Parental ratings of behavioral adjustment in two samples of adopted Chinese girls: Age-related versus socio-emotional correlates and predictors

Reared-apart/reared-together Chinese twins and virtual twins: Evolving research program and general intelligence findings

China's One-Child Policy (1979-2015) limited rural families to two children and urban families to one child. This practice, which led to the abandonment of hundreds of thousands of female infants, is indirectly responsible for the separate placement of infant twins. The availability of this sample launched the first prospective study of these pairs. Participants include families and twins comprising 15 monozygotic (MZA) pairs and 7 dizygotic (DZA) pairs from countries throughout the world. The research program is described, and the initial wave of IQ scores for MZA and DZA twin pairs is examined in the first comprehensive report from this study. The twins' mean age at participation was 9.41 years (SD = 6.36), and their ages ranged from 3.19 to 24.98 years. Informative contrasts with adopted-together Chinese twins and virtual twins (same-age unrelated individuals reared together) highlight shared genetic and environmental effects on intellectual development. Applied directions based on findings from these novel samples are described.

Risk of eating disorders in international adoptees: a cohort study using Swedish national population registers

AIMS

Compared to the general population, adoptees are more often referred to specialist psychiatric treatment, exhibit increased risk of suicide and display more symptoms of attention-deficit/hyperactivity-disorder. However, little is known about the impact of being an adoptee on the risk of developing an eating disorder. The aim of the present study was to assess whether international adoptees have a higher risk for eating disorders than native Swedes.

METHODS

In the present retrospective cohort study, data from the Swedish total population registers on individuals born between 1979 and 2005 were used to assess whether international adoptees residing in Sweden (n = 25 287) have a higher risk for anorexia nervosa (AN) and other eating disorders (OED) than non-adoptees with Swedish-born parents from the general population (n = 2 046 835). The patterns of these results were compared to those for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and anxiety disorders to determine whether any observed effects were unique to eating disorders or reflected a more general impact on mental health outcomes.

RESULTS

A survival analysis adjusting for relevant demographic covariates revealed an elevated risk of all examined psychiatric disorders in international adoptees: hazard ratios (95% confidence intervals) are 1.21 (1.04-1.41) for AN, 1.60 (1.44-1.79) for OED, 1.90 (1.81-2.00) for MDD, 1.25 (1.09-1.44) for OCD, and 1.69 (1.60-1.78) for anxiety disorders.

CONCLUSIONS

Elevated risk of eating disorders as well as of MDD, OCD, and anxiety disorders was found in international adoptees. A parallel pattern between AN and OCD was observed, which both display less elevated rates than the other diagnoses. A considerable number of biological, environmental, and societal factors have been suggested to explain the observed differences in mental health between adoptees and non-adoptees, but they remain primarily theoretical.

Bullying Among International Adoptees: Testing Risks and Protective Factors

This study examined the risks and protective factors for experiencing bullying and especially racist bullying among internationally adopted children in Finland. Factors examined were related to children's background, adoptive family, children's social problems and social skills, and their associations with bullying experiences. About 56.9% of children reported bullying victimization and 24.2% racist bullying victimization. Boys were at bigger risk of becoming bullied (B = 0.14, p < .05), as were children with disability (B = 0.11; p < .05). The continent of birth (European; B = 0.51; p < .001) and adoptive family's lower socioeconomic status (SES; B = 0.16; p < .05) were associated with increased victimization. Child's social problems increased the likelihood of victimization for both general (B = 0.59, p < .001) and racist bullying (B = 0.10, p < .001). Child's social skills appeared as a protective factor against general bullying (B = 3.87; p > .001). This study shows that interventions for tackling children's social problems and improving their social skills may reduce children's risk for bullying involvement.

Emotional and behavior problems in adopted children - The role of early adversities and adoptive parents' regulation and behavior

BACKGROUND

Early adversity and negative experiences in the adoptive family can put adopted children at risk for emotional and behavior problems.

OBJECTIVE

This study analyzes the influence of children's preadoptive history and adoptive parents' characteristics on the psychosocial adjustment of nationally and internationally adopted children in Germany.

PARTICIPANTS AND SETTING

The survey included 172 adopted children aged between 24 and 145 months and their adoptive parents.

METHODS

Parents provided information about preadoptive history. Information about emotional and behavior problems was obtained from the parental version of the Strengths and Difficulties Questionnaire (SDQ). Parental well-being was obtained through a composite score of three standardized measures (self-efficacy questionnaire, Perceived Stress Scale PSS-4, Brief Symptom Inventory BSI); parenting behavior was assessed with the Alabama Parenting Questionnaire (DEAPQ).

RESULTS

12.5% of the adopted children scored in the clinical range of the SDQ. In a multiple regression analysis, the experience of maltreatment and neglect was the most important predictor of emotional and behavior problems at time of assessment, followed by pre- and perinatal risk and parental stress regulation difficulties, R² = .423, F(4, 128) = 28.539. Increases in the number of risk factors present were associated with a greater odd of children scoring in the clinical range of the SDQ.

CONCLUSIONS

Most of the nationally and internationally adopted children in this sample were well-adjusted. Prenatal and preadoptive risk as well as stress regulation capacities of the main caregiver contributed to the child's development. An accumulation of risks increased the likelihood of adjustment problems in adopted children.

Adverse Childhood Experiences of Children Adopted from Care: The Importance of Adoptive Parental Warmth for Future Child Adjustment

We investigated the relationship between adverse childhood experiences (ACEs) and children's internalising symptoms and externalising problems in the Wales Adoption Cohort Study, a prospective longitudinal study that used case file records (n = 374) for a sample of British children adopted from care (M = 2 years, 55% male). Parents (n = 96) completed questionnaires at 3-5 months, 15-17 months, and 31-33 months post-placement. We hypothesised that: (1) children adopted from care would have experienced more ACEs than children in the general population; (2) the number of ACEs would be associated with higher internalising symptom and externalising problem scores; and (3) adoptive parental warmth would moderate the relationship between ACEs and post-placement internalising symptoms and externalising problems. Nearly half (42%) of the children experienced four or more ACEs. Internalising symptoms and externalising problems were significantly higher than the UK general population. The number of ACEs was associated with internalising symptoms 3 years post-adoptive placement but this relationship was moderated by adoptive parental warmth. This study profiles the experiences and characteristics of a national sample of adopted children and highlights the potential importance of parent warmth as a factor that ameliorates the impact of ACEs on poor child outcomes.

A new look at the supposed risks of early institutional rearing

The main focus is on the assessment of the effects of early institutional care and compares three longitudinal studies from Romania, Greece and Hong Kong/China. The findings have been strikingly contrasting. The review asks if the risks are dependent on whether or not the institutional rearing is accompanied by gross pervasive deprivation (as it was in Romania) and investigates the methodological issues to explore the causal influence of the outcomes. Evidence is considered on changing institutional practices and the benefits of doing so. Comparison is made between institutions with major deprivation and those without global deprivation. A small number of studies are discussed that look at direct comparisons between institutional and community care. The empirical and conceptual implications of the findings are discussed.

East Meets West: Adopted Chinese Girls' Nighttime Sleep Problems and Adoptive Parents' Self-Judgment About Parenting

We investigated the association between adopted Chinese girls' nighttime sleep problems and adoptive parents' self-judgment about their parenting. The girls were 1.7-6.9 years old (M = 4.6 years, SD = 1.0) and were adopted at 7-56 months (M = 13.9 months, SD = 6.6) by families in North America. At Wave 2 of a longitudinal study on adopted Chinese children's development, the adoptive parents provided survey data on bedtime resistance or anxiety and parasomnias in their daughters and their own parental sense of entitlement and parenting competence. Results showed that controlling for child and family demographics, parasomnias, but not bedtime resistance or anxiety, negatively predicted parental sense of entitlement (B = -.13, p < .01) and parenting competence (B = -.14, p < .01).

Social Skills in Children Adopted from Socially-Emotionally Depriving Institutions

This study assessed social skills in post-institutionalized (PI) children with respect to age-at-adoption, age-at-assessment, and gender. Parent ratings of social skills (Social Skills Rating System) and behavior problems (Child Behavior Checklist) were obtained for 214 children and 127 adolescents who were adopted from socially-emotionally depriving Russian institutions. Results showed that children adopted before 18 months of age have better social skills than those adopted after this age; those assessed in childhood demonstrate better social skills than those assessed in adolescence. PI females, especially later-adopted adolescents, have particularly poor social skills. Children with poor social skills tend to have higher rates of behavior problems.

