Is there a common pathway to maladjustment for internationally adopted and non-adopted adolescents?

Attachment, Mentalizing and Trauma: Then (1992) and Now (2022)

This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the review then considers recent neurobiological work on mentalizing and trauma and suggests areas of new development and implications for clinical practice.

Narrating Displacement Adoptees' Challenges Due to Minority Stress

The experiences and the stories of adopted individuals cannot be understood apart from the social context that shapes them. Interpretative phenomenological analysis was used as the aim of this study was to assess the impact of the adoption of dominant social discourse on adoptees. Four themes relating to the aims of the current research emerged from the data: (1) adoptees' deviant construction of themselves, (2) experiences of invalidation and marginalization, (3) rationalization of adoption, and (4) adoption-related un-acknowledged losses. This study's results show that participants' individualized and/or societal distressing experiences can be considered within the context of minority stress. For clinical and counseling purposes it is important to understand whether these minority identities result in extra social stresses as a result of their social stigma.

Aggressiveness in Adopted and Non-Adopted Teens: The Role of Parenting, Attachment Security, and Gender

The aim of this study was to examine the relationship among aggressiveness, parenting practices, and attachment security in adolescents, assessing maternal and paternal effects separately. Two different subsamples of adolescents between 12 and 16 years old participated in the study (n = 157): 67 adopted adolescents (61.2% girls) and 90 non-adopted adolescents (56.7% girls). Partial and full mediation models were analyzed in multi-group structural equation models (using maximum likelihood estimates), allocating non-adoptive and adoptive adolescents into two different groups. Results showed that whereas acceptance/involvement of each parent predicted attachment security towards the corresponding parental figure, only the father's coercion/imposition predicted aggressiveness, and only attachment security to the mother was a (negative) predictor of adolescent's aggressiveness. The partial mediation model provided the most parsimonious explanation for the data, showing no differences between adopted and non-adopted subsamples and supporting a good model fit for both boys and girls in a multi-group invariance analysis. The implications of these results are discussed in light of the protective effects of care relationships in early adolescence (vs. late adolescence) as well as the differential role of parent figures.

Sleep patterns and insomnia among internationally adopted adolescents

OBJECTIVE

Sleep is essential for adolescent development. We aimed to investigate sleep patterns and insomnia among internationally adopted adolescents compared with their nonadopted peers.

DESIGN

Cross-sectional.

SETTING

Data stem from the population-based youth@hordaland-survey, conducted during winter/spring 2012, in Hordaland, Norway.

PARTICIPANTS

Of the 9846 adolescents who responded to the sleep measures in the youth@hordaland-survey, 44 were identified as international adoptees by linkage to the Central Adoption Registry.

MEASURES

The adolescents provided self-report information on demographic characteristics, mental health problems, and a range of sleep measures.

RESULTS

There were no significant differences between the adoptees and nonadopted peers regarding how much time they spent in bed, but the internationally adopted adolescents reported significantly shorter sleep duration, both on weekdays (d=0.37, P = .014) and weekends (d=0.37, P = .015). The difference was due to the adoptees spending longer time awake after sleep onset (d=0.78, P > .001). Furthermore, 32% of the adopted adolescents fulfilled the DMS-5 criteria for insomnia, compared with 18% of their nonadopted peers (odds ratio 2.06, 95% CI: 1.09-3.90). However, this association was no longer significant after adjusting for symptoms of depression. Adolescents adopted after 12 months of age reported more sleep problems than those who were adopted earlier.

CONCLUSION

The short sleep duration and high occurrence of insomnia among the internationally adopted adolescents suggest both a problem area that should receive more focus and a potential avenue for intervention. The results further suggest that assessing both mental health problems and sleep problems among internationally adopted adolescents who are experiencing difficulties could help target interventions.

