Long-Term Effects of Pre-Placement Risk Factors on Children's Psychological Symptoms and Parenting Stress Among Families Adopting Children From Foster Care

Professional Quality of Life of Foster and Kinship Carers in Australia, United Kingdom, and the United States: A Scoping Review

Professional quality of life (ProQOL) refers to workers' subjective feelings associated with work involved in helping others who have experienced trauma. It consists of positive and negative aspects, that is, subscales of compassion satisfaction, and burnout and secondary traumatic stress. Foster and kinship caring inherently involves risks associated with exposure to the trauma responses of children in their care. This exposure can lead to poor ProQOL, carer attrition, and placement instability. While limited studies specifically explore ProQOL of carers, many studies have examined factors and interventions related to ProQOL. However, there is a lack of synthesis of these studies. To fill such a research gap, we undertook a scoping review of 70 empirical studies from Australia, the United Kingdom, and the United States, published from 2012 to 2022 reporting on ProQOL, and its related factors and concepts. We applied a multilevel ecosocial construct to examine complex interrelationships between private and governance settings to better understand factors related to ProQOL of carers and interventions aimed to improve it in these dynamic systems. In our review, some studies showed positive outcomes for carers, such as reduced stress or burnout associated with training. However, there was insufficient attention to factors associated with ProQOL at relational and sociopolitical levels. It is crucial to improve carers' ProQOL or well-being to ensure their retention and placement stability. Long-term systemic improvements require interventions across different levels of the system.

Therapeutic and Preventive Interventions in Adolescents with Borderline Personality Disorder: Recent Findings, Current Challenges, and Future Directions

BACKGROUND

Borderline personality disorder (BPD) has long suffered from overshadowing in adolescents and hopelessness from the psychiatrists themselves. Comprehensive guidelines for this age group are lacking.

AIMS

This narrative review aims to describe current recommendations for BPD and recent empirical evidence on effective treatments (both pharmacological and non-pharmacological) and preventive approaches. Innovative approaches, based on recent and original research on BPD adolescents, are also discussed.

RESULTS

Very low-certainty evidence has supported that medication has a positive effect on core BPD symptoms in adolescents. Medication prescribed for suicidal crises or associated disorders should be included in a global therapeutic plan, including efficacy reassessment, treatment duration, and a security plan. The overall benefit of structured psychotherapy for adolescents with BPD (cognitive behavioral therapy, mentalization-based therapy, dialectic behavioral therapy, and group therapy) is more important for self-harm behaviors than other BPD symptoms. Their specific efficacy, although difficult to distinguish from the overall non-specific effect of integrative care.

CONCLUSIONS

structured care of young BPD individuals should be based on the following principles: (1) setting the frame of care, including recognition of the diagnosis, and sharing information with patients and families about symptoms, prognosis, and putative psychological mechanisms involved; and (2) promoting comprehensive approaches, including both specific and non specific therapy, ecological interventions, community care, and preventive interventions in at-risk groups.

Overlapping brain correlates of superior cognition among children at genetic risk for Alzheimer's disease and/or major depressive disorder

Early life adversity (ELA) tends to accelerate neurobiological ageing, which, in turn, is thought to heighten vulnerability to both major depressive disorder (MDD) and Alzheimer's disease (AD). The two conditions are putatively related, with MDD representing either a risk factor or early symptom of AD. Given the substantial environmental susceptibility of both disorders, timely identification of their neurocognitive markers could facilitate interventions to prevent clinical onset. To this end, we analysed multimodal data from the Adolescent Brain and Cognitive Development study (ages 9-10 years). To disentangle genetic from correlated genetic-environmental influences, while also probing gene-adversity interactions, we compared adoptees, a group generally exposed to substantial ELA, with children raised by their biological families via genetic risk scores (GRS) from genome-wide association studies. AD and MDD GRSs predicted overlapping and widespread neurodevelopmental alterations associated with superior fluid cognition. Specifically, among adoptees only, greater AD GRS were related to accelerated structural maturation (i.e., cortical thinning) and higher MDD GRS were linked to delayed functional neurodevelopment, as reflected in compensatory brain activation on an inhibitory control task. Our study identifies compensatory mechanisms linked to MDD risk and highlights the potential cognitive benefits of accelerated maturation linked to AD vulnerability in late childhood.

Long-term effects of pre-adoptive risk on emotional and behavioral functioning in children adopted from foster care

BACKGROUND

Children adopted from foster care are at heightened risk for emotional and behavioral challenges, potentially due to early trauma exposure and related risk factors. Research has demonstrated that adoptees with greater pre-adoptive risk exhibit higher rates of internalizing and externalizing problems across childhood and into adulthood. However, these studies have been limited by their use of individual risk factors or sum scores of cumulative risk and their measurement of internalizing and externalizing behaviors separately.