Language and memory abilities of internationally adopted children from China: evidence for early age effects

The goal of the present study was to examine if internationally adopted (IA) children from China (M = 10;8) adopted by French-speaking families exhibit lags in verbal memory in addition to lags in verbal abilities documented in previous studies (Gauthier & Genesee, 2011). Tests assessing verbal and non-verbal memory, language, non-verbal cognitive ability, and socio-emotional development were administered to thirty adoptees. Their results were compared to those of thirty non-adopted monolingual French-speaking children matched on age, gender, and socioeconomic status. The IA children scored significantly lower than the controls on language, verbal short-term memory, verbal working memory, and verbal long-term memory. No group differences were found on non-verbal memory, non-verbal cognitive ability, and socio-emotional development, suggesting language-specific difficulties. Despite extended exposure to French, adoptees may experience language difficulties due to limitations in verbal memory, possibly as a result of their delayed exposure to that language and/or attrition of the birth language.

Preadoption adversity, MAOA, and behavioral adjustment in internationally adopted Chinese girls

OBJECTIVES

We studied postinstitutionalized adopted Chinese girls to determine whether those with different variants of the MAOA gene promoter region (MAOA-VNTR) differed in their internalizing and externalizing behavior problems and whether the MAOA genotype moderated the relation between preadoption adversity and current behavior problems.

METHODS

MAOA genotyping was obtained for 94 girls (mean age: 9.2 years) and the number of 4-repeat (4R) alleles was determined (zero, one, or two). The adoptive mothers rated several indicators of preadoption adversity shortly after adoption (mean age at adoption 15.8 months) and completed the Child Behavior Checklist when the children were 8.1 years on average.

RESULTS

No main effects were found for preadoption adversity. However, the MAOA genotype had a nominally significant effect (P<0.05) on internalizing problems. Regression analyses controlling for age, household income, authoritarian parenting, and family problems showed that among children with no physical signs of preadoption adversity, those carrying a greater number of 4R alleles scored significantly lower (P<0.01) on internalizing problems than those with fewer 4R alleles. Differences in internalizing scores related to the MAOA genotype were not observed for children who showed one or more physical signs of adversity at the time of adoption. A similar pattern was found for externalizing problems, although the results did not reach conventional levels of significance.

CONCLUSION

Our results suggest that higher MAOA activity may be protective with respect to internalizing problems in internationally adopted Chinese girls, but that this protective effect decreases at higher levels of preadoption adversity. A similar pattern may exist for externalizing problems.

Developmental delays at arrival, early intervention enrollment, and adopted Chinese girls' academic performance and internalizing problems in adolescence

The author investigated the extent of developmental delays in girls adopted from China, their subsequent early intervention (EI) enrollment, and how the delays and EI were related to their academic performance and internalizing problems in adolescence. The sample included 180 adolescent girls (M = 13.4 years, SD = 2.0 years) who were adopted at 3-23.5 months (M = 11.5 months, SD = 3.7 months). Data on the adopted Chinese girls' delays at arrival and EI enrollment in physical therapy (PT) and speech-language therapy (SLT) were collected from the adoptive mothers at the Baseline; data on the adopted Chinese girls' present academic performance and internalizing problems were collected from the adoptive mothers and adopted girls at Wave 4 six years later. Data analyses revealed that 55% of the adoptees had moderate-to-severe delays when first arrived at the adoptive homes. Motor delays significantly increased the odds for PT (odds ratio [OR] = 3.98, 95% CI [2.18, 7.82], p <.001) and SLT (OR = 2.36, 95% CI [1.50-3.72, p <.001). Social-cognitive delays also significantly increased the odds for PT (OR = 1.90, 95% CI [1.36, 2.63], p <.001) and SLT (OR = 1.63, 95% CI [1.22, 2.17], p <.001). Motor delays were negatively associated with academic performance but positively associated with internalizing problems. General linear modeling showed that the adoptees who had developmental delays at arrival and subsequently enrolled in EI scored significantly lower on academic performance than their peers who had delays but did not enroll in EI, as well their peers who had no delays and did not enroll in EI. Implications of these findings are discussed.

Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms

PURPOSE

Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood and adolescence. Both neurocognitive and environmental factors have been related to ADHD. The current study contributes to the documentation of the predictive relation between early attachment deprivation and ADHD.

METHOD

Data were collected from 641 adopted adolescents (53.2% girls) aged 11-16 years in five countries, using the DSM oriented scale for ADHD of the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families, Burlington, 2001). The influence of attachment deprivation on ADHD symptoms was initially tested taking into consideration several key variables that have been reported as influencing ADHD at the adoptee level (age, gender, length of time in the adoptive family, parents' educational level and marital status), and at the level of the country of origin and country of adoption (poverty, quality of health services and values). The analyses were computed using the multilevel modeling technique.

RESULTS

The results showed that an increase in the level of ADHD symptoms was predicted by the duration of exposure to early attachment deprivation, estimated from the age of adoption, after controlling for the influence of adoptee and country variables. The effect of the age of adoption was also demonstrated to be specific to the level of ADHD symptoms in comparison to both the externalizing and internalizing behavior scales of the CBCL.

CONCLUSION

Deprivation of stable and sensitive care in infancy may have long-lasting consequences for children's development.

Age at adoption from institutional care as a window into the lasting effects of early experiences

One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.

Pre-adoption adversity and self-reported behavior problems in 7 year-old international adoptees

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers' reports. The sample consisted of 95 adopted children and their mothers. Children's health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children's self-reports were compared to their non-adopted peers'. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers' and children's reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees' perception of their psychological adjustment and the long-term impact of early risk factors.

Second-first language acquisition: analysis of expressive language skills in a sample of girls adopted from China

In this study we investigated adopted Chinese girls' expressive English language outcomes in relation to their age at adoption, chronological age, length of exposure to English and developmental risk status at the time of adoption. Vocabulary and phrase utterance data on 318 girls were collected from the adoptive mothers using the Language Development Survey (LDS) (Achenbach & Rescorla, 2000). The girls, aged 18-35 months (M=26·2 months, SD=4·9 months), were adopted at ages ranging from 6·8 to 24 months (M=12·6 months, SD=3·1 months), and had been exposed to English for periods ranging from 1·6 to 27·6 months (M=13·7, SD=5·7). Findings suggest that vocabulary and mean length of phrase scores were negatively correlated with age at adoption but positively correlated with chronological age and length of exposure to English. Developmental risk status at the time of adoption was not correlated with language outcomes. The gap between their expressive language and that of same-age girls from the US normative sample was wider for children aged 18-23 months but was closed for children aged 30-35 months. About 16% of the children met the LDS criteria for delays in vocabulary and 17% met the LDS criteria for delays in mean length of phrase. Speech/language interventions were received by 33·3% of the children with delays in vocabulary and 25% with delays in phrase.

Developmental Outcomes of Internationally Adopted Children

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.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

CBCL behavior problems of post-institutionalized international adoptees

With the increase in international adoptions during the last decade, many researchers have investigated the developmental outcomes of these adoptees, including their extreme behaviors. Collectively, these results have not always appeared consistent across studies, perhaps because studies have used children reared in institutions or not, the institutional environments vary in severity, children spend different lengths of time in the institution and are assessed at different ages, and studies use different outcome measures. In an attempt to discern more order in the literature, this review focuses on 18 studies, each of which used the Child Behavior Checklist, and their outcomes are viewed with respect to these parameters. Results suggest that the major factor contributing to extreme behaviors is age at adoption, with those adopted after 6/18 months having more behavior problems, especially Internalizing, Externalizing, and Attention problems. Generally, samples of post-institutional children have more problems than samples of mixed or non-institutional internationally adopted children, and some problems are more likely to be manifest in adolescence, suggesting the effects of deficient early experiences are not simply the persistence of learned behavior but more general dispositions that become more noticeable or severe during adolescence. Findings are discussed in terms of early deficient social-emotional caregiver-child interactions that characterize most institutional environments as a possible major cause of later difficulties in post-institutionalized children.

Two-Year Follow-up of Girls Adopted from China: Continuity and Change in Behavioural Adjustment

BACKGROUND

  To determine the developmental course of behavioural adjustment in 842 girls adopted from China.

