Preadoption Adversity Research Articles

Family environment and development in children adopted from institutionalized care

BackgroundAfter adoption, children exposed to institutionalized care show significant improvement, but incomplete recovery of growth and developmental milestones. There is a paucity of data regarding risk and protective factors in children adopted from institutionalized care. This prospective study followed children recently adopted from institutionalized care to investigate the relationship between family environment, executive function, and behavioral outcomes.MethodsAnthropometric measurements, physical examination, endocrine and bone age evaluations, neurocognitive testing, and behavioral questionnaires were evaluated over a 2-year period with children adopted from institutionalized care and non-adopted controls.ResultsAdopted children had significant deficits in growth, cognitive, and developmental measurements compared to controls that improved; however, residual deficits remained. Family cohesiveness and expressiveness were protective influences, associated with less behavioral problems, while family conflict and greater emphasis on rules were associated with greater risk for executive dysfunction.ConclusionsOur data suggest that a cohesive and expressive family environment moderated the effect of pre-adoption adversity on cognitive and behavioral development in toddlers, while family conflict and greater emphasis on rules were associated with greater risk for executive dysfunction. Early assessment of child temperament and parenting context may serve to optimize the fit between parenting style, family environment, and the child’s development.ImpactChildren who experience institutionalized care are at increased risk for significant deficits in developmental, cognitive, and social functioning associated with a disruption in the development of the prefrontal cortex. Aspects of the family caregiving environment moderate the effect of early life social deprivation in children.Family cohesiveness and expressiveness were protective influences, while family conflict and greater emphasis on rules were associated with a greater risk for executive dysfunction problems.This study should be viewed as preliminary data to be referenced by larger studies investigating developmental and behavioral outcomes of children adopted from institutional care.

Early adversity and children's regulatory deficits: Does postadoption parenting facilitate recovery in postinstitutionalized children?

Children reared in orphanages typically experience the lack of stable, reliable caregivers and are at increased risk for deficits in regulatory abilities including difficulties in inhibitory control, attention, and emotion regulation. Although adoption results in a radical shift in caregiving quality, there remains variation in postadoption parenting, yet little research has examined postadoption parenting that may promote recovery in children experiencing early life adversity in the form of institutional care. Participants included 93 postinstitutionalized children adopted between 15 and 36 months of age and 52 nonadopted same-aged peers. Parenting was assessed four times during the first 2 years postadoption (at 2, 8, 16, and 24 months postadoption) and children's regulation was assessed at age 5 (M age = 61.68 months) and during kindergarten (M age = 71.55 months). Multiple parenting dimensions including sensitivity/responsiveness, structure/limit setting, and consistency in routines were examined. Both parental sensitivity and structure moderated the effect of preadoption adversity on children's emotion regulation while greater consistency was associated with better inhibitory control and fewer attention problems. Results support the notion that postadoption parenting during toddlerhood and the early preschool years promotes better regulation skills following early adversity.

Young offenders caught in the act: A population-based cohort study comparing internationally adopted and non-adopted adolescents

Empirical research has shown an elevated risk for externalizing behavior problems in international adoptees. To address the extent to which this risk exists for more serious externalizing problems we compared the rates of registered criminal offending of internationally adopted adolescents with those of non-adopted adolescents in the Netherlands. In a large population-based cohort study (N = 3,758,506 including n = 10,563 international adoptees) on Dutch youth with ages up to 19 years we examined registrations in the program on juvenile crime and in the national police system from 2005 to 2013. Controlling for time lapse and background variables we found that international adoptees had been in contact with the criminal justice system more frequently than non-adoptees. However, the findings differed across region of adoption: Adoptees from South America and from Africa had been in contact with the criminal justice system most frequently (and more often than non-adoptees), whereas adoptees from China (total n = 4569) had the least contacts (and less often than non-adoptees). The percentages of criminal offending of adoptees ranged between 1.16% and 15.83% across regions of adoption (versus 10.86% in non-adoptees). The large majority of adoptees – including those from South America and Africa – were not involved in criminal acts. We hypothesize that the higher and lower risks of criminal offending found for adoptees from certain countries are associated with the varying levels of pre-adoption adversity (e.g., neglect and abuse) that the adoptees have experienced.