OBJECTIVE

The current study aimed to examine effects of pre-adoptive risk on long-term functioning in children adopted from foster care.

METHOD

In a longitudinally-followed sample of 82 adoptees, we utilized latent growth curve modeling to examine effects of two latent indices of pre-adoptive risk, postnatal (i.e., trauma-related) risk and prenatal risk (not including prenatal substance exposure, since it was nearly ubiquitous in this sample), on adoptee internalizing, externalizing, and latent scores of dysregulation across childhood. Additionally, in three separate models, we tested whether baseline levels and change across childhood in internalizing, externalizing, and dysregulation mediated effects of prenatal and postnatal risk on adolescent/young-adult functioning.

RESULTS

Greater postnatal risk, but not prenatal risk, predicted higher levels of internalizing and dysregulation across childhood. However, only dysregulation mediated the effect of postnatal risk on adolescent/young-adult functioning.

CONCLUSIONS

These results are consistent with prior research evidencing long-term effects of postnatal pre-adoptive risk, but not prenatal risk, in adoptees. Furthermore, they suggest that trauma exposure in this population may result in a profile of broad dysregulation that increases risk for maladjustment into adulthood.

Attachment Theory: A Barrier for Indigenous Children Involved with Child Protection

BACKGROUND

Attachment theory is an established theoretical understanding of the intimate relationships between parental figures and children. The theory frames the ways in which a child can be supported to develop within a secure base that prepares them for adulthood, including entering into and sustaining intimate relationships. The theory, built on the work of John Bowlby following World War II, has extensive literature supporting its application across multiple cultures and nations, although its roots are heavily tied to Eurocentric familial understandings. However, the theory has also been heavily criticized as not being appropriate for child intervention decision-making. Further, its application to Indigenous caregiving systems is also under question. Yet courts rely heavily on applying the theory to questions of sustaining Indigenous children in non-Indigenous care when return to biological parents is deemed impossible.

METHODS

This article draws upon the consistent arguments used in leading Canadian child welfare legal decisions and case examples to show how Attachment Theory is applied relative to Indigenous children and families.

RESULTS

Attachment Theory drawing upon Eurocentric framing, and as applied in Canadian child protection systems, as seen in precedent court decisions, is given priority over living in culture. This occurs even though the research reviewed has shown that the traditional dyadic version of the theory is not valid for Indigenous peoples.

CONCLUSIONS

While all children will attach to a caregiver or caregiving system, such as kinship or community, leading legal decisions in Canada tend to rely on Eurocentric versions of the theory, which is contrary to the best interests of Indigenous children. Child protection needs to reconsider how attachment can be used from appropriate cultural lenses that involve the communal or extended caregiving systems common to many Canadian Indigenous communities. Child protection should also recognize that there is not a pan-Indigenous definition of attachment and child-rearing, so efforts to build working relationships with various Indigenous communities will be needed to accomplish culturally informed caregiving plans. In addition, continued advocacy in Canada is needed to have child protection decision-making conducted by the Indigenous communities, as opposed to Eurocentric provincial or territorial agencies.

Adoptive parents' finances and employment status: a 5-year longitudinal study

We investigated risk and facilitating factors related to families' change in finances and employment over 5 years following adoption of a child from local authority care in a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Parents completed questionnaires at approximately 5, 21, 36, 48 and 60 months post-placement. We used time series analysis to examine the impact of child (e.g. pre-placement experiences, mental health), family structure (e.g. number of siblings, parent relationship status), and parent (e.g. mental health) factors on change in household income and parent employment status after adoption. We also examined the tendency for parents to comment on employment and finances and the emotional valence of their comments to gauge their concern about their circumstances. Children's mental health problems were associated with primary caregivers reducing their time spent in employment and parents' tendency to comment on their financial and work circumstances. Children who experienced more moves in care were more likely to have a primary caregiver not in full-time work, as were children with higher prosocial behaviour scores. Being in full-time work was associated with parents' symptoms of anxiety. We also detected associations between structural features of the family and changes in income and employment. This study represents one of the first empirical investigations of factors associated with the socioeconomic features of adoptive families' lives and informs ongoing discussion regarding the support needs of families and the timing, nature, and delivery of post-adoption professional services.

