Children in adoptive families: overview and update

The Placement of Children in Need of Out-of-Home Care: Forms of Care and Differences in Attachment Security and Behavioral Problems in the Italian Context

The current paper investigated differences in secure attachment levels and behavioral problems among four groups of children in out-of-home care in Italy: closed adoption (child and birth parents not in contact following adoption), open adoption (child and birth parents still in contact after placement), foster care (child living temporarily with relatives or unrelated foster parents) and institutional care (child in residential care for large groups of children). One hundred and thirty children aged 10-19 were included in this study. The Attachment Interview for Childhood and Adolescence and the Achenbach Youth Self-Report were employed to measure participants' secure attachment levels and behavioral problems. Both a multivariate analysis of covariance and measured variable path analysis were performed. Age, gender and time elapsed between the request for child protection and placement on out-of-home care were used as covariates. The results showed that adolescents in closed adoption had higher secure attachment scores than those in foster care and institutional care, while adolescents in open adoption scored significantly higher on problem behaviors than those in the other out-of-home care groups. Findings were discussed in terms of limitations and implications for future research.

When the Good Object is also a Thief: A Memoir of Adoption

This contemporary Kleinian memoir explores the possible existence of an intrapsychic, adoption-specific preoedipal triad including child, birth mother, and adoptive mother that can shape the emerging mind. As an intrapsychic construct, the adoption triad comes to exist in the infantile mind, requiring that adoptees contend with four additional part-object maternal representations: a villain (bad birth mother), a victim (good birth mother), a rescuer (good adoptive other), and a thief (bad adoptive mother). The psychic complexities of this possible adoption triad are explored, with an eye to how it might illuminate the psychosocial challenges experienced by some adoptees, including dysregulated behavior, rage, dissociation, and shame. To this end, Bion's ideas regarding presymbolic, nondefensive communication and Winnicott's understanding of use of the object are invoked. Expanding the preoedipal paradigm of adoption to include the possibility of an intrapsychic, adoption-specific maternal triad can enhance our understanding of the psychology of adoption, as well as highlight the need to consider the ways in which internal objects can exist simultaneously in both dyadic and triadic paradigms.

Developmental and behavioral profile in a domestic adoptees sample: a new challenge for the pediatrician

BACKGROUND

The aim of this study is to investigate the changes of developmental and behavioral profile in a domestic adoptees sample.

METHODS

Thirty-six domestic adoptive families were recruited, resulting in a sample of 39 children. Families were sent a general questionnaire for collecting data related to the children demographic variables, infant's background (time spent in institutional care, age at adoption), children's health status and anthropometric measures at T<inf>0,</inf> T<inf>1</inf>, T<inf>2</inf>, and T<inf>3</inf>. Moreover, the Infant Behavior Questionnaire-Revised Very Short Form and a modified version of parent-report of Child Behavior Checklist were used to assess temperament and to detect behavioral problems.

RESULTS

As regards the psychopathological evaluation, behavior problems were more common in older children, especially among girls. In particular they exhibited a higher frequency of internalizing problems versus externalizing.

CONCLUSIONS

Children in foster care suffer discontinuity of care that negatively affects their emotional and physical development. It is important for pediatricians to be aware of the special needs of adopted children, providing adequate support to adoptive families.

Growth recovery in newly arrived international adoptees in Italy: relation to parenting stress

BACKGROUND

Following initial adversities, most internationally adopted children arrive with significant growth delays. Postplacement recovery has been widely documented, but research about risk or protective factors is still limited. Even less is known about the relationship between growth recovery and the quality of the family environment.

METHODS

Twenty-eight children in 26 adoptive families were involved in this longitudinal study. A comprehensive evaluation (including anthropometry, cognitive assessment [using the Leiter International Performance Scale-Revised], and completion by both parents of the Parenting Stress Index - Short Form) was done at arrival of the child, and 1 year later.

