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Psychiatric Disorders and Treatment in Adoptees: A Meta-Analytic Comparison with Non-Adoptees
Abstract
This meta-analysis integrates the results of 85 studies on psychiatric disorders and treatment in adoptees and non-adoptees. The risk of adoptees developing psychiatric disorders, contact with mental health services, or being treated in a psychiatric hospital was approximately twice as high as that of non-adoptees. Elevated risks were observed for attention deficit/hyperactivity disorders, anxiety disorders, conduct disorders/oppositional defiant disorders, depression, substance use disorders, and psychoses. Larger effect sizes were, in part, found in clinical studies than in community-based studies, in studies with a higher percentage of individuals adopted after the age of three years, international adoptees, and in older studies.
... On top of medical SN noted at arrival, additional SN may emerge during the school years. SN issues such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, and behavior problems have been identified with increased frequency in young international adoptees, compared with various control populations (Verhulst et al. 1990, Juffer et al. 2005, Gunnar et al. 2007, Hawk et al. 2010, Wiik et al. 2010, Pinderhughes et al. 2013, Behle et al. 2016, Askeland et al. 2017, Dekker et al. 2017, Smith et al. 2018. The complicated early lives of most international adoptees suggest reasons why such problems might occur with greater frequency than among non-adoptees (Gagnon-Oosterwaal et al. 2012, Smith et al. 2018, Hornfeck et al. 2019. ...
... Numerous reports describe the occurrence of medical, educational, and psychological SN among international adoptees in Europe (reviewed in (Juffer et al. 2005, Behle et al. 2016, Askeland et al. 2017). Findings from multiple receiving countries are aggregated (Juffer et al. 2005, Askeland et al. 2017. ...
... SN, especially those which emerge at school-age, often many years after placement, are recognized with increasing frequency among international adoptees (Verhulst 2000, Juffer et al. 2005, Weitzman et al. 2005, Gunnar et al. 2007, Miller et al. 2009, Van der Vegt et al. 2009, Hawk et al. 2010, Behle et al. 2016, Askeland et al. 2017, Smith et al. 2018, Hornfeck et al. 2019). The complicated histories and adversity experienced by many of the children prior to adoption have been cited as risk factors for these problems (Gunnar et al. 2007, Gagnon-Oosterwaal et al. 2012, Smith et al. 2018). ...
Introduction
The extent and nature of SN among international adoptees at adolescence in different receiving countries (RC) has not been completely described, nor have differences between children of Eastern Europe (EE) and non-EE origin been fully assessed. Furthermore, the impact of SN on parent adoption satisfaction has not been systematically assessed or compared between RC.
Aims
In 4 European RC (1) determine the prevalence and type of SN among internationally adopted adolescents, (2) compare these for children of EE and non-EE origin, (3) relate SN to mothers’ adoption satisfaction.
Methods
685 mothers of internationally adopted adolescents in four different RC (France n=246, Italy n=322, Norway n=60, Spain n=57) completed on-line surveys including (a) child’s medical, behavior, psychological, or school problems, (b) Pinderhughes’ Adoption Satisfaction Questionnaire.
Results
Mothers reported that 54% of the adolescents (58%M, arrival age:53.53±40.35 months, current:14.98±1.70 years, 44% EE origin) had at least one SN. Learning disabilities were most common (40% of adolescents), followed by ADHD (30%), and medical issues (21%), but patterns differed by receiving country. Except for speech/language problems, the frequency of specific SN (developmental delay, attention deficit hyperactivity disorder [ADHD], behavior problems, learning disabilities, psychiatric issues, prenatal alcohol exposure) varied significantly between RC. The frequency of these conditions between children of EE and non-EE origin also varied by RC. Mothers’ adoption satisfaction did not differ significantly between RC; the presence of ADHD, behavior and/or psychiatric problems consistently related to mothers’ adoption satisfaction in all 4 RC. The relation to mothers’ ASQ and the presence and number of SN was assessed by hierarchical linear regression, controlling for child demographic characteristics. Both the presence and number of SN negatively predicted mothers’ adoption satisfaction. Child’s age at adoption (and to a lesser extent, current age) also negatively predicted mothers’ ASQ score.
Conclusions
SN were relatively common among internationally adopted adolescents in 4 European RC, but the pattern of specific conditions and relationship to mothers’ adoption satisfaction differed among RC. However, ADHD, behavioral and/or psychiatric problems consistently related to mothers’ ASQ in all 4 RC. In regressions controlling for demographic characteristics, the presence of any SN and the number of SN related to mothers’ adoption satisfaction. SN represent an additional stress on adoptive families; further work is needed to understand how differences in RC may impact post-adoption adjustment and experiences.
... Adoptive families may be at elevated risk for poor outcomes during a pandemic such as COVID-19. Compared with nonadopted youth, adopted youth have higher rates of emotional and behavioral problems (Behle & Pinquart, 2016), particularly youth adopted via foster care (Howard et al., 2004;Wind et al., 2007), which can stem from prenatal substance exposure, early neglect, home instability, and caregiver loss (Child Welfare Information Gateway, 2014). In turn, adoptive parents may report high stress (Rijk et al., 2006) and parent-child conflict (Rueter et al., 2009). ...
... Adopted children, especially those adopted postinfancy (e.g., via foster care), are also at greater risk for developmental and learning problems, including speech/ language delays, learning disabilities, and ADHD, and are more likely to receive special education services (Altarac & Saroha, 2007;Beverly et al., 2008;Harwood et al., 2013;Wind et al., 2007). Anxiety, concentration difficulties, and other issues that are more prevalent among adopted youth (Behle & Pinquart, 2016) may be exacerbated by the pandemic, contributing to parenting stress and parent-child conflict (Rueter et al., 2009). Further, the learning difficulties that adopted children struggle with may worsen in the context of remote education, particularly if the delivery and quality of special education and other supports are poor. ...
... In addition, many had been attending individual or group therapy-although notably, children adopted via foster care were more likely to be in therapy than children adopted internationally. This may reflect the fact that children adopted via foster care were adopted at older ages and in turn were more likely to have been exposed to early adversity (e.g., neglect; multiple caregiving transitions), which in turn is linked to elevated risk for learning disabilities, ADHD, and emotional-behavioral challenges (Behle & Pinquart, 2016;Beverly et al., 2008;Wind et al., 2007). Physical separation from teachers and school counselors could be particularly unsettling for children with special needs or attachment issues, including adopted children-suggesting that maintaining access to support services and therapy may be especially important during periods of stay-at-home measures or lockdown. ...
Objective
This mixed-methods exploratory study sought to address the experiences of 89 adoptive parents (heterosexual, lesbian, and gay) in the United States with school-age children in relation to the transition to remote schooling and their children's mental health during the early part of the COVID-19 pandemic.
Background
The transition to remote schooling and associated confinement during the COVID-19 pandemic presents challenges for families, particularly when children are struggling with mental health and learning challenges.
Methods
Data were collected via an online survey between May and June 2020. Before the pandemic, almost half of the children received special education services.
Results
Findings revealed that although a minority of children were doing well with remote schooling, the majority were struggling due to lack of motivation and an inability to work independently. Some parents voiced challenges with teacher communication and inconsistencies across classes and were overwhelmed by the demands of their new role as proctor/teacher. Some were dissatisfied with how children's school services had been implemented and noted difficulties with the online format of various services (e.g., therapy was less engaging). Regarding children's mental health, half of parents said it had stayed the same, one third said it had worsened, and the remainder said it had improved. The mental health of children adopted via foster care seemed to have benefited from the additional time spent at home. Yet most children were described as struggling in part due to social isolation and loss of routine, which manifested in a variety of ways, including anxiety, schoolwork avoidance, and boundary testing. Most parents tried to show patience, tolerance, and reassurance, but more than one third reported stress and frustration associated with not knowing how to best support their children.
Conclusion
The transition to remote schooling during COVID-19 may be especially challenging for adoptive families and other families whose children have higher levels of need.
Implications
Findings have implications for parents, teachers, school social workers and psychologists, and other professionals who work with children and families.
... Adopted persons are at a higher risk to receive mental health and substance use treatment (Behle & Pinquart, 2016;Brodzinsky, 2013) and are also at a higher risk for a lifetime prevalence of substance use disorder (Kendler et al., 2012;Yoon et al., 2012). Despite the known risks for adopted persons, there remains a gap in counselor awareness and knowledge of the unique counseling needs of adopted persons and their families seeking substance use counseling (Atkinson et al., 2013;Brodzinsky, 2013;Lancaster et al., 2017). ...
... It is likely professional counselors will work with adopted persons and their families at some point during their clinical practice as adopted persons are at a greater risk than nonadopted persons to receive mental health and substance use treatment services (Behle & Pinquart, 2016;Brodzinsky, 2013). Moreover, adopted persons have a higher risk for overall lifetime prevalence of substance use disorder (Kendler et al., 2012;Yoon et al., 2012). ...
... Adopted persons are at an increased risk for substance use (Behle & Pinquart, 2016;Brodzinsky, 2013) and overall prevalence of substance use during their lifetimes as compared to nonadopted persons (Kendler et al., 2012;Yoon et al., 2012). Research related to biological, environmental, and postadoption factors contributing to substance use offers an understanding of the increased risks for those persons adopted via private domestic, from foster care, and transracially and internationally. ...
Adopted persons are at a higher risk to receive mental health and substance use treatment (Behle & Pinquart, 2016; Brodzinsky, 2013) and are also at a higher risk for a lifetime prevalence of substance use disorder (Kendler et al., 2012; Yoon et al., 2012). Despite the known risks for adopted persons, there remains a gap in counselor awareness and knowledge of the unique counseling needs of adopted persons and their families seeking substance use counseling (Atkinson et al., 2013; Brodzinsky, 2013; Lancaster et al., 2017). Therefore, we provide an overview of the related substance use research, describe the counseling needs of adopted persons and their families, and offer practice implications.
... Several works acknowledged adult adoptees' support-seeking for their mental health or psychosocial adjustment (Pearson et al., 2007;Beine et al., 2008;Behle and Pinquart, 2016;Melero and Sánchez-Sandoval, 2017). Some studies identified a higher prevalence of psychological difficulties among adopted people (Behle and Pinquart, 2016;Beine et al., 2008), so the need for resources and support in this population is higher. ...
... Several works acknowledged adult adoptees' support-seeking for their mental health or psychosocial adjustment (Pearson et al., 2007;Beine et al., 2008;Behle and Pinquart, 2016;Melero and Sánchez-Sandoval, 2017). Some studies identified a higher prevalence of psychological difficulties among adopted people (Behle and Pinquart, 2016;Beine et al., 2008), so the need for resources and support in this population is higher. During adolescence, adoptees seek counselling for identity-related matters, but in adulthood, they look for help when they are starting a new family or when they have questions about their background (Kreisher, 2002, cited by Pearson et al., 2007. ...
... twenty-two to ninety-eightyears, mean of 43.2 in Pearson et al., 2007), with a higher prevalence of females Petersson, 2011, cited by Melero andSá nchez-Sandoval, 2017;Pearson et al., 2007). Concerning the manifested disorders, in their meta-analysis, Behle and Pinquart (2016) showed that adoptees' risk of psychiatric diagnosis, treatment and hospitalisation is nearly twice as high as that of non-adoptees. Concretely, adoptees have a higher risk for attention deficit hyperactivity disorder, anxiety, substance use, depression, personality disorders and psychosis. ...
Post-adoption services provide guidance to adoptive families concerning common and specific circumstances. Despite adoption is a lifelong experience, most of the post-adoption resources are oriented towards children, adolescents and their adoptive parents. However, it is also necessary to focus on the demands and interventions with adult adoptees. The aim of this article is to review adult adoptees’ demands for post-adoption resources, applicants’ characteristics and resources offered to them. A systematic search was conducted in several databases, finding forty studies that fulfilled the selection criteria (about adults, domestic/international adoptions and published between 2005 and 2018). The included studies showed mainly three needs: contact with birth family, ethnic identity and birth culture, and psychological support. Additionally, adoptees who demand post-adoption resources are a heterogeneous group. This review collects structured programmes focused on different topics: search for origins, attachment development and professionals’ training in adoption. In addition, we also found some specific post-adoption services and other tools, such as support groups or cultural events. Finally, adoptees also have access to other resources that are not specifically for them, such as mental health services. The scarce existence of evidence-based interventions is an important weakness in this work. Recommendations for future research and practice are included.