Intelligent Simulation of Children's Psychological Path Selection Based on Chaotic Neural Network Algorithm

In recent years, there are many problems in the study of intelligent simulation of children's psychological path selection, among which the main problem is to ignore the factors of children's psychological path selection. Based on this, this paper studies the application of chaotic neural network algorithm in children's mental path selection. First, an intelligent simulation model for children's mental path selection based on chaotic neural network algorithm is established; second, it will combine the network based on different types of visual analysis strategies. The model is used to analyze the influencing factors of children in different regions in the choice of psychological paths. Finally, experiments are designed to verify the actual application effect of the simulation model. The results show that compared with the current mainstream intelligent simulation methods with iterative loop algorithms as the core, it adopts the intelligent simulation model based on the chaotic neural network algorithm has a good classification effect. It can effectively select the optimal psychological path according to the differences in children's personality and can adaptively classify children in different regions, and the experimental results are accurate. Compared with the traditional method, it is improved by at least 37%.

Charting the trajectories of adopted children's emotional and behavioral problems: The impact of early adversity and postadoptive parental warmth

Children who are adopted from care are more likely to experience enduring emotional and behavioral problems across development; however, adoptees’ trajectories of mental health problems and factors that impact their trajectories are poorly understood. Therefore, we used multilevel growth analyses to chart adoptees’ internalizing and externalizing problems across childhood, and examined the associations between preadoptive risk and postadoptive protective factors on their trajectories. This was investigated in a prospective longitudinal study of case file records (N = 374) and questionnaire-based follow-ups (N = 96) at approximately 5, 21, and 36 months postadoptive placement. Preadoptive adversity (indexed by age at placement, days in care, and number of adverse childhood experiences) was associated with higher internalizing and externalizing scores; the decrease in internalizing scores over childhood was accelerated for those exposed to lower levels of preadoptive risk. Warm adoptive parenting was associated with a marked reduction in children's internalizing and externalizing problems over time. Although potentially limited by shared methods variance and lack of variability in parental warmth scores, these findings demonstrate the deleterious impact of preadoptive risk and the positive role of exceptionally warm adoptive parenting on children's trajectories of mental health problems and have relevance for prevention and intervention strategies.

Early adversity predicts adoptees' enduring emotional and behavioral problems in childhood

Children adopted from the public care system are likely to experience a cluster of inter-related risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children's mental health post-placement are not well understood. We conducted a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Adoptive parents completed questionnaires at approximately 5, 21, 36, and 48 months post-placement. We used time series analysis to examine the impact of pre-adoptive risk factors [adverse childhood experiences [ACEs], number of moves, days with birth parents and in care] on children's internalizing and externalizing problems, and prosocial behavior over 4 years post-placement. Adoptees' internalizing and externalizing problems remained consistently high over the 4-year study period, but more ACEs predicted increases in internalizing and externalizing problems. Contrary to expectations, more pre-placement moves and time in care predicted fewer problems over time, but exploratory analyses of interactive effects revealed this was only the case in rare circumstances. We identify pre- and post-removal factors that may incur benefits or have a deleterious impact on adoptees' outcomes in post-adoptive family life. Our findings provide knowledge for front-line professionals in the support of adoptive families and underscore the vital need for effective early intervention.

"People said we were nuts … I understand what they were saying now": An Exploration of the Transition to Parenthood in Sibling Group Adoption

Despite U.S. federal laws that require placing siblings together in foster care whenever possible, a majority of children are still separated from at least one of their siblings when in foster care or when adopted, due to various barriers including difficulty finding adoptive parents that match the needs of sibling groups. Few studies have focused on the experiences of parents who adopt sibling groups, resulting in little understanding of (a) their motivations for doing so, and (b) the challenges and strengths that accompany sibling group adoption. The current exploratory longitudinal qualitative study aims to address this gap. Twelve parents in six same-sex couples who adopted a sibling group from foster care were interviewed before, immediately after, and two years after they adopted. Findings indicate that sibling group adoption introduces several obstacles during the transition to parenthood including difficulty responding to children's varied needs during the transition and difficulty developing a close bond with each child. Further, parents described challenges integrating their own expectations with the family practices of the sibling group. Parents also indicated ways that adopting siblings together deepened their understanding of their children's behaviors and provided opportunities to establish family norms even when one child was struggling to adapt to the transition. After several years, parents reported reorganizing their family roles to meet the needs of their children. They also identified areas of perceived competence (e.g., behavior management) and areas where challenges persisted (e.g., navigating birth family contact). Implications for policy and practice around supporting sibling group adoptions are discussed.