Behavior problems in adolescence among international adoptees, pre-adoption adversity, and parenting stress

The evolution of behavior problems from school age to adolescence and their relationships with early risk factors and parenting stress were examined among 71 international adoptees. Children's health status and development were assessed soon after arrival in their family to provide indices of early adversity. At ages 7 and 15, self-report measures (DI and DIA) were used to evaluate behavior problems while mothers completed the CBCL. Mothers also completed the Parenting Stress Index and Stress Index for Parents of Adolescents. A lower percentage of children reported internalizing problems during adolescence than at school age while mothers reported a decrease in externalizing problems over age. A few correlations were found between internalizing and externalizing symptoms and early risk factors. However, these links were sequentially mediated by parenting stress at school age and in adolescence. The potential impact of parenting stress on international adoptees' psychological adjustment is discussed.

Peer Problems Among Postinstitutionalized, Internationally Adopted Children: Relations to Hypocortisolism, Parenting Quality, and ADHD Symptoms.

Seventy-eight postinstitutionalized (PI) children adopted at ages 17-36months were assessed 2, 8, 16, and 24months postadoption on measures of cortisol and parenting quality, and compared to same-aged children adopted from foster care (FC, n=45) and nonadopted children (NA, n=45). In kindergarten (Mage =6.0years), teachers, parents, and trained observers completed measures of peer relationships and attention deficit hyperactivity disorder (ADHD) symptoms. PI children had more peer problems and ADHD symptoms according to teachers and observers than NA children with FC children in between, whereas both PI and FC children were at significantly greater risk of hypocortisolism (i.e., blunted cortisol diurnal rhythm and reactivity). Hypocortisolism and ADHD symptoms mediated the association between preadoption adversity and peer difficulties. Higher postadoption parenting quality was protective.

Preadoption adversity and long-term clinical-range behavior problems in adopted Chinese girls.

In this study, we report findings on the role of preadoption adversity on long-term clinical-range problems in adopted Chinese girls. Four waves (2005, 2007, 2009 and 2011) of problem behavior data on 1,223 adopted Chinese girls (M = 4.86 years, SD = 2.82 in 2005) were collected from the adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1 (2005), data on the following indicators of preadoption adversity was collected: age at adoption, physical signs/symptoms (e.g., sores) of preadoption adversity, developmental delays at arrival, refusal/avoidance behaviors and crying/clinging behaviors toward adoptive parents during the first 3 weeks of adoption. We found that the percentage of clinical-range internalizing problems was 11.1%, 16.5%, 11.3%, and 16.1% at Wave 1, Wave 2, Wave 3, and Wave 4, respectively; the corresponding percentage of clinical-range externalizing problems was 8.4%, 10.5%, 8.4% and 9.9% respectively; and the corresponding percentage of clinical-range total CBCL problems was 9.3%, 13.0%, 9.8% and 12.6% respectively. Analyses with Mplus showed that controlling for demographic variables, indicators of preadoption adversity, except age at adoption, increased the odds for clinical-range behavior problems. Longitudinal path models revealed that controlling for demographic variables and the children's adjustment status in the previous wave, refusal/avoidance remained significant in predicting clinical-range internalizing, externalizing and total CBCL problems at Wave 2, delays at arrival and signs/symptoms were significant in predicting clinical-range internalizing problems at Wave 3. Overall, adoptees with clinical-range CBCL problems in earlier waves were 9-28 times as likely to show clinical-range CBCL problems in subsequent waves.

Pre-adoption adversity and behavior problems in adopted Chinese children: A longitudinal study

In this paper, we report (1) trajectories in adopted Chinese children's behavior problems over six years, (2) how pre-adoption adversity predicted Wave 1 behavior problems and the rate of behavioral change in subsequent Waves, and (3) the predictive importance of age at adoption relative to four psychosocial measures of pre-adoption adversity. Four waves (across six years) of data on 1285 adopted children (Mage at adoption=16.40months, SD=15.40; Mage=4.89years, SD=2.96 at Wave 1) were collected from adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1, data on age at adoption, and four psychosocial measures of pre-adoption adversity were collected: physical signs/symptoms (e.g., sores) of deprivation, developmental delays at arrival, refusal/avoidance behaviors, and crying/clinging behaviors during the first three weeks of adoption. Multilevel modeling yielded three key findings: First, the adopted Chinese children's CBCL scores increased over time. Second, signs/symptoms, refusal/avoidance and crying/clinging behavior predicted differences in the adopted children's Internalizing, Externalizing and Total CBCL scores at study entry; developmental delays at arrival predicted differences in Internalizing and Total CBCL scores at study entry. Crying/clinging scores also predicted rates of change in Internalizing and Total CBCL scores. Refusal/avoidance scores also predicted rates of change in Internalizing, Externalizing and Total CBCL scores. Finally, the four psychosocial measures of pre-adoption adversity outperformed age at adoption as predictors of CBCL scores at study entry and the rate of change in CBCL scores in subsequent Waves.

