Non-adopted Youth Research Articles

Early Life Stress Is Associated with Alterations in Lymphocyte Subsets Independent of Increased Inflammation in Adolescents.

Early life stress (ELS) is linked to an elevated risk of poor health and early mortality, with emerging evidence pointing to the pivotal role of the immune system in long-term health outcomes. While recent research has focused on the impact of ELS on inflammation, this study examined the impact of ELS on immune function, including CMV seropositivity, inflammatory cytokines, and lymphocyte cell subsets in an adolescent cohort. This study used data from the Early Life Stress and Cardiometabolic Health in Adolescence Study (N = 191, aged 12 to 21 years, N = 95 exposed to ELS). We employed multiple regression to investigate the association between ELS, characterized by early institutional care, cytomegalovirus (CMV) seropositivity (determined by chemiluminescent immunoassay), inflammation (CRP, IL-6, and TNF-a determined by ELISA), and twenty-one immune cell subsets characterized by flow cytometry (sixteen T cell subsets and five B cell subsets). Results reveal a significant association between ELS and lymphocytes that was independent of the association between ELS and inflammation: ELS was associated with increased effector memory helper T cells, effector memory cytotoxic T cells, senescent T cells, senescent B cells, and IgD- memory B cells compared to non-adopted youth. ELS was also associated with reduced percentages of helper T cells and naive cytotoxic T cells. Exploratory analyses found that the association between ELS and fewer helper T cells and increased cytotoxic T cells remained even in cytomegalovirus (CMV) seronegative youth. These findings suggest that ELS is associated with cell subsets that are linked to early mortality risk in older populations and markers of replicative senescence, separate from inflammation, in adolescents.

Early-life stress and current stress predict BMI and height growth trajectories in puberty.

In cross-sectional analyses, early institutional care is associated with shorter stature but not obesity during puberty in children adopted into US families. We examined whether shorter stature and leaner body composition in youth adopted internationally from institutions would continue as puberty progressed. We also examined whether current psychosocial stress would moderate the association between early institutional deprivation and growth during adolescence. Using an accelerated longitudinal design and linear mixed-effects models, we examined the height and body mass index (BMI) of 132 previously institutionalized (PI) and 176 nonadopted (NA) youth. We examined youth aged 7-15 at the beginning of the study three times across 2 years. Nurses assessed anthropometrics and pubertal status. Current psychosocial stress was measured using the Youth Life Stress Interview. Our results indicated that PI youth remained shorter and leaner across three assessments than NA youth. However, age-and-sex-adjusted BMI increased faster in PI youth. Psychosocial stress during puberty predicted greater age-and-sex-adjusted BMI, but this effect did not differ by group. The gap in BMI but not height appears to close between PI and NA youth. Higher psychosocial stress was associated with higher BMI during puberty.

High Rates of Viral Suppression and Care Retention Among Youth Born Outside of the United States with Perinatally Acquired HIV.

Youth born outside of the US with perinatally acquired HIV infection (YBoUS-PHIV) account for most children living with HIV in the US, but there are few data characterizing their care outcomes. We conducted a retrospective study of YBoUS-PHIV receiving care across 3 HIV clinics in the Southeastern US between October 2018 and 2019. Primary outcomes were retention in care and viral suppression defined as (1) proportion of suppressed viral loads (VLs) and (2) having all VLs suppressed (definition 1 presented in the abstract). Primary predictors were age, adoption and disclosure status (full, partial and none/unknown). Multivariable logistic regression and χ 2 tests were used to test for associations with care outcomes. Analysis of disclosure status was restricted to youth greater than or equal to 12 years. The cohort included 111 YBoUS-PHIV. Median age was 14 years (interquartile range, 12-18), 59% were female, and 79% were international adoptees. Overall, 84% of patients were retained in care, and 88% were virally suppressed at each VL measurement. Adopted youth were more likely to be virally suppressed than nonadopted youth [odds ratio (OR), 7.08; P < 0.01] although the association was not statistically significant in adjusted analysis (adjusted OR, 4.26; P = 0.07). Neither age nor adoption status was significantly associated with retention. Among 89 patients greater than or equal to 12 years, 74% were fully disclosed of their HIV status, 12% were partially disclosed, and 13% had not started the disclosure process. There was no significant difference in retention or viral suppression by disclosure status. YBoUS-PHIV achieved high rates of retention and viral suppression. Adopted youth may be more likely to achieve viral suppression which may reflect the need for tailored interventions for nonadopted youth.

