Adoptees' experiences of using direct-to-consumer genetic testing and determinants of this use: A mixed study in Quebec

Adoptees' use of direct-to-consumer genetic testing (DTC-GT) is known to raise both ethical and emotional issues, and it can also challenge their identity. The objective of the present study was to describe the experiences of DTC-GT use among adoptees living in Quebec and to better understand the benefits and disadvantages of use. We adopted a mixed method approach whereby a questionnaire comprising standardized scales was administered to 143 adoptees who had used genetic testing and 40 adoptees who had not. Semi-structured interviews were performed with five respondents from the DTC-GT use group. The quantitative and qualitative data were analyzed and integrated together using the Pillar Integration Process. The results highlighted familial reunion as the primary motivation for the use of DTC-GT among responding adoptees. Reported challenges included needing help with results interpretation, as well as the need for autonomy in the ownership of the results. Participants describe not being particularly concerned by potential ethical issues, describing the benefits of the tests as more important than possible disadvantages. Overall, participants had a good experience of using DTC-GT, and users were less anxious. Various factors associated with the use and experience of use were highlighted (age, psychological distress, community membership, etc.). The results from this study provide much-needed information about adoptees' needs regarding DTC-GT, highlight key risk factors, and introduces best practice recommendations so that adoptees are properly informed and supported when pursuing DTC-GT.

Adoption and social identity loss: Insights from adults adopted through Ireland's mother and baby homes

A central issue in adoption research is understanding why some individuals adapt to their adoption experience while others face considerable difficulties. The social identity approach (SIA) offers a valuable framework for examining this. Recent research has increasingly shown that identifying with social groups can protect and promote well-being. However, in the context of adoption, certain groups may also present challenges or become sources of strain. The present study seeks to understand how social identities shape individuals' adoption experiences. Semi-structured interviews (N = 16) with adults who were adopted through Mother and Baby Homes in Ireland were analysed using reflexive thematic analysis. The analysis produced two interrelated themes: (1) 'Adopted' as a social identity, which explores how participants' 'adopted' status itself constitutes a significant social identity, leading to experiences of marginalization and exclusion and (2) Adoption as social identity loss, which describes how participants face contested membership and compromised belonging within important social groups. Both themes illustrate how the process of adoption can result in social identity loss. Discussion of this analysis considers the consequences of social identity change for adoption adjustment. These findings expand the theoretical application of the SIA, in the context of adoption.

Beyond the disclosure debate in donor-conception: how do we help families to discuss origin stories with their children?

Families have been subject to enormous transformations with the emergence of artificial reproductive technology and the appearance of donor-conceived children. These new families are challenged to disclose origins with their children and parents feel concern that conception stories might have an emotional impact on their children. Fertility counsellors still feel ill-equipped on what to recommend to parents because developmental psychology has not designed systematic evidence-based guidelines to address a three-dimensional matter: 'what', 'when', and 'how' to discuss conception stories. The argument developed herein is that professionals working with families in fertility clinics, could benefit from understanding these new family conversational processes of origin storytelling from these three perspectives, not only on 'what' and 'when' but also on the less elaborated 'how' to talk about it. For this purpose, understanding elaborative reminiscing as a specific way of talking about the past that helps children to build autobiographical memories and develop their identity might be key.

"I'm trying to figure out who the hell I am": Examining the psychosocial and mental health experience of individuals learning "Not Parent Expected" news from a direct-to-consumer DNA ancestry test

BACKGROUND

According to recent estimates, around 30 million people have taken Direct-to-Consumer DNA ancestry tests, typically marketed as a fun, harmless and exciting process of discovery. These tests estimate a user's ethnic ancestry, also matching users with biological relations on their database. This matching can produce a surprising 'not parent expected' discovery, where a user learns that an assumed parent (typically the father) is not a biological parent. Such news may negatively affect mental health, self-identity and familial relationships, while prompting the utilization of putatively helpful resources by affected individuals. However, there is a lack of research on this topic. Thus, this study aimed to document the psychