Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms in Children Adopted from Poland and their Atypical Association Patterns: a Bayesian Approach

René A. C. Hoksbergen,Anneloes L. van Baar,Donna A. de Maat,Catharina H. A. M. Rijk,Sandra Knuiman

doi:10.1007/s10802-017-0307-4

Abstract

Although high rates of attention-deficit hyperactivity disorder (ADHD) symptoms have been observed among internationally adopted children, research on these symptoms in Polish adoptees is lacking. Therefore, we examined ADHD symptoms in Polish adoptees and their relationship to pre-adoptive risk factors, that is, time in institutional care, early deprivation, and prenatal alcohol exposure. We further compared the association patterns and gender distribution of ADHD symptoms in children adopted from Poland to those reported in the literature for ADHD symptoms in non-adopted children. Dutch adoptive parents of 121 Polish adoptees (52% boys; Mage = 10.9 years, range 6.2–15.6; Mageadoption = 3.0 years, range 0.8–6.9) completed questionnaires regarding ADHD symptoms, pre-adoptive risk factors, attachment problems, conduct problems, and executive functioning deficits. Bayesian evaluation of informative hypotheses showed that Polish adoptees had increased levels of ADHD symptoms, compared to Dutch children in the general population. Time in institutional care, early deprivation, and prenatal alcohol exposure were not associated with ADHD symptoms. ADHD symptoms in Polish adoptees were more strongly associated with attachment problems and executive functioning deficits, but less strongly with conduct problems, compared to ADHD symptoms in non-adoptees. Furthermore, ADHD symptoms were more equally distributed among boys and girls than they are in non-adopted children. The findings indicate that Polish adoptees and their adoptive parents need special attention and support. The dissimilarities between ADHD symptoms in Polish adoptees and non-adoptees might indicate a different underlying causal mechanism, which may have important implications for clinical practice.

Highlights

High rates of attention-deficit hyperactivity disorder (ADHD) symptoms have been observed among internationally adopted children, research on these symptoms in Polish adoptees is lacking
Since children’s age at adoption and at time of study were not related to ADHD symptom levels, these variables were not included in the remaining analyses
It was found that hypothesis 2, assuming no effects of time in institutional care, early deprivation, and prenatal alcohol exposure on ADHD symptoms, received most support in the data

Summary

Introduction

High rates of attention-deficit hyperactivity disorder (ADHD) symptoms have been observed among internationally adopted children, research on these symptoms in Polish adoptees is lacking. This study may increase our understanding of behaviour problems in international adoptees with multiple early risk factors as well as their dissimilarities to behaviour problems often found in the general population of children This knowledge may help adoptive parents and professionals working with adoptees to offer the most appropriate care. Early institutionalization has been consistently related to increased levels of ADHD symptoms among adopted children (Gunnar et al 2007; Hawk and McCall 2010; MacLean 2003) Based on these findings, Rutter et al (2001) suggested that ADHD symptoms in international adoptees constitute a specific response to early institutional deprivation. Romanian adoptees who had spent more time in severely depriving institutions showed more ADHD symptoms (Kreppner et al 2001; Rutter et al 2007), supporting the idea that these symptoms may be partially caused by institutional deprivation

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