Comparisons of adopted and nonadopted adolescents in a large, nationally representative sample

Genetic and Nongenetic Components of Stroke Family History: A Population Study of Adopted and Nonadopted Individuals

Background Genetic and nongenetic factors account for the association of family history with disease risk. Comparing adopted and nonadopted individuals provides an opportunity to disentangle those factors. Methods and Results We examined associations between family history of stroke and heart disease with incident stroke and myocardial infarction (MI) in 495 640 UK Biobank participants (mean age, 56.5 years; 55% women) stratified by childhood adoption status (5747 adoptees). We estimated hazard ratios (HRs) per affected family member, and for polygenic risk scores in Cox models adjusted for baseline age and sex. A total of 12 518 strokes and 23 923 MIs occurred over a 13-year follow-up. In nonadoptees, family history of stroke and heart disease was associated with increased stroke and MI risk, with the strongest association of family history of stroke for incident stroke (HR, 1.16 [95% CI, 1.12-1.19]) and family history of heart disease for incident MI (HR, 1.48 [95% CI, 1.45-1.50]). In adoptees, family history of stroke associated with incident stroke (HR, 1.41 [95% CI, 1.06-1.86]), but family history of heart disease was not associated with incident MI (P>0.5). Polygenic risk scores showed strong disease-specific associations in both groups. In nonadoptees, the stroke polygenic risk score mediated 6% risk between family history of stroke and incident stroke, and the MI polygenic risk score mediated 13% risk between family history of heart disease and incident MI. Conclusions Family history of stroke and heart disease increases risk for their respective conditions. Family history of stroke contains substantial potentially modifiable nongenetic risk, indicating a need for novel prevention strategies, whereas family history of heart disease represents predominantly genetic risk.

Genetic and non-genetic components of family history of stroke and heart disease: a population-based study among adopted and non-adopted individuals

Background

It is increasingly clear that genetic and non-genetic factors account for the association of family history with disease risk in offspring. We sought to distinguish the genetic and non-genetic contributions of family history of stroke and heart disease on incident events by examining adopted and non-adopted individuals.

Methods

We examined associations between family history of stroke and heart disease with incident stroke and myocardial infarction (MI) in 495,640 participants of the UK Biobank (mean age 56.5 years, 55% female) stratified by early childhood adoption status into adoptees (n=5,747) and non-adoptees (n=489,893). We estimated hazard ratios (HRs) per affected nuclear family member, and for polygenic risk scores (PRS) for stroke and MI in Cox models adjusted for baseline age and sex.

Results

12,518 strokes and 23,923 MIs occurred over a 13-year follow-up. In non-adoptees, family history of stroke and heart disease were associated with increased stroke and MI risk, with the strongest association of family history of stroke for incident stroke (HR 1.16 [1.12, 1.19]) and family history of heart disease for incident MI (HR 1.48 [1.45, 1.50]). In adoptees, family history of stroke associated with incident stroke (HR 1.41 [1.06, 1.86]), but family history of heart disease did not associate with incident MI (p>0.5). PRS showed strong disease-specific associations in adoptees and non-adoptees. In non-adoptees, the stroke PRS mediated 6% risk between family history of stroke and incident stroke, and the MI PRS mediated 13% risk between family history of heart disease and MI.

Conclusions

Family history of stroke and heart disease increase risk for their respective conditions. Family history of stroke contains a substantial proportion of potentially modifiable non-genetic risk, indicating a need for further research to elucidate these elements for novel prevention strategies, whereas family history of heart disease represents predominantly genetic risk.

A trauma-informed substance use disorder prevention program for transracially adopted children and adolescents

The prevalence of substance use among transracial and international adoptees is higher than that of non-adopted persons, and yet no specialized treatment modalities exist for this underserved population. Our purpose is to propose a substance use disorder (SUD) prevention program for transracial adoptive families that addresses the specific issues that face this community. There are several pre- and post-adoption factors which position transracial and international adoptees (TRIAs) to be at higher risk to develop SUDs. Some of these factors include adoption identity, trauma, loss, genetics, and racial discrimination. The biopsychosocial (BPS) model (Engel, 1977) is used to conceptualize SUDs in adoptees, and theories that focus on adoption-related development issues such as the Adoptee Stress and Coping Model (Brodzinsky, 1990) are also presented. Our proposed program, Strengthening Transracial Adoptive Families (STAF), utilizes the Guiding Good Choices (GGC) prevention program as its foundation to integrate a culturally responsive adoption-focused curriculum to best serve transracial adoptive families.

Racial Family Configurations and Inequalities in Private School Enrollment Among Adopted Children

This study uses data from the American Community Survey to examine the relationship between race, family configurations, and inequalities in private school enrollment among adoptees. We find that private school enrollment is higher in transracial than in same-race families. This disparity is driven by the outcomes of adoptees in transracial families with zero rather than one same-race parent. Among adoptees themselves, there are diverging patterns of racial stratification in same-race and transracial families. White adoptees in same-race families are more likely to be enrolled in private school than Black, Asian, or Hispanic adoptees in such families. However, among adoptees in transracial families, the highest odds of private school enrollment are found among Asians. Finally, we argue that our findings have important implications for understanding how kinship cues, compensation, and social disadvantage shape parental investment in adopted children.

Adoption openness and adoption stigma: a retrospective study of adult adoptees

This study explored adult adoptees' experiences and challenges concerning their adoption and the extent to which adoption issues were openly discussed within the adoptive family. Listening to the perspective of adoptees is important as their experiences, and expectations can influence their well-being and the success of their placement. Fourteen adult adoptees participated in this study. Qualitative data were gathered using semi-structured interviews. Interviews took place between June 2020 and November 2020. The analysis of transcripts was conducted according to the interpretative phenomenological analysis (IPA) guidelines. Three themes related to the aims of the current research emerged from the data: (a) adoption secrecy, (b) adoptees' expectations for communication openness, and (c) adoption stigma. This study provides valuable insight into adoption communication openness, recognition of adoption stigma, and adoption microaggressions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43545-022-00339-2.

