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Adoption Research- Attachment, psychological adjustment in adopted children


This study used a risk and resilience perspective and the catch-up model of adoption to study the effect of parent-child relationship on the resilience of adoptive adolescences.  This study examined 701 adopted adolescents, with a subsample of 288 transracially adopted adolescents.  It focuses on school achievement and behavioral problems to measure the outcome.  The results showed that better parent-child relationship quality was significantly associated with reduced odds of skipping school, being suspended, and reporting substance abuse or police trouble.  It was also associated with better performance in language arts, but not math.  No significant differences were discovered between transracially adopted children and children adopted by families of the same ethnicity.

  • "The Mental Health of US Adolescents Adopted in Infancy" by Margaret Keys, Anu Sharma, Irene J. Elkins,  William G. Iacono and Matt McGue. Originally published in that Archives of Pediatrics & Adolescent Medicine.

    Research has been fairly clear that adopted children with a history of prenatal substance exposure or pre-placement deprivation and those who were older when adopted are at heightened risk for all sorts of social, intellectual, and emotional problems.  McGue and his fellow researchers set out to determine if those adoptees with no evidence of early deprivation and placed for adoption before two years of age were at an increased risk for mental health problems.  They also compared international adoptees to domestic adoptees.

    The study focused on 540 non adopted adolescents randomly selected from Minnesota birth records and 514 international adoptees and 178 domestic adoptees from three large Minnesota adoption agencies.  The international adoptees were mostly female (60.3%) and mostly adopted from South Korea (89.7).  The domestic adoptees were 41.0% female and 78.7% white.   Consistent with Minnesota demographics, 95.6% of the non-adopted adolescents are white and 54.1% are female.

    Researchers found that most adolescence adopted as infants are well-adjusted and psychologically healthy.  Nevertheless, a subset of adoptees may be at increased risk for externalizing problems and disorders, such as oppositional defiant (ODD) and attention deficit/hyperactivity (ADHD).  The odds of being diagnosed as having ADHD and ODD were approximately twice as high in adoptees compared with non-adoptees.  There appeared to be no difference between adopted and non-adopted adolescence for internalizing problems (anxious, withdrawn, depression, and separation anxiety).  Domestic adoptees consistently fared worse than international adoptees, and all adopted adolescents were significantly more likely to have had contact with a mental health professional compared with non-adopted adolescents. Full study can be read here.

  • "Openness in Adoption: From Secrecy and Stigma to Knowledge and Connections," an Evan B. Donaldson Adoption Institute report written by Deborah H. Siegel and Susan Livingston Smith. This survey of agency practices relating to domestic infant adoption placements found:
    • "Closed" infant adoptions have shrunk to a tiny minority (about 5 percent), with 40 percent "mediated" and 55 percent "open." In addition, 95 percent of agencies now offer open adoptions.
    • In the overwhelming majority of infant adoptions, adoptive parents and expectant parents considering adoption meet, and the expectant parents pick the new family for their baby.
    • Adoptive parents, like most participants in open adoptions, report positive experiences; more openness is also associated with greater satisfaction with the adoption process.
    • Women who have placed their infants for adoption – and then have ongoing contact with their children – report less grief, regret and worry, as well as more peace of mind.
    • The primary beneficiaries of openness are the adopted persons – as children and later in life – because of access to birth relatives, as well as to their own family and medical histories.
  • Factors affecting attachment in international adoptees at 6 months post adoption by Sandra Niemann & Sandra Weiss.
    Although a relatively small (22 adoptive mother–child pairs) study, the results on attachment security six months after international adoption were fascinating.  Contrary to what is commonly believed, age at adoption, developmental status, and length and quality of pre-adoption care, and adoptive mother’s feelings of attachment were not significant predictors of child attachment status 6 months post adoption. The two factors that were significantly predictive of healthy attachment between a mother and child 6 months post adoption were the number of pre-adoption placements and the child's stress level. Children who had fewer pre-adoption placements had higher attachment security; similarly, children who had lower stress levels had higher attachment security.  Results suggest that consistency of pre-adoption care was more important than its length or quality. Further, children having foster versus orphanage care prior to adoption differed in quality of pre-adoption care and in certain attachment behaviors, but not in overall attachment security. Published in Children and Youth Services Review Volume 34, Issue 1, January 2012, Pages 205–212. Also published in Adoption Quarterly Volume 14, Issue 4, 2011 under the title Attachment Behavior of Children Adopted Internationally at Six Months Post Adoption.
  • In Appreciation Of "The Primal Wound": How this understanding can help adoptees and their parents by Marcy Axness. Wonderful article explaining the feelings of loss and alienation some adoptees feel by a therapist who is herself an adoptee.
  • "Adoptees Do Not Lack Self-Esteem: A Meta-Analysis of Studies on Self-Esteem of Transracial, International, and Domestic Adoptees" - study states, "there are no differences in self-esteem between adopted and nonadopted children and no differences in self-esteem between transracial and same-race adopted children." Psychological Bulletin, 2007 Summary of study
  • The Healthy Adjustment of Adopted Adolescents study summary By Kathleen L. Whitten, Ph.D. - study looks at "17,000 families in the U.S. (Whitten, 2002). There were 535 adoptive families. Each family had an adolescent between 12 and 18 years old. The quick good news: adoptive families overall had more positive relationships than the nonadoptive families. In more good news for parents, I found no differences between adopted and nonadopted teens on 12 outcomes: delinquency, depression/anxiety, psychosomatic illness, amount of activities with male friends, amount of activities with female friends, self-efficacy, grade-point average, ever repeated a grade, ever been suspended from school, ever been expelled from school, ever had sex, and ever attempted suicide. This contrasts to other studies, especially older ones, that which emphasize negative behavior among adopted children. "
  • The Minnesota / Texas Adoption Research Project (MTARP) is a longitudinal adoption research study that focuses on how open adoption affects adopted children,  birth mothers, and adoptive parents.  It was national in scope and followed participants for over 20 years.  It is the largest adoption study of its type involving over 720 individuals (190 adoptive families and 169 birth mothers). Participants were interviewed and visited at several times during the study.  Some of the highlights of this study are as follows:
    •  Adopted kids between the ages of 4-12 scored within the normal range on self esteem. Average levels of self-esteem did not differ by level of openness in the children’s adoptions.

    • Adopted adolescents were as well adjusted as non-adopted teens.  The level of openness by itself was not a major predictor of adjustment outcomes.  However, the degree of collaboration between the adopted and birth parents and the adopted parent’s perception of the child’s incompatibility with the family were predictive of problematic adjustment.
    • Differences in degree of preoccupation with adoption were not related to the level of openness in the adolescent’s adoption.

    • Birthmothers in open adoptions had lower adoption-related grief and loss than those in confidential (closed) adoptions. There were no significant differences by openness level associated with birth mother regret about the decision to place.

    • Birth mother mental health was not related to open adoption or frequency of contact.

    • Adoptive parents in open adoptions fared better than adoptive parents in closed adoptions. Up to adolescence, when compared to adoptive parents in closed adoptions, those in open adoptions generally reported higher levels of acknowledgment of the adoption, more empathy toward the birth parents and child, stronger sense of permanence in the relationship with their child as projected into the future, and less fear that the birth mother might try to reclaim her child.
  • "Internationally Adopted Adults Who Did Not Suffer Severe Early Deprivation: The Role of Appraisal of Adoption," published in Children and Youth Services Review (Volume 32, Issue 1 February 2010). An adoption  study of the psychological adjustment of 53 adults adopted from Greece to the Netherlands without early deprivation found their general well-being and self-esteem were comparable to the general population, though adopted men reported more depression.  The average age at adoption was 9 months and the average age at the time of the study was 20.  Factors related to lower mental health scores included search status (those who searched reported more mental health problems), no current partner (lower well-being); and a negative appraisal of adoption (more mental health problems and lower well-being). Note that this was a very small study and that these children had very good pre-adoption care, but the result support what almost all research shows, that adopted people compare favorably on psychological test with non adopted people.
  • “Differential patterns of whole-genome DNA methylation in institutionalized children and children raised by their biological parents”.  Oksana Naumova, et al.  Researchers compared the DNA of 14 children in Russian orphanages with 14 children living with their biological families and found that the DNA of institutionalized children was different from children being reared with their families.  The genes that were different involved the control of immune response and cellular signaling systems, including a number of crucial players important for neural communication and brain development and functioning.  Researchers speculate that these differences were caused by the lack of parental care and attention.  It should also be noted that this was a very small study involving only 14 children in each group.