Twins and virtual twins: Do genetic (as well as experiential) factors affect developmental risks?

Factors underlying developmental delays and psychosocial risks are of interest to international adoption communities. The current study administered a Pre-Adoption Adversity (PAA) Questionnaire to mostly American parents raising (a) adopted Chinese twins or (b) same-age unrelated adopted siblings. A goal was to replicate earlier analyses of pre-adoption adversity/adjustment among adopted preschool-age Chinese girls. A second goal was to conduct genetic analyses of four content areas (Developmental Delays at Adoption, Initial Adaptation to Adoption, Crying/Clinging, and Refusal/Avoidance) derived from the PAA Questionnaire. A key finding was that age at adoption added less than other predictors to adoptees’ externalizing and internalizing behaviors. Family factors (e.g., parental education) contributed significantly to behavioral outcomes among the adopted Chinese twins. Genetic effects were indicated for all four content areas, with shared environmental effects evident for Developmental Delays at Adoption and Crying/Clinging. Future investigators should consider incorporating genetically sensitive designs into developmental research programs.

Adopted children's country of origin and post-adoption parent–child relationship quality: Findings from the United States National Survey of Adoptive Parents (NSAP)

In this paper, we investigated adoptive parent–child relationship quality as a function of the adopted children's country of origin, pre-adoption adversity, age at placement, age, gender, and special healthcare needs status. From the 2007 National Survey of Adoptive Parents (NSAP; N=2089), we identified 1906 families that had adopted children from the US foster care system, US private agencies, China, Guatemala, Russia and South Korea. Regression analysis showed that when country of origin was the sole predictor, adoption from the US private agencies (β=.18, p<.001), China (β=.21, p<.001), Russia (β=.06, p<.05) and South Korea (β=.07, p<.05) predicted higher parent–child relationship quality score than adoption from the US foster care system (referent) (R2=5.59%). Adoption from Guatemala was not different from adoption from the US foster care system in parent–child relationship quality (β=−.01, p>.10). In the absence of country of origin, being a boy (β=−.10, p<.05), older age at placement (β=−.20, p<.001), older age (β=−.11, p<.001), having special healthcare needs (β=−.19, p<.001), and more pre-adoption adversity (β=−.08, p<.05) all significantly predicted lower parent–child relationship quality scores (R2=17.56%). When country of origin and the above variables were entered into the regression model simultaneously, being a boy, age at placement, age, and special healthcare needs status remained significant. However, none of the countries of origin except China (β=.07, p<.05) remained significant in predicting higher parent–child relationship score. Our findings showed that the unique circumstances that fueled the availability of children from different countries to become available for adoption played some role in parent–child relationship quality. However, the adopted children's gender, age at placement, age, and special healthcare needs were more predictive of post-adoption parent–child relationship quality.

Preadoption adversity, MAOA, and behavioral adjustment in internationally adopted Chinese girls.

We studied postinstitutionalized adopted Chinese girls to determine whether those with different variants of the MAOA gene promoter region (MAOA-VNTR) differed in their internalizing and externalizing behavior problems and whether the MAOA genotype moderated the relation between preadoption adversity and current behavior problems. MAOA genotyping was obtained for 94 girls (mean age: 9.2 years) and the number of 4-repeat (4R) alleles was determined (zero, one, or two). The adoptive mothers rated several indicators of preadoption adversity shortly after adoption (mean age at adoption 15.8 months) and completed the Child Behavior Checklist when the children were 8.1 years on average. No main effects were found for preadoption adversity. However, the MAOA genotype had a nominally significant effect (P<0.05) on internalizing problems. Regression analyses controlling for age, household income, authoritarian parenting, and family problems showed that among children with no physical signs of preadoption adversity, those carrying a greater number of 4R alleles scored significantly lower (P<0.01) on internalizing problems than those with fewer 4R alleles. Differences in internalizing scores related to the MAOA genotype were not observed for children who showed one or more physical signs of adversity at the time of adoption. A similar pattern was found for externalizing problems, although the results did not reach conventional levels of significance. Our results suggest that higher MAOA activity may be protective with respect to internalizing problems in internationally adopted Chinese girls, but that this protective effect decreases at higher levels of preadoption adversity. A similar pattern may exist for externalizing problems.

