Adopted and biological children in the clinic: family, parental and child characteristics

COVID-19-Related Stress and Resilience Resources: A Comparison Between Adoptive and non-Adoptive Mothers

Despite an increasing interest in how adoptive parents deal with situations appraised as stressful, there is a lack of research regarding adoptive parents' adjustment to the challenges posed by the prolonged COVID-19 pandemic. The current study explores similarities and differences between adoptive and non-adoptive mothers in terms of risks (i.e., COVID-19-related stress) and individual (i.e., sense of coherence [SOC]), couple (i.e., partner's support), parent-child (i.e., parent-child relationship satisfaction), and social (i.e., friends' support) resources in the face of the prolonged COVID-19 pandemic. Specifically, the present study was aimed at predicting which variables discriminate more effectively between the two groups. Participants were 445 Italian mothers (40.9% adoptive mothers), who were asked to fill in an anonymous online survey between May 2021 and October 2021. Results showed that adoptive and non-adoptive mothers reported different resilience resources to face the stressors posed by the health emergency. Specifically, COVID-19 traumatic stress symptoms, parent-child relationship satisfaction, and SOC were found to contribute most in discriminating between the two groups. Findings are discussed in relation to future research developments and practical implications.

"What Makes Us Strong?": Dyadic Coping in Italian Prospective Adoptive Couples

Becoming an adoptive parent is a particularly stressful transition, given the additional challenges couples have to face. Dyadic coping, an under-investigated dimension in the adoption literature, may play a relevant role for prospective adoptive couples' ability to better cope with the adoptive process. The general aim of the present study was to investigate the association between dyadic coping and relationship functioning, in terms of relationship satisfaction and couple generativity, among prospective adoptive couples. Participants were 103 prospective adoptive couples pursuing international adoption in Italy. Couples were asked to fill in a self-report questionnaire. Results of the Actor-Partner Interdependence Model showed that prospective adoptive partners reported high levels of positive and common dyadic coping and low levels of negative dyadic coping - suggesting partners' ability to successfully cope together with a common stressor - a high level of relationship satisfaction, and an average level of couple generativity. Moreover, analyses showed significant actor effects of one's own perception of the partner's dyadic coping (positive, negative, and common) on one's own relationship satisfaction and on couple generativity for both wives and husbands. With regard to partner effects, we found that both partners' perceptions of the other's dyadic coping responses (positive, negative, and common) were associated with the other's relationship satisfaction, with the only exception of wives' perceptions of common dyadic coping, which were not associated with their husbands' relationship satisfaction. As for couple generativity, the only significant partner effect referred to negative dyadic coping responses for both wives and husbands.

Relationship quality from pre- to postplacement in adoptive couples

Although there is an extensive research literature examining the change in relationship quality of birth parents during the transition to parenthood, there is comparatively less work on how the relationship of adoptive parents fares from pre- to postplacement of the adopted child. In the current study, we examine the relationship quality (global satisfaction, feelings of love, feelings of ambivalence) of 127 adoptive parents across the transition from preplacement to approximately 6 months postplacement of the adopted child. Following the vulnerability-stress-adaptation (VSA) model of marital quality and stability, we examined various intrapersonal vulnerability factors, couple adaptive processes, and stressful factors primarily related to the adoption process as predictors of relationship quality across 3 waves (4 to 6 weeks prior to placement of the adopted child, 4 to 6 weeks postplacement of the adopted child in the home, and 5 to 6 months post-postplacement). Results indicated that, in general, relationship satisfaction and feelings of love decreased, and relationship ambivalence increased, from pre- to postplacement across the sample. Significant predictors of greater relationship satisfaction, regardless of time, included higher self-esteem, greater relationship maintenance, a better sexual relationship, and more partner support; love was significantly predicted by greater maintenance and sexual relationship, lower conflict, and a history of infertility; and higher conflict significantly predicted higher ambivalence. Our findings suggest that, in general, adaptive processes between couples are the most consistent predictors of marital quality over the transition to parenthood in adoptive parents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychological adjustment of adoptees in adulthood: Family environment and adoption-related correlates