The Effect of Adoption on Functioning and Psychosocial Well-Being in Patients With Congenital Upper-Extremity Differences

PURPOSE

Adoption status has been investigated in numerous populations, identifying negative and positive effects on patient outcomes. This study compared parent-reported outcomes in adopted and nonadopted individuals with congenital upper-extremity (UE) anomalies to determine whether there was a measurable difference in parent perceptions of psychosocial health and functioning.

METHODS

The Congenital Upper Limb Differences registry identified adopted individuals from a large cohort of patients. Each adopted patient was matched to 2 nonadopted patients by sex, age, and diagnosis of UE difference using the Oberg-Manske-Tonkin classification. Parent-reported scores on functional and psychosocial subjective outcomes were compared between the 2 cohorts using the Pediatric Outcome Data Collection Instrument.

RESULTS

Ninety-one adopted pediatric patients with congenital UE differences were identified. Sixty had complete matches for comparison, and the remaining 31 patients were not able to be matched and were excluded from the analysis. Pediatric Outcome Data Collection Instrument scores for the UE function domain were worse in the adopted cohort as judged by minimally clinically important difference. In contrast, scores for Pediatric Outcome Data Collection Instrument domains of transfer and mobility, sports and physical function, pain and comfort, and happiness did not exceed the minimally clinically important difference, although the adopted cohort scores were all relatively lower than the nonadopted cohort scores.

CONCLUSIONS

In pediatric patients with UE differences, adoption status is seen to affect only the parent-reported domain of UE function. While differences by specific congenital diagnosis call for additional investigation, overall, these findings should be reassuring to families planning to adopt children with UE differences, and they should be supported in their expectations of UE functioning.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic III.

Different Placement Practices for Different Families? Children's Adjustment in LGH Adoptive Families

Objective

The purpose of this study was to examine the characteristics of children placed with lesbian, gay, and heterosexual adopters, and to examine children’s problem behaviors and positive psychosocial adjustment across the three family types.

Background

There is evidence that children with hard-to-place profiles may be more likely to be matched with lesbian and gay parents. In addition, children adopted from care face greater developmental difficulties than children raised by their birth families, although adoptive parents may buffer the negative effects of early adversity on their children’s psychosocial adjustment.

Method

A final sample of 149 adoptive families from across the United Kingdom was recruited: 71 heterosexual parented, 39 lesbian parented, and 39 gay parented.

Results

The results showed that gay and lesbian parents were more likely than heterosexual parents to be matched with hard-to-place children, partially because they were more open to being matched with children with hard-to-place profiles. However, no differences among the three family types on children’s psychosocial adjustment were found, when controlling for children’s early adversity.

Conclusion

Adopted children displayed similar levels of problem behaviors and positive adjustment in lesbian, gay, and heterosexual parented families. Early adversity and having a physical problem/disability accounted for much of the variance in problem behaviors whereas parenting did not. In contrast, it was suggested that parenting processes, namely, parental closeness, may help to explain children’s positive adjustment.

Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation

KEY CONTENT

Following the diagnosis of absolute uterine factor infertility (AUFI), women may experience considerable psychological harm as a result of a loss of reproductive function and the realisation of permanent and irreversible infertility.Adoption enables women with AUFI, and their partners, to experience social and legal parenthood, also often providing benefits for the adopted child.Surrogacy offers the opportunity to have genetically related offspring. Outcomes are generally positive in both surrogates and the children born as a result.Uterine transplantation is the only option to restore reproductive anatomy and functionality. While associated with considerable risk, it allows the experience of gestation and the achievement of biological, social and legal parenthood.

LEARNING OBJECTIVES

To gain an understanding of the routes to parenthood available for women with AUFI experiencing involuntary childlessness, such as adoption, surrogacy and, most recently, uterine transplantationTo consider a suggested management plan to facilitate counselling in women with AUFI who experience involuntary childlessness.

ETHICAL ISSUES

In the UK, while the number of children requiring adoption continues to increase, the number being adopted from care is decreasing.Some cultures may hold ethical or religious beliefs that surrogacy is unacceptable, and its legal position in many jurisdictions is problematic.Restrictive selection criteria and high costs may limit future availability of uterine transplantation.

Adoptive Gay Father Families: A Longitudinal Study of Children's Adjustment at Early Adolescence

Findings are presented from the second phase of a UK longitudinal study of 33 gay father, 35 lesbian mother, and 43 heterosexual parent families when their adopted children reached early adolescence. Participants predominantly lived in urban/suburban areas and were mostly white and well-educated. Standardized interviews, observations, and questionnaires of parental mental health, parent-child relationships, and adolescent adjustment were administered to parents, children, and teachers between 2016 and 2018. There were few differences between family types. However, adjustment problems had increased in all family types, with better parenting quality and parental mental health associated with fewer adjustment problems. The findings contribute to adoption policy and practice, and to theoretical understanding of the role of parental gender in child development.

Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey

OBJECTIVE

More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals.

METHOD

We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis.

RESULTS

Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms.

DISCUSSION

This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.

The Peer Relationships of Those Who Have Experienced Adoption or Foster Care: A Meta-Analysis

This meta-analytic review examines the presence and quality of close peer relationships for adoptees and individuals with foster care experience. Results indicate that adoptees show difficulty forming close peer relationships compared with biologically reared individuals, but they do not differ in the quality of these relationships. In contrast, those with foster care experience report lower quality peer relationships than biologically reared individuals. Additionally, this meta-analysis includes prevalence rates of close peer relationships that illustrate most adoptees and foster youth report having high-quality peer relationships. These findings have important implications for intervention and prevention efforts and offer directions for future research on peer relationships among adoptees and foster youth, but should be considered in light of the presence of some publication bias.

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.

Children after adoption: Exploring their psychological needs

Children adopted from care are known to be at increased risk for mental health difficulties although relatively little research has been carried out to explore this question. This study assessed the mental health and psychological development of children placed for adoption by one UK Local Authority. We compared the pattern and prevalence of difficulties to existing data including that on Looked-After Children (LAC) children. Totally, 106 families were initially approached and parent interviews and at least partial questionnaire data were gathered on 47 children, 72.3% of whom were known to have been maltreated prior to adoption. Of the 34 children with a complete data set including Development and Well-Being Assessment (DAWBA), 76.4% met full criteria for at least one neurodevelopmental or mental health diagnosis, a markedly higher rate than comparison data on LAC or community samples. Less than half of those identified with a mental health diagnosis had received any prior diagnosis, and only a minority had received appropriate services. Despite the children's difficulties, the great majority of parents reported high enjoyment of bringing up their child.

Counseling Adopted Persons in Adulthood

For the past 50 years, adults who were adopted during infancy have been research participants for empirical studies with goals ranging from twin studies for heritability, to adjustment following adoption, to attachment. While the research body is broad, it has given little attention to counseling practices with adopted adults. Because empirical research and clinical practice can inform each other, this article integrates literatures in both areas so that counseling practice with adopted adults can guide research, just as research guides practice. The authors grouped the clinically relevant literature into three main areas: identity (including genealogical and transracial adoption issues), search and reunion, and long-term outcomes. Within each section, the authors critiqued the literature as it informs counseling practice, used case studies to depict clinical implications, and suggested treatment strategies for use with adult adoptees. Epidemiological research found adequate adjustment for adopted adults. However, clinicians and researchers must address the consistent finding that a subset of adoptees struggles and copes with issues different than their nonadopted counterparts. The authors identify best clinical practices and a future research agenda related to adult adoptees and propose an adoption-sensitive paradigm for research and practice.

Adoption, Foreign-Born Status, and Children's Progress in School

Using recent data from the American Community Survey, the author investigated how the dynamics of immigration influence our understanding of the adoption-schooling relationship. The results suggest that implications of immigrant and adoption statuses could be understood within specific familial contexts. Thus, no statistical differences were found in the outcomes of foreign-born adoptees in U.S. native families and their peers with immigrant parents. Instead, the most favorable patterns of schooling progress were found among U.S.-born adoptees living in immigrant families. Among immigrants, the analysis indicated similar patterns of achievement among Hispanic and White adoptees that are inconsistent with the predictions of segmented assimilation theory. However, there was a Hispanic disadvantage relative to Whites among immigrant children living with biological and stepparents. The article concludes with a discussion of the implications of these findings for kinship selection and assimilation processes and the contention that alternative theoretical frameworks should be used to understand the implications of adoption status.

Personality disorders in adopted versus non-adopted adults

The goal of this epidemiological study was to investigate lifetime history and odds ratios of personality disorders in adopted and non-adopted adults using a nationally representative sample. Data, drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), were compared in adopted (n=378) versus non-adopted (n=42,503) adults to estimate the odds of seven personality disorders using logistic regression analyses. The seven personality disorders were histrionic, antisocial, avoidant, paranoid, schizoid, obsessive-compulsive, and dependent personality disorder. Adoptees had a 1.81-fold increase in the odds of any personality disorder compared with non-adoptees. Adoptees had increased odds of histrionic, antisocial, avoidant, paranoid, schizoid, and obsessive-compulsive personality disorder compared with non-adoptees. Two risk factors associated with lifetime history of a personality disorder in adoptees compared to non-adoptees were (1) being in the age cohort 18-29 years (but no difference in the age 30-44 cohort), using the age 45 or older cohort as the reference and (2) having 12 years of education (but no difference in higher education groups), using the 0-11 years of education as the reference. These findings support the higher rates of personality disorders among adoptees compared to non-adoptees.

Internalizing disorder in adopted versus non-adopted adults: a NESARC based study

The objective of the study consisted of comparing lifetime prevalence rates and odds ratios of anxiety, mood, and psychotic disorders in adopted-versus-non-adopted people in a nationally representative sample. The data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The main outcome measure was the prevalence of lifetime internalizing psychiatric disorders in adopted (n=378) versus non-adopted (n=42,503) individuals. Adoptees and non-adoptees were compared to estimate the odds of lifetime internalizing disorders using logistic regression analyses. Adoptees had higher prevalence rates of several lifetime mood and anxiety disorders compared with non-adoptees, with a 1.61-fold increase (95% CI 1.29-2.02) in the odds of any mood disorder and a 1.49-fold increase (95% CI 1.18-1.89) in the odds of any anxiety disorder compared with non-adoptees. Regarding specific mood and anxiety disorders, adoptees had increased odds of major depressive disorder, bipolar I disorder, panic disorder without agoraphobia, specific phobia, and generalized anxiety disorder. Disorders not differing between adoptees and non-adoptees included dysthymia, bipolar II disorder, panic disorder with agoraphobia, social phobia, and psychotic disorder. One adoption-specific risk factor was associated with lifetime mood disorder (i.e., Asian/Pacific Island). In conclusion, adoptees in a large sample from the general population had higher rates of mood and anxiety disorders compared to non-adoptees.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Children of treated substance-abusing mothers: a 10-year prospective study

This study examined children of substance-abusing mothers approximately 10 years after mothers' admission to drug abuse treatment, and identified maternal characteristics that may be risk factors for child behavior problems on the Child Behavior Checklist. Data were obtained from 396 mothers who were included in a sample consecutively admitted to 44 treatment programs in 13 California counties during 2000-2002. The Addiction Severity Index was administered at both intake and follow-up. Each mother reported on one child 6-17 years of age. All of the children had been exposed to drugs, either in utero or postnatally. At follow-up about 22% of the children demonstrated borderline or clinical range problem behaviors. Child behavior problems were related significantly to the mothers' ethnicity (lower among Hispanics relative to white), and problem severity in family/social relationship and mental health, marginally related to her prior medical/health problem, and not related to severity of alcohol, drug, legal and employment problems. Assisting mothers to address their family/social relationship and psychological problems may have an added value to prevent or reduce behavioral problems of their children.

Parent-adolescent communication in foster, inter-country adoptive, and biological Italian families: Gender and generational differences

There is a paucity of studies aimed at comparing how parents and children in different family structures cope with the challenges posed by the adolescence transition; in particular, there are few studies aimed at comparing adoptive and foster families. In order to partially fill this gap, the principal aims of the present study were to verify whether there are differences in parent-child communication among foster, intercountry adoptive, and biological families according to the adolescents' gender, and to compare the perceptions of parents and adolescents concerning parent-child communication. Data were elaborated on two levels: a generational level (adolescent's and his/her parents' perceptions among the three family groups) and a dyadic level (mother-child and father-child perceptions). The sample was composed of 276 Italian families with adolescents aged between 11 and 17 (81 foster, 98 international adoptive, and 97 biological families). Subjects (mothers, fathers, and children) filled out a questionnaire including the Parent-Adolescent Communication Scale (Barnes & Olson, 1985 ). Results highlighted that in foster families, parent-child communication showed more difficulties from both the adolescent's and the parents' point of view. Adoptive adolescents, however, reported a more positive communication with both their parents than did their peers living in biological and foster families. At a dyadic level, some differences emerged among the three groups. In biological families, a more pronounced distance emerged between parents and children. In adoptive families, father and adolescent shared more similar perceptions, whereas a significant discrepancy emerged between mother and child. A higher level of perceptual congruence between adolescents and parents was found in foster families. Gender differences were also seen: Mothers experienced a more open communication with their children than did fathers, and adolescents, and above all females, communicated better with their mothers than with their fathers in all three family groups. Il existe peu d'études qui visent à comparer comment les parents et les enfants, dans différentes structures familiales, composent avec les défis amenés par la transition à l'adolescence; en particulier, il existe peu d'études qui visent à comparer les familles adoptives et les familles d'accueil. Dans le but de combler en partie cette lacune, les principaux buts de la présente étude étaient de vérifier s'il existe des différences dans la communication parent-enfant entre les familles d'accueil, les familles adoptives (adoption entre pays) et les familles biologiques en fonction du sexe des adolescents et de comparer les perceptions des parents et des adolescents au sujet de la communication parent-enfant. Les données ont été élaborées à deux niveaux: un niveau générationnel (les perceptions de l'adolescent et de son parent parmi les trois groupes familiaux) et un niveau dyadique (perceptions mère-enfant et père-enfant). L'échantillon était composé de 276 familles italiennes avec adolescents entre 11 et 17 ans (81 familles d'accueil, 98 familles adoptives internationales et 97 familles biologiques). Les participants (mères, pères et enfants) ont complété un questionnaire incluant le «Parent-Adolescent Communication Scale (Barnes & Olson, 1985 ). Les résultats ont souligné que, dans les familles d'accueil, la communication parent-enfant a montré plus de difficultés à la fois du point de vue de l'adolescent et du point du parent. Cependant, les adolescents adoptifs ont évalué leur communication avec leurs mères et pères comme étant plus positive en comparaison à leurs pairs vivant dans des familles d'accueil et dans des familles biologiques. A un niveau dyadique, quelques différences ont émergé entre les trois groupes. Dans les familles biologiques, une distance plus prononcée a émergé entre les parents et les enfants. Dans les familles adoptives, le père et l'adolescent partageaient des perceptions similaires, tandis qu'une différence significative a émergé entre la mère et l'enfant. Un plus grand niveau de congruence perceptuelle entre les adolescents et les parents a été trouvé dans les familles d'accueil. Des différences entre les sexes ont aussi apparu: en comparaison aux pères, les mères ont expérimenté une communication plus ouverte avec leurs enfants et les adolescents, surtout les filles, communiquaient mieux avec leurs mères qu'avec leurs pères dans les trois groupes familiaux. Son escasos los estudios que se han propuesto comparar cómo los padres e hijos pertenecientes a diferentes estructuras familiares afrontan los retos que impone la transición a la adolescencia; en particular, pocos estudios comparan las familias adoptivas y las que ejercen el cuidado temporal. Para subsanar parcialmente esta deficiencia, los propósitos principales de el presente estudio fueron verificar si difiere la comunicación padres-hijos entre familias que ejercen cuidado temporal, aquéllas adoptivas entre países, y biológicas de acuerdo con el sexo del adolescente, y comparar las percepciones de los padres y de los adolescentes en cuanto a la comunicación padres-hijo. Los datos se analizaron en dos niveles: un nivel de generaciones (las percepciones del adolescente y de sus padres entre los tres grupos de familias) y un nivel de díadas (las percepciones madre-hijo y padre-hijo). Doscientas setenta y seis familias italianas con adolescentes entre 11 y 17 años de edad (81 familias de cuidado temporal, 98 adoptivas internacionalmente y 97 biológicas) constituyeron la muestra. Los participantes (madres, padres e hijos) respondieron a un cuestionario que incluía la Escala de Comunicación Padre-Adolescente (Barnes & Olson, 1985 ). Los resultados resaltan más dificultades en la comunicación padres-hijo en las familias que ejercen cuidado temporal, tanto desde la perspectiva del adolescente como de los padres. En tanto que los adolescentes adoptados perciben una comunicación más positiva que la de sus compañeros que viven en familias biológicas y de cuidado temporal. En el nivel de díadas, surgieron algunas diferencias entre los tres grupos. En las familias biológicas, se observó una distancia más pronunciada entre padres e hijos. En las familias adoptivas, el padre y el adolescente comparten percepciones más similares, mientras que discrepan significativamente madre e hijo. Se encontró un nivel mayor de congruencia perceptual entre los adolescentes y sus padres en las familias de cuidado temporal. En cuanto a diferencias de género, las madres experimentan una comunicación más abierta con sus hijos en comparación con los padres, y los adolescentes, sobretodo las mujeres, se comunican mejor con sus madres que con sus padres en los tres grupos de familias.

