Factors Affecting Attachment in International Adoptees at 6 Months Post Adoption

Optimizing Surgical Treatment of Internationally Adopted Children with Cleft Lip and/or Palate: Understanding the Family Experience

Objective

To understand the experience of families with children undergoing cleft surgery following adoption from a country outside the United States. To identify factors, including the timing of surgery, that influence family function throughout the surgical experience.

Design

Semistructured qualitative interviews were conducted with parents of internationally adopted children postrepair of cleft lip and/or cleft palate and coded by a multidisciplinary study team. Mixed methods were used to contextualize themes derived from the parent interviews.

Results

Twenty parent interviews were conducted, and four core themes were identified: (1) parental anxieties prior to surgery, (2) considerations for the timing of surgery, (3) impact of the surgical experience on the child and family, and (4) modifiable sociocontextual factors. Parents considered a strong child bond with at least one parent and the ability of the child to communicate basic needs to be important before undergoing surgery. In retrospect, parents generally felt that the surgical experience did not have a negative impact on their child or their families and that the surgical experience may have even facilitated bonding and attachment with their child. Acceleration of family bonding was expressed more often by parents of children who were adopted at older than 2 years.

Conclusions

In our study, parents reported that cleft surgery soon after international adoption did not appear to impair child bonding or adjustment. Specific family and provider factors that could optimize the experience for families were identified.

Beauty, brains or health: trends in ovum recipient preferences

BACKGROUND

What do ovum donation (OD) recipients request most from their ideal donor: beauty, brains, health or physical self-resemblance? Previous data have shown recipients primarily requested "similar appearance or gene pool." We consider the possibility that these criteria may have changed due to a positive social shift towards OD participation and have evaluated recipients' requests for donor criteria over a span of 5 years.

METHODS

Donor trait preferences of OD recipients (n=438) enrolled in a private, academic OD program from 2008-2012 were assessed in this retrospective cohort analysis. Requests were categorized by appearance, ethnicity, intellect, ability, and mental health. Statistical analyses were conducted by Cochran-Armitage trend tests with significance at p<0.05.

RESULTS

The percentage of requests for "health" increased steadily from 2008 (50%) to 2012 (72%) (p<0.05). The percentage of requests for "intelligence" were highest in 2012 (55%), increasing from 2008 (18%) (p<0.05). Requests for "athletic ability" rose from 2008 (1%) to 2012 (17%) (p<0.05). Recipients requested a "similar gene pool" most in 2009 (40%) and least in 2012 (25%), though this trend did not reach statistical significance.

CONCLUSIONS

Our study demonstrates an increase in the percentage of OD recipients' requests for health, athleticism, and intelligence over our 5-year analysis. It appears that the current recipient is more likely to request a donor with practical traits that would serve their offspring overall quality of life rather than self-reflective traits such as physical resemblance or their genetic composition. We believe that improved awareness and acceptance of OD as a treatment of infertility will continue to inform practical considerations and approaches toward donor recruitment and the donor-recipient matching process.

Hepatitis a screening for internationally adopted children from hepatitis A endemic countries

Screening for hepatitis A virus (HAV) infection is not currently routinely recommended in internationally adopted children. International adoptees seen at the University of Minnesota International Adoption Clinic from 2006 to 2010 were assessed for acute HAV infection (positive HAV immunoglobulin M). Thirty of the 656 children screened (4.6%) were acutely HAV infected. HAV-infected children emigrated from Ethiopia (16), Guatemala (4), China (2), Colombia (2), Haiti (2), Philippines (2), Liberia (1), and Nepal (1). Infection was most frequent among children younger than 2 years (6.7%). No symptoms distinguished children with acute HAV infection from uninfected children. HAV infection caused significant social disruption, including separation of children from their ill adoptive parents during the initial weeks postarrival, a period important for postadoption adjustment and attachment. All international adoptees arriving from countries with high or intermediate HAV endemicity should be screened for HAV infection on arrival to the United States.

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.

Attachment Behavior of Children Adopted Internationally at Six Months Post Adoption

The purpose of this pilot study was to describe attachment behavior in children adopted internationally at 6 months post adoption. Twenty-two children and their adoptive mothers were observed at home for completion of an attachment measure. Mothers also completed a questionnaire on their child's preadoption care. Comparisons of children low and high in attachment security suggested that low secure children showed predominantly ambivalent attachment behavior or that they were still in the process of forming an attachment. Children having foster versus orphanage care prior to adoption differed in quality of preadoption care and in certain attachment behaviors, but not in overall attachment security.