RESULTS

Results evidenced that on arrival nearly half of children had growth measurements in the normal range. All the children showed a significant recovery in height and weight at 6 and 12 months postplacement. Initial and follow-up growth measurements correlated strongly. Growth recovery was related to the age of the child at adoption, the proportion of time the child had resided in institutional care, as well as parenting stress. Results suggested that the higher the parenting stress experienced the less improvements occurred in children: for mothers for height and weight, for fathers for all the growth indicators.

CONCLUSIONS

Results suggested the critical importance of family factor in influencing children's growth recovery.

Dyadic adjustment and parenting stress in internationally adoptive mothers and fathers: the mediating role of adult attachment dimensions

Previous research has shown that a positive marital functioning represents a resource in adoptive families, leading to a decrease in parenting stress, but little is known about the factors mediating such a relationship. This study aimed to explore whether adult attachment avoidance and anxiety mediate the effect of dyadic functioning on parenting stress in 90 internationally adoptive couples (mothers and fathers) who had adopted a child (aged 3–10 years) in the last 36 months. Participants completed self-report measures of dyadic adjustment, adult attachment, and parenting stress. A series of path analyses supported the mediation hypothesis, but differentially for mothers and fathers. Among mothers, there was a direct and negative relationship between dyadic adjustment and parenting stress. In addition, a better dyadic adjustment was related to lower levels of attachment anxiety, which in turn were associated with less parenting stress. Among fathers, increased dyadic adjustment was related to lower levels of attachment avoidance, which in turn were associated with reduced parenting stress. These findings suggest the importance of including both mothers and fathers in adoption research. Adoptive parents could benefit from specific interventions aimed at reducing attachment avoidance and anxiety by supporting parental sense of competence and involvement for mothers and fathers, respectively.

Adoptive and Nonadoptive Mother-Child Behavioral Interaction: A Comparative Study at 4 Years of Age

Comparable samples of low-risk adopted and nonadopted children and mothers were observed during 3 tasks at age 4 years. Quality of mother-child interactions, child level of functioning in 4 domains, and maternal parenting satisfaction and social support were assessed. Adopted children were as competent as nonadopted children on measures of developmental functioning. Both groups of mothers expressed high satisfaction and support as parents. However, ratings of child, maternal, and dyadic behavior when interacting were all lower for adoptive dyads than for nonadoptive dyads, and adoptive dyads with boys accounted for the maternal and dyadic group differences.

Adoption status and family relationships during the transition to young adulthood

Although adoptive family research has increased, most has focused on childhood and adolescence. Despite the known importance of parent-adolescent relationships drawn from the general population, we know little about how adoptive family relationships change or remain the same as adopted adolescents enter young adulthood. Using the Sibling Interaction and Behavior Study, the purpose of this study was to build on previous research to explore differences in conflict, closeness, and relationship quality between adoptive and nonadoptive families during the transition from late adolescence into young adulthood. Self-report and independent observations were collected from children, mothers, and fathers at late adolescence (range: 14.50-18.49 years) and young adulthood (range:18.50-22.49 years), and analyzed using within-subjects repeated measures. Although adoptive family dyads had lower relationship indicators than nonadoptive family dyads, similar trends over time occurred for both family types. Using individuation theory, we suggest individuation occurs for both types of families, with adoptees facing unique additional challenges during this process, including integration of adoption status, adoption communicativeness, adoption information seeking, and relationship with birth parents as possible influences in this process.

Predictors of school engagement among same-sex and heterosexual adoptive parents of Kindergarteners