The neurocognitive profiles of children adopted from care and their emotional and behavioral problems at home and school

Adoptees' mental health problems in childhood and later life are well described, but little attention has been paid to domestically adopted children's emotional and behavioral problems and neurocognitive profiles. The aim of this study was to describe the neurocognitive profiles of domestically adopted children in the UK and their parent- and teacher-rated emotional and behavioral problems. Forty-five children (M age = 75.96 months, SD = 12.98; 51.1% female) who were placed for adoption from public care at a M age of 22.14 months (SD = 14.21) completed a battery of age standardized neurocognitive tests, and adoptive parents and school teachers rated their emotional and behavioral problems. Children had more emotional and behavioral problems than the general population and over a fifth scored low (> 1 SD below the expected range for their age) in 5/6 neurocognitive tasks. Children who scored low on the non-verbal reasoning task were more likely to have more parent- and teacher-rated behavioral problems, and children's performance on the inhibitory control and cognitive flexibility tasks were associated with parent-rated behavioral problems. Children's verbal reasoning scores were positively associated with both parent- and teacher-rated emotional problems. Children who were adopted later in childhood scored significantly lower in non-verbal reasoning. Although longitudinal studies are needed to clarify the nature of neurocognitive functioning as a marker for later mental health problems, our findings underscore the importance of using comprehensive assessments to better recognize adopted children's difficulties and inform appropriate intervention initiatives.

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.

Externalizing behaviors among adopted children: A longitudinal comparison of preadoptive childhood sexual abuse and other forms of maltreatment

Previous research has established that child sexual abuse (CSA) and other forms of child maltreatment can have lasting and profound implications for survivors in terms of externalizing symptomatology. Few studies, however, have examined long-term consequences of CSA and maltreatment among adopted children. Guided by a polyvictimization framework, the present study investigated: (a) rates of co-occurrence of pre-adoptive CSA and maltreatment among adopted children, and (b) the relative impact of pre-adoptive CSA and maltreatment on externalizing behaviors at 14 years post-adoption. Analyses were based on four waves of data from the California Long-Range Adoption Study (CLAS) (n = 522); outcomes were measured using an adapted version of the Behavioral Problems Index (BPI). The diverse sample (36% non-White) was evenly divided by gender (50% female/male) and included a large number of children adopted from foster care (42.1%). Results indicated that 24.3% (n = 127) of children experienced at least one form of maltreatment; of those children, nearly half (46.5%; n = 59) experienced multiple abuse types (e.g., neglect, sexual, physical). Among cases of CSA (7.7%; n = 40), the vast majority (92.5%; n = 37) occurred with other forms of maltreatment. Hierarchical linear mixed models indicated that pre-adoptive CSA was associated with nearly a full unit increase in BPI scores (.92; p<.01). Neglect was associated with nearly a half unit increase in BPI (.48; p<.05). Gender was also significant; girls had lower BPI scores than boys (-0.57; p< .001). Implications for future research and practice are discussed.

Longitudinal Relationships Between Foster Children’s Mental Health Problems and Parental Stress in Foster Mothers and Fathers

Abstract. This paper focuses on the longitudinal relationships between foster children’s mental health problems and parental stress across a 1-year interval with three measurements. A sample of 94 foster children and a comparison group of 157 biological children and their families participated in this study. The age of the children was between 2 and 7 years. At the initial assessment, the foster children had been in their foster families since 2–24 months. Based on Child Behavior Checklist (CBCL) scores, the results indicated increased internalizing and externalizing mental health problems in the foster children group. Both mental health scores remained rather stable across the longitudinal assessments in foster as well as in biological children. Internalizing as well as externalizing scores were substantially correlated with parental stress in both samples. Moreover, changes in mental health scores were associated with changes in parental stress. However, cross-lagged panel analyses showed no clear pattern of temporal relationships between children’s mental health scores and parental stress. Implications as well as strengths and limitations of the current study are addressed in the Discussion section.

Children's mental health problems and their relation to parental stress in foster mothers and fathers

BACKGROUND

This study focuses on children living in foster families with a history of maltreatment or neglect. These children often show adverse mental health outcomes reflected in increased externalizing and internalizing problems. It is expected that these adverse outcomes are associated with increased parental stress levels experienced by foster mothers as well as foster fathers.

METHODS

The study sample included 79 children living in foster families and 140 children living in biological families as comparison group. The age of the children ranged from 2 to 7 years. Mental health problems were assessed with the Child Behavior Checklist, while parenting stress was measured with a parenting stress questionnaire including subscales on the amount of experienced stress and the amount of perceived support. The Child Behavior Checklist assessments were based mainly on maternal reports, while the parental stress assessments were based on maternal as well as paternal reports.

RESULTS

As expected the results showed increased externalizing and internalizing scores for the foster children accompanied by increased parental stress experiences in the foster family sample (however only in the maternal, but not in the paternal stress reports). The stress differences between the foster and biological family groups disappeared, when the children's mental health problem scores were included as covariates. Moreover, especially the externalizing scores were strong predictors of parental stress in both, the groups of foster and biological parents. The amount of perceived social support was associated with reduced parental stress, but only in the group of biological fathers.

CONCLUSION

The emergence of parental stress in biological as well as foster parents is closely related to child characteristics (mainly externalizing child problems). Possible implications for the reduction of parental stress are discussed as a consequence of the present results.