Emotional health of Indonesian adoptees living in Australian families

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.

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.

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.

Troubles du comportement externalisés à l’adolescence et adoptions internationales : revue de la littérature

INTRODUCTION

International adoption involves more than 40 000 children a year. The objective of this review is to estimate the effects of international adoption on externalizing behaviour problems during adolescence. In this paper we examine the prevalence of externalizing problem behaviours in samples of adolescents who were adopted from a foreign country as infants or young children, compare to non-adopted adolescents.

SETTING

We searched Medline, Inist and psycInfo from 1960 to 2005 using the terms adopt* combined with behaviour problem, behaviour disorder, maladjustment or mental health.

METHODS

The search was limited to English and French-language publications. Studies that were selected involved adoptees in the general population and compared international adoptees with non-adopted controls. Adoptees from 12 to 22 years old were included. We included studies using the Child Behaviour Check List or related measures to measure externalizing problem behaviour. We reviewed 10 studies from 1990 to 2002 and 2 meta-analyses (2003, 2005).

RESULTS

Results indicate that 6 studies conclude that internationally adopted adolescents exhibit more externalizing behaviour problems than do non-adopted adolescents, and 4 studies conclude that there is no difference between the two groups. The two meta-analyses concluded that the prevalence of externalizing behaviour problems is increased. The difference, however, is small. International adoptees with preadoption adversity showed more externalizing problems than international adoptees whithout evidence of extreme deprivation.

CONCLUSION

Finally, it should be stressed that adoption itself is not a risk factor in the adjustment of adolescents. Differences between groups of adopted and non-adopted adolescents may reflect the presence of a small number of severely disturbed adolescents, possibly with extremely adverse pre-placement histories.