Attachment to Parents and Aggressiveness in Adopted Adolescents: A Multi-Sample Comparison Study

This study examined adopted adolescents' levels of attachment security to parents and aggressiveness as compared to those of community nonadopted adolescents and of clinical nonadopted adolescents. Three different subsamples participated (n = 262): 101 community nonadopted adolescents (48.5% girls), 80 community adopted teens (65.0% girls), and 81 nonadopted counterparts (35.8% girls) who participated in a treatment program for youth with behavioral problems. There were no differences between community groups in attachment security or aggressiveness, whereas clinical nonadopted adolescents showed less attachment security and more aggressiveness than the other two groups. The implications of these results are discussed in terms of the potential healing impact that living with adoptive families could have on adopted teenagers' risk of maladaptive outcomes.

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.

Attachment across the lifespan: insights from adoptive families

Research with adoptive families offers novel insights into longstanding questions about the significance of attachment across the lifespan. We illustrate this by reviewing adoption research addressing two of attachment theory's central ideas. First, studies of children who were adopted after experiencing severe adversity offer powerful tests of the unique consequences of experiences in early attachment relationships. Although children who experience early maltreatment or institutionalization show remarkable recovery in the quality of their attachments after being placed with their adoptive families, experiencing pre-adoptive adversity also has long-lasting repercussions for these individuals' later attachment representations. Second, adoptive families allow for genetically-informed examinations of the intergenerational transmission process. Indeed, despite the lack of genetic relatedness, adoptive parents' attachment representations are associated with their children's attachment behaviors and representations across childhood and adolescence.

Mental Health in Internationally Adopted Adolescents: A Meta-Analysis

OBJECTIVE

To investigate whether mental health problems differ between internationally adopted adolescents and their non-adopted peers and examine design and sample characteristics that might underlie differences among studies.

METHOD

Studies published through August 2015 were collected through Embase, Medline, PsychINFO, Web of Science, ERIC, and Svemed+. Combined effect estimates were calculated using random-effects models.

RESULTS

Eleven studies investigating 17,919 adoptees and 1,090,289 non-adopted peers were included in the meta-analysis. Internationally adopted adolescents reported more mental health problems across domains than their peers, with effect estimates (standardized mean differences [SMDs]) of 0.16 (95% CI 0.03 to 0.28) for questionnaire-based studies and 0.70 (95% CI 0.50 to 0.90) for register-based studies. They also reported significantly more externalizing difficulties (SMD 0.20, 95% CI 0.03 to 0.38), although the effect estimate for internalizing difficulties was not statistically significant (SMD 0.10, 95% CI -0.03 to 0.24). Studies using categorical measurements of mental health problems, indicating more serious problems, yielded larger effect estimates than continuous measurements (SMD 0.31, 95% CI 0.21 to 0.41; SMD 0.13, 95% CI -0.01 to 0.26, respectively). The difference in mental health problems between international adoptees and their peers was somewhat larger when using parent report compared with self-report. More recent studies (conducted in 1995 and later) yielded larger estimates than older studies, although no significant difference was found for this analysis or subgroup analyses investigating sex and age at adoption.

CONCLUSION

Although most internationally adopted adolescents are well adjusted, adoptees as a group report higher levels of mental health problems compared with non-adopted peers. This difference should be acknowledged and adequate support services should be made available.

Mental health problems and resilience in international adoptees: Results from a population-based study of Norwegian adolescents aged 16-19 years

The aim of the study was to investigate mental health and resilience in adolescents who have been internationally adopted and their non-adopted peers and examine the potential interaction between adoption status and resilience on mental health problems. Data from the population based youth@hordaland-survey, conducted in Hordaland County, Norway, in 2012 was used. In all, 10 257 adolescents aged 16-19 years provided self-reported data on several mental health instruments. Of these, 45 adolescents were identified as internationally adopted. Adoptees reported more symptoms of depression, attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and perfectionism than non-adopted adolescents, but there were no differences regarding resilience. Adolescents with higher resilience scores reported fewer symptoms of mental health problems, however, no interaction effects were found for adoption status and total resilience score on measures of mental health problems. Our findings indicate that knowledge of resilience factors can form the basis for preventive interventions.