... For instance Tan and Marn (2013) state, based on US data, that one in every four to one in every two adopted children use mental health services. Behle & Pinquart (2016) found in a meta-analysis a twice as high risk for adoptees to experience psychiatric disorders, to come into contact with mental health services or to be treated in a psychiatric hospital. The adverse circumstances and experiences prior to the adoption leave their marks: many adoptees will be in need of mental health services at some point in their life (Juffer & Van IJzendoorn, 2005;Juffer & Van IJzendoorn, 2012b;Swinton, 2011). ...
... Recent studies corroborate these findings. Behle and Pinquart (2016) found elevated risks for the DSM classifications of ADHD, anxiety disorders, CD/ODD, depression, disorders of substance abuse, personality disorders, and psychoses. Attachment disorders and problems with relationships are commonly found both in institutionalized children as well as in adopted children (Van den Dries et al., 2009;Kerr, 2014;Van IJzendoorn et al., 2020). ...
Intercountry adoption is declining and many adoptees at any point of their life are in search of therapeutic services. Specialized care is scare and regular services seem to be missing the point. Regular therapeutic services do not cater to the specific needs of adoptees because they often forget to take the early adversity into account.
Adoption specific therapeutic services are called for worldwide, this needs not be very difficult. Affective neurobiology, trauma and attachment research next to adoption studies have given practitioners many tools to design a sustainable therapeutical practice for both adoption aware assessment as well as adoption aware treatment.
... Neither meta-analysis included other problems (OP), such as social (e.g., substance and alcohol abuse), identity (e.g., gender identity confusion), and thought difficulties (e.g., dissociative symptoms), which are widespread in adolescence. Furthermore, a recent meta-analysis by Behle and Pinquart (2016) on psychiatric disorders and treatment in adoptees and non-adoptees reported that both international and domestic adoptees are more likely to receive diagnoses for both externalizing disorders (such as conduct problems) and internalizing ones (such as major depressive disorder or anxiety disorder) compared to non-adopted peers, and are more at risk of receiving psychiatric diagnoses related to other problems such as attention deficit hyperactivity disorder (ADHD), or dissociative disorders. ...
... The present study had the primary goal to investigate the developmental outcomes in terms of emotional-behavioral problems (i.e., EP, IP, OP, and total problems), attachment representations, and verbal skills, (Barroso et al., 2017;Behle & Pinquart, 2016;Bimmel et al., 2003; in a sample of Italian domestic and intercountry late-adopted adolescents. The study also investigated possible predictors for the aforementioned outcomes, such as pre-adoptive adversities (maltreatment, institutionalization, and multiple placements) and adoption variables (age at adoption and type of adoption), checking for demographics (gender and age). ...
Background
There are few studies on late-adopted adolescents' outcomes -e.g., emotional-behavioral problems, attachment and cognitive status- and their possible predictive factors, none from Italy. Objective: This paper aimed to investigate emotional-behavioral problems, attachment representations, and verbal skills in late-adopted adolescents in Italy and to explore the predictive role of pre-adoption adversities and adoption variables for worse adoptees' outcomes.
Participants and setting
The study included N = 79 late-adopted (mean age at adoption = 6 years) adolescents, between 11 and 18 years, placed via both intercountry and domestic adoption.
Methods
Parents provided information about pre-adoption and adoption history and filled the Children's Behavior Checklist 6–18 for measuring participants' emotional-behavioral problems. Attachment representations were assessed through the Friend and Family Interview administered directly to adolescents, like the verbal comprehension index of the Wechsler Intelligence Scale for Children (4th edition) for measuring participants' verbal IQ.
Results
Maltreatment and its interaction with multiple placements were the main predictors of other problems—i.e., social, thought, and identity difficulties (respectively, p = .007 and p = .029)—while intercountry adoption was the unique predictor of both externalizing and total problems (respectively, p = .047 and p = .015). However, domestic adoption was the most important predictor both for higher insecurity and disorganized attachment representations and lower verbal skills (all p < .044); even stronger if domestic adoption interacted with pre-adoptive institutionalization.
Conclusions
Pre-adoption adversities as well as domestic vs. intercountry adoption, but not the age at placement, contributed to adolescent adoptees' developmental outcomes.
... Meta-analyyttisten tutkimusten mukaan kansainvälisesti adoptoidut ovat yleisesti ottaen hyvin sopeutuneita, joskin heidän on havaittu olevan nuoruudessa ja aikuisuudessa muuta väestöä enemmän edustettuina mielenterveyspalveluissa . Lisäksi kansainvälisesti adoptoitujen on havaittu kärsivän muuta väestöä ja kotimaan adoptoituja enemmän erilaisista psyykkisistä häiriöistä, kuten ahdistuneisuudesta, masennuksesta, psykoosista, käyttäytymisen häiriöistä sekä päihteiden käytöstä (Behle & Pinquart, 2016;. Adoptoitujen muuta väestöä heikompaa psyykkistä terveyttä perustellaan usein adoptiota edeltävillä traumaattisilla kokemuksilla, laitoshoidolla sekä adoptiovanhempien matalalla kynnyksellä hakea lapsilleen apua mielenterveyspalveluista (Miller ym., 2000). ...
... Paradies ym., 2015). Vaikka adoptiotutkimukset ovat osoittaneet, että kansainvälisesti adoptoiduilla on muuhun väestöön verrattuna enemmän erilaisia psyykkisiä terveyteen liittyviä haasteita (Behle & Pinquart, 2016), tutkimuksissa ei ole kiinnitetty huomiota siihen, miten rodullistamisen kokemukset ovat yhteydessä adoptoitujen psyykkiseen terveyteen. Tässä tutkimuksessa tarkasteltiin FinAdo-kyselylomaketutkimuksen osa-aineiston avulla 213:en kansainvälisesti adoptoidun aikuisen rodullistamisen kokemuksia sekä niiden yhteyttä adoptoitujen taustatietoihin sekä psyykkiseen oireiluun, jota tutkimuksessa ilmensivät psyykkinen ahdistus ja unihäiriöt. ...
... Some systematic reviews or meta-analyses have been carried out to summarize the association between the adoption situation and outcomes in intelligence quotient (9, 10), cognitive functioning (12,13), social functioning (14), school performance (15,16), behavioral problems (14)(15)(16)(17), psychological adjustment (13)(14)(15)18), and mental health (14,15,(18)(19)(20)(21). However, no meta-analysis consolidates the information about the specific association between the adoption situation and suicide attempt. ...
... This observation is consistent with other studies that found that people in adoption had two to three times more risk of total suicide than non-adopted people (33). This finding agrees with other systematic reviews or metaanalyses, which found poorer outcomes for adoptees than persons from the general population on indicators of intelligence quotient, cognitive functioning, social adjustment, school achievement, behavioral troubles, psychological problems, and psychiatric diagnoses (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). ...
Context: Several investigations have shown that people in an adoption situation have a higher frequency of mental problems or disorders than the general population. However, no known meta-analysis consolidates information about the association between the adoption situation and suicide attempt.
Objectives: We aimed to systematically evaluate the primary observational studies that quantified the association between the adoption situation and suicide attempt.
Methods: A systematic review was designed that used a logical strategy based on specific descriptors in Spanish, English, and Portuguese, in combination with the Boolean operators (AND, OR). The search was performed on the following databases: PubMed, Scopus, Health Virtual Library, ProQuest, EBSCOhost, PsycArticles, BioMed Central, and Sage Journal. Articles were included until December 2016. The quality of the studies was evaluated with a tool based on the STROBE criteria.
Results: Six studies met the inclusion criteria. Three studies used case-control designs and the remaining three were cohort studies. Case-control studies computed 69 suicide attempts in 1,216 adopted people compared to 436 attempts amidst 20,555 non-adopted people (OR = 2.30, 95% CI 1.24 - 4.28, I2 = 61%). Cohort studies computed 536 suicide attempts among 36,965 people in adoption compared to 15,112 attempts in 3,118,069 non-adopted people (RR = 2.99, 95% CI 2.54 - 3.53, I2 = 73%).
Conclusions: The adoption situation can increase suicide attempts; it predicts at least two times more cases of suicide attempts among adopted people than in the general population.
... As stated above, intercountry adoptees make extensive use of mental health services and in spite of all these services provided, a significant number of adoptees still experiences life long negative effects of the past (Barroso et al., 2017;Behle & Pinquart, 2016;Dekker et al., 2017;Gindis, 2019;Hjern et al., 2002;Juffer & Van IJzendoorn, 2012;Lindblad, Hjern, & Vinnerljung, 2003;Tieman et al., 2005;Van IJzendoorn & Juffer, 2006;Verhulst, 2008). ...
... Experiences such as inconsistent care, maternal stress, malnutrition, violence, abuse, neglect and maltreatment contribute to early life stress, which inhibits regular development and therefore, can be seen as responsible for the social, relational, cognitive and behavioral problems that often arise after the adoption (Swinton, 2011;Juffer & Van IJzendoorn, 2012;Gindis, 2019). Behle and Pinquart (2016) found elevated risks for the DSM classifications of ADHD, anxiety disorders, CD/ODD, depression, substance use disorders, personality disorders, and psychoses. Attachment disorders should be added to this list: both in institutionalized children as well as in adopted children. ...
Although intercountry adoption, according to systematic reviews as well as meta-analysis, is from a perspective of child protection, a successful intervention, this often comes at the cost of lengthy therapy and support. Both in studies as in clinical practice intercountry adoptees are overrepresented in mental health services worldwide. (Barroso, Barbosa-Ducharne, Coelho, Costa & Silva 2017; Brodzinsky & Palacios, 2011; Van IJzendoorn & Juffer, 2006; Rutter, Beckett, Castle, Kreppner, Stevens & Sonuga-Barke, 2009). From my clinical experience, the focus on classifying the problems and using highly standardized treatments, is not enough to help intercountry adoptees and their families (Vinke, 2011, 2012).
In this practice based article I propose to use the concept of Van der Kolk’s Developmental Trauma Disorder to describe the problems intercountry adoptees face in combination with Waters’ Star model (Waters, 2016, Van der Kolk & Pynoos et al, 2009; Gindis, 2019 ). Although not an official DSM-5 disorder, DTD has been embraced by many clinicians as a valid concept to approach the diversity of symptoms seen in patients coming from severe deprivational backgrounds such as intercountry adoptees. Both have proven useful in my small private practice
DTD and the Star model prove helpful especially when dealing with dissociative symptoms. In 2004 the ISSTD published guidelines on evaluation and treatment of dissociative symptoms in children and adolescents (ISSTD, 2004), yet dissociation is hardly ever mentioned in diagnostical evaluations. This strikes as odd since in daily life of adopted families, in clinical practice, in peer supervision, when discussed, dissociative behaviours seem often very present. Still they are hardly ever referred to in research, assessment or treatment in relation to intercountry adoptees. In this article I will focus on trauma related dissociation in intercountry adoptees and present a theoretically informed, practical approach to this phenomenon with respect to intercountry adoptees that integrates insights from developmental, trauma and neurobiological research. The approach is illustrated by using some clinical case-examples.
... Numerous studies have now reported developmental outcomes for adopted children. Cognitive skills and school achievements are typically positive , but in the mental health domain meta-analyses have documented increased vulnerability in both childhood and adult life (Behle & Pinquart, 2016). Tracing the source of these vulnerabilities is not straightforward, however: many children are placed for adoption following adverse experiences in their families of origin, or periods in institutional care, making it hard to determine whether it is adversity in the preadoption environment or the quality of the postadoption rearing environment that affects risk for mental health difficulties. ...
... Many past follow-up studies have documented increased risks of affective disorders and internalizing problems in adopted samples (see e.g. Behle & Pinquart, 2016). We found no evidence of such difficulties here: instead, across a range of assessments in childhood, adolescence and adulthood, levels of psychological distress in the adopted samples were comparable with those in the general population samples in both cohorts. ...
Background:
Adoption studies can cast light on environmental influences on development, but heterogeneity in preplacement experiences often complicates interpretation of findings.
Methods:
We studied infant-adopted samples drawn from the 1958 and 1970 British birth cohorts and examined mental health, well-being, physical health and externalizing outcomes at mid-life. Outcomes for adopted cohort members were compared with those of (a) individuals raised in two biological parent families ('general population' comparisons) and (b) birth comparison groups of other nonadopted children from similar circumstances at birth.
