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Method: Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4-9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers' state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents' verbal intelligence was controlled for. Results: Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers' AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure-insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents' verbal intelligence made a significant contribution to this prediction. Discussion: Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children.
    Frontiers in Psychology 09/2015; 6. DOI:10.3389/fpsyg.2015.01433 · 2.80 Impact Factor
  • Source
    • "Des problèmes de comportement et d'attachement pathologique sont également rapportés (Zeanah, 2000). Toutefois, diverses études ont montré que, pour une majorité d'enfants, plusieurs de ces problèmes ont tendance à disparaître après quelques années (Chisholm, 1998 ; Rutter, 1998 ; Juffer & Van IJzendoorn, 2005). Le contexte de l'adoption internationale donne une opportunité unique d'étudier les aspects socioaffectifs indépendamment des facteurs génétiques, tout en tenant compte de l'histoire des interactions entre les parents et leur enfant. "

    Enfance; psychologie, pédagogie, neuropsychiatrie, sociologie 09/2015; 2015(03):273-288. DOI:10.4074/S0013754515003031
Show more