    All the children in the study were between the ages of 7 and 10, and the children in the orphanage had been there since birth. The orphanages in study were chosen because of the “high quality” of care.  “They were well equipped, had an adequate ratio of children to adults, had good physical plant facilities, and demonstrated adequate administrative leadership.”  The children living with their biological families were from the same region as the orphanage children and the biological families were of a low socio-economic level since it is assumed that children placed at birth in the orphanage were also born to parents in the lower socio-economic level.  Only families with no evidence of marital dysfunction, records of child abuse, or indications of any substance abuse were included in this comparison sample

    We know from animal studies that environmental factors might causes epigenetic modification of the genome and might affect gene expression during the whole lifespan. The epigenetic changes can be caused by diets and chemical substances, as well as behavioral programming and early life experiences, such as child abuse and parental stress.  Epidemiological research has demonstrated that heart disease, diabetes, obesity, depression, substance abuse, and other health maladies might originate from the early stages of development. .  Now there is evidence that early deprivation of parental care can also cause epigenetic changes in children.  Researchers believe that the changes in DNA are heritable, thus the children of these children may also carry some of the scars of institutionalization.  Development and Psychopathology, 2011.
  • Building Kinship and Community: Relational Processes of Bicultural Identity Among Adult Multiracial Adoptees - Study of multiracial adult adoptees and how they perceive their bicultural identity. Family Process, 2010.
  • ‘‘Being Raised by White People’’: Navigating Racial Difference Among Adopted Multiracial Adults - Discusses the results of a study of adult multiracial adoptees and their experience managing parent-child conflicts and societal perceptions. The participants experienced highly racialized situations throughout their childhood and into adulthood. Journal of Marriage and Family, 2009.
  • Domestic Transracial Adoption and Multiraciality -  This chapter explores the academic concept of multiracial, and what effects it can have on multiracial adoptees' identity. Multiracial Child Resource Book, 2003.
  • "Expanding Resources For Children: Is Adoption By Gays and Lesbians Part of the Answer for Boys and Girls Who Need Homes?" - Examines relevant issues, laws and practices relating to gay and lesbian adoption and parenting, 2006
  • "Open Adoption of Infants: Adoptive Parents' Feelings Seven Years Later" - How parents feel about the openness in their child's adoption in retrospect.  Social Work, 2003
  • "Raising Adopted Kids - New Research"- Creating a Family blog summarizing the report by the Evan B. Donaldson Adoption Institute titled “Beyond Culture Camps: Promoting Healthy Identity Formation in Adoption
  • "Bridging the Divide: Openness in Adoption and Post-adoption Psychosocial Adjustment among Birth and Adoptive Parents"- How does Open Adoption affect adopted children, adoptive parents, and birth mothers.  Journal of Family Psychology, 2008. 
  • The University of Minnesota has been on the forefront of adoption research for years, which is one of the reasons I make an annual contribution to them.  One of their best research projects is The Minnesota / Texas Adoption Research Project (MTARP), which studied the affect of openness in adoption on adopted children, adoptive parents, and birth parents. Summary
  • “History of Early Neglect and Middle Childhood Social Competence: An Adoption Study” by Dr. Tony Xing Tan. Adoption Quarterly, 9(4), 57-72 (2006) Summary
  • Preschool-age Adopted Chinese Children’s Sleep Problems and Family Sleep Arrangement by Dr. Tony Xing Tan and Dr. Kofi Marfo 2008 Adoption research that looks at sleep problems/sleep issues with adopted children. Evaluated the effects of sleeping alone, sleeping with parents, the Family Bed, co-sleeping, and sharing the parent's bedroom.  Summary

  • Behavioral Outcomes for Substance-Exposed Adopted Children: Fourteen Years Postadoption.” By Crea, Thomas M.;Barth, Richard P.;Guo, Shenyang.;Brooks, Devon. American Journal of Orthopsychiatry v. 78, 1, p. 11-19 (2008)
    One counterintuitive finding is that children adopted from foster care were faring better than children adopted through private agencies or independently. The researchers hypothesized that this may be because families adopting from foster care had a realistic expectations of the challenges they were likely to face, and adoption research has consistently shown that realistic expectations are directly related to positive outcomes. Realistic expectations for children's behavior likely affects parents' perceptions of the severity of their children's problem behaviors.

    This was an interesting longitudinal study of adopted children exposed to prenatal substance abuse . It was expected that substance exposed children would fare significantly worse than non exposed children and that the problem behaviors would increase as they aged. This study followed the children for 14 years. They found that children exposed to drugs or alcohol during pregnancy fared slightly worse overall, but their behavior problems do not appear to be increasing at a faster rate than those of nonexposed children. It appears that the behavior problems in adopted children that result from prenatal alcohol and drug exposure exposure are consolidated early in life and do not generate ongoing deterioration. The report also found that children 3 years or older at adoption appeared to have overall poorer outcomes compared with children adopted at younger ages.
  • Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project by Charles A. Nelson, III, Charles H. Zeanah, Nathan A. Fox, Peter J. Marshall, Anna T. Smyke, Donald Guthrie Science 21 December 2007: Vol. 318. no. 5858, pp. 1937 - 1940

    This adoption research compared the cognitive development of children raised in one of three settings: institution or orphanages, foster home, or family of birth. The study was designed to compare abandoned children reared in child welfare institutions to abandoned children placed in institutions but then moved to foster care. A control group of children born at the same maternity hospitals but living with birth families was also studied. Of the non-control group, there were 187 children less than 31 months of age residing in six orphanages for young abandoned children in Bucharest, Romania.

    Young children living in institutions were randomly assigned (drawing names out of a hat) to continued institutional care or to placement in foster care, and their intellectual development was tracked through 54 months of age. The cognitive outcome of children who remained in the institution was markedly below that of never-institutionalized children and below children taken out of the institution and placed into foster care. The improved cognitive outcomes observed at 42 and 54 months were most marked for the youngest children placed in foster care.
    The three main findings from this study are:

    •     Children reared in orphanages showed greatly diminished intellectual performance (borderline mental retardation) relative to children reared in their families of origin.
    •     Children in foster care experienced significant gains in intellectual development.
    •     The younger an orphan is when placed in foster care the better for brain development. There may be a sensitive period spanning the first 2 years of life within which the onset of foster care exerts a maximal effect on cognitive development. Indeed, there was a continuing "cost" to children who remained in the institution over the course of our study. These results are compatible with the notion of a sensitive period, but discovering whether such a period truly exists or determining the borders that delineate it would likely require a larger sample size with a broader age range at intervention onset.
  • The Evan B. Donaldson Adoption Institute release a report titled "Finding Families for African American Children: The Role of Race & Law in Adoption from Foster Care." The New York Times, Time, and The Washington Post ran articles on this report.
    This report found that:
    • The federal laws passed in the mid 1990's to remove race as a factor in placements from foster care have not resulted in equity in adoption for African American children.
    • The "color blind" interpretations of these laws run counter to widely accepted best practices in adoption.
    • The laws call for "diligent recruitment" of prospective adoptive parents who represent the racial and ethnic backgrounds of children in foster care has not been well implemented or enforced.

Adjustment and Self Esteem of Children in Transracial Adoption

Researchers in the fields of sociology, psychology, and social work began to focus on transracial adoption in the 1970s and 1980s, examining children's overall adjustment, including self-esteem, achievement, and level of adjustment problems. Most used very small sample sizes and evaluated children at one point in time and at young ages; and some did not have comparison groups of children placed in same-race families. Also, almost all of these studies have been conducted on children adopted as infants or from other countries, rather than on children adopted from foster care. Generally, these studies found that children adopted transracially in the U.S. or from other countries had overall adjustment outcomes similar to children placed in same-race families (Grow & Shapiro, 1974; Kim, 1977; McRoy, Zurcher, Lauderdale, & Anderson, 1982, 1984; McRoy & Zurcher, 1983; Simon & Alstein, 1987; Feigelman & Silverman, 1983; Shireman & Johnson, 1986).

Research on transracial adoption has progressed over the past 35 years in methodological rigor and complexity. Overall, the current body of research on this issue supports three key conclusions:

  1. Transracial adoption in itself does not produce psychological or social maladjustment problems in children.
  2. Transracially adopted children and their families face a range of challenges, and the manner in which parents handle them facilitates or hinders children's development.
  3. Children adopted from foster care have more risk factors. For these children, research points to the importance of adoptive placements with families who can address their individual issues and maximize their opportunity to develop to their fullest potential.
Little adoption research has examined transracial adoption of children from foster care, but the adoption studies that do exist have found that while parents are equally satisfied, there is a higher rate of problems in minority foster children adopted transracially than children adopted by families or their same race. Also, when children have issues, there is evidence that they have a stronger association with problematic parent-child relationships among transracial adoptions than in same-race adoptions (Rosenthal & Groze, 1992; Howard & Smith, 2003).