Results:
In both cohorts, to-be-adopted children shared early characteristics in common with birth comparison children, but were placed in more socially advantaged adoptive homes. Followed to mid-life, there were few group differences on indicators of physical health or psychological well-being. Levels of psychological distress were comparable in the adopted and general population samples in both cohorts, and more favourable than in the birth comparison groups among women in the 1958 cohort; more beneficial childhood family circumstances contributed to these differences. Rates of adult externalizing outcomes were comparable in the adopted and birth comparison groups in both cohorts, and higher than in the general population samples; indicators of maternal and prenatal exposures contributed to these differences.
Conclusions:
Rearing in adoptive homes may provide protective effects in relation to internalizing problems but may not be as protective in relation to externalizing outcomes.
... Similar results have been found with regards to adoptees in a recent meta-analysis, integrating 85 studies published between 1953 and 2016 and carried out in different countries (Behle & Pinquart, 2016). Findings showed that, during adolescence and adulthood, international transracial adoptees are more likely than domestic adoptees or nonadoptees to show psychiatric disorders (such as attention deficits, hyperactivity disorders, anxiety disorders, conduct disorders/oppositional defiant disorders, depression, substance use disorders, and psychoses). ...
... Future studies should assume a longitudinal perspective, in order to better disentangle the influence of perceived discrimination on self-esteem and the moderating role of ethnic identity. Additionally, we focused on self-esteem, but in order to strengthen our conclusions, future research should include additional measures of psychological well-being, such as satisfaction with life, pleasure attainment, and happiness, which have been applied in previous studies regarding adoptees (Basow et al., 2008;Behle & Pinquart, 2016) and immigrants (Cristini et al., 2011;Vieno et al., 2009;Walsh et al., 2010). Future studies should also include alternative measures of perceived discrimination and take into account additional aspects of ethnic identity such as "centrality" (Yip, 2016). ...
Research has consistently shown that discrimination based on ethnic group membership affects the psychological well-being of ethnic minorities. Recent studies revealed that discrimination is also a relevant experience for international transracial adoptees, who have experienced a unique migration process. Yet, there is still a paucity of studies focused on similarities and differences between how immigrants and international transracial adoptees perceive discrimination and on how perceived discrimination impacts psychological well-being, also depending on ethnic identity. Our study aimed to fill these gaps by investigating the moderating role of ethnic identity affirmation in the association between perceived discrimination and psychological well-being, measured in terms of self-esteem. A comparison between international transracial adoptees and immigrants was carried out in the Italian context. Participants were 119 international transracial adoptees and 90 immigrants, aged between 15 and 24, all categorizing themselves as Latinos. Findings revealed that immigrants perceived more discrimination and showed higher levels of ethnic identity affirmation than did adoptees, but no difference emerged with respect to self-esteem. Ethnic identity affirmation buffered the detrimental effects of perceived discrimination on self-esteem among international transracial adoptees but not among immigrants. Results are discussed in relation to practical implications for preventive interventions.
... For children placed in foster or kinship care who cannot safely return to live with their birth parents, establishing permanency through adoption is considered the most favorable outcome, according to US policy (Adoption and Safe Families Act of 1997; P. L. 105-89). Following adoption, many children continue to suffer from the impact of early maltreatment and other adversities, which increases their risk for mental health disorders when compared to the general population (Behle and Pinquart 2016). However, children who are adopted generally have better outcomes than children who remain in foster care (Vinnerljung and Hjern 2011). ...
... Among vulnerable groups, adoptive families should be specifically considered. Indeed, adoptive children experienced early adversities and struggled with traumas and usually had a higher risk to show emotional and behavioral problems as well as learning difficulties compared to their non-adopted peers (e.g., Askeland et al., 2018;Barroso et al., 2017;Behle & Pinquart, 2016;van IJzendoorn & Juffer, 2006) that may have exposed them to greater challenges during the pandemic (e.g., Goldberg et al., 2021). Adoptive parents, in turn, may have faced additional stressors, too. ...
Despite an increasing interest in how adoptive parents deal with situations appraised as stressful, there is a lack of research regarding adoptive parents’ adjustment to the challenges posed by the prolonged COVID-19 pandemic. The current study explores similarities and differences between adoptive and non-adoptive mothers in terms of risks (i.e., COVID-19-related stress) and individual (i.e., sense of coherence [SOC]), couple (i.e., partner's support), parent–child (i.e., parent–child relationship satisfaction), and social (i.e., friends’ support) resources in the face of the prolonged COVID-19 pandemic. Specifically, the present study was aimed at predicting which variables discriminate more effectively between the two groups. Participants were 445 Italian mothers (40.9% adoptive mothers), who were asked to fill in an anonymous online survey between May 2021 and October 2021. Results showed that adoptive and non-adoptive mothers reported different resilience resources to face the stressors posed by the health emergency. Specifically, COVID-19 traumatic stress symptoms, parent–child relationship satisfaction, and SOC were found to contribute most in discriminating between the two groups. Findings are discussed in relation to future research developments and practical implications.
... Age at adoption may be seen as an expression of the duration of exposure to adversity and previous research has documented that negative psychosocial outcomes have a positive correlation with age at adoption (Hjern, Palacios, & Vinnerljung, 2018;Sonuga-Barke et al., 2017). Gender has not previously been found to play a moderating effect for psychiatric morbidity among adoptees (Behle & Pinquart, 2016). ...
Background
Previous Scandinavian studies have shown increased levels of psychiatric morbidity in young refugees and international adoptees with an origin outside Europe. This study investigated their risk of non-affective psychotic disorders (NAPD) and whether this risk is influenced by early childhood adversity, operationalised as age at adoption/residency, and/or gender.
Methods
Register study in Swedish national cohorts born 1972–1990 including 21 615 non-European international adoptees, 42 732 non-European refugees that settled in Sweden at age 0–14 years and 1 610 233 Swedish born. The study population was followed from age 18 to year 2016 for hospitalisations with a discharge diagnosis of NAPD. Hazard ratios (HRs) were calculated in gender stratified Cox regression models, adjusted for household income at age 17.
Results
The adjusted risks of NAPD were 2.33 [95% confidence interval (CI) 2.07–2.63] for the international adoptees and 1.92 (1.76–2.09) for the former child refugees, relative to the Swedish-born population. For the international adoptees there was a stepwise gradient for NAPD by age of adoption from adjusted HR 1.66 (1.29–2.03) when adopted during the first year of life to adjusted HR 4.56 (3.22–6.46) when adopted at ages 5–14 years, with a similar risk pattern in women and men. Age at residency did not influence the risk of NAPD in the refugees, but their male to female risk ratio was higher than in Swedish-born and the adoptees.
Conclusion
The risk pattern in the international adoptees gives support to a link between early childhood adversity and NAPD. Male gender increased the risk of NAPD more among the refugees.
... Many adoption studies have showed that adoptees are overrepresented in diagnosed people with a psychiatric disorder and in outpatient clinical settings (Hjern et al., 2002;Juffer and van Ijzendoorn, 2005;Wicks et al., 2010). A meta-analysis, conducted in 2016 (Behle and Pinquart, 2016) presented evidence for an increased risk of adoptees, compared to non-adoptees, for experiencing psychiatric disorders, contact with mental health services, or treatment in a psychiatric hospital. ...
In the current area of social media propagation, the adoptees' search for the birth family is increasingly reversed: more and more adopted adolescents are contacted directly by their birth parents, even if they did not search for them. This study explores the impact of these new forms of contact between adoptive family members and birth family members, through the qualitative analysis of clinical protocols of five adoptive families that sought counseling in a clinical setting devoted to international adoption. The interpretative phenomenological analysis revealed three themes. Two of them shared by the parents and their children: the feelings of anxiety and intrusion, as well as the feelings of guilt and debt. The last theme concerns only the parents: feelings of endangered family relations and can be divided into two sub-themes: feelings of threat by the birth family, feelings of an undermined parental role. Nevertheless, these new kinds of confrontations with the children's origins bear a potential of renegotiating adoptive family relationships and positive effects on mutual feeling of filiation. Exploring the impact of the search of adoptees by the birth family enables professionals involved in adoption to improve preventive and supportive work in the adoption process.
... Because they represent the majority of adopted children in Western countries and may represent a unique target population when studying resilience processes, this study focused in particular on international adoptees. Indeed, international adoptees are especially vulnerable during adolescence, as they are more likely to develop psychological issues and to need psychiatric treatment than domestic adoptees and non-adopted adolescents (Behle & Pinquart, 2016). At the same time, international adoptees showed a relevant recovery from early adversities (Greene et al., 2008;Van IJzendoorn & Juffer, 2006). ...
Introduction
In accordance with the “resilience paradigm”, this study was aimed at exploring the role of the parent-child relationship in supporting internationally adopted adolescents’ ability to develop a strong adoptive identity and a feeling of satisfaction with their own life.
Methods
Participants were 105 Italian adopted adolescents (13–17 years) asked to complete a self-report questionnaire.
Results
Results showed that adolescents generally feel fairly comfortable discussing adoption-related issues (especially with their mothers), have a medium-high level of adoptive identity, and appear to be quite satisfied with their life. Moreover, while adoptive identity mediates the association between openness in communication regarding adoption and adoptees’ well-being with mothers, father-child communication openness has a direct influence on well-being.
Conclusions
Findings highlighted that the quality of mother-child and father-child relationship plays a crucial role in guiding the process of adoptees’ identity formation and influencing their well-being. Recommendations for professionals working with adoptive families were discussed.
... Indeed, this study involved only non-psychiatric RC teenagers, as in Italy teenagers with or without psychiatric diagnoses are mostly placed in different residential homes, while many international Countries have mixed RC facilities . Moreover, late-adoptees have also shown a long-life risk for psychiatric diagnoses (Behle & Pinquart, 2016); thus, there is a need for future studies inclusive of psychiatric LA and RC groups to fully interpret the current results within the existing literature (Muzi & Pace, 2020;Wallis & Steele, 2001). Lastly, the correlational nature of this study prevented testing causal connections between the type of childcare, residential-care or adoption, and attachment outcomes. ...
In this study, 117 adolescents (12-19 years) from three groups (39 each), two groups from adverse caregiving environments as placed in residential-care (RC; i.e. istitutions) or late-adopted (LA; i.e. adopted after 12 months), and one of low-risk community adolescents (COM), were compared for the attachment distribution of categories in the Friends and Family Interview (FFI), and in several attachment-related domains where RC and LA showed difficulties during childhood. Only institutionalized adolescents showed more insecure and disorganized categories than both late-adopted and community peers, who did not differ. In the attachment-related domains, only RCs showed lower coherence, reflective functioning, secure-base/safe-haven parents, social and school competence, adaptive response, and more parental anger and derogation than the other two groups. Late-adoptees only showed higher hostility towards sibling(s) than COM.Therefore, only residential-care adolescents were at "high-risk" in attachment, but the analysis of attachment-related domains helped to detect vulnerabilities in both groups.
... For example, meta-analyses have found that children who have experienced disrupted parent-child relationships have an increased risk of attachment-related challenges (Madigan et al., 2006;Van Ijzendoorn, Schuengel, & Bakermans-Kranenburg, 1999). Further, numerous studies have found that persons with disrupted attachments are at a higher risk of psychological and behavioral disorders, including depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, and suicidality (Behle & Pinquart, 2016;Boysan & Çam, 2018;Corcoran & McNulty, 2018;Nilsson, Nordentoft, & Hjorthøj, 2019;Sheftall, Schoppe-Sullivan, & Bridge, 2014). There remains a shortage of prospective longitudinal studies focusing on the attachment-related outcomes of children adopted out of the child welfare system, in addition to investigations of the predictors of child adjustment throughout this complex process. ...
The adoption of children involved in the child welfare system is viewed as a favorable outcome when family reconstitution is impossible, partially due to the relationship security afforded by long-term placement permanence. Recognition of the importance of secure caregiver-child relationships has informed the development of caregiving-oriented attachment-focused services, such as those provided by the Therapeutic Family Care Program (TFCP). The present study examines the trajectories of adopted children (n = 71) between 3.33 and 13.70 years of age at first assessment (M = 7.65, SD = 2.53) involved with TFCP. Children were assessed by their caregivers on a semiannual basis using the Assessment Checklist for Children (ACC) and the ACC+, with children receiving up to 9 assessments (n = 201, M = 2.57, SD = 1.83). We conducted growth curve analyses for children's total clinical scores, self-esteem, adaptive functioning, and attachment-specific clinical domains. Results suggest that children start with clinically significant psychopathology, with older children and females having more psychosocial and attachment-related difficulties initially. Males' psychosocial functioning was stable over time, whereas females improved significantly in all domains. We discuss implications for mental health services within child welfare and future directions for research.