Pubertal stress recalibration and later social and emotional adjustment among adolescents: The role of early life stress

The current study investigated whether recalibration of the hypothalamic-pituitary -adrenocortical (HPA) axis stress response in youth who had previously experienced early life stress (ELS) would predict socioemotional adjustment in a follow-up assessment approximately 2–4 years later when youth were 12- to 21-years old. The sample consisted of previously institutionalized (PI) (N = 96) youth and a comparison non-adopted (NA) group (N = 117). Youth were 16 years old on average at the time of the follow-up assessment. Parent and youth-reported measures were used to assess youth’s internalizing symptoms and emotion regulation. Parent-reported measures were used to assess youth’s externalizing symptoms. We tested whether showing cortisol increases (vs. not) across the peripubertal period was associated with later social and emotional adjustment differently for PI and NA youth. Significant interactions emerged showing that for PI youth only, increases in cortisol reactivity across the peripubertal period was associated with poorer subsequent socioemotional functioning.

Academic Achievement and Postsecondary Educational Attainment of Domestically and Internationally Adopted Youth

Adopted youth often do not achieve in school as well as their non-adopted peers. We used data from the High School Longitudinal Study to examine high school and postsecondary achievement outcomes in adopted youth. We compared outcomes for domestically adopted youth, internationally adopted youth, and non-adopted youth. Results indicate that domestically adopted youth have lower grade point averages. Internationally adopted youth were less likely to enroll in four-year postsecondary institutions than were non-adopted youth.

Reconciling realities, adapting expectations, and reframing “success”: Adoptive parents respond to their children’s academic interests, challenges, and achievement

Adoptive parents are often well-educated, and potentially highly involved in children’s schooling. At the same time, adopted youth tend to struggle more academically than non-adopted youth. Amidst this reality, of interest is how adoptive parents perceive and make sense of their children’s academic performance, and form expectations for the future. This study of 63 parents in 33 families (11 lesbian mother, 11 gay father, 11 heterosexual parent) with school-aged children (mean age = 10) adopted via private domestic, public domestic, and international adoption, explores parents’ ideas about (a) children’s academic functioning, (b) the relative role of “nature” versus “nurture” in their abilities and challenges, and (c) children’s educational and vocational futures. Findings indicated a typology of parents: “inspired,” “pragmatic,” and “concerned.” “Inspired” parents described their children as bright and high-performing and were generally optimistic about their educational futures. Parents often acknowledged the positive contributions of birth family to, and downplayed their own role in, their children’s talents. “Pragmatic” parents described their children as academically average but bright, and as possessing learning or behavioral challenges. They acknowledged the role of birth family and genetics when describing their children’s aptitude, and also emphasized their own role in shaping and hopefully improving their children’s academic performance. “Concerned” parents had significant worries about children’s self-esteem and emotional/behavioral challenges, and these often outweighed academic concerns. Concerned parents tried to provide adequate supports to their children, but, unlike pragmatic parents, perceived an upper limit to how much school interventions could optimize their children’s abilities. Across the sample, as parents’ concerns about their children’s challenges increased, parents were less focused on academic success (e.g., college) and more on them living a happy, independent life. Some parents—especially male parents—struggled to adapt to or accept the reality that their own academic interests, orientation, and/or achievement were fairly different from those of their children. Results have implications for teachers and therapists who may need to help adoptive parents reconcile their perspectives on and experiences with school with those of their children.

