Adoptee Rage! This blog is written exclusively for the 38% of Abused and Neglected Adopted Children. The U.S. HHSA Identifies #1 Risk: Maltreatment, Child Abuse and Risk for Death In Adopted children. Childhood domination, Coping compensation. Research in Adoption Psychology, Developmental Trauma"The Adoption Paradox". By Rainstorm Red-Smith
About Adoptee Rage
Statistics Identify large populations of Adoptees in prisons, mental hospitals and committed suicide.
Fifty years of scientific studies on child adoption resulting in psychological harm to the child and
poor outcomes for a child's future.
Medical and psychological attempts to heal the broken bonds of adoption, promote reunions of biological parents and adult children. The other half of attempting to repair a severed Identity is counselling therapy to rebuild the self.
Wednesday, March 4, 2015
Longterm Outcomes In Adoption
Assessing Adopted Children's Risk For Psychosocial Problems
Three research strategies have been used to address the question of psychological risk associated with adoption: (1) epidemiological studies of the incidence and prevalence of adoptees in various patient or special education populations, (2) clinical studies examining the nature of presenting symptomatology in adopted and nonadopted individuals, and (3) studies examining the behavioral and personality characteristics and adjustment patterns of adoptees and nonadoptees in community-based samples.
Before it can be determined whether adopted children are overrepresentated in mental health clinics and other types of psychiatric settings, one must first have a baseline for the percentage of adoptees in the general population. A large-scale national health survey found that approximately 2% of the population of children under 18 years of age are nonrelated adoptees, that is, children who are being raised by nonbiological relatives.8 In contrast, nonrelated adoptees constitute approximately 5% of the children referred to outpatient mental health clinics9 and, on the average, between 10% and 15% of the children in residential care facilities and inpatient psychiatric settings.10-12
Although such statistics suggest that adoptees manifest a disproportionate rate of psychological problems when compared with their nonadopted counterparts, caution must be maintained in interpreting the data. It is possible that this finding may reflect, in part, differential patterns of referral and differential use of mental health facilities by adoptive parents, as opposed to increased rates of disturbance.13 In fact, a recent study by Warren14supports this position. When data from a 1981 national health survey of 3,698 adolescents were reanalyzed, Warren found that although adopted teenagers 12 to 17 years of age were more likely to manifest behavior problems than nonadopted youth, they also were more likely to be referred for mental health services, even when displaying relatively minor problems. Thus, as Warren notes, "The results do not support the belief that adoptees appear more often in psychiatric setting purely[emphasis added] because they are more troubled" (p. 516).
Three possible explanations for the lower threshold for psychiatric referral for adoptees were offered by Warren. First, both parents and others outside the family may be more prone to view adoptees as being at risk for problems and, thus, more likely to refer them for treatment even when problems are still relatively minor. In such cases, adoption is likely to be used as a convenient explanation for understanding the development and manifestation of problem behavior. In essence, the underlying belief is that the child's problems exist because of the adoption. Second, quicker referral for mental health services could occur because the child's problems are viewed as a more serious threat to the integrity and identity of the family. In other words, the more tenuous family relationships and the social stigma associated with adoption could make parents more reactive to children's problems, leading to quicker psychiatric or psychological referral. Finally, the greater use of mental health services by adoptive parents could, in part, reflect the fact that they have grown accustomed to utilizing social service resources during the process of adopting their child. If so, this attitude might lead adoptive parents to seek out mental health services more quickly than nonadoptive parents.
In addition to examining the incidence and prevalence of adoptees in mental health settings, researchers also have examined the extent to which adoptees are found in special education populations. Recently, Brodzinsky and Steiger15 reported on a statewide survey of public and private special education programs in New Jersey. They found that adoptees accounted for approximately 6.7% of the children classified for educational purposes as neurologically impaired, 5.4% of the children classified as perceptually impaired, and 7.2% of the children classified as emotionally disturbed.
Comparing Adopted and Nonadopted Individuals in Clinical Settings
Researchers have been particularly interested in determining whether there are unique patterns of presenting symptoms among adopted children seen in clinical settings. A review of the literature provides some support for this speculation. In most studies, adopted children have been shown to manifest a higher than expected rate of acting out, or "externalizing" behaviors, including aggression, oppositional and defiant behaviors, hyperactivity, stealing, lying, running away, and other antisocial behavior.7,16-21 However, other researchers have not found significant differences in these conduct disorders when adopted and nonadopted children are compared in clinical settings.11,12,22
In addition to these disruptive behaviors, adoptees in clinical settings also have been found to manifest a higher rate of personality disorders (for example, antisocial personality, borderline personality) than nonadoptees,7,12,23,24 as well as a higher rate of substance abuse,23,25 eating disorders,25 learning disabilities26,27 and attention deficit hyperactivity disorder.22,28,29 On the other hand, there is a tendency for adoptees to manifest either the same level or a lower level of schizophrenia and other psychotic disorders,7,17,21,30 as well as "internalizing" symptoms such as anxiety12,18 and depression.12
Finally, research also has indicated that adoptees are distinguished from nonadoptees in clinical settings in terms of several admission, discharge, and treatment characteristics. For example, two studies found that adoptees were younger at first admission to a psychiatric facility and were more likely to have had a previous psychiatric hospitalization.21,22 Hospitalized adoptees also were likely to stay longer in the treatment facility,22to form significantly closer ties to peers while rejecting close ties to hospital staff,17 and to be more likely to run away from the inpatient treatment setting.17,31
Comparing Adopted and Nonadopted Individuals in Nonclinical Settings
The majority of studies documenting increased risk of psychological and academic problems among adopted children have utilized clinical groups of subjects. Because the subjects in these studies are likely to be unrepresentative of adoptees as a whole, other investigators have studied behavioral and personality characteristics, and adjustment patterns, in community-based groups. In contrast to the clinical literature, the picture that emerges from the latter studies is more complex.