... The review begins by outlining current findings in follow-ups of mixed adoptive samples, and then focuses specifically on outcomes for children placed in adoptive homes early in life, without known post-natal adversity, and followed-up to adolescence and adulthood. Behle and Pinquart (2016) undertook a meta-analysis of mental health outcomes in 85 follow-up studies, including international and national adoptees, and samples varying in age at adoption, age at follow-up and the extent of any pre-adoption exposure to abuse and/or neglect. The risk of psychiatric disorder was roughly twice as high among adopted people compared with non-adopted comparison groups. ...
Studies of adult outcomes of infant domestic adoptions are considered: the range of psychological and behavioural outcomes recorded, the current state of knowledge summarised and the importance of the chosen comparison groups discussed. The social context of infant adoptions is described. Findings from our follow-ups of British infant adoptions in the post-World War 11 period are then briefly reported and set alongside the previous studies. In these follow-ups, infant adopted children were tracked up to mid-life and compared with others born in similar circumstances and with those raised in two-parent families. We summarise findings on the long-term influence of factors in the prenatal period and in the adoptive home environment. We discuss how rearing in adoptive homes may provide protective effects in relation to internalising problems, but may not be as protective in relation to externalising outcomes. Implications for adoption policy and practice are drawn out.
... In the context of homeschooling, such learning difficulties may pose unique challenges for parents, who are likely used to a limited level of engagement with their children's academic work. Further, certain difficulties to which adopted children are more prone (e.g., anxiety, fears; Behle & Pinquart, 2016) could be exacerbated by the characteristics of the pandemic, which may in turn contribute to parenting stress and difficult parent-child interactions. Indeed, adopted youth may have more conflictual relationships with parents than nonadopted youth (Rueter et al., 2009), and adoptive parental difficulties with their own emotional regulation can exacerbate child behavior problems and parent-child conflicts (Hornfeck et al., 2019). ...
The COVID‐19 pandemic presents unforeseen challenges to families. This mixed‐methods study aimed to address how 89 adoptive parents (lesbian, gay, heterosexual) with school‐age children are navigating a major public health crisis with social, economic, and mental health consequences. Specifically of interest were adoptive parents' worries and concerns; work–family arrangements; and mental, physical, and relational health, in the context of the pandemic and associated quarantine. Findings revealed that 70% of participants had changed work situations, with most newly working from home just as their children initiated remote homeschooling. The division of labor was rarely a source of stress, although the parent who was more involved in homeschooling sometimes experienced resentment. Concerns related to the pandemic included worries about health and children's emotional well‐being and global concerns such as the national economy. Almost half reported declines in mental health (e.g., due to the stress of working and homeschooling), with lesbians being significantly more likely than others to report declines. Declines in physical health were rarer (less than 20%), with more than a quarter reporting improvements (e.g., due to increased exercise). Few reported declines in relationship quality, although almost a quarter reported declines in intimacy. Findings have implications for family and health professionals.
... Significant differences were found in externalising, but not internalising problems; a finding which is consistent with the results of other studies on adoptees compared to non-adopted peers (Pace & Muzi, 2017). In addition, reports from various studies point to the fact that internationally adopted children and adolescents (i.e. with no, or little information on their biological background) had a higher referral rate to mental health services compared to non-adopted children (Behle & Pinquart, 2015;Juffer & van IJzendoorn, 2005;Miller, 2005). ...
Children and adolescents who have been anonymously adopted are an understudied subgroup of adoptees, particularly with regards to their mental health. Hence, the objective of this study was to assess whether the mental health of anonymously adopted children and adolescents differs from a representative norm population, with particular regards to age and gender specific norms. Additionally, possible predictors of anonymous adoptees’ mental health, such as the adoptive parents’ mental health, their attachment styles and demographic variables were evaluated. Data was collected between 2018 and 2019 using an online survey or paper pencil questionnaires (parents’ choice). The sample consisted of 97 adoptive parents, who reported on their anonymously adopted children aged between 2 and 17 years using the Child Behavior Checklist (CBCL). Older adoptees born anonymously showed a higher overall score and more externalising behaviours, when compared to a representative German (non-adopted) reference norm population. The younger anonymously born adoptee group showed significantly lower overall, internalising and externalising behaviour problem scores in comparisons to the norm population. Child mental health problems were positively associated with parental mental health problems and children’s age. Additionally, adoptive parents’ anxious attachment style was a predictor for children’s mental health problems. The current results imply that prevention and treatment of existing mental health problems should target the whole adoptive family and should be implemented by default in post-adoption services.
... While the results of adoption are largely positive-e.g., adoption is effective at promoting physical growth, cognitive development, and self-esteem (van Ijzendoorn & Juffer, 2006)-adopted individuals are more likely than nonadopted individuals to experience certain difficulties. For example, having been adopted is associated with greater psychopathology among children and adolescents (Askeland et al., 2017;Behle & Pinquart, 2016). Previous studies have suggested that, compared to nonadopted individuals, adopted individuals exhibit more externalizing problems (Askeland et al., 2017;Keyes, Sharma, Elkins, Iacono, & McGue, 2008); endorse greater emotional distress (Borders, Penny, & Portnoy, 2000;; and are more likely to attempt (Keyes, Malone, Sharma, Iacono, & McGue, 2013) or complete (Hjern, Lindblad, & Vinnerljung, 2002) suicide. ...
Objective
More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating‐disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals.
Method
We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self‐induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis.
Results
Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (p s < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (p s < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms.
Discussion
This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.
... However, adoptees remain more likely to experience emotional and behavioral problems that endure into later life (Dekker et al., 2017;Paine, Fahey et al., 2020;Paine, Perra et al., 2020). Adopted children are also overrepresented within clinical settings (Behle & Pinquart, 2016) and lag behind their classmates academically (Brown et al., 2017;Van IJzendoorn et al., 2005). ...
Adoptees’ mental health problems in childhood and later life are well described, but little attention has been paid to domestically adopted children’s emotional and behavioral problems and neurocognitive profiles. The aim of this study was to describe the neurocognitive profiles of domestically adopted children in the UK and their parent and teacher-rated emotional and behavioral problems. Forty-five children (M age = 75.96 months, SD = 12.98; 51.1% female) who were placed for adoption from public care at a M age of 22.14 months (SD = 14.21) completed a battery of age standardized neurocognitive
tests, and adoptive parents and school teachers rated their emotional and behavioral problems. Children had more emotional and behavioral problems than the general population and over a fifth scored low (> 1 SD below the expected range for their age) in 5/6 neurocognitive tasks. Children who scored low on the non-verbal reasoning task were more likely to have more parent- and teacher-rated behavioral problems, and children’s performance on the inhibitory control and cognitive flexibility tasks were associated with parent rated behavioral problems. Children’s verbal reasoning scores were positively associated with both parent- and teacher-rated emotional problems. Children who were adopted later in childhood scored significantly lower in non-verbal reasoning. Although longitudinal studies are needed to clarify the nature of neurocognitive functioning as a marker for later mental health problems, our findings underscore the importance of using comprehensive assessments to better recognize adopted children’s difficulties and inform appropriate intervention initiatives.
... Similarly, a recent meta-analysis carried out by Behle and Pinquart (2016) showed that, in the event of a psychiatric diagnosis, adopted children and their families are as inclined as others to seek professional help; and that adopted children are twice as likely as nonadopted children to receive psychiatric treatment or a diagnosis of mental illness. This last figure is higher than that found in previous studies and meta-analyses which explored the symptomatology with continuous measurement (e.g. ...
https://www.routledge.com/The-Routledge-Handbook-of-Adoption/Wrobel-Helder-Marr/p/book/9781138362505
... With respect to the family context, autonomy support was investigated, as parental behaviors related to providing support for youth's autonomy may be particularly challenging for immigrants and adoptive families, despite the fact that this dimension of parenting was found to have a crucial positive impact on the offspring' identity processes (Deci & Ryan, 2000). Our outcome variable, psychological well-being, was operationalized in terms of low depression, following a number of previous studies on immigrant and adopted youth (Behle & Pinquart, 2016;Dekker et al., 2016;Tan, 2016). The present research represents, to the best of our knowledge, the first study to examine all these variables together, and for both immigrant and adoptive groups. ...
Intercountry adoptees constitute a distinct acculturating group that differs from traditional immigrant groups. Yet, there is a lack of research examining the psychosocial processes related to the well-being of this group and how these differ from other immigrant groups. A study carried out in Italy based on a sample group of young immigrants (N = 168) and intercountry adoptees (N = 160) tests a model in which social (perceived discrimination) and family factors (parental autonomy support) predict psychological well-being. The model also examines whether these associations are mediated by Bicultural Identity Integration (BII), the degree to which the ethnic and national identities are experienced as blended and compatible. Results indicate that while discrimination undermines BII among immigrants, it does not among adoptees. Moreover, parental autonomy support improves BII for both immigrants and intercountry adoptees. The findings showed significant associations between BII and psychological well-being. The implications of these results are discussed with regard to possible interventions with immigrants and intercountry adoptees.
... Samtidig peger langt størstedelen af studierne dog på, at adoption er en risikofaktor, idet adoption er forbundet med en forhøjet risiko for bl.a. psykiatrisk sygdom, død, misbrug, lavere uddannelse og anbringelse uden for hjemmet (Behle & Pinquart, 2016;Hjern, Vinnerljung, & Lindblad, 2004a;Juffer & van IJzendoorn, 2005;Laubjerg, Christensen, & Petersson, 2009;Lindblad, Hjern, & Vinnerljung, 2003a) Det er dog vigtigt at understrege, at studierne ikke kan fastslå, at adoptionen i sig selv er årsagen til de udfordringer, som adopterede oplever, men at adoption statistisk optraeder sammen med de naevnte forhold. Dette haenger sammen med, at det er meget svaert at sige noget om, hvordan det ville vaere gået de adopterede, hvis de ikke var blevet adopteret (den kontrafaktiske situation), da det enten kraever (kvasi-)eksperimentelle design eller muligheden for at sammenligne med en matchet kontrolgruppe, der mest muligt ligner de adopterede med undtagelse af netop adoptionen. ...
Aim:
The aim of this study was to investigate within-group differences among Danish non-kin adoptees with regard to probability of mental health problems and post-adoption out-of-home care (OHC) placement, with a particular focus on whether adoption age and country of origin mattered.
Methods:
I used Danish registry data on non-kin adoptees born between 1989 and 1994 (N=2922) at the age of 17 and applied bivariate analyses and seemingly unrelated regression to describe associations between non-kin adoptees' adoption characteristics and two outcomes: (a) psychiatric contact and (b) post-adoption OHC.
Results:
Psychiatric contact and post-adoption OHC co-occurred among non-kin adoptees, and these two life events should be considered jointly. Adoption age mattered equally for the risk of psychiatric contact and OHC, but country of origin mattered more for psychiatric contact than for OHC. Adoption at one year of age and older was associated with an elevated risk of psychiatric contact and OHC. Romanian adoptees had a higher likelihood of psychiatric contact when compared to all the other adoptees, regardless of country of origin. In contrast, adoptees from India had a lower probability of psychiatric contact and of entering OHC compared to all the other adoptees.
Conclusions:
The heterogeneity in non-kin adoptees' psychiatric contact and OHC in terms of adoption age and country of origin is important to consider in future research, as well as for social workers and clinicians in their role of promoting health and preventing mental health problems.
Family systems theories consider cohesion, flexibility, and communication as distinct but related key dimensions of family functioning. These dimensions are underexplored within adoptive families. We investigated the extent to which family cohesion, flexibility, and adoption communication openness relate to the adjustment of adoptees in adolescence. A self-report questionnaire was completed by 134 family triads, composed of internationally adopted adolescents and their parents, for a total of 402 participants. Adoptees and their parents shared similarities, but also differences in perceptions of cohesion, flexibility, and adoption communication openness, all playing specific roles within the family context. Structural equation model with family-level analyses showed that the association between cohesion and the adjustment of adoptees was mediated by adoption communication openness, whereas flexibility was not associated with either communication openness nor with the adjustment of adoptees. Results are discussed in terms of implications for adoption research and practice.