Little research has explored parental engagement in schools in the context of adoptive parent families or same-sex parent families. The current cross-sectional study explored predictors of parents' self-reported school involvement, relationships with teachers, and school satisfaction, in a sample of 103 female same-sex, male same-sex, and heterosexual adoptive parent couples (196 parents) of kindergarten-age children. Parents who reported more contact by teachers about positive or neutral topics (e.g., their child's good grades) reported more involvement and greater satisfaction with schools, regardless of family type. Parents who reported more contact by teachers about negative topics (e.g., their child's behavior problems) reported better relationships with teachers but lower school satisfaction, regardless of family type. Regarding the broader school context, across all family types, parents who felt more accepted by other parents reported more involvement and better parent-teacher relationships; socializing with other parents was related to greater involvement. Regarding the adoption-specific variables, parents who perceived their children's schools as more culturally sensitive were more involved and satisfied with the school, regardless of family type. Perceived cultural sensitivity mattered more for heterosexual adoptive parents' relationships with their teachers than it did for same-sex adoptive parents. Finally, heterosexual adoptive parents who perceived high levels of adoption stigma in their children's schools were less involved than those who perceived low levels of stigma, whereas same-sex adoptive parents who perceived high levels of stigma were more involved than those who perceived low levels of stigma. Our findings have implications for school professionals, such as school psychologists, who work with diverse families.

Predictors of parenting stress in lesbian, gay, and heterosexual adoptive parents during early parenthood

Little work has examined parenting stress in adoptive parents, particularly lesbian and gay adoptive parents. The current longitudinal study examined parent-reported child characteristics (measured postplacement) and parent and family characteristics (measured preplacement) as predictors of postplacement parenting stress and change in parenting stress across three time points during the first 2 years of adoptive parenthood, among 148 couples (50 lesbian, 40 gay, and 58 heterosexual) who were first-time parents. Children in the sample were, on average, 5.61 months (SD = 10.26) when placed, and 2.49 years (SD = .85) at the 2 year postplacement follow-up. Findings revealed that parents who had been placed with older children and parents who perceived severe emotional/behavioral problems in their children reported more postplacement stress. In addition, parents who reported fewer depressive symptoms, more love for their partners, and more family and friend support during the preplacement period had less postplacement stress. Parenting stress decreased for parents who perceived severe emotional/behavioral problems in their children, but it increased somewhat for those who reported developmental problems in their children. Findings highlight vulnerabilities and resources that may shape adoptive parents' experiences of stress in early parenthood, and have implications for both researchers and professionals who wish to support adoptive family adjustment.

Lesbian, Gay, and Heterosexual Adoptive Parents' Experiences in Preschool Environments

Little research has examined the school experiences of lesbian/gay (LG) parent families or adoptive parent families. The current exploratory study examined the experiences of 79 lesbian, 75 gay male, and 112 heterosexual adoptive parents of preschool-age children with respect to their (a) level of disclosure regarding their LG parent and adoptive family status at their children's schools; (b) perceived challenges in navigating the preschool environment and advocating on behalf of their children and families; and (c) recommendations to teachers and schools about how to create affirming school environments with respect to family structure, adoption, and race/ethnicity. Findings revealed that the majority of parents were open about their LG and adoptive family status, and had not encountered challenges related to family diversity. Those parents who did experience challenges tended to describe implicit forms of marginalization, such as insensitive language and school assignments. Recommendations for teachers included discussing and reading books about diverse families, tailoring assignments to meet the needs of diverse families, and offering school community-building activities and events to help bridge differences across families.

Health care support issues for internationally adopted children: a qualitative approach to the needs and expectations of families

BACKGROUND

Families of internationally adopted children may face specific problems with which general practitioners (GPs) may not be familiar. The aim of the study was to explore problems faced by families before, during and after the arrival of their internationally adopted child and to assess the usefulness of a specific medical structure for internationally adopted children, which could be a resource for the GP.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted a qualitative study using individual semistructured guided conversations and interviewed 21 families that had adopted a total of 26 children internationally in the Puy de Dome department, France, in 2003. Quantitative data were used to describe the pathologies diagnosed and the investigations performed.Our study showed that the history of these families, from the start of the adoption project to its achievement, is complex and warrants careful analysis. Health-care providers should not only consider the medical aspects of adoption, but should also be interested in the histories of these families, which may play a role in the forming of attachments between the adoptee and their adoptive parents and prevent further trouble during the development of the child. We also showed that adoptive parents have similar fears or transient difficulties that may be resolved quickly by listening and reassurance. Most such families would support the existence of a specific medical structure for internationally adopted children, which could be a resource for the general practitioner. However, the health-care providers interviewed were divided on the subject and expressed their fear that a special consultation could be stigmatizing to children and families.

