Behavior problems and mental health referrals of international adoptees: a meta-analysis.
ABSTRACT 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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ABSTRACT: hanges in the institution of adoption over the past few decades have resulted in many questions about the best way to prepare and support adoptive parents for the task of raising their children. Historically, many parents who adopted children were given little, if any, information about their children's origins or about adoption in general. Yet, without adequate information, the chances for developing appropriate expectations about adoption, or for understanding the best ways of managing the challenges that can be associated with adoptive family life, are lessened. This is especially true for adoptions from the child welfare system and from other countries, where there is significant risk of medical and/or psychological issues. C It is widely accepted among adoption professionals today that parental preparation, education and support is crucial for the stability of an adoption and for the long-term emotional well-being of all family members. Nevertheless, there is a high degree of variability in the types and extent of preparation and education offered by agencies, attorneys, and others who facilitate adoption placements. Some of these organizations and individuals offer extensive services, both during the pre-adoption and post-adoption periods; however, others offer little to adoptive parents in these areas. This paper, which represents the first phase of the Evan B. Donaldson Adoption Institute's Adoptive Parent Preparation Project, outlines the basic principles, key issues, methods, and content areas forming best-practice standards regarding the preparation and education of adoptive parents. This phase focuses on preparing adoptive parents to better understand and manage the mental health, developmental, and parenting issues about which all adoptive parents should be educated, as well as those issues more relevant to specific types of adoptions. The information in this paper should be viewed as a roadmap for the development of specific curricula for professionals to use in preparing and educating adoptive parents in a wide range of content areas.
Technical Report: A Need to Know
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