Mental health is a critical area of concern for adoptees, particularly during adolescence. The use of individual counseling services is one way through which adoptees can gain support and learn coping strategies for their mental health needs. However, for adolescents, parents are often the gatekeepers for access to these services. Using data from the Minnesota-Texas Adoption Research Project (MTARP), a longitudinal study of domestic infant adoptees, the present study investigated adolescent domestic adoptees’ (N = 156, mean age 15.7 years, 52% female) reported levels of internalizing symptoms compared to their mothers’ (N = 173) and fathers’ (N = 162) reports. The adopted adolescents ranged in age from 11 to 20 years (mean = 15.7). Rates of symptom agreement were compared and examined in relation to the likelihood that the adoptee was currently or had been engaged in individual counseling services in the past year. The group with the highest rate of enrollment in counseling services were those in which the adoptive parent and adoptee agreed that the adoptee was experiencing high rates of internalizing symptoms. Of greatest concern was the finding that a large portion of adolescents reported significant levels of internalizing symptoms while their parent did not, and that many of these adoptees were not receiving any counseling services at that time. The results from this study demonstrate the importance of parent-adolescent reports and the need to improve parent perceptions of adoptee mental health.
The prevalence of substance use among transracial and international adoptees is higher than that of non-adopted persons, and yet no specialized treatment modalities exist for this underserved population. Our purpose is to propose a substance use disorder (SUD) prevention program for transracial adoptive families that addresses the specific issues that face this community. There are several pre- and post-adoption factors which position transracial and international adoptees (TRIAs) to be at higher risk to develop SUDs. Some of these factors include adoption identity, trauma, loss, genetics, and racial discrimination. The biopsychosocial (BPS) model (Engel, 1977) is used to conceptualize SUDs in adoptees, and theories that focus on adoption-related development issues such as the Adoptee Stress and Coping Model (Brodzinsky, 1990) are also presented. Our proposed program, Strengthening Transracial Adoptive Families (STAF), utilizes the Guiding Good Choices (GGC) prevention program as its foundation to integrate a culturally responsive adoption-focused curriculum to best serve transracial adoptive families.
Previous research suggests that adopted children are at a greater risk of experiencing psychological and behavioural difficulties or accessing mental health services than non-adopted peers and that post-adoption variables are significant risk and protective factors producing this situation. This review seeks to summarise the post-adoption variables associated with adopted children’s mental health or behavioural difficulties to inform future research and shape interventions. A search for publications that assess associated risk and protective factors using Web of Science, Psychinfo, Medline and Sociological Abstracts identified 52 studies that met rigorous methodological criteria. Children’s and adolescents’ mental health and behavioural outcomes were associated with parent, parent–child and wider family factors and by contextual variables. The findings highlight the importance of focusing on the multitude of systemic factors surrounding a child following adoption. Clinical implications and direction for future research are discussed.
Background:
Research suggests that individuals who have been adopted are at increased risk for suicidal behaviors, but this research does not account for the role of trauma.
Objectives:
The study provided rates of trauma exposure among individuals who were adopted with child welfare involvement. The study also examined risk of suicidal ideation (SI) and behaviors (SB) based on adoption status, first as bivariate associations and then in context of trauma exposure and symptoms.
Participants and setting:
Participants in the LONGSCAN study were recruited at multiple US sites based on various risk factors for maltreatment. The current study included only those individuals with adequate information at key timepoints (n = 894), 106 (11.9%) of whom were adopted.
Methods:
Measures were collected at multiple timepoints, including caregiver-report, self-report, and review of child welfare records. Data were analyzed through logistic regression and descriptive statistics.
Results:
High rates of potentially traumatic experiences were found among individuals who were adopted (over 93%). The bivariate logistic regression replicated previous findings that adolescents who were adopted had increased likelihood of endorsing SI (OR 2.14, 95% CI 1.27-3.60, p = .004) and SB (OR 2.40, 95% CI 1.24-4.63, p = .009) compared to non-adopted peers. However, when polytrauma and traumatic stress symptoms were added to the model, adoption was no longer a significant predictor for SI (OR 1.35, 95% CI 0.70-2.60, p = .369) or SB (OR 1.46, 95% CI 0.68-3.13, p = .332).
Conclusions:
Although much remains to be explored about the association between adoption and risk for suicidal thoughts and behaviors, the current study indicates that traumatic stress plays a critical role.
The current study examined the efficacy of Pathways to Permanence 2: Parenting Children who have Experienced Trauma and Loss© (Pathways), a trauma-informed curriculum designed for resource (adoptive, foster and kinship) parents. This initial study examined data from the implementation of a resource training intervention in Ontario, Canada. Participants included 177 resource parents. The current study used a pre-experimental, pre-post design. Preliminary findings from this study indicate positive changes in several dimensions, including resource parent resilience, family functioning, nurturing and attachment. The findings of this initial evaluation are promising and highlight the need for further research.
The Specificity Principle in Adoption asserts that specific setting conditions for adoption of specific adoptees born to specific birth parents and adopted by specific adoptive parents at specific times moderate specific domains in all members of the adoption tetrad by specific processes. Understanding adoption depends critically upon what is studied in whom, how, and when. This article defines, explains, and illustrates the Specificity Principle as applied to adoption. Research hypotheses about adoption can be more adequately tested, inconsistencies and discrepancies in the adoption literature can be more easily identified and resolved, adoptions can be refined to be improved for all parties, and adoption policies can be brought to more differentiated levels of effectiveness if the specificity principle that governs adoption is more widely recognized and applied.
Introduction
Both adoption status and ethnic differences may contribute to stigmatization and microaggressions experienced by adopted individuals and their families. Internationally adopted children have been increasingly recognized to have elevated rates of special needs (SN), especially learning disabilities, attention deficit hyperactivity disorder (ADHD), emotional-behavioral problems, and medical-physical issues. However, little is known about the feelings, perceptions, and stigma experienced by adoptive families of children with SN.
Methods
461 French parents responded to a questionnaire (308 on-line, 153 paper) regarding their feelings and perceptions after international adoption (feelings of difference, ease of attachment, similarities and dissimilarities from their child), as well as their views of their child’s feelings and experiences (difference, exclusion, and prejudice). Parents were asked if their children were diagnosed by professionals as having special needs, specifically: (1) medical/physical conditions, (2) attention deficit disorder, (3) learning disabilities, or (4) emotional-behavioral difficulties. Results were compared for parents of children with and without SN.
Results
The children (57%M;43%F) of the parent respondents were adopted from 47 countries. The children were age (mean±SD) 3.19±2.59 years old at arrival and 11.33±5.03 years old at the time of the survey. 301 (65%) parents reported that their child had at least one SN: physical-medical SN (13% of children) were reported significantly less often than the other 3 categories (attention deficit disorder 39%, learning disabilities 36%, emotional-behavioral problems 40%). Overall, parents reported 652 distinct SN among these 301 children: 102/301 (34%) had a diagnosis in a single category, whereas 199/301 (66%) had diagnoses in at least two categories. SN diagnoses varied by continent of origin: Eastern European children had proportionally more ADHD, learning disabilities, and emotional-behavior problems as well as more diagnoses per child. Compared with parents of non-SN children, parents of SN children (especially children with learning disabilities or emotional-behavioral problems) significantly more often endorsed feelings of difference, more difficulties attaching to their child, and fewer similarities and more dissimilarities with their child. The SN parents also more often reported that their child experienced exclusion and/or prejudice. The more SN diagnosed in their children, the more likely their feelings and perceptions differed from parents of children without SN. These relationships remained significant after controlling for arrival and current age, gender, and adoption visibility, and after adjusting for exclusion due to adopted status or country of origin.
Conclusions
Compared to adoptive parents of children without SN, parents of children with SN report differing patterns of perceptions and feelings. Child SN represent an additional burden for parents of internationally adopted children, and for their children’s feelings and experiences (difference, exclusion, and prejudice, as reported by the parents). These perceptions and feelings are present, even when the SN are not physically obvious. SN must be recognized as an increasingly common, complex, and added dimension to the issues of adoptive status and ethnic differences faced by internationally adopted children and their parents.
Background: There is a consensus that adoptees and immigrants both experience more mental health problems than their peers. The two groups share many risk factors for psychosis, but an increased risk for psychotic illness has only been demonstrated for immigrants. Aims:
The aim of this review is to describe psychosis risk factors in adoptees, with a focus on difficulties with identity formation, identification with in-groups, attachment to parents, and coping with loss and with discrimination. Method: The literature in these five areas is reviewed as it pertains to adoption and psychosis. Results: There are no clear findings because the relevant studies have not been done, but the literature suggests that adopted children face challenges very similar to those of immigrants to a new country. Conclusion: The immigration field and the adoption field have much to learn from each other. It is recommended that a prevention strategy analogous to increased neighbourhood ethnic density be implemented with adoptees – that they be intentionally exposed from early childhood and throughout adolescence to age peers who share a similar background and with whom they can readily identify. It is also recommended that immigrants be welcomed into their host country with the same open arms as adoptive parents welcome their new children.
Empirical research has shown an elevated risk for externalizing behavior problems in international adoptees. To address the extent to which this risk exists for more serious externalizing problems we compared the rates of registered criminal offending of internationally adopted adolescents with those of non-adopted adolescents in the Netherlands. In a large population-based cohort study (N = 3,758,506 including n = 10,563 international adoptees) on Dutch youth with ages up to 19 years we examined registrations in the program on juvenile crime and in the national police system from 2005 to 2013. Controlling for time lapse and background variables we found that international adoptees had been in contact with the criminal justice system more frequently than non-adoptees. However, the findings differed across region of adoption: Adoptees from South America and from Africa had been in contact with the criminal justice system most frequently (and more often than non-adoptees), whereas adoptees from China (total n = 4569) had the least contacts (and less often than non-adoptees). The percentages of criminal offending of adoptees ranged between 1.16% and 15.83% across regions of adoption (versus 10.86% in non-adoptees). The large majority of adoptees – including those from South America and Africa – were not involved in criminal acts. We hypothesize that the higher and lower risks of criminal offending found for adoptees from certain countries are associated with the varying levels of pre-adoption adversity (e.g., neglect and abuse) that the adoptees have experienced.
There is a growing recognition that adoptive families have unique clinical needs, including the need for postadoption mental health services that are adoption competent, trauma informed, and evidence based. Although underrepresented in the literature, the assessment process is the gateway to the provision of trauma-informed, adoptioncompetent services for adoptive families. Based on a thorough review of the literature and clinical experience, the current article provides several specific recommendations for social workers and other mental health clinicians in conducting assessment with adoptive families, including domains to assess; specific strategies for assessing each domain; and guidelines for using the results of the assessment for case conceptualization, treatment planning, and family engagement. Implications for practice are discussed, including recommendations for obtaining training needed for adoption competence.
The present study examines the effects of a new cultural socialization strategy on the well-being of transracially adopted adolescents and emerging adults. Specifically, we propose a novel strategy focused on the role of adoptive parents’ positive contact with members of their children’s ethnic group of origin, which we labelled “extended intragroup contact.” The hypothesis was that observing ingroup members (adoptive parents, belonging to the family ingroup) engaging in contact with another ingroup (members of children’s original ethnic group) would be associated with adoptees’ meaning in life and, in turn, with well-being. A self-report questionnaire was administered to 120 families, each composed of transracial adoptees (all born in Latin American countries) and their adoptive parents. The results were generally supportive of predictions, showing that knowing of positive interactions between members of two different ingroups (family ingroup and ethnic ingroup) had beneficial effects for the well-being of transracial adoptees. The theoretical and practical implications of findings are discussed, focusing on the importance of investigating extended intragroup contact as a strategy for improving the well-being of disadvantaged group members.
Prema National Adoption Attitudes Survey (2002) polovina Amerikanaca za posvojenu djecu smatra da će vjerojatnije imati probleme u ponašanju i školovanju, a trećina da će vjerojatnije imati medicinske probleme i probleme s drogom/alkoholom te manje vjerojatno biti sretna, samopouzdana i dobro prilagođena. Slični rezultati dobiveni su i na stručnjacima – školskim savjetnicima, socijalnim radnicima i obiteljskim terapeutima, što upozorava na mogućnost stigmatizacije posvojene djece, čak i kod profesionalaca koji (im) pružaju podršku i pomoć. S ciljem istraživanja te teme u Hrvatskoj ispitivali smo implicitne stavove prema posvojenoj djeci kod budućih stručnjakinja (psihologinja, socijalnih radnica i učiteljica) te ispitali njihovu informiranost i potrebu za edukacijom o posvojenju. Studentice (N=255) su po slučaju pridijeljene jednoj od četiri skupine. Nakon čitanja jedne od četiri vinjete (biološko/posvojeno dijete x 1/2 roditelja) trebale su procijeniti osobine, potrebu za stručnom pomoći te potencijalne buduće probleme opisanog djeteta. Studentice su osobine i buduće probleme djeteta procjenjivale neovisno o načinu formiranja obitelji, ali su ipak potrebu za stručnom pomoći u slučaju posvojenog djeteta procijenile većom. Vlastitu informiranost buduće stručnjakinje procjenjuju slabijom – pri čemu kao glavne izvore informacija o posvojenju uglavnom navode televiziju/dnevne novine, Internet te obitelj i prijatelje, dok istovremeno takve sadržaje smatraju dosta korisnima za buduću profesiju. Rezultati sugeriraju potrebu za dodatnom edukacijom na temu posvojenja u sklopu fakultetskog obrazovanja – u svrhu osiguravanja većeg znanja i osviještenosti budućih stručnjaka te prevencije stigmatizacije posvojene djece.
Conclusions:
Adoptees in the Netherlands generally do not use more medication than their non-adopted peers. What is Known: • Meta-analytical evidence shows that international adoptees present physical growth delays and mental health referrals more often than non-adopted controls. • With the exception of one Swedish study on ADHD medication, there is no other systematic research on medication use of international adoptees. What is New: • All differences in medication use between international adoptees in the Netherlands and non-adopted controls were below the threshold of a small effect with the exception of medication for precocious puberty, but this effect was in the opposite direction with female adoptees using less medication for precocious puberty than non-adoptees. • International adoptees in the Netherlands do not use more medication despite experiences of preadoption adversity and higher rates of mental health referrals during childhood and adolescence.
Background:
Migrants' socioeconomic adversity has been linked to schizophrenia.
Aims:
To investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants.
Method:
Register study in a cohort of refugees and inter-country adoptees aged 16-40 years, born in East Africa (n=8389), Latin America (n=11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care.
Results:
Despite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30-10.27) and 5.80 (5.03-6.70), followed by Latin Americans: HRs 3.09 (2.49-3.83) and 2.31 (1.79-2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees.
Conclusions:
This study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement.
Declaration of interest:
None.
Copyright and usage:
© 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
This meta-analysis of 62 studies (N=17,767 adopted children) examined whether the cognitive development of adopted children differed from that of (a) children who remained in institutional care or in the birth family and (b) their current (environmental) nonadopted siblings or peers. Adopted children scored higher on IQ tests than their nonadopted siblings or peers who stayed behind, and their school performance was better. Adopted children did not differ from their nonadopted environmental peers or siblings in IQ, but their school performance and language abilities lagged behind, and more adopted children developed learning problems. Taken together, the meta-analyses document the positive impact of adoption on the children's cognitive development and their remarkably normal cognitive competence but delayed school performance.
This study examined associations between alcohol misuse and childhood maltreatment and out-of-home placement among urban lesbian, gay, and bisexual (referred to as two-spirit) American Indian and Alaska Native adults. In a multi-site study, data were obtained from 294 individuals who consumed alcohol during the past year. The results indicated that 72.3% of men and 62.4% of women engaged in hazardous and harmful alcohol use and 50.8% of men and 48.7% of women met criteria for past-year alcohol dependence. The most common types of childhood maltreatment were physical abuse among male drinkers (62.7%) and emotional abuse (71.8%) among female drinkers. Men and women reported high percentages of out-of-home placement (39% and 47%, respectively). Logistic multiple regressions found that for male drinkers boarding school attendance and foster care placement were significant predictors of past-year alcohol dependence. For female drinkers, being adopted was significantly associated with a decreased risk of past-year drinking binge or spree. Dose-response relationships, using number of childhood exposures as a predictor, were not significant. The results highlight the need for alcohol and violence prevention and intervention strategies among urban two-spirit individuals.
Objective consisted of comparing lifetime prevalence rates and odds ratios of anxiety, mood, and psychotic disorders in adopted-versus-non-adopted people in a nationally representative sample. The data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The main outcome measure was the prevalence of lifetime internalizing psychiatric disorders in adopted (n = 378) versus non-adopted (n = 42,503) individuals. Adoptees and non-adoptees were compared to estimate the odds of lifetime internalizing disorders using logistic regression analyses. Adoptees had higher prevalence rates of several lifetime mood and anxiety disorders compared with non-adoptees, with a 1.61-fold increase (95% CI 1.29-2.02) in the odds of any mood disorder and a 1.49-fold increase (95% CI 1.18-1.89) in the odds of any anxiety disorder compared with non-adoptees. Regarding specific mood and anxiety disorders, adoptees had increased odds of major depressive disorder, bipolar I disorder, panic disorder without agoraphobia, specific phobia, and generalized anxiety disorder. Disorders not differing between adoptees and non-adoptees included dysthymia, bipolar II disorder, panic disorder with agoraphobia, social phobia, and psychotic disorder. Two adoption-specific risk factors were associated with lifetime mood disorder (i.e., Asian/Pacific Islander, and age cohort 18-29 years). In conclusion, adoptees in a large sample from the general population had higher rates of mood and anxiety disorders compared to non-adoptees.
This chapter first presents a review of research on the development of adopted children, focusing on meta-analytic evidence and highlighting comparisons between adopted children with and without histories of early adversity. Some methodological issues arising from this literature are considered as well. Second, 7 longitudinal studies of adopted children's development are described, and the convergence of findings across the longitudinal studies and with the cross-sectionally based meta-analytic evidence is discussed. Third, the role of the adoptive family in supporting adopted children's development is explored.
This paper investigates whether adoptees are more prone to problems than their nonadopted peers. To illuminate this question another known higher problem risk-group was included: children living with one biological parent. Based on data collected from the National Longitudinal Study of Adolescent Health, adoptees living in two-parent families (N = 369) were contrasted with children living in two-parent biologic families (N = 9,676) and with children living with one biological parent in step- or single-parent families (N = 7,457). As expected, adolescents living in step- and single-parent families showed far more adjustment difficulties than the other two subgroups. Adoptees showed behavior patterns much like those raised in two-parent biological families, except for three differences: they were more likely to run away from home, to get counseling help and to show less desire to attend college. The implications of these findings are discussed.
This study followed the development of a sample of 106 (67 girls) internationally adopted children over a period of 18 months. Children were adopted from five birth regions, including China, Korea, Latin America, Eastern Europe, and other Asian countries. Mean age at adoption was 11 months. Mothers completed the Ages and Stages Questionnaire (ASQ) at 6, 12, and 24 months post-adoption, assessing children's gross and fine motor, communicative, personal-social, and problem solving skills. Results revealed that the sample as a whole demonstrated linear improvement over time in most developmental domains, but children with initially low scores remained significantly lower than other children at the 18-month follow-up. At the first time point, communication was the domain where children most commonly experienced delays. Children with medical problems had significantly lower developmental scores than those without medical diagnoses. ASQ scores were unrelated to age at adoption, but significant differences by birth country region were found. Across most domains, children adopted from Eastern Europe showed generally lower scores than children adopted from other birth regions.
This article examines the successes and shortcomings of international intervention in child welfare in Romania, highlighting the importance of an empowerment approach. Implementing such an approach brings its own challenges, and the authors debate the possibilities and potential pitfalls. They identify key principles and essential personal qualities for putting empowerment into practice in situations of economic, political and social difficulty.
This study is based on a statewide longitudinal sample of adopted foster youth and explores the relationship between early pre-adoption risk factors and subsequent elevated levels of psychopathology symptomatology. One central goal of the study was to evaluate the impact of pre-adoption stressors (prenatal drug/nicotine exposure, early maltreatment, chaotic foster care history) on the 293 adopted foster children's short- and long-term psychosocial functioning at ages 2, 4, and 8 years post-adoption. An additional objective pertained to measuring how post-adoption attributes (adoptive parents' appraisals of their readiness for this type of adoptive placement and of their parenting style using the HOME scale) contributed a partial mediating influence to the children's functioning. The effects of risk and protective factors were examined through linear regression analyses.The strongest risk factors for the display of behavior problems were sexual abuse, neglect, and having been placed in multiple foster homes. Crucially, lack of parental readiness contributed a substantial increment to the overall models. In addition, longitudinally, the behavior problems remained stable across time.The implications of these findings for the development of services and interventions targeted for adoptive families are discussed.
Prior research has shown that adoptees have a higher rate of substance use disorders (SUDs) than nonadoptees. But these findings have not been verified with a population-based sample of adult adoptees in the United States. Also, no previous adoption study has measured the prevalence of each specific substance use disorder (SUD). We aimed to compare lifetime prevalence rates and odds ratios of SUDs in adopted and nonadopted adults.
The data come from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The main outcome measure was the prevalence of lifetime SUDs in adopted (n = 378) and nonadopted adults (n = 42503). Adoptees and nonadoptees were compared to estimate the odds of lifetime SUDs using logistic regression analysis. Adoptees had higher prevalence rates of lifetime SUDs than nonadoptees. Overall, adoptees had a 1.87-fold increase (adjusted odds ratio [AOR] 1.87, 95% CI 1.51-2.31) in the odds of any lifetime SUD compared to nonadoptees. For each SUD, adoptees had higher odds for alcohol abuse/dependence (AOR 1.84), nicotine dependence (AOR 1.78), cannabis abuse/dependence (AOR 1.77), cocaine abuse/dependence (AOR 2.54), amphetamine abuse/dependence (AOR 3.14), hallucinogen abuse/dependence (AOR 2.85), opioid abuse/dependence (AOR 2.21), and other drug abuse/dependence (AOR 2.87) compared to nonadoptees. This study also identified two adoption-specific risk factors (Hispanic, never married) associated with any lifetime SUD.
This study demonstrated an increased risk of lifetime SUDs in adopted adults. The findings can be useful for clinicians and policy makers to provide education, prevention, and support for adoptees and their families.
Through parent surveys, the level of adjustment in home, school, health, mental health, and community of children from three types of adoptive and from birth families was compared. The sample groups include: child welfare adoptions (1340), domestic infant adoptions (481), international adoptions (89), and birth families (175). On most measures, particularly in relation to school functioning, adopted children were rated by their parents as having more problems than children from birth families. Children adopted from the child welfare system had significantly higher rates of problems than other types of adopted children. Using the Behavior Problem Index (BPI) as a measure of behavior problems, child welfare adopted children were rated as having a mean of 11.9 problems as compared to 6.2 for birth children and 9.1 and 9.4 respectively for domestic infant and internationally adopted children. Logistic regression analysis demonstrates the odds ratio present for an elevated BPI score for children from each family form. Children adopted from the child welfare system are 3.4 times as likely and internationally adopted children are 2.4 times as likely to be in the upper quartile of the BPI as children in birth families.
Internationally adopted (IA) children are at increased risk for health-related, developmental, and behavioral difficulties.
This article reviews the literature on various interventions currently used with IA populations; including health-related
interventions provided by medical specialists, preparation programs provided by adoption agencies and other social service
organizations, treatments for attachment and behavioral disorders, psychoeducational services, programs designed to improve
children’s care prior to adoption, and parent-based initiatives. Surprisingly, very little systematic information exists regarding
the effectiveness of interventions designed to prevent and remediate these difficulties in IA children. Recommendations for
future research activity and for best practice approaches to intervention are discussed.
INTRODUÇÃO/OBJETIVOS: Estudos realizados em diferentes países demonstram que a proporção de crianças e adolescentes adotivos atendidos em clínicas psiquiátricas é maior em relação à verificada nas demais clínicas e na população em geral. O objetivo deste estudo é verificar a prevalência de adoção em amostra clínica e não-clínica, identificando possíveis associações entre tipos de adoção (extrafamiliar e intrafamiliar) e procura de serviço psiquiátrico. MÉTODOS: Estudo de corte transversal, envolvendo crianças de seis a 14 anos: amostra clínica (G1) de um serviço de psiquiatria da infância e da adolescência de uma região da cidade de São Paulo (n=551) e amostra não-clínica (G2) de uma escola localizada na mesma região (n=365). RESULTADOS: A proporção de meninos foi significantemente maior no G1 que no G2 (p<0,001). Observou-se maior prevalência de adoção no G1 (7,4%) que no G2 (4,1%; p=0,048). Entre as crianças adotivas, predominaram a adoção extrafamiliar, na amostra clínica (73,2%), e a intrafamiliar, na amostra não-clínica (60,0%; p=0,030). Entre os meninos adotivos (n=32), também predominaram a adoção extrafamiliar no G1 (80,8%) e a intrafamiliar no G2 (66,7%; p=0,038). Entre as meninas adotivas (n=24), não foram constatadas diferenças entre os grupos G1 e G2 quanto à proporção de adoção extrafamiliar e intrafamiliar (p=0,675). CONCLUSÕES: Os dados sugerem que: (1) crianças adotivas são freqüentemente levadas a serviços de saúde mental; (2) a adoção intrafamiliar é a mais comum na população geral, porém são as crianças adotivas extrafamiliares que mais procuram as clínicas psiquiátricas; e (3) meninos em geral e meninos adotivos extrafamiliares são mais freqüentemente levados a serviços de saúde mental que seus pares do sexo feminino.
To investigate adoptees' psychiatric contact compared with non-adoptees and to clarify the related diagnoses.
Observational, nationwide, register-based study, where correlations between psychiatric, demographic and socioeconomic variables were analyzed for adoptees compared with non-adoptees. The study period is 1992-2008. The setting is Denmark, encompassing seven different types of adoptees registered from 1988 to 2005 (n = 13,524). The non-adoptees (n = 839,989) are matched on sex, age and residence. Various comparison models are designed: one with delayed entries (17 years) shows a 5.0% psychiatric contact prevalence for non-adoptees and 9.2% for adoptees (adjusted odds ratio: 2.91). Another design without delayed entries (2 years) shows a 2% prevalence for non-adoptees and 3.9% for adoptees (adjusted odds ratio 2.65). p-values <0.0005.
Only one type of adoptee: ''registered partner's adoption of the other partner's child'' has a lower risk than non-adoptees (odds ratio: 0.26). Comparison within the same birth region shows a significant increased risk for most adoption types. More adoptees than non-adoptees have more than one contact. Age at adoption is an additional risk factor for4one year only. The most frequent diagnosis is ''Inherent or acquired brain suffering'' (ICD-10: F50 - F99).
The results stress that ''adoptee'' is an independent risk factor for psychiatric contact for international as well as for Danish adoptees. Danish stepchildren have a higher risk than non-adopted Danish children, while ''registered partner's child adopted by the other partner'' have a lower risk than non-adopted Danish children.
In an investigation of adopted children admitted to residential, psychiatric care over a five year period it was found that the percentage of adoptees far outnumbered their proportion in the general population. Clinical variables related to adoption were analyzed and early deprivation in the child and family pathology were found to be major factors in many cases. It was suggested that these findings should not discredit adoption as such, but rather that they pointed out areas to which attention could be directed, namely, more careful selection of adoptive parents together with post adoptive counselling and follow-up for the adoptive families.
This study predicted treatment resistance in 104 adolescents undergoing long-term residential treatment from adoptive status. Resistance was defined by rejection of adults and runaway behavior. Results indicated that these hospitalized adoptees: (1) formed significantly closer bonds with peers while rejecting close ties with adults; and (2) had significantly more runaway episodes and hospitalization terminations by runaway than nonadoptees. Termination runaways occurred after 1 year of hospitalization for adoptees. Significantly more adoptees ran away in groups of two or more patients. Psychodynamic and theoretical considerations for psychiatric treatment of adoptees are discussed and illustrated by case material, emphasizing the value of differentiating treatment approaches for patient subgroups.
During the past three years reports have appeared suggesting that parents of adopted children apply for psychiatric care of their children many times more frequently than nonadopting parents. These reports have aroused interest and concern among child welfare agencies. Prompted by this concern, the Staten Island Mental Health Center undertook a review of 593 cases studied at that child psychiatric clinic between 1956 and 1962. In this sample of cases only a small difference could be discovered between the rate of applications for adopted versus biological children and the proportions of such children living in the community.
The sample of children studied at the Staten Island Mental Health Center differed from the children studied in two reports which have generated much discussion. Dr. Schecter1 reported a high rate of adopted children admitted to his private practice of child psychiatry in Southern California between 1948 and 1953.
The goal of this epidemiological study was to investigate lifetime history and odds ratios of personality disorders in adopted and non-adopted adults using a nationally representative sample. Data, drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), were compared in adopted (n=378) versus non-adopted (n=42,503) adults to estimate the odds of seven personality disorders using logistic regression analyses. The seven personality disorders were histrionic, antisocial, avoidant, paranoid, schizoid, obsessive-compulsive, and dependent personality disorder. Adoptees had a 1.81-fold increase in the odds of any personality disorder compared with non-adoptees. Adoptees had increased odds of histrionic, antisocial, avoidant, paranoid, schizoid, and obsessive-compulsive personality disorder compared with non-adoptees. Two risk factors associated with lifetime history of a personality disorder in adoptees compared to non-adoptees were (1) being in the age cohort 18-29 years (but no difference in the age 30-44 cohort), using the age 45 or older cohort as the reference and (2) having 12 years of education (but no difference in higher education groups), using the 0-11 years of education as the reference. These findings support the higher rates of personality disorders among adoptees compared to non-adoptees.
Published by Elsevier Ireland Ltd.
Alcohol use disorder (AUD) runs strongly in families. It is unclear to what extent the cross-generational transmission of AUD results from genetic vs environmental factors.
To determine to what extent genetic and environmental factors contribute to the risk for AUD.
Follow-up in 8 public data registers of adoptees, their biological and adoptive relatives, and offspring and parents from stepfamilies and not-lived-with families in Sweden. In this cohort study, subtypes of AUD were assessed by latent class analysis. A total of 18 115 adoptees (born 1950-1993) and 171 989 and 107 696 offspring of not-lived-with parents and stepparents, respectively (born 1960-1993).
Alcohol use disorder recorded in medical, legal, or pharmacy registry records.
Alcohol use disorder in adoptees was significantly predicted by AUD in biological parents (odds ratio, 1.46; 95% CI, 1.29-1.66) and siblings (odds ratio, 1.94; 95% CI, 1.55-2.44) as well as adoptive parents (odds ratio, 1.40; 95% CI, 1.09-1.80). Genetic and environmental risk indices created from biological and adoptive relatives acted additively on adoptee AUD liability. Results from biological and adoptive relatives were replicated and extended from examinations of, respectively, not-lived-with parents and stepparents. Multivariate models in these families showed that AUD in offspring was significantly predicted by AUD, drug abuse, psychiatric illness, and crime in not-lived-with parents and by AUD, drug abuse, crime, and premature death in stepparents. Latent class analyses of adoptees and offspring of not-lived-with parents with AUDs revealed 3 AUD classes characterized by (1) female preponderance and high rates of psychiatric illness, (2) mild nonrecurrent symptoms, and (3) early-onset recurrence, drug abuse, and crime. These classes had distinct genetic signatures in the patterns of risk for various disorders in their not-lived-with parents and striking differences in the rates of recorded mood disorders.
Parent-offspring transmission of AUD results from both genetic and environmental factors. Genetic risk for AUD reflects both a specific liability to AUD and to other externalizing disorders. Environmental risk reflects features of both parental psychopathology and other aspects of the rearing environment. Alcohol use disorder is a heterogeneous syndrome and meaningful subtypes emerged from latent class analysis, which were validated by patterns of disorders in biological parents and specific psychiatric comorbidities. The general population contains informative family constellations that can complement more traditional adoption designs in clarifying the sources of parent-offspring resemblance.
A review of existing literature concludes that there is an increased risk for the development of behaviour problems among adopted children compared to non-adopted children. This study was conducted with the objective of finding out whether the findings are consistent within the Indian context, which offers a different psycho-cultural setting to most western settings in which the previous studies were carried out. We compared groups of adopted children and non-adopted children on various parameters i.e. Parent Symptom Questionnaire (PSQ), ADHD rating scale, Alabama Parenting Questionnaire and the Social Adjustment Inventory for Children and Adolescents (SAICA). The Malin's intelligence scale for Indian children (MISIC) was administered to the children for assessing IQ while the Diagnostic and Statistical Manual (DSM-IV) was used to diagnose psychopathology. We found that adopted children had more behaviour problems on the PSQ. On SAICA, adopted children showed less social competence. The parenting practices as revealed by the Alabama Parenting Questionnaire did not differ between the two groups. The IQ of the children in both groups was within the normal range. We concluded that the psycho-social consequences of adoption in India do not differ from those of other countries, all of which show a higher incidence of behaviour problems in adopted children.
Data from the National Survey of Children’s Health, 2011–12 were used to compare children in foster care with children adopted from foster care with respect to health, health care and well-being. Children living with both biological parents and children living with never-married biological mothers were included as comparison groups. The findings suggest that adoption confers socioeconomic advantages for children, relative to children who remain in foster care. However, these advantages do not tend to translate into better developmental, academic, or other well-being outcomes. The evidence suggests that children in foster care who are adopted tend to cost the public less than children who remain in foster care or are reunited with their biological families.
Introduction
The number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting.
Methods
Prospective data were collected over 56 months (n = 431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission.
Results
Adopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=.086).
Conclusions
The over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more.
Conducted a meta-analysis of 66 published studies that compared the psychological adjustment of adoptees and nonadoptees. The mean within-study effect size was .72, indicating that adoptees had significantly higher levels of maladjustment. This was largely due to studies that found that adoptees are significantly overrepresented in clinic populations (mean effect size = 1.38). In addition, adoptees were found to have higher levels of externalizing disorders and academic problems than nonadoptees. Effect sizes tended to be larger for adolescents than for children and adults. These results are consistent with the conclusions of previous qualitative reviews of the research on the psychological adjustment of adoptees. The relationship of effect size to both methodological and subject variables is discussed, and suggestions for future research are provided.
Background:
Previous work reports an association between familial risk factors stemming from parental characteristics and offspring disruptive behavior disorders (DBDs). This association may reflect (a) the direct effects of familial environment and (b) a passive gene-environment correlation (r(GE)), wherein the parents provide both the genes and the environment. The current study examined the contributions of direct environmental influences and passive r(GE) by comparing the effects of familial risk factors on child DBDs in genetically related (biological) and non-related (adoptive) families.
Method:
Participants were 402 adoptive and 204 biological families. Familial environment was defined as maternal and paternal maladaptive parenting and antisociality, marital conflict and divorce; offspring DBDs included attention deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD). Mixed-level regressions estimated the main effects of familial environment, adoption status and the familial environment by adoption status interaction term, which tested for the presence of passive r(GE).
Results:
There was a main effect of maternal and paternal maladaptive parenting and marital discord on child DBDs, indicating a direct environmental effect. There was no direct environmental effect of maternal or paternal antisociality, but maternal and paternal antisociality had stronger associations with child DBDs in biological families than adoptive families, indicating the presence of a passive r(GE).
Conclusions:
Many familial risk factors affected children equally across genetically related and non-related families, providing evidence for direct environmental effects. The relationship of parental antisociality and offspring DBDs was best explained by a passive r(GE), where a general vulnerability toward externalizing psychopathology is passed down by the parents to the children.
One of the defining characteristics of American Indian and Alaska Native communities is the removal of hundreds of thousands of children from their natural parents, extended families, and often, reservation environments. Though widely discussed, little is known about the sequelae of out-of-home placement among American Indians. In this paper we investigate the occurrence of out-of-home placement among 580 Southwestern American Indian tribal members. Out-of-home placement is examined here within a broad context of trauma, alcohol abuse and dependence, and other psychiatric disorders.
Stepchildren are abused, neglected and murdered at higher rates than those who live with two genetically related parents. Daly and Wilson used kin selection theory to explain this finding and labeled the phenomenon "discriminative parental solicitude." I examined discriminative parental solicitude in American households composed of both genetic and unrelated adopted children. In these families, kin selection predicts parents should favor their genetic children over adoptees. Rather than looking at cases of abuse, neglect, homicide and other antisocial behavior, I focused on the positive investments parents made in their children as well as the outcomes of each child. The results show that parents invested more in adopted children than in genetically related ones, especially in educational and personal areas. At the same time, adoptees experienced more negative outcomes. They were more likely to have been arrested, to have been on public assistance and to require treatment for drug, alcohol or mental health issues. They also completed fewer years of schooling and were more likely to divorce. In adoptive families, it appears that "the squeaky wheel gets the grease." Parents invest more in adoptees not because they favor them, but because they are more likely than genetic children to need the help. I conclude that discriminative parental solicitude differs in adoptive and step households because adoptive families generally result from prolonged parenting effort, not mating effort like stepfamilies.