CONCLUSIONS/SIGNIFICANCE

A specific consultation with well-trained and experienced practitioners acting in close collaboration with GPs and paediatricians may be of help in better understanding and supporting adopted children and their families.

Associations between Family Communication Patterns, Sibling Closeness, and Adoptive Status

Previous research has demonstrated the protective effect of family and sibling closeness on child adjustment, but fewer studies have investigated how closeness is promoted within families. Guided by Family Communication Patterns Theory, we tested the association between family communication and sibling emotional and behavioral closeness, and whether adoptive status moderated this relationship. Participating families included 616 adoptive and non-adoptive families with two adolescent children. Hypotheses were tested using structural equation modeling. Sibling closeness was highest in families that emphasized both conversation and conformity and lowest in families that emphasized only conversation or neither conversation nor conformity. Emotional and behavioral closeness were differentially associated with adoption status, sibling age, and sibling gender. Few moderating effects of adoption status were found. Post hoc analyses showed moderating effects of sibling gender composition.

Contributions of parent-adolescent negative emotionality, adolescent conflict, and adoption status to adolescent externalizing behaviors

Although most adopted children are well adjusted, research has consistently found that adopted adolescents are at an increased risk for externalizing behaviors. The present investigation tested a model whereby parent-adolescent negative emotionality traits, adolescent conflict, and adoption status contribute to adolescent externalizing behaviors. The study included 616 families with at least one parent and two adolescent siblings with a maximum 5-year age difference. The analyses used data from the mothers (M age = 45.56, SD = 4.23), fathers (M age = 48.23, SD = 4.42), and the elder sibling (M age = 16.14, SD = 1.5). Findings support two conflict-mediated family processes that contributed to externalizing behaviors: one initiated by parent-adolescent traits and one by adoption status. Findings also underscore the salience of conflict in families and the significance of aggressive traits and negative emotionality. Contrary to previous research, we found that adoption status did not directly add to our explanation of adolescent externalizing behaviors beyond our proposed process. Instead, adoption status was indirectly associated with externalizing problems through a conflict-mediated relationship.

Induced lactation and exclusive breast milk feeding of adopted premature twins

The authors report the first published case of premature twins whose adoptive mother induced lactation. Both infants are receiving exclusively human milk (adoptive mother's milk) at 2 months of age. This remarkable achievement reflects careful planning by the adoptive mother beginning in the prenatal period, her active role during the infants' hospital stay, and support from health care personnel and family members. Health care professionals are encouraged to support any adoptive mother who expresses interest in breastfeeding her infant(s).

A preliminary study of medial temporal lobe function in youths with a history of caregiver deprivation and emotional neglect

Previous research findings have linked caregiver deprivation and emotional neglect with sensitivity to threatening cues. The present preliminary study investigated whether dysfunctions of the medial temporal lobe could underlie these associations. Using fMRI, we measured medial temporal lobe responses to emotional faces (angry, fearful, happy, neutral) among 30 youths. Eleven of the youths had a history of caregiver deprivation and emotional neglect. Attention states (i.e., attention to anger, fear, or physical attributes, or passive viewing) were systematically manipulated. Relative to comparison youths, youths with a history of caregiver deprivation and emotional neglect showed significantly greater left amygdala and left anterior hippocampus activation during the processing of threatening information. To our knowledge, these findings are the first to demonstrate altered medial temporal lobe function during the processing of threat cues in youths with a history of caregiver deprivation and emotional neglect.

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.

An adoption study of parental depression as an environmental liability for adolescent depression and childhood disruptive disorders

OBJECTIVE

The authors used an adoption study design to investigate environmental influences on risk for psychopathology in adolescents with depressed parents.