This longitudinal study explored psychological adjustment, evaluated in terms of self-concept and pathological symptomatology, in a nonclinical, community-based sample of adult adoptees and a matched control group of nonadoptees. Also explored was the role of adoption-related variables—age of placement of adoption, openness to adoption, and reunion with biological parents as well as family environment in predicting adjustment. Adoptees, as compared with nonadoptees, scored lower on self-concept but higher on pathological symptomatology. Likewise, they scored their families lower on all three dimensions of family environment—relationships, personal growth, and system maintenance. However, family environment variables were more predictive of adjustment in adoptees than in nonadoptees. Age of placement and openness to adoption were also associated with adoptees’ adjustment.

Understanding Adoptive Families

Contrary to societal stereotypes about adoption, this integrative review of published empirical research on adoptive families noted several positive and few negative out-comes with regard to satisfaction with the adoption, familial functioning, and parent-child communication. The critical analysis of 38 studies on adoptive families revealed a prevalence of descriptive passive research designs with concomitant concerns regarding sampling and generalizability. However, despite their limitations, the studies form the foundation for future research that, if replicated, provide support for viewing most adoptive families as resilient. To contribute to the empirical literature on adoption, counseling psychologists should base research in theory, study societal and cultural factors affecting adoptive families, improve methodology, and focus on resiliency and successful out-comes for adoptive families.

Interpersonal relatedness and psychological functioning following traumatic brain injury: implications for marital and family therapists

Recovery from a mild-to-moderate traumatic brain injury (TBI) is a challenging process for injured persons and their families. Guided by attachment theory, we investigated whether relationship conflict, social support, or sense of belonging were associated with psychological functioning. Community-dwelling persons with TBI (N = 75) and their relatives/significant others (N = 74) were surveyed on relationship variables, functional status, and TBI symptom severity. Results from this cross-sectional study revealed that only sense of belonging was a significant predictor of postinjury psychological functioning, although interpersonal conflict approached significance. No relevant preinjury or injury-related variables impacted these relationships, except marital status. Our findings suggest that interventions targeting strengthening the injured persons' sense of belonging and lowering interpersonal conflict may benefit those living with TBI.

Is screening effective in detecting untreated psychiatric disorders among newly diagnosed breast cancer patients?

BACKGROUND

A key purpose of routine distress screening is to ensure that cancer patients receive appropriate mental health care. Most studies validating screening instruments overestimate the effectiveness of screening by not differentiating between patients with untreated disorders and patients who are already being treated. This study adopts the novel strategy of evaluating the effectiveness of screening after correcting for disorder for which treatment is already being provided.

METHODS

A total of 437 recently diagnosed breast cancer patients received in-clinic distress screening and telephone-based psychiatric interviews. Analyses were conducted using receipt of psychotropic medication for mental health difficulties in the context of a psychiatric disorder as a proxy for identification and treatment.

RESULTS

Rates of elevated distress (33%), major depressive disorder (8%), minor depression (6%), dysthymia (2%), or generalized anxiety disorder (3%) were similar to those in other samples. Thirty-six percent of patients received psychotropic medication around the time of cancer diagnosis, including 64% of those with a current psychiatric diagnosis. Although 39% of patients with elevated distress had a psychiatric disorder, the positive predictive value of screening fell to 15% for an untreated psychiatric disorder and 6% had untreated depression.

CONCLUSION

Given the high rates of existing treatment, screening may not be efficient for identifying untreated disorder. Almost two-thirds of patients with treated disorders remain symptomatic. Use of symptom scales might reasonably be expanded to surveillance of treatment response or ruling out disorder. Substantial resources would likely be required to coordinate or manage psychiatric care among patients, as would a willingness to intervene in existing relationships with other providers.