An underlying assumption of past research was that transracial adoption was not a challenge for adoptees if there were no significant differences on overall adjustment measures between groups of transracial and in-race adoptees. However, recent studies - using more rigorous methods to directly measure the racial and ethnic experiences of adoptees and how these experiences may contribute to psychological adjustment - have found parents' attitudes and behaviors related to racial socialization affect their transracially adopted children's outcomes on a range of variables (Lee, 2003).
  • When children in foster care cannot be safely reunited with their  birth parents or members of their extended families, they need the security, stability and love of adoptive parents. To ensure that children of color are placed with adoptive families who can meet their long-term needs, this report makes the following recommendations:
    • Reinforce in all adoption-related laws, policies and practices that a child's best interests must be paramount in placement decisions.
    • Amend IEP to allow consideration of race/ethnicity in permanency planning and in the preparation of families adopting transracially. The original MEPA standard - which provided that race is one factor, but not the sole factor, to be considered in selecting a foster or adoptive parent for a child in foster care - should be reinstated.
    • Enforce the MEPA requirement to recruit families who represent the racial and ethnic backgrounds of children in foster care and provide sufficient resources, including funding, to support such recruitment.
    • Address existing barriers to fully engaging minority families in fostering and adopting by developing alliances with faith communities, minority placement agencies, and other minority recruitment programs.
    • Provide support for adoption by relatives and, when that is not the best option for a particular child, provide federal funding for subsidized guardianship.
    • To help families address their transracially adopted children's needs, provide post-adoption support services from time of placement through children's adolescence.
  • See my review and concerns about this report under my blog titled "Transracial Adoption Revisited"
    For a well reasoned rebuttal to this report see the Stress Reactivity Study.

  • The Minnesota International Adoption Project is one of my very favorite research programs, and I contribute to them every year to help them with their research. One of their ongoing studies is examining whether children adopted from difficult situations have a more “reactive” stress biology system due to their early experiences. In the fall of 2007 they published their results. For most of the children, although they may have had more reactive systems when they were adopted, after several years in their adoptive families, their stress systems have settled down. They were rather stunned, but also very happy with the results they found. Both the post-institutionalized children and the children adopted from foster care looked exactly like the birth children in their response to stress in this adoption study.
  • Eastern European Growth Project is an adoption research project out of the University of Minnesota International Adoption Medicine Program. The project studied 120 internationally adopted children from Eastern Europe between the ages of 6 to 48 months. The children were first evaluated within three weeks of their arrival in the United States and again at 6 months post-adoption.

    This project looked at the risk factors that would predict stunted physical growth. The results so far indicate the following risk factors:

    • If the child has a history of severe deprivation, it is more likely that they will be of shorter stature at the time of arrival.
    • If the child is an older age at adoption, it is more likely that they will be of shorter stature at the time of arrival.
    • If the child has a history of prenatal alcohol exposure, it is more likely that they will be of lower weight at the time of arrival.
    • If the child has a history of prenatal alcohol exposure, it is more likely that they will have a smaller head circumference at the time of arrival.

    Interestingly, they did not find a single risk factor that is able to predict growth stunting in all three growth measures (height/length, weight, and head circumference); also, failure in one area of growth (i.e.: height) can be predicted by more than one risk factor.

    Adoptive parents will be more interested in the second part of the study which focused on the factors that influence whether the child will “catch up” growth once home. This adoption study found that most children demonstrated excellent catch-up growth in height, weight, head circumference within 6 months. Factors which might predict whether a child would catch up height were as follows: influenced the amount of

    • Female sex seems to predict better linear growth.
    • Severity of growth stunting at the initial assessment seems to predict better linear growth.
    • An increase in IGFBP-3 between the initial and follow-up visit is associated with better linear growth.
    • Changes in IFG-1 levels and weight are not significant predictors of linear growth. Why girls did better than boys, and the role of IGFBP-3 both remain to be studied.
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