METHOD

Participants were 568 adopted adolescents ascertained through large adoption agencies, 416 nonadopted adolescents ascertained through birth records, and their parents. Clinical interviews with parents and adolescents were used to determine lifetime DSM-IV-TR diagnoses of major depressive disorder, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder (ADHD), and substance use disorders in adolescents and major depression in mothers and fathers. Effects of parental depression (either parent with major depression, maternal major depression, and paternal major depression) on adolescent psychopathology were tested in nonadopted and adopted adolescents separately, and interactive effects of parental depression and adoption status were tested.

RESULTS

Either parent having major depression and a mother having major depression were associated with a significantly greater risk for major depression and disruptive behavior disorders in both nonadopted and adopted adolescents. Paternal depression did not have a main effect on any psychiatric disorder in adolescents and, with one exception (ADHD in adopted adolescents), did not predict significantly greater likelihoods of disorders in either nonadopted or adopted adolescents.

CONCLUSIONS

Maternal depression was an environmental liability for lifetime diagnoses of major depression and disruptive disorders in adolescents. Paternal depression was not associated with an increased risk for psychopathology in adolescents.

The mental health of US adolescents adopted in infancy

OBJECTIVE

To determine whether adopted adolescents are at excess risk for clinically relevant behavioral and emotional problems.

DESIGN

We examined whether adopted and nonadopted adolescents differed on quantitative indicators of mental health and the prevalence of childhood disorders and whether differences exist between internationally and domestically placed adoptees.

SETTING

Assessments occurred at the University of Minnesota from December 11, 1998, to June 4, 2004.

PARTICIPANTS

Adolescents adopted in infancy were systematically ascertained from records of 3 large Minnesota adoption agencies; nonadopted adolescents were ascertained from Minnesota birth records. The final sample included these adolescents with their rearing parents. Main Exposure The main exposure was adoptive status: nonadopted (n = 540), international adoptive placement (n = 514), or domestic adoptive placement (n = 178).

OUTCOME MEASURES

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) clinical assessments based on child and parent reports of attention-deficit/hyperactivity, oppositional defiant, conduct, major depressive, and separation anxiety disorders; teacher reports of psychological health; and contact with mental health professionals.

RESULTS

Adoptees scored only moderately higher than nonadoptees on quantitative measures of mental health. Nevertheless, being adopted approximately doubled the odds of having contact with a mental health professional (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.48-2.84) and of having a disruptive behavior disorder (OR, 2.34; 95% CI, 1.72-3.19). Relative to international adoptees, domestic adoptees had higher odds of having an externalizing disorder (OR, 2.60; 95% CI, 1.67-4.04).

CONCLUSIONS

Moderate mean differences in quantitative indicators of mental health can lead to substantial differences in disorder prevalence. Although most adopted adolescents are psychologically healthy, they may be at elevated risk for some externalizing disorders, especially among those domestically placed.

The moral complexity of sperm donation

Sperm donation is a widely accepted and increasingly common practice. In the standard case, a sperm donor sells sperm to an agency, waives his parental rights, and is absolved of parental responsibility. We tend to assume that this involves no problematic abandonment of parental responsibility. If we regard the donor as having parental responsibilities at all, we may think that his parental responsibilities are transferred to the sperm recipients. But, if a man creates a child accidentally, via contraception failure, we tend to assume that the man does indeed have parental responsibilities. Assessing these contrasting conclusions requires a theory of parental responsibility. I analyse prevalent theories of what makes someone parentally responsible and show that none of these theories can withstand scrutiny. I propose a new theory of parental responsibility, which, I argue, is more plausible than the alternatives. My theory of parental responsibility is based on our ownership and control over hazardous materials, namely, our gametes. I show that neither my theory, nor the theories I reject, can support our contrasting intuitions. I conclude that sperm donors are fathers, with parental responsibility. I argue that the alternative conclusion, that neither sperm donors nor accidental fathers are parentally responsible for their resulting offspring, is less plausible. I then consider whether parental responsibility can be transferred and argue that it is far from clear that it can. Finally, I address objections and consider some practical implications of these views.

Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption

Are serious growth delays caused by malnutrition and neglect permanent or reversible? The effects of institutionalization and international adoption on children's physical growth are estimated with meta-analysis. Studies with sufficient data to compute differences between adoptees and the reference population (33 papers with 122 study outcomes) were collected through Web of Science, ERIC (Education Resource Information Center), PsycINFO (Psychological Literature), and Medline (U.S. National Library of Medicine) (1956-2006). The influence of pre- and postadoption care on height, weight, and head circumference was tested. Effect sizes (d) and confidence intervals (CIs) around the point estimate for the growth lag indices were computed. The more time spent in institutional care, the more the children lagged behind in physical growth (d = 1.71, 95% CI: 0.82-2.60, n = 893). At adoptive placement, the children showed large delays in height, weight, and head circumference (d = -2.39 to -2.60; n = 1331-3753). Although after adoption, they showed almost complete catch-up of height (d = -0.57, 95% CI: -0.87 to -0.27, n = 3437 adoptees) and weight (d = -0.72, 95% CI: -1.04 to -0,39, n = 3259 adoptees), catch-up of head circumference seemed slower and remained incomplete (d = -1.56, 95% CI: -2.27 to -0.85, n = 527). Later age at arrival was related to less complete catch-up of height and weight. International adoption leads to substantial catch-up of height and weight but not of head circumference, demonstrating differential plasticity of children's physical growth.

The health and well-being of adopted children

OBJECTIVE

We compared the health and well-being of adopted and biological children and examined whether observed differences may be a result of differences between these 2 groups in demographic characteristics and special health care needs.

METHODS

The 2003 National Survey of Children's Health was funded by the Maternal and Child Health Bureau, Health Resources and Services Administration, and was conducted as a module of the State and Local Area Integrated Telephone Survey by the National Center for Health Statistics, Centers for Disease Control and Prevention. The nationally representative sample consisted of 102,353 children, including 2903 adopted children. We compared estimates for 31 indicators of health and well-being for adopted and biological children and present adjusted estimates that control for differences in demographic characteristics and special health care needs prevalence.

RESULTS

Adopted children are more likely than biological children to have special health care needs, current moderate or severe health problems, learning disability, developmental delay or physical impairment, and other mental health difficulties. However, adopted children are more likely than biological children to have had a preventive medical visit or a combination of preventive medical and dental visits during the previous year, to receive needed mental health care, and to receive care in a medical home; they are more likely to have consistent health insurance coverage, to be read to daily, or to live in neighborhoods that are supportive, and they are less likely to live in households in which someone smokes. These differences between adopted and biological children remain statistically significant even after adjustments for differences in demographic characteristics and the prevalence of special health care needs.

CONCLUSION

The results suggest that, although adopted children may have poorer health than biological children, their parents may be doing more to ensure that they have needed health care and supportive environments.

The Emanuel Miller Memorial Lecture 2006: adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development

BACKGROUND

Adopted children have been said to be difficult children, scarred by their past experiences in maltreating families or neglecting orphanages, or by genetic or pre- and perinatal problems. Is (domestic or international) adoption an effective intervention in the developmental domains of physical growth, attachment security, cognitive development and school achievement, self-esteem, and behaviour problems?

METHOD

Through a series of meta-analyses on more than 270 studies that include more than 230,000 adopted and non-adopted children and their parents an adoption catch-up model was tested.

RESULTS

Although catch-up with current peers was incomplete in some developmental domains (in particular, physical growth and attachment), adopted children largely outperformed their peers left behind. Adoptions before 12 months of age were associated with more complete catch-up than later adoptions for height, attachment, and school achievement. International adoptions did not lead to lower rates of catch-up than domestic adoptions in most developmental domains.

CONCLUSIONS

It is concluded that adoption is an effective intervention leading to massive catch-up. Domestic and international adoptions can be justified on ethical grounds if no other solutions are available. Humans are adapted to adopt, and adoption demonstrates the plasticity of child development.