Substance use disorders and adoption: findings from a national sample

BACKGROUND

Prior research has shown that adoptees have a higher rate of substance use disorders (SUDs) than nonadoptees. But these findings have not been verified with a population-based sample of adult adoptees in the United States. Also, no previous adoption study has measured the prevalence of each specific substance use disorder (SUD). We aimed to compare lifetime prevalence rates and odds ratios of SUDs in adopted and nonadopted adults.

METHODS AND FINDINGS

The data come from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The main outcome measure was the prevalence of lifetime SUDs in adopted (n = 378) and nonadopted adults (n = 42503). Adoptees and nonadoptees were compared to estimate the odds of lifetime SUDs using logistic regression analysis. Adoptees had higher prevalence rates of lifetime SUDs than nonadoptees. Overall, adoptees had a 1.87-fold increase (adjusted odds ratio [AOR] 1.87, 95% CI 1.51-2.31) in the odds of any lifetime SUD compared to nonadoptees. For each SUD, adoptees had higher odds for alcohol abuse/dependence (AOR 1.84), nicotine dependence (AOR 1.78), cannabis abuse/dependence (AOR 1.77), cocaine abuse/dependence (AOR 2.54), amphetamine abuse/dependence (AOR 3.14), hallucinogen abuse/dependence (AOR 2.85), opioid abuse/dependence (AOR 2.21), and other drug abuse/dependence (AOR 2.87) compared to nonadoptees. This study also identified two adoption-specific risk factors (Hispanic, never married) associated with any lifetime SUD.

CONCLUSIONS

This study demonstrated an increased risk of lifetime SUDs in adopted adults. The findings can be useful for clinicians and policy makers to provide education, prevention, and support for adoptees and their families.

How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study

The New Family Structures Study (NFSS) is a social-science data-collection project that fielded a survey to a large, random sample of American young adults (ages 18-39) who were raised in different types of family arrangements. In this debut article of the NFSS, I compare how the young-adult children of a parent who has had a same-sex romantic relationship fare on 40 different social, emotional, and relational outcome variables when compared with six other family-of-origin types. The results reveal numerous, consistent differences, especially between the children of women who have had a lesbian relationship and those with still-married (heterosexual) biological parents. The results are typically robust in multivariate contexts as well, suggesting far greater diversity in lesbian-parent household experiences than convenience-sample studies of lesbian families have revealed. The NFSS proves to be an illuminating, versatile dataset that can assist family scholars in understanding the long reach of family structure and transitions.

Conduct Problems in Adopted and Non-adopted Adolescents and Adoption Satisfaction as a Protective Factor

The present study compared the level of conduct problems at age 17 in a large, non-clinical sample of adopted participants placed in infancy and children in non-adoptive families matched to the adoptive families on demographic characteristics. Higher levels of adolescent and parent adoption satisfaction were associated with lower levels of conduct problems. Gender by adoption status interactions were not significant. However, female adopted participants had higher levels of conduct problems than female non-adopted participants, whereas male adopted and non-adopted participants had similar levels of conduct problems. In the overall sample, differences between adopted and matched control participants on all conduct problem measures were nonsignificant.

Predicting family reunification, adoption, and subsidized guardianship among adolescents in foster care

Although national legislation has attempted to decrease the length of time that children spend in foster care, these policies have been less effective with adolescents than with children, raising questions about how best to promote permanency for adolescents. This study examined factors that predict adolescent adoption, subsidized guardianship, and reunification. The caseworkers and foster parents of 203 randomly selected 12- to 13-year-olds placed in traditional or specialized foster care were interviewed. Permanency outcomes were prospectively tracked for 8 years. By the end of the study, over 40% of the adolescents were placed in permanent homes. As hypothesized, a strong relationship with a biological mother predicted successful reunification, and a high degree of integration into a foster home predicted adoption. Additionally, when compared with adoption, subsidized guardianship with foster parents occurred more frequently for youth with strong relationships with their biological mothers and weaker relationships with their foster families. Unexpectedly, behavior problems were not related to any permanency outcomes. Results suggest that promotion of strong relationships with adults is the key in efforts to find permanent families for foster children. Furthermore, efforts to attain permanency should not cease during adolescence.

Review: Adoption research: Trends, topics, outcomes

The current article provides a review of adoption research since its inception as a field of study. Three historical trends in adoption research are identified: the first focusing on risk in adoption and identifying adoptee—nonadoptee differences in adjustment; the second examining the capacity of adopted children to recover from early adversity; and the third focusing on biological, psychosocial, and contextual factors and processes underlying variability in adopted children’s adjustment. Suggestions for future areas of empirical investigation are offered, with an emphasis on the need to integrate research, policy, and practice.