The emergence of attachment following early social deprivation

This study examined the formation and quality of attachment of 65 postinstitutionalized (PI) toddlers with their parents at 1-3 and 7-9 months postadoption compared to 52 nonadopted (NA) children. The formation of attachment relationships of PI children with adoptive parents occurred relatively quickly. Children exposed to greater preadoption adversity took longer to form an attachment to their adoptive parents, although by 7-9 months postadoption, nearly all (90%) of the children achieved the highest level on an attachment formation rating scale. PI children did not differ from NA children in attachment security, based either on the Attachment Q-Sort or Strange Situation categorical scoring. However, the PI children were more likely to be disorganized in their attachment patterns. Preadoption adversity was related to lower Q-sort security scores especially at the initial assessment 1-3 months postadoption. The results indicated that attachment formation and attachment quality in PI children are differentiable constructs with different precursors.

Mental health service utilization in children adopted from US foster care, US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Abstract Aims In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization. Data As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse). Results For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.

Pre-adoption adversity, maternal stress, and behavior problems at school-age in international adoptees

Internationally adopted children present more behavior problems than non-adopted children and are overrepresented in mental health services. These problems are related to children's pre-adoption environment, but adoptive families’ functioning and characteristics may also affect the development of behavior problems in adopted children. The aim of this longitudinal study was to examine the effect of pre-adoption adversity and parenting stress on children's behavior problems at school-age. Our sample consisted of 95 children adopted during infancy. Children's health and developmental status was evaluated soon after arrival in their adoptive country. Their behavior problems were assessed at age 7 using a self-report measure, the Dominic Interactive, and the CBCL completed by the mothers. Parenting stress was measured using the PSI. Children's characteristics at time of adoption were significantly related to their behavior problems at school-age, and maternal stress was found to have a mediating effect on this relationship.

Pre-Adoption Adversity and Self-Reported Behavior Problems in 7 Year-Old International Adoptees

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers' reports. The sample consisted of 95 adopted children and their mothers. Children's health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children's self-reports were compared to their non-adopted peers'. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers' and children's reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees' perception of their psychological adjustment and the long-term impact of early risk factors.

Social skills of adopted Chinese girls at home and in school: Parent and teacher ratings

This study examines adopted Chinese girls' social skills at home and in school as well as the effect of pre-adoption adversity on these skills. Parent ratings of 869 girls and teacher ratings of 611 of the 869 girls were obtained using the Social Skills Rating System for parent (SSRS-P) and teacher (SSRS-T) respectively. The girls were adopted on average at 15.6 months ( SD = 13.9) and were in three age groups, including preschool, elementary school, and secondary school. Data on five indicators of pre-adoption adversity (i.e., signs/symptoms, delays at adoption, initial refusal/avoidance of adoptive mothers, crying/clinging behaviors, and age at adoption) were obtained from the same adoptive parents 2 years prior. Findings suggest that both parents and teachers rated the girls as either similar to or better than US norms on the SSRS. Parent–teacher agreement on SSRS subscales was significant but modest ( rs = 0.12–0.25). Two indicators of pre-adoption adversity (i.e., delays at adoption and initial refusal/avoidance of adoptive mothers) predicted poorer social skills at home; two other indicators of pre-adoption adversity (i.e., signs/symptoms and age at adoption) predicted poorer social skills in school.

Parental perceived discrimination as a postadoption risk factor for internationally adopted children and adolescents.