METHOD

  Longitudinal data were collected with the Child Behaviour Checklist (CBCL/1.5-5 or CBCL/6-18) from the same parent with a two-year interval. In data analysis, the entire sample was first treated as a whole, then was divided into three age cohorts, including (1) children who were in preschool ages in both phases (Preschool Cohort) (n = 417, M_age  = 2.5 years in Phase I), (2) children who crossed from preschool ages over to school ages (Transition Cohort) (n = 174, M_age  = 4.8 years in Phase I), and (3) children who were in school ages in both phases (School-age Cohort) (n = 251, M_age  = 8.5 years in Phase I).

RESULTS

  The data revealed a strong behavioural continuity (rs = .57-.75) from Phase I to Phase II. The whole sample experienced a significant increase in both average score and rate of suboptimal adjustment on the CBCL Internalising and Total Problem scale. For children with suboptimal adjustment in Phase I, the odds for them to remain in suboptimal range in Phase II were very high. Repeated measures ANOVA revealed that the three cohorts changed differently over 2 years.

Social-emotional adjustment and attachment in children adopted from China: Processes and predictors of change

This study examined the processes and predictors of change in maternal ratings of internalizing and externalizing symptoms and attachment security in 70 infant girls adopted from China at a mean age of 13.5 months. These children’s mental and language development were also directly assessed. The adopted children were assessed within the first month of adoption and again six, 12 and 24 months later. Comparisons were made with 43 girls of similar age and family background. Results indicated that from six months postadoption onward, adopted children exhibited a rapid increase in internalizing symptoms, especially in emotion reactivity. Adopted children initially formed attachment rapidly. Growth in attachment gradually slowed down over time. Individual differences that emerged in the rate of attachment growth from six months postadoption were related to mental ability in both groups. The results point to the effects of potential risk factors on the processes of change, at least in the two years following adoption.

Correlates and predictors of parenting stress among internationally adopting mothers: A longitudinal investigation

This study examined correlates and predictors of parenting stress among internationally adopting (IA) mothers with the goal of expanding the knowledge base on the experiences of adoptive parents. One hundred and forty-three IA mothers completed pre-adoption (Time 0) and six months post-adoption (Time 1) surveys with questions regarding child-, parent-, and family-related characteristics. Mother reports of higher depression symptoms, higher expectations of child developmental and behavioral/emotional problems, and a greater number of children in the family at pre-adoption were significantly related to higher parenting stress six months post-adoption. In contrast, mother reports of higher expectations for child acceptance and higher perceived social support at pre-adoption were significantly related to lower parenting stress six months post-adoption. Higher maternal depression symptoms, higher expectations of child behavior/emotional problems, and a greater number of children in the family at pre-adoption together accounted for 22% of the variance in parenting stress six months post-adoption. Concurrent higher maternal depression symptoms and higher reports of child behavioral/emotional problems predicted higher parenting stress six months post-adoption over and above pre-adoption predictors, and accounted for an additional 33% of the variance. Results and directions for future research are discussed from a transactional perspective, with particular emphasis on the importance of pre-adoptive information for adoption research and practice.

School-age adopted Chinese girls' behavioral adjustment, academic performance, and social skills: longitudinal results

Longitudinal data on 177 school-age adopted Chinese girls (Time 1: mean age = 8.92 years, SD = 1.76; Time 2: mean age = 11.18 years, SD = 1.79) were analyzed to determine their long-term outcomes in behavioral adjustment, academic performance (measured with the Child Behavior Checklist/6-18), and social skills (measured with the Social Skills Rating System) and how these outcomes were related to preadoption adversity. More than 90% of the girls were adopted at 24 months or younger (M = 19.25, SD = 21.67). Results revealed that over a 2-year period, there was a moderate to strong stability in the children's behavioral adjustment and academic performance. However, there was a significant increase in the number of children with deviant internalizing problems. At both times, higher degrees of preadoption adversity were related to more internalizing problems and poorer academic performance. Children who were adopted at older ages had poorer academic performance. Children who were older had a lower level of assertion and a higher level of responsibility. Children's attention problems at Time 1 mediated the effect of preadoption adversity on academic performance at Time 2.