The relationships of adoptive status to presenting psychopathology and to demographic and psychosocial variables were examined in a large sample of children and adolescents who attended psychiatric outpatient services over a 14-year period. Adopted boys and girls were both at increased risk of disruptive behavior, including conduct disorders and ADHD. Age at time of adoption was not related to psychopathology.
Adopted adolescents represent 21.2% of 160 consecutive admissions to an adolescent psychiatric inpatient unit. Within the general population the estimate of adopted adolescents is 3.5%. Some of the demographics of the clinical population and some reasons for the high percentage are discussed.
To examine whether major depressive disorder (MDD) and substance use disorders [SUDs: specifically, nicotine dependence (ND), alcohol use disorders (AUDs), and cannabis use disorders (CUDs)] in parents predicted increased risk for these disorders in late adolescent-emerging adult offspring and, specifically, the extent to which the pattern of risk differed for adopted and non-adopted youth.
Late adolescent and emerging adult participants from the Sibling Interaction and Behavior Study (mean age = 18.8), a community-based investigation of adopted and non-adopted adolescents, and their parents (adoptive parents of adopted youth, biological parents of non-adopted adolescents) were included.
Structured interviews were used to assess these disorders.
(i) When the same disorder in parents and adolescents was examined, parental MDD was associated with increased risk for MDD among both adopted (P < 0.001) and non-adopted (P < 0.01) adolescents; in contrast, SUDs were associated with increased risk for the same SUD in non-adopted offspring (all P < 0.01). (ii) When cross-SUD effects were examined, for the most part, each SUD was associated with increased risk for other SUDs among non-adopted but not adopted offspring (most P < 0.05). (iii) When MDD-SUD associations were examined, parental ND and CUDs predicted increased risk for MDD in non-adopted (P < 0.001), but not adopted, adolescents. These effects tended to remain significant when adjusting for within-person comorbidity (P < 0.05).
Major depressive disorder in parents appears to be a risk factor for late adolescent-emerging adult major depressive disorder but not substance use disorder in offspring, with this risk being environmentally mediated. Substance use disorder in parents appears, via genetic mediation, to increase risk of substance use disorder in adolescent offspring, and cannabis and nicotine use disorders in parents contribute similarly to major depressive disorder in those offspring.
Selon la littérature, l’émergence de troubles mentaux est liée statistiquement à l’adoption chez les adolescents, ainsi que leur surreprésentation en hôpital psychiatrique. Nous formulons l’hypothèse que les difficultés liées à cette situation s’expriment selon une catégorie diagnostique spécifique. Pour la vérifier, nous avons collecté, de manière rétrospective, les diagnostics de 148 adolescents hospitalisés dans une clinique psychiatrique bruxelloise en 2003–2004 et nous les avons comparés selon leur origine familiale (adoptés, immigrés, autochtones non-adoptés). Les diagnostics les plus fréquents étaient les troubles du comportement chez les adoptés, les troubles psychotiques chez les immigrés et les troubles affectifs chez les autochtones. Dans cet échantillon de petite taille, aucune différence diagnostique n’a été observée entre les adoptés internationaux et nationaux. Les résultats globaux indiquent que les diagnostics des adolescents adoptés internationaux sont différents de ceux des immigrés. Les troubles du comportement seraient pour les adolescents adoptés un mode préférentiel d’expression des difficultés liées à l’abandon et l’adoption. Le recours à un traitement hospitalier de ces troubles pourrait être influencé par d’autres facteurs, notamment, la perception des troubles par l’entourage. Une étude plus large permettrait de confirmer cette hypothèse.
Recent studies suggest a role for social factors during childhood in the later development of schizophrenia. Since social conditions in childhood are closely related to parental psychiatric illness, there is a need to disentangle how genes and social environmental factors interact.
A total of 13,163 children born in Sweden between 1955 and 1984 and reared in Swedish adoptive families were linked to the National Patient Register until 2006 regarding admissions for non-affective psychoses, including schizophrenia. Hazard ratios for nonaffective psychoses were estimated in relation to three indicators of socioeconomic position in childhood (household data of the rearing family obtained via linkage to the National Censuses of 1960-1985) and in relation to indicator of genetic liability (biological parental inpatient care for psychosis). In addition, the total Swedish-born population was investigated.
Increased risks for nonaffective psychosis were found among adoptees (without biological parental history of psychosis) reared in families with disadvantaged socioeconomic position, which consisted of adoptive parental unemployment (hazard ratio=2.0), single-parent household (hazard ratio=1.2), and living in apartments (hazard ratio=1.3). The risk was also increased among persons with genetic liability for psychosis alone (hazard ratio=4.7). Among those exposed to both genetic liability and a disadvantaged socioeconomic situation in childhood, the risk was considerably higher (hazard ratio=15.0, 10.3, and 5.7 for parental unemployment, single-parent household, and apartment living, respectively). Analyses in the larger population supported these results.
The results indicate that children reared in families with a disadvantaged socioeconomic position have an increased risk for psychosis. There was also some support for an interaction effect, suggesting that social disadvantage increases this risk more in children with genetic liability for psychosis.
The aim is to highlight adoptees' and stepchildren's psychiatric contact and diagnoses compared with non-adoptees.
The setting is Greenland and the methodology is a comparative in-ward patient register-based study. The background is the Greenlandic tradition for adoption and community child care and international research stressing that adoptees demonstrate adverse health outcomes. The cohort is in-ward patients (>24 hours), born between 1973 and 2005. Correlation between various dependent and independent variables are analyzed. The research makes different comparative statements of psychiatric admissions and diagnoses related to adoptees and stepchildren compared to non-adoptees with respect to demographic and socioeconomic indicators. The psychiatric data material is collected from 1992 to 2008 and the socioeconomic indicators are included from 1996.
The findings show, contrary to findings related to adoptees in Western societies, that being an adoptee in Greenland does not increase the risk for psychiatric admission, but being a ''female stepchild'' does. The adjusted risk for adoptees is ''non-significant'' at 1.1 (95% confidence interval (95% CI) 0.6- 1.9) but the adjusted risk for female stepchildren is ''significant'' at 3.4 (95% CI 1.8-6.6). The most frequent diagnosis is ''Inherent or acquired brain suffering''. The findings open up possibilities for new hypotheses as to reasons for adoptees' adverse health outcomes in the Western world.
Epidemiological and medical contact recording do not exist outside central hospital level in Greenland, therefore, in order to put psychiatric contact patterns into perspective, in-depth field studies are required in close collaboration with the local Greenlandic population.
Several investigators have reported an increased frequency of attention/hyperactivity symptoms in international adoptees, though population-based studies are lacking. In this national cohort study, we aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985-2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the odds ratios. The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10-15-year olds) and girls (2.1 vs. 0.3% for 10-15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice.
In an epidemiological study of 2,323 adopted adults, the registrations about sick-leave, diagnoses and hospitalization (F-cards) from the National Health Insurance were studied. There was a significantly higher frequency of psychiatric illness among the adoptees compared with non-adopted controls. A classification into different diagnostic groups from the records of psychiatric hospitals showed an over-representation due to alcohol and drug abuse and personality disorders in both male and female adoptee groups compared with non-adopted controls. There was also an over-representation in the male adoptee group due to neuroses.
Studies of clinical populations suggest that adopted children are overrepresented among children using mental health facilities, whereas studies using non clinical populations of adopted children have reached mixed conclusions about whether or not there is an increased psychological risk associated with adoption. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years, which included a subpopulation of adopted children, were used to: 1. profile the characteristics of adoptive families; 2. examine the strength of adoptive status as a marker for psychiatric and educational morbidity; and 3. determine the extent to which adoptive status has an independent relationship with psychiatric and educational morbidities. The findings were: 1. adoptive mothers were significantly older than non adoptive mothers, but otherwise adoptive families did not differ significantly from non adoptive families, 2. adoption in boys, but not in girls, was a significant marker for psychiatric disorder and poor school performance; adoption in adolescent girls was a significant marker for substance use; and 3. multivariate analyses demonstrated no independent effect of adoption on psychiatric disorder or poor school performance; for adolescents, adoptive status did have an independent relationship with substance use for girls. The implications of these findings will be discussed.
Epidemiological data on a national sample of 3,698 adolescents, of whom 145 were adopted, indicate that adoption significantly increases the likelihood of referral for psychiatric treatment even after controlling for the fact that adoptees display more behavior problems and come from more educated families. This is accounted for by the fact that adoptees are significantly more likely to be referred when they display few problems. Thus, contrary to popular myth and clinical lore, the overrepresentation of young adoptees in clinical settings is not attributable solely to the fact that adoptees are more troubled. Rather, adoptees do display more problems but they are also referred more readily even after controlling for extent of problems.
Over a 15-year period adopted children were overrepresented in a psychiatric clinic population. The excess was seen in all age groups and there was no rise of referrals of adoptees during adolescence. Adopted boys showed the same range of disorder as all referred boys. Adopted girls were more likely than other girls to have conduct disorders. Those with conduct disorders were more likely than non-adopted girls with the same disorder to be taken into care and to be given inpatient treatment. Differences in family structure and relationships were found both between conduct disordered girls of different adoptive status and between adopted girls with conduct and other disorders.
Between 1975 and 1985, 3.8% of patients referred to the Maudsley Hospital with anorexia and bulimia were adoptees. This exceeds the rate of adoption (1.5%) in the general population matched for year of birth. The 18 adoptees with eating disorders had significantly more associated behavioural disturbance and lower academic achievement than the 18 matched controls, and different precipitating factors.
Among 375 children and adolescents admitted to a psychiatric hospital inpatient unit, the proportion of adopted children was considerably higher than that of a general pediatric population or of census figures, and the majority of nonadoptees were from disrupted homes. Based on a review of case records, adoption and family disruptions appear to increase significantly the length of hospitalization and to shift diagnoses toward behavioral disturbances. Implications for prevention and treatment are considered.
Students from three different facilities who were diagnosed as learning disabled were studied to determine the frequency of adoption with this population as compared to the national norm. The frequency of adoption was found to be 4.5 times higher than the norm, that is, 17.3% versus 3.9%. The possible reasons for this high incidence are discussed.
Of 763 consecutive admissions to a children's psychiatric hospital, 66 (8.7%) were adopted. The adopted subjects had a higher frequency of personality disorder diagnosis, a difference accounted for by an increased frequency of personality disorder diagnosis in the girls. The not-adopted subjects had more frequent diagnoses of separation anxiety disorder and major depressive disorder. Adopted boys had more concentration symptoms and hyperactivity symptoms than not-adopted boys and adopted girls had fewer anxiety symptoms than not-adopted girls.
The number of adopted children referred to a Canadian psychiatric service was found to be greater than warranted by their ratio in the community. They presented more with conduct disorders and less with anxiety disorders and were significantly more impaired than the controls.
A survey of the proportion of adopted children and adolescents in the general population, in a psychiatric inpatient program, and in the juvenile court of the same region revealed a significantly lower rate of intrafamilial adoption in both psychiatric inpatient and juvenile court subjects than in the general population. When compared with the extrafamilial adoption rate of the general population in the region, a significant overrepresentation of adopted children and adolescents among the inpatient psychiatric subjects, and a significant underrepresentation of adopted children and adolescents referred to the juvenile court, were found.
A retrospective analysis was made of case records of children attending a Children's Mental Health Centre during the years 1959 to 1973. Annual comparisons were made between the numbers of adopted, children seen in the province of Ontario and within the clinic setting. The results indicated that over a fifteen year period the adopted children in the clinic were seen with twice the expected annual incidence predicted from the community rates.
“So far as it is known, the proportion of successful and unsuccessful adoptions does not seem unsatisfactory. This result is in accordance with clinical experience which does not suggest that an undue proportion of adopted children are referred to child guidance clinics.”
Bowlby (1951)
The authors found that adoptive fathers of children with aggressive conduct disorder less often had alcoholism and antisocial personality than the natural fathers of nonadopted children with the same disorder. This evidence suggests that social factors which are widely held to produce the disorder are not necessary causes.