Parental perceived discrimination was investigated as a risk factor in a U.S. sample of 1,579 internationally adopted children ages 5 to 18 years. Drawing on stress proliferation theory, we hypothesized a positive association between parental perceived discrimination and child problem behaviors, controlling for preadoption adversity. We also expected differences by world region and age of the child. Adoptive parents with Asian and Latin American children reported more discrimination than parents with Eastern European children. Perceived discrimination was uniquely associated with greater problem behaviors for adopted children from Asia and Latin America, with the strongest association among Latin American adolescents. The study findings highlight the need to study postadoption risk factors related to adoption and minority status for internationally adopted individuals and families.

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.

Eastern European adoption: policies, practice, and strategies for change

Between 1990 and 2004, more than 68,000 children born in Europe were adopted into American families. Almost two-thirds of these children came from Russia. And in contrast to children adopted from Korea, China, Central America, and South America, most of the Russian children were not infants, but between one and four years old. This volume addresses adoption policies and practices as they pertain to adopted children from Europe, children who have histories of pre-adoption adversity. Drawing on her decade-long experience as an adoptive parent of siblings born in Russia and her expertise as an applied sociologist, Josephine Ruggiero examines the central issues involved in international adoptions, focusing on older children as well as siblings, and suggesting needed changes in policy and practice. Regardless of whether children are adopted domestically or internationally, age is a significant factor in their ability to adjust to and function well in their new families. Only about three in ten Russian adoptees joined their new families as infants. Pre-adoption experiences are also significant factors in a child's ability to adjust and function well in a new family. Countries differ in risk factors that may figure into the likelihood of adoptees adapting to life in a new family. Fetal Alcohol Syndrome, serious medical conditions, emotional problems, behavioral problems, attachment issues, learning disabilities, and exposure to family violence must be considered as potential risk factors in adoptions. Pre-adoption adversity is less likely when children from birth families that are economically poor but have bonded with them. At a time when adoption has finally come out of the closet and the definition of the family is changing dramatically, Eastern European Adoption takes a much-needed look at current adoption policies and practices and how well they do or do not work. Ruggiero draws on the literature on older-child and sibling adoption, and data from a questionnaire survey she designed and conducted with 121 adoptive parents. Ruggiero's examples from real adoptive families give a human face to the issues, needs, and strategies she discusses.

Communication and Academic Challenges in Early Adolescence for Children Who Have Been Adopted From the Former Soviet Union

This was a Time II survey of outcomes for children, now ages 9 to 13 years, who were almost 4 years old on average when they were adopted from the former Soviet Union. As part of a larger study (see T. McGuinness, R. Ryan, & C. Broadus Robinson, 2005), parents of 55 children (M age = 11 years) were surveyed regarding their children's speech-language, behavior, and eligibility for special education. The children's mean length of institutionalization was 36 months. A total of 45, or 82%, of the children had at least one special education label. The most frequent was communication disorder, which was reported for 34 children, or 62%. The frequency of attention deficit hyperactivity disorder (ADHD) was high, 42%. The ratio of boys to girls for communication disorders and ADHD was 1.5:1. Girls who were adopted after 36 months of age were 4 times more likely than girls who were adopted before 36 months to be labeled ADHD, and children with low birth weight exhibited learning disabilities twice as often as children with normal birth weight. Speech-language, learning, and attention deficits for late-adopted, early adolescent children were higher than expected. These children from the former Soviet Union experienced substantial preadoption adversity associated with lengthy orphanage stays and poor care. Gender and low birth weight were also factors.

Special needs adoption from China: Exploring child-level indicators, adoptive family characteristics, and correlates of behavioral adjustment

Since 1994, China has been a leading source of international adoptions in the US, and since 2000, an increasing number of these children have entered the country under the special needs classification. While there is a large body of research on domestic special needs adoptions, very little is known about special needs adoptions from China. This study took advantage of a large survey of 1096 adopted Chinese children to explore a number of questions on special needs adoptions from China. The sample included 124 children adopted under the special needs classification. In addition to parental reports of child behavioral problems on the Child Behavior Checklist (CBCL), data on age at adoption, type of special needs, pre-adoption adversity, developmental delays at adoption, and Initial Adaptation to Adoption were collected retrospectively from the adoptive parents. The analysis revealed no differences between special needs (SN) and non-special needs (NS) children on any of the measures. In addition, the nature of the disabilities associated with the SN classification for many of the children may not pose significant challenges to optimal development. Policy and practice implications are discussed in light of these findings.