Adopted Children’s Behavioral Adjustment Over Time: Pre-Adoption Experiences and Adoptive Parenting

We tested whether adoptive parenting played a role in the association between pre-adoption experiences and children’s adaptive (responsiveness) and maladaptive (internalizing and externalizing behavioral problems, attention and sleep problems) behavioral adjustment over time. Ten-year-old girls, adopted at 13 months from institutional care ( n = 50) or foster care ( n = 42) in China to the Netherlands, participated 2 months (Time 1, N = 92), 6 months (Time 2, N = 92), and 9 years after adoption (Time 3, N = 87). At Times 1 and 2, the adoptees showed significantly fewer behavioral problems in many areas than non-adopted youth, with medium to large effect sizes. At Time 3, the adoptees showed similar rates of behavioral problems as non-adopted youth, with the exception of somewhat elevated levels of internalizing problems. Pre-adoption experiences were not associated with their behavioral adjustment. Furthermore, adoptive parenting did not moderate the association between pre-adoption experiences and behavioral adjustment over time. Nevertheless, the finding that the adoptees generally did not show above-average levels of behavioral problems illustrates that adoption had a positive impact on their development.

Cognitive-affective strategies and cortisol stress reactivity in children and adolescents: Normative development and effects of early life stress.

This study examined cognitive-affective strategies as predictors of hypothalamic-pituitary-adrenal (HPA) axis responses to a social-evaluative stressor in adolescence as compared to late childhood as a function of early life experiences. Participants included 159 children (9-10years) and adolescents (15-16years) divided into two groups based on early care experiences: non-adopted youth raised in their birth families (n=81) and post-institutionalized youth internationally adopted from orphanage care (n=78). Youth completed a version of the Trier Social Stress Test modified for use with children and reported on their trait emotion regulation and coping strategies. Children reported more use of suppression and disengagement than adolescents, while adolescents reported more engagement coping strategies. Non-adopted and post-institutionalized youth did not differ in reported strategies. Cognitive reappraisal predicted higher cortisol reactivity in non-adopted children and adolescents, and was not associated with reactivity in the post-institutionalized group. This study has implications for efforts aimed at promoting self-regulation and adaptive stress responses during the transition to adolescence for both typically developing children and children who experienced adverse early care.

Risk taking, decision-making, and brain volume in youth adopted internationally from institutional care

Early life stress in the form of early institutional care has been shown to have wide-ranging impacts on the biological and behavioral development of young children. Studies of brain structure using magnetic resonance imaging have reported decreased prefrontal volumes, and a large literature has detailed decreased executive function (EF) in post-institutionalized (PI) youth. Little is known about how these findings relate to decision-making, particularly in PI youth entering adolescence—a period often characterized by social transition and increased reliance upon EF skills and the still-maturing prefrontal regions that support them. As decision-making in risky situations can be an especially important milestone in early adolescence, a clearer knowledge of the relationship between risky decision making and prefrontal structures in post-institutionalized youth is needed. The youth version of the Balloon Analogue Risk Task and a two-deck variant of the Iowa Gambling Task were used to assess risky decision-making in post-institutionalized youth and a community control group (N = 74, PI = 44, Non-adopted = 30; mean age = 12.93). Participants also completed a structural MRI scan for the assessment of group differences in brain structure. We hypothesized that participants adopted from institutions would display poorer performance on risky-decision making tasks and smaller brain volumes compared to non-adopted youth. Results indicated that later-adopted participants made fewer risky decisions than those experiencing shorter periods of deprivation or no institutional rearing. Further, decreased prefrontal volumes were observed in later-adopted youth and were significantly associated with task performance. Our results suggest that changes in risky-decision making behavior and brain structure are associated with the duration of early institutional care.

To trust or not to trust: social decision-making in post-institutionalized, internationally adopted youth.

Chronic parental maltreatment has been associated with lower levels of interpersonal trust, and depriving environments have been shown to predict short-sighted, risk-averse decision-making. The present study examined whether a circumscribed period of adverse care occurring only early in life was associated with biases in trust behavior. Fifty-three post-institutionalized (PI) youth, adopted internationally on average by 1year of age, and 33 never-institutionalized, non-adopted youth (Mage =12.9years) played a trust game. Participants decided whether or not to share coins with a different anonymous peer in each trial with the potential to receive a larger number of coins in return. Trials were presented in blocks that varied in the degree to which the peers behaved in a trustworthy (reciprocal) or untrustworthy (non-reciprocal) manner. A comparison condition consisted of a computerized lottery with the same choices and probabilistic risk as the peer trials. Non-adopted comparison youth showed a tendency to share more with peers than to invest in the lottery and tended to maintain their level of sharing across trials despite experiencing trials in which peers failed to reciprocate. In contrast, PI children, particularly those who were adopted over 1year of age, shared less with peers than they invested in the lottery and quickly adapted their sharing behavior to peers' responses. These results suggest that PI youth were more mistrusting, more sensitive to both defection and reciprocation, and potentially more accurate in their trusting decisions than comparison youth. Results support the presence of a sensitive period for the development of trust in others, whereby conditions early in life may set long-term biases in decision-making.

Adopted Youth in Residential Care: Prevalence Rate and Professional Training Needs

ABSTRACTClinical program directors from 59 residential treatment facilities responded to an online survey addressing the representation of adopted youth currently being served by their organization, the extent to which adoption issues are incorporated into clinical intake and treatment processes, and the training needs of clinical staff related to adoption. Results indicated that adopted youth are disproportionately represented in these programs. Although constituting slightly more than 2% of the U.S. child population, 25–30% of youth currently enrolled in these programs were adopted. Clinical directors reported that most clinical staff had received at least a moderate level of training in adoption-related issues and typically integrated them into the assessment and treatment processes. However, they also viewed additional adoption-related training as important for their mental health staff. In addition, adopted youth were viewed by clinical directors as manifesting a higher rate of adjustment difficulties in a number of areas compared to nonadopted youth. Results are discussed in terms of risk factors associated with adoption and the need for adoption clinical training for mental health professionals in residential treatment centers.

Differential DNA methylation in peripheral blood mononuclear cells in adolescents exposed to significant early but not later childhood adversity.

Internationally adopted adolescents who are adopted as young children from conditions of poverty and deprivation have poorer physical and mental health outcomes than do adolescents conceived, born, and raised in the United States by families similar to those who adopt internationally. Using a sample of Russian and Eastern European adoptees to control for Caucasian race and US birth, and nonadopted offspring of well-educated and well-resourced parents to control for postadoption conditions, we hypothesized that the important differences in environments, conception to adoption, might be reflected in epigenetic patterns between groups, specifically in DNA methylation. Thus, we conducted an epigenome-wide association study to compare DNA methylation profiles at approximately 416,000 individual CpG loci from peripheral blood mononuclear cells of 50 adopted youth and 33 nonadopted youth. Adopted youth averaged 22 months at adoption, and both groups averaged 15 years at testing; thus, roughly 80% of their lives were lived in similar circumstances. Although concurrent physical health did not differ, cell-type composition predicted using the DNA methylation data revealed a striking difference in the white blood cell-type composition of the adopted and nonadopted youth. After correcting for cell type and removing invariant probes, 30 CpG sites in 19 genes were more methylated in the adopted group. We also used an exploratory functional analysis that revealed that 223 gene ontology terms, clustered in neural and developmental categories, were significantly enriched between groups.

Differences Between Adopted and Nonadopted Adolescents in Wilderness and Residential Treatment

Adopted children are disproportionately represented in residential treatment programs in the United States. Adopted children in the United States constitute only 2% to 3% of the U.S population. Nevertheless, they comprise approximately 16.5% of the population in residential care. This descriptive study evaluated a sample of 473 psychological evaluations of adolescents in wilderness and residential treatment centers. Results indicated that, compared with nonadopted youth, adopted youth had greater histories of recent trauma, higher rates of suicidal tendency and biological parents’ mental illness, and poorer academic achievement. However, there were no significant differences between adopted and nonadopted youths in terms of defiant behaviors, IQ, substance use/abuse, reasons for referral, impulsivity, anxiety, or depression. Study results suggest that wilderness and residential programs may need to target programmatic elements specifically to meet the special needs of adopted adolescents who comprise a significant percentage of their client population.