Effects of the history of adoption in the emotional adjustment of adopted adolescents

Since the decade of 1980, the model of stress and coping proposed for the assessment of vulnerability of adoptive families emphasizes that the emotional adjustment of those adopted is moderated by variables such as institutionalization, the manner and age at which the adoption was revealed, the change of first name, and the contact with the biological family. The objective of this study was to investigate the relationship of these variables to the perceived parenting style, mood, and self-esteem of the adopted adolescents. Participants in the study were 68 adolescents, between the ages of 14 and 15, adopted during infancy through judicial channels. The adolescents responded to a questionnaire about the history of adoption and to scales of Parenting Styles, Depression and Self-esteem. The main results indicated that the late revelation of adoption and the change of the first name are connected to higher levels of depression and low self-esteem and to more frequent perceptions of negligent or authoritarian parenting style. The contact with the biological family was frequently mentioned among those who perceived their parents as authoritative and presented the best indicator of mood and self-esteem. These findings were discussed in light of the necessity for multidisciplinary actions which can improve the psychological adaptation of the adopting families.

Families by Adoption and Birth: II. Mother-Infant Cognitive Interactions

Adopted children are more likely to develop learning and school adjustment problems than are their non-adopted peers, despite the fact that learning potential appears to be comparable in the two groups. In an effort to explain this phenomenon, the present study examined cognitive behavior repertoires in healthy 5-month-old first infants and their mothers during their normal daily routine in families by adoption and by birth. Two areas of functioning, vocal/verbal communication and exploration, were examined. Infants and mothers in both groups were similar in the frequency and ranking of a full array of age-appropriate cognitive behaviors. Both groups of babies experienced rich and comparable opportunities for the development of language competence. In the exploratory realm, group differences emerged for some infant measures; infants by birth were in an alert state and mouthed objects more than infants by adoption. Examination of the linkages among infant behaviors and between mothers and infants suggested that, while mothers by birth and adoption provided comparable opportunities for exploration, infants by birth were engaging in exploratory behavior to a somewhat greater extent.

Are there genetic influences on addiction: evidence from family, adoption and twin studies

AIMS

In this exciting era of gene discovery, we review evidence from family, adoption and twin studies that examine the genetic basis for addiction. With a focus on the classical twin design that utilizes data on monozygotic and dizygotic twins, we discuss support in favor of heritable influences on alcohol, nicotine, cannabis and other illicit drug dependence.

METHODS

We review whether these genetic factors also influence earlier stages (e.g. experimentation) of the addictive process and whether there are genetic influences specific to each psychoactive substance.

RESULTS

Converging evidence from these studies supports the role of moderate to high genetic influences on addiction with estimates ranging from 0.30 to 0.70. The changing role of these heritable factors as a function of gender, age and cultural characteristics is also discussed. We highlight the importance of the interplay between genes and the environment as it relates to risk for addiction and the utility of the children-of-twins design for emerging studies of gene-environment interaction is presented.

CONCLUSIONS

Despite the advances being made by low-cost high-throughput whole genome association assays, we posit that information garnered from twin studies, especially extended twin designs with power to examine gene-environment interactions, will continue to form the foundation for genomic research.

Substance use disorder among adoptees: a clinical comparative study

Goals of the study were to assess whether adoptees in treatment for Substance Use Disorder (SUD) (1) were over-, equi-, or under-represented in a clinical sample of patients with (SUD) and (2) differed demographically and clinically from non-adoptees with SUD. Sample consisted of 608 patients in two alcohol-drug treatment programs. Data collection included the Childhood Problems Scale, the Minnesota Substance Abuse Problem Scale, and the Minnesota Substance Abuse Treatment Questionnaire, and the Michigan Assessment-Screening Test/Alcohol-Drug. Findings showed that the prevalence of adoptees among SUD patients was 14 times higher than expected (95% Confidence Interval, 10 to 18 times). Adoptees reported childhood histories similar to those of non-adoptees with "any parental SUD", but they more closely resembled non-adoptees without parental SUD in regard to SUD severity and SUD treatment. Conclusion is that adoptees and their adoptive families should be alert to the increased risk of SUD among adoptees. Clinicians can expect that adoptees should manifest milder levels of SUD morbidity, similar to "non-heredity" SUD.

The health and well-being of adopted children

OBJECTIVE

We compared the health and well-being of adopted and biological children and examined whether observed differences may be a result of differences between these 2 groups in demographic characteristics and special health care needs.

METHODS

The 2003 National Survey of Children's Health was funded by the Maternal and Child Health Bureau, Health Resources and Services Administration, and was conducted as a module of the State and Local Area Integrated Telephone Survey by the National Center for Health Statistics, Centers for Disease Control and Prevention. The nationally representative sample consisted of 102,353 children, including 2903 adopted children. We compared estimates for 31 indicators of health and well-being for adopted and biological children and present adjusted estimates that control for differences in demographic characteristics and special health care needs prevalence.

RESULTS

Adopted children are more likely than biological children to have special health care needs, current moderate or severe health problems, learning disability, developmental delay or physical impairment, and other mental health difficulties. However, adopted children are more likely than biological children to have had a preventive medical visit or a combination of preventive medical and dental visits during the previous year, to receive needed mental health care, and to receive care in a medical home; they are more likely to have consistent health insurance coverage, to be read to daily, or to live in neighborhoods that are supportive, and they are less likely to live in households in which someone smokes. These differences between adopted and biological children remain statistically significant even after adjustments for differences in demographic characteristics and the prevalence of special health care needs.

CONCLUSION

The results suggest that, although adopted children may have poorer health than biological children, their parents may be doing more to ensure that they have needed health care and supportive environments.

Relation problems in internationally adopted juvenile delinquents

OBJECTIVE

Internationally adopted delinquents are overrepresented in juvenile Swedish institutions. With the purpose of investigating possible reasons for this overrepresentation, this study compared adopted delinquent adolescents and internationally adopted controls in the structure and functioning of their current relations, especially with their parents.

METHODS

Internationally adopted adolescents admitted to institutional care (N=20) and non-delinquent internationally adopted controls (N=21) were compared through: a questionnaire; "family relations", a subscale in I think I am; "Family climate" (from Karolinska Scale of Personality); Individual Schedule of Social Interaction; and an Attachment Test.

RESULTS

Bad relations with adoptive parents were more prevalent in internationally adopted delinquents compared to internationally adopted controls. Furthermore, the adopted delinquents and their parents blamed each other for the problems and the adopted delinquents reported physical and emotional abuse.

CONCLUSIONS

Internationally adopted delinquents reported more problems in their relationships to their parents than adopted controls did.

Genetic and environmental influences on age at sexual initiation in the Colorado Adoption Project

Whereas the majority of research on adolescent sexual initiation has focused solely on environmental factors, the present study used behavioral genetic analyses to investigate the relative contributions of genetic and environmental influences. Structural equation models were fitted to data from adoptive and non-adoptive sibling pairs (231 biologically related pairs and 169 unrelated pairs) from the Colorado Adoption Project. Information from censored individuals who had not yet experienced sexual initiation was maximized by adapting the twin survival analysis method of Pickles et al. (Behav Genet 24(5):457-468, 1994) to accommodate adoptive and non-adoptive siblings. Point estimates of variance components from an ACE model, including additive genetic (A), shared environmental (C), and non-shared environmental (E) influences were 28%, 24%, and 48%, respectively. Despite the lower point estimate for shared environmental effects than additive genetic effects, a CE model provided the best fit to the data. However, because adoptive siblings provide a direct estimate of shared environmental influences there is greater power to detect shared environmental effects in adoption designs. Evidence for genetic influences from our data were somewhat lower than those obtained in previous twin studies, possibly reflecting a return to more socially conservative sexual attitudes, changing sexual behaviors, or ambiguities in the wording of questions commonly used in research on adolescent sexuality.

Egg donation parents and their children: follow-up at age 12 years

OBJECTIVE

To assess the quality of parenting and psychological adjustment of egg donation families as the child approaches adolescence in comparison with donor insemination (DI) and IVF families.

DESIGN

A study of 17 egg donation families, 35 DI families, and 34 IVF families with a 12-year-old child. Standardized interview and questionnaire measures were administered to mothers and children.

SETTING

Follow-up of families recruited from three assisted conception units in the United Kingdom.

PATIENT(S)

Mothers and their 12-year-old children conceived through egg donation, DI, and IVF.

INTERVENTION(S)

Mothers and children were interviewed and administered questionnaires.

MAIN OUTCOME MEASURE(S)

Parents' marital and psychological state, quality of parent-child relationships, father's contribution to parenting, and children's socioemotional development.

RESULT(S)

No differences were found between the egg donation and IVF families. The differences between egg donation and DI families reflected lower levels of sensitive responding of egg donation mothers toward their children compared with DI mothers. Donor insemination mothers were more likely to be emotionally over-involved with their child than egg donation mothers. The egg donation children were well adjusted in terms of their social and emotional development.

CONCLUSION(S)

The findings are discussed in relation to the different pattern of genetic relationships between egg donation and DI families and the secrecy surrounding the use of donated gametes to conceive a child.

Post-Institutional Autistic Syndrome in Romanian adoptees

Romanian adoptees have a background of severe neglect. International research has shown that this can give rise to symptoms of autistic behavior. Rutter et al. (1999, Journal of Child Psychology Psychiatry, 40(4), 537-549.) refers to "quasi-autistic patterns", and Federici (1998, Help for the hopelss child: A guide for families. Alexandria: Federici & Assocoates.) to Post-Institutional Autistic Syndrome (PIAS). Eighty Romanian adoptees, averaging 8 years of age, who had resided in the Netherlands for 5 years were studied. Parent interviews and the Auti-R scale showed the extent to which the children exhibited PIAS. In one third of these children we observed (in addition to other behavioral problems) stereotypic behaviors and communication and language disorders. Our findings resembled the Rutter et al. (1999, Journal of Child Psychology Psychiatry, 40(4), 537-549). data. Six of the children were classified within the autistic spectrum pursuant to the Auti-R, and seven within the so-called intermediate group. No difference was found between the girls and the boys. Children who had been in their adoptive families for 5 years or more showed fewer behavior problems than children who had been in their adoptive families for four or less years.

Mental health outcomes of cocaine-exposed children at 6 years of age

OBJECTIVE

To assess 6-year-old cocaine- and noncocaine-exposed children's mental health outcomes controlling for potential confounders.

METHODS

The sample consisted of 322 children [169 cocaine exposed (CE) and 153 noncocaine exposed (NCE)] enrolled in a longitudinal study since birth. At age 6, children were assessed for mental health symptoms using the Dominic Interactive (DI), a child self-report measure, and the Child Behavior Checklist (CBCL), a caregiver report of behavioral problems.

RESULTS

CE children were more likely to self-report symptoms in the probable clinical range for oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). In contrast, prenatal cocaine exposure was not related to child behavior based on the CBCL. After control for exposure, CE children in adoptive or foster care were rated as having more problems with aggression, externalizing behaviors, and total behavioral problems than NCE children and CE children in maternal or relative care. Also, CE children in adoptive or foster care self-reported more externalizing symptoms than CE children in maternal or relative care and NCE children. Findings could not be attributed to caregiver intelligence or depressive symptoms, or to the quality of the home environment.

CONCLUSIONS

CE children report more symptoms of ODD and ADHD than nonexposed children. Adoptive or foster caregivers rated their CE children as having more behavioral problems than did maternal or relative caregivers of CE children or parents of NCE children. Although further studies are needed to understand the basis for the more negative ratings by adoptive or foster caregivers of their CE children, the self-report of CE children indicates a need for psychological interventions.

Children in adoptive families: overview and update

OBJECTIVE

To summarize the past 10 years of published research concerning the 2% of American children younger than 18 years old who are adoptees.

METHOD

Review recent literature on developmental influences, placement outcome, psychopathology, and treatment.

RESULTS

Adoption carries developmental opportunities and risks. Many adoptees have remarkably good outcomes, but some subgroups have difficulties. Traditional infant, international, and transracial adoptions may complicate adoptees' identity formation. Those placed after infancy may have developmental delays, attachment disturbances, and posttraumatic stress disorder. Useful interventions include preventive counseling to foster attachment, postadoption supports, focused groups for parents and adoptees, and psychotherapy.

CONCLUSIONS

Variables specific to adoption affect an adopted child's developmental trajectory. Externalizing, internalizing, attachment, and posttraumatic stress disorder symptoms may arise. Child and adolescent psychiatrists can assist both adoptive parents and children.

Are adoptees at increased risk for attempting suicide?

This study addresses the controversy of whether adopted adolescents are at risk for more mental health problems than the nonadopted and specifically evaluates differences in suicide ideation and depression. Same gender comparisons were made between 346 adopted adolescents and nearly 14,000 others living with biological parents, with nationally representative data from the National Longitudinal Study of Adolescent Health. Results showed few divergences in suicide ideation, attempts, and depression between adopted and nonadopted adolescents and young adults. Future studies employing this same dataset will need to pay closer attention to the high percentages of respondents adopted by blood relatives, which only became known with the collection of the Wave III Add Health data.

Gender differences and dynamics shaping the adoption life cycle: review of the literature and recommendations

The role of gender in the experiences of adoptive family members has received little systematic attention. Gender differences in response to different tasks and phases of the adoption life cycle are described. Gendered dynamics within the adoptive family, for birth parents, and in the field of adoption are highlighted. Birth fathers and adoptive fathers are typically marginalized, which leaves women to address emotion, connection, and communication, and family dialogues about adoption may engage daughters more successfully than sons. The article reviews reasons why differential rates of problem behavior for adopted boys and girls may result from gender differences in emotional expressiveness, social support seeking, and identity formation. Implications of the feminization of adoption are explored, and recommendations for practice and research are proposed.

Children's voices: the perceptions of children in foster care

Scant research exists on how abused and neglected children view the foster care experience and how these perceptions vary by demographic characteristics and placement type. Data come from a national probability sample of children placed in child welfare supervised foster care for at least 1 year. These findings indicate that children generally feel positively toward their out-of-home care providers and maintain hope for reunification with their biological family. Differences are present between children in family foster care, group care, and kinship care placements.

Adolescent adjustment in a nationally collected sample: identifying group differences by adoption status, adoption subtype, developmental stage and gender

The current study investigated group differences in adolescent adjustment by adoption status and adoption subtype in a national sample, in contrast to group differences based on developmental stage or gender. Secondary analyses of the National Longitudinal Study of Adolescent Health were performed to describe group differences in a broad range of adjustment measures (a) between adoptees and non-adoptees, (b) between different-race adoptees and same-race adoptees and, (c) across adolescent developmental stage and gender groups. Based upon a developmental deviance hypothesis, the current study hypothesized that early adolescent different-race adoptees would fair better across measures of academic performance, familial relationships, psychological adjustment, and physical health than their middle and late adolescent counterparts. Group comparisons revealed little evidence of increased maladjustment among adopted adolescents compared to non-adopted study participants. In addition, group comparisons revealed few differences across indices of adolescent adjustment by adoption subtype (i.e. by the degree of racial congruence adopted child and adoptive parent). However, significant group differences in adolescent adjustment were found based on participants' developmental stage and gender. The implications of the findings are discussed.

Adopted children's problem behavior is significantly related to their ego resiliency, ego control, and sociometric status

BACKGROUND

Many studies have documented that adopted children are at higher risk for behavior problems, but less is known about the correlates of their problem behavior.

METHOD

The correlates of parent-reported and teacher-reported problem behavior in 7-year-old internationally adopted children (N = 176) were investigated by examining these children's ego resiliency, ego control, and sociometric status, and exploring possible risks factors in the home and racial influences.

RESULTS

Using the 25th percentiles lowest and highest scores on ego resiliency and ego control as cut-off criteria, we found that: (1) resilient children were almost free of behavior problems; (2) overcontrolling children showed predominantly internalizing behavior problems (33% at school, and 28% at home); (3) undercontrolling children showed high rates of externalizing behavior problems (50% at school, and 34% at home), and an elevated rate of comorbidity (21% at school, and 21% at home). Adopted children identified by peer report as controversial or rejected had significantly higher externalizing problem scores than popular, average or neglected adopted children. The adopted children did not experience much (racial) discrimination. Nevertheless, children who wished to be white (46%) presented more mother-reported behavior problems.

CONCLUSIONS

Our findings replicate R.W. Robins et al.'s (1996) work on three types of personality functioning: resilients, overcontrollers and undercontrollers (identified by J. Block, 1971), extending the model from adolescent boys to school-aged boys and girls, adopted from Asia and South America. The wish to identify with white parents and white peers may constitute a potential risk factor for internationally adopted children in middle childhood.