Studies focusing on infants, toddlers, and preschoolers generally have not found differences between adopted and nonadopted children in temperament,32 mental and motor functioning,33communication development,34 and mother-infant attachment.35 Some studies focusing on older children and teenagers also have failed to find evidence of increased psychological problems or different patterns of behavioral and personality characteristics among adoptees compared to nonadoptees.36-38 One methodologically flawed study actually found more positive adjustment among adolescent adoptees than among nonadoptees.39,40
In contrast to the studies above, a growing body of nonclinical research supports the view that beginning at school age, adoptees manifest different patterns of adjustment than nonadoptees. In one study, teachers rated adopted children in kindergarten through eighth grade as having a higher incidence than nonadopted children of conduct disorders, personality problems, and socialized delinquency, but they did not have a higher incidence of signs of immaturity or psychosis.41 Poorer school adjustment in fourth through eighth grade was also reported for adopted children than for nonadopted children, but this finding held only for adoptees living in all-adoptive families.42 Adopted children living in mixed families (that is, families which included both adopted and biological children) showed no difference in adjustment when compared with nonadopted children.
A series of studies by Brodzinsky and his colleagues also found that 6-12-year-old adopted children manifested more adjustment problems than their nonadopted peers.43-45 For example, adoptees were rated by parents as showing less social competence and more behavior problems than nonadopted children. Adopted boys were rated by parents as lower in school success and as showing more uncommunicative behavior, hyperactivity, aggression, and delinquency. Adopted girls were rated as doing less well in social interaction and school success and having a greater amount of depression, social withdrawal, hyperactivity, delinquency, aggression, and cruelty. In addition, teachers rated the adopted children as scoring lower than nonadopted children in originality, independent learning, school involvement, productive involvement with peers, and school achievement. They also noted in adoptees a higher incidence of intellectual dependency, failure anxiety, unreflectiveness, irrelevant classroom talk, social over-involvement, negative feelings, and classroom inattention. In addition, these adoptees were more likely than nonadoptees to be rated by parents as exceeding the normal range in one or more behavioral areas (36% in adoptees versus 14% in nonadoptees). For example, adopted boys were more likely to be rated within a maladaptive range for uncommunicative behavior (20% versus 4.6%) and hyperactivity (8.2% versus 0%); adopted girls exceeded nonadopted girls in symptomatology related to depression (13.9% versus 3%), hyperactivity (13.9% versus 0%), and aggression (10.8% versus 0%).
Findings from a national health household survey of parents are especially relevant to the question of psychological risk associated with adoption.8 At 12 to 17 years of age, children adopted in infancy were 2.5 times more likely than nonadopted youngsters to have ever received professional help from a psychiatrist or psychologist and over 3 times more likely to have received or needed such help in the past year. Adoptees were also rated by parents as being higher on a behavior problem index and lower on academic class standing. No group differences were found for any physical health indices.
Several longitudinal investigations also have addressed the issue of psychological risk in adoption. In Sweden, Bohman and his colleagues studied adjustment patterns in groups of adopted children (group 1); children living in long-term foster care (group 2); and children living with their biological mothers who originally had registered them for adoption but subsequently changed their minds (group 3).1,2 These groups were contrasted with classmates in the community living with their biological parents. Children were followed from gestation through young adulthood, with various outcome measures collected at 11, 15, 18 (boys only), and 23 years. At 11 years, adopted boys had a higher rate of "nervous" and problem behavior, as rated by teachers, than their nonadopted classmates. With the exception of lower mathematics scores, adopted girls generally did not differ from their nonadopted classmates. Similar findings of somewhat greater magnitude were noted in comparisons between groups 2 and 3, and their control classmates.
Four years later, when the children were 15 years old, additional outcome measures were collected, based primarily on school records and teacher ratings. Although adopted children (group 1) still showed a tendency to have lower adjustment scores and lower mean grades than their classmates, the differences were no longer significant for either boys or girls. In contrast, both the foster children (group 2) and those youngsters living with their mothers (group 2) showed greater maladjustment than their classmates. At 18 years of age, IQ test data collected from military enlistment records indicated that there were no differences between adopted boys and their controls for any of the test measures. In contrast, boys raised in foster homes or with their biological mothers who initially considered adoption scored significantly lower than control groups on most IQ subtests.
At approximately 23 years of age, a search was made of public records for evidence of alcohol-related problems and evidence of criminal activity. No differences were found for adoptees or those individuals reared by their biological mothers compared with control groups. On the other hand, young adult men, but not women, reared in long-term foster care were significantly more likely to have public records of alcohol-related problems and criminal activity than were members of the control groups.
Longitudinal data from the Delaware Family Study also provide valuable information about the psychological risk associated with adoption.46 At 5 years of age, adopted children were rated by researchers, but not by parents, as more fearful, less confident, and less task motivated than were nonadopted children. During the elementary school years, this pattern was even more apparent, in terms of both children's self-reports and teachers' ratings. However, parental reports did not distinguish between adopted and nonadopted children in terms of these personality characteristics and adjustment patterns. Similarly, in a follow-up study with a subsample of adolescents 15 to 18 years of age, Stein and Hoopes reported no differences between adopted and nonadopted groups on three separate measures of identity development and self-image.38
Finally, the Colorado Adoption Project, although primarily concerned with behavioral genetics issues, is providing data on the relative adjustment of adopted and nonadopted children. Although no differences were found in various indices of development and adjustment between these groups of children during infancy and toddlerhood,33,34data gathered when the children were between 4 and 7 years indicate that adopted boys were more likely to be classified by the researchers as being at risk for conduct disorder than were their nonadopted peers.47