Risk‐taking and sensation‐seeking propensity in postinstitutionalized early adolescents

Youth with histories of institutional/orphanage care are at increased risk for externalizing and internalizing problems during childhood and adolescence. Although these problems have been well described, the related adolescent behaviors of risk-taking and sensation-seeking have not yet been explored in this population. This study examined risk-taking and sensation-seeking propensity, and associations with conduct problems and depressive symptoms, in early adolescents who were adopted as young children from institutional care. Risk-taking and sensation-seeking propensities of 12- and 13-year-old postinstitutionalized (PI; n = 54) adolescents were compared with two groups: youth who were internationally adopted early from foster care (PFC; n = 44) and nonadopted youth (NA; n = 58). Participants were recruited to equally represent pre/early- and mid/late-pubertal stages within each group. Participants completed the youth version of the Balloon Analogue Risk Task (Lejuez et al., ) and the Sensation-Seeking Scale for Children (Russo et al., ). Parents completed clinical ratings of participants' conduct problems and depressive symptoms. PI adolescents demonstrated lower risk-taking than PFC and NA peers. Pre/early-pubertal PI youth showed lower sensation-seeking, while mid/late-pubertal PI youth did not differ from other groups. PI adolescents had higher levels of conduct problems but did not differ from the other youth in depressive symptoms. In PI youth only, conduct problems were negatively correlated with risk-taking and positively correlated with sensation-seeking, while depressive symptoms were negatively correlated with both risk-taking and sensation-seeking. Early institutional care is associated with less risk-taking and sensation-seeking during adolescence. The deprived environment of an institution likely contributes to PI youth having a preference for safe choices, which may only be partially reversed with puberty. Whether this reflects hyporesponsiveness to rewards and how it relates to psychopathology are discussed.

Behavioral and EEG Correlates of Reduced Executive Functioning in Adolescents

Exposure to orphanage care or other deprived conditions represent a contributing risk factor in the development of ADHD behaviors. Upon leaving these contexts, the resting EEG patterns found in post-institutionalized (PI) children resemble the EEG profile of children with behavior problems, such as inattention, hyperactivity, and impulsivity. Specifically, this atypical pattern consists of increased theta power relative to other power spectra and decreased alpha power. This study examined if this pattern persists years after adoption and/or whether they were found only in PI youth who developed ADHD. PI and nonadopted (NA) children, between 11-15 year old, comprised the two groups in the study. Approximately half of the participants in each group were diagnosed with ADHD. Parent-reported executive function and attention problems differed by ADHD, but not by adoption classification (PI/NA). The PI youth and NA youth with ADHD exhibited the atypical EEG pattern related to early deprivation and ADHD-related deficits. In the PI youth only, concentrations in beta power and alpha power were positively and negatively associated with fewer executive functions.

Pubertal Timing as a Potential Mediator of Adoption Effects on Problem Behaviors

Adopted children show more problem behaviors than nonadopted children. Given that internationally-adopted individuals show earlier puberty than non-adopted individuals, and early puberty is associated with problem behaviors in nonadopted youth, we analyzed data from domestic adoptees to determine whether problem behaviors could be explained by differences in pubertal timing. Relative to nonadopted controls (n = 153), domestically-adopted girls (n = 121) had earlier menarche, earlier sexual initiation, and more conduct disorder symptoms. Age at menarche partially mediated the relation of adoptive status to sexual initiation, but not to conduct disorder symptoms. Extending findings from international adoptees, results show that domestic adoption is also linked to earlier puberty, and suggest early puberty as one mechanism linking adoption to problematic outcomes.