Chronic Stress Conditions Do Explain Posttraumatic Brain Injury Depression

Psychosocial and biologic mechanisms are implicated in depression after traumatic brain injury (TBI). Using McEwen's stress theory of allostasis as a guidepost, this study examined whether pre- and postinjury chronic stress conditions could explain post-TBI depressive symptoms. Seventy-five community-dwelling persons who sustained a mild-to-moderate TBI and were within 2 years of the injury participated in this cross-sectional study. The participants completed measures of chronic stress and depression, measured with the Neurobehavioral Functioning Inventory. Data were collected also on brain injury severity. Using multiple regression analysis, the frequency of childhood adversities and postinjury stress explained post-TBI depression. When time-since-injury was in the regression model, the frequency of preinjury stressors and postinjury stress significantly explained post-TBI depressive symptoms while the combined effect of childhood adversity with postinjury stress was not significant in explaining depressive symptoms. Pre- and postinjury chronic stress explained post-TBI depressive symptoms. These findings support stress-diathesis theory within the psychiatric literature and a linkage between chronic stress, an indicator of allostatic load, and post-TBI depression. These findings are important for nurse specialists working with persons who sustained brain injury, for chronic stress can be buffered by efficient and effective support systems.

Distress, psychiatric morbidity, and prescriptions for psychotropic medication in a breast cancer waiting room sample

We examined relationships among psychiatric screening, the prevalence of psychiatric morbidity, and prescription rates for psychotropic medication in a waiting room sample of breast cancer patients (N=113). Rates of distress (29%), major depressive disorder (MDD; 9%), and generalized anxiety disorder (GAD; 6%) were low and similar to those found in primary care settings. A substantial proportion of patients (52%) had received psychotropic medication during treatment, including almost half (48%) of those without a current psychiatric diagnosis. Most individuals with MDD received pharmacotherapy during cancer treatment (80%), although only half of those with GAD were treated. Overall high rates psychotropic medication negatively impacted the efficiency of screening, and individuals with elevated distress were about 6 times less likely to represent a case of untreated psychiatric morbidity than to be a new case. We conclude that the risk of psychiatric morbidity attributable to breast cancer may be lower and treatment rates for psychiatric morbidity higher than previously believed and that screening is unlikely to provide efficient identification of untreated psychiatric morbidity. Adequacy of follow-up care is unclear and medication may be prescribed nonspecifically. The low rate of untreated psychiatric morbidity may signal a need for multisite collaborations to generate adequate numbers of participants in clinical trials.

What do ratings of cancer-specific distress mean among women at high risk of breast and ovarian cancer?

Women recruited from a hereditary cancer registry provided ratings of distress associated with different aspects of high-risk status and genetic testing and completed measures of general psychological distress, emotional and social health, and role functioning. Overall, high-risk status was rated as more distressing than undergoing genetic testing. Women without a personal history of cancer rated the level of distress associated with a positive test result to be greater than that associated with high-risk status. In contrast, level of distress associated with a positive test result was not significantly different from that associated with high-risk status for women with a personal history of cancer. Furthermore, women with a personal cancer history also anticipated that if they had an altered gene associated with increased risk of cancer, it would be less distressing than their diagnosis of cancer had been. Women with the highest ratings of cancer-related stress were less inclined to obtain testing, but were not more generally distressed or maladjusted. The need to interpret psychological distress and the stressfulness of genetic testing among high-risk women with respect to relevant comparison data is discussed.

The familial aggregation of the lesser variant in biological and nonbiological relatives of PDD probands: a family history study

OBJECTIVE

To determine the risk of the lesser variant (or PDD-like traits) in the biological and nonbiological second- and third-degree relatives of PDD probands using a screening questionnaire and to investigate the extent to which the risk of the lesser variant differs according to various characteristics of the proband.

METHOD

The sample consists of a series of 34 nuclear families with 2 affected PDD children (multiplex, MPX), 44 families with a single PDD child (simplex, SPX), and 14 families who adopted a PDD child. Data on characteristics of the lesser variant in 1362 biological and 337 nonbiological second- and third-degree relatives were collected from parents by telephone interview and from several maternal and paternal relatives by questionnaire.