Associations between substance use disorders and major depression in parents and late adolescent–emerging adult offspring: an adoption study

To examine whether major depressive disorder (MDD) and substance use disorders [SUDs: specifically, nicotine dependence (ND), alcohol use disorders (AUDs), and cannabis use disorders (CUDs)] in parents predicted increased risk for these disorders in late adolescent-emerging adult offspring and, specifically, the extent to which the pattern of risk differed for adopted and non-adopted youth. Late adolescent and emerging adult participants from the Sibling Interaction and Behavior Study (mean age = 18.8), a community-based investigation of adopted and non-adopted adolescents, and their parents (adoptive parents of adopted youth, biological parents of non-adopted adolescents) were included. Structured interviews were used to assess these disorders. (i) When the same disorder in parents and adolescents was examined, parental MDD was associated with increased risk for MDD among both adopted (P < 0.001) and non-adopted (P < 0.01) adolescents; in contrast, SUDs were associated with increased risk for the same SUD in non-adopted offspring (all P < 0.01). (ii) When cross-SUD effects were examined, for the most part, each SUD was associated with increased risk for other SUDs among non-adopted but not adopted offspring (most P < 0.05). (iii) When MDD-SUD associations were examined, parental ND and CUDs predicted increased risk for MDD in non-adopted (P < 0.001), but not adopted, adolescents. These effects tended to remain significant when adjusting for within-person comorbidity (P < 0.05). Major depressive disorder in parents appears to be a risk factor for late adolescent-emerging adult major depressive disorder but not substance use disorder in offspring, with this risk being environmentally mediated. Substance use disorder in parents appears, via genetic mediation, to increase risk of substance use disorder in adolescent offspring, and cannabis and nicotine use disorders in parents contribute similarly to major depressive disorder in those offspring.

Suicidal Thoughts in Adopted Versus Non-Adopted Youth: A Longitudinal Analysis in Adolescence, Early Young Adulthood, and Young Adulthood

Data from 3 waves of the National Longitudinal Study of Adolescent Health, a nationally representative database, are used to test complex models addressing the developmental links between child adoption or non-adoption and suicidal ideation across adolescence, early young adulthood, and young adulthood. Diverse developmental dynamics are tested, while controlling for a variety of potential demographic confounds. Models are tested comparing kin and non-kin adopted youth to non-adopted youth, as well as the estimated effects of earlier versus later age at adoption to non-adoption. The models suggest modest differences in suicidal ideation during adolescence, early young adulthood, and young adulthood as a function of being adopted versus not-adopted and being adopted at age 4 years or later versus non-adoption.

Predictors of children in foster care being adopted: A classification tree analysis

When returning home is not a viable option, adoption is the primary means by which youth in substitute care achieve permanency. Therefore, understanding the factors that impact adoption is critical to both evaluating and improving the child welfare system. Prior research has mostly studied “main effects” in regard to adoption rates and has not explored the ways in which youth and foster family variables might interact in complex ways to predict adoption. This study uses a classification tree analysis approach known as Optimal Data Analysis (ODA) to predict probability of adoption in 2003 using Adoption and Foster Care Analysis and Reporting System (AFCARS) data. 30,000 adopted youth and 30,000 non-adopted youth were randomly selected for participation in the study. Similar to previous studies, univariate analyses revealed that age, foster parent race/ethnicity, foster parent marital status, and number of previous placements all predicted probability of adoption. However, going further, several combinations of individual variables (multivariate ODA) improved prediction accuracy (e.g., age × structure of foster family × number of previous placements). Results also suggested that the impact of the state on adoption rates varied when essentially controlling for youth and family variables, supporting concerns regarding the crude use of AFCARS data when comparing states.

Parental divorce and adolescent delinquency: ruling out the impact of common genes.

Although the well-documented association between parental divorce and adolescent delinquency is generally assumed to be environmental (i.e., causal) in origin, genetic mediation is also possible. Namely, the behavior problems often found in children of divorce could derive from similar pathology in the parents, pathology that is both heritable and increases the risk that the parent will experience divorce. To test these alternative hypotheses, the authors made use of a novel design that incorporated timing of divorce in a sample of 610 adoptive and biological families. They reasoned that if genes common to parent and child mediate this association, nonadopted youth should manifest increased delinquency in the presence of parental divorce even if the divorce preceded their birth (i.e., was from a prior parental relationship). However, should the association be environmental in origin, the authors reasoned that adolescents should manifest increased delinquency only in response to divorce exposure, and this association should not vary by adoption status. Results firmly supported the latter, suggesting that it is the experience of parental divorce, and not common genes, that drives the association between divorce and adolescent delinquency.