RESULTS

All components of the lesser variant were more common in biological relatives (BR) than nonbiological relatives (NBR), confirming the familial aggregation of the traits. Proband characteristics associated with an increased risk of the lesser variant in relatives were a higher level of functioning and coming from a MPX family.

CONCLUSIONS

These findings on the familial aggregation of the lesser variant suggest that the genes for PDD also confer susceptibility to the lesser variant and that PDD may be a genetically heterogeneous disorder.

Adoptee overrepresentation among clinic-referred boys with gender identity disorder

OBJECTIVES

To test the hypothesis that adoptees are overrepresented among a sample of clinic-referred boys with gender identity problems (N = 238). To compare the adoptees and nonadoptees on demographic, behaviour problem, and gender-typed measures.

METHOD

The percentage of clinic-referred boys with gender identity problems adopted in the first 2 years of life ("early adoptees") was compared to the base rate of boys adopted in Ontario. Parent-report and behavioural measures were used to compare the early adoptees with "late adoptees" (adopted after the second year of life) and nonadoptees.

RESULTS

The percentage of boys with gender identity problems who were early adoptees (7.6%) was significantly higher than the base rate of males adopted in Ontario in the first 2 years of life (1.5%). Both the early and late adoptees were significantly less intelligent than the nonadoptees. The early adoptees also had significantly higher externalizing T scores on the Child Behavior Checklist than did the late adoptees and the nonadoptees. The 3 groups did not differ in the percentage who met the complete Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for gender identity disorder and on 4 other measures of gender-typed behaviour.

CONCLUSION

Adoptees are overrepresented among clinic-referred boys with gender identity problems. The reasons for this finding are not clear but may be accounted for by general risk factors that increase the likelihood of clinical referral or by psychosocial and biological factors associated with adoption.

Parents' sense of "entitlement" in adoptive and nonadoptive families

The literature suggests that problems with developing a sense of entitlement are unique to adoptive families, but this assumption has not been examined empirically. In this study, a questionnaire was constructed to define operationally those characteristics associated with the construct of entitlement, and was administered to adoptive and nonadoptive families with children averaging 11.5 years in age who presented either for mental health service or were recruited as a comparison-control sample. Factor analysis yielded four factors on which the four groups of subjects were compared. Results indicated that problems with entitlement are not specific to adoptive families. Instead, differences in sense of entitlement occurred primarily between clinic and nonclinic control families, regardless of whether the target child had been adopted. Findings are discussed in terms of methodological shortcomings in the adoption research literature and how problems in entitlement may be associated with other family characteristics.

The McMaster Model of Family Functioning: observer and parental ratings in a nonclinical sample

The McMaster Model of Family Functioning defines seven dimensions, which may be assessed either by an observer applying a Clinical Rating Scale (CRS) to a semi-structured interview of the family and/or by family members completing a questionnaire, the Family Assessment Device (FAD). The present article applied both methods of assessment, as well as the Dyadic Adjustment Scale (DAS), to a nonclinical sample (N = 105). Interobserver reliability on the CRS was highly significant. Parent (FAD) vs. observer (CRS) agreement was also highly significant, except for Affective Responsiveness and Behavior Control, for which agreement was barely significant. When families were labeled as "healthy" or "unhealthy" according to cut-offs, agreement between observers and parents was high (87%), and disagreements illuminated dynamics of individual families. Finally, the DAS (completed by mothers) was significantly correlated with both the CRS and the FAD, particularly for General Functioning.

Adoption as a risk factor for mental disorders

Although adoption has been viewed as a risk factor for mental disorders in children and adolescents, few studies have investigated this association in adults. To address this question, we analyzed data from a random community sample of adults where the presence of adoption in the first year of life was systematically noted and where the presence of lifetime mental disorders was determined by structured interview. In comparison to individuals raised by both biological parents, adoption was strongly associated with a history of childhood conduct disorder, antisocial personality and drug abuse or dependence. Adoption may thus be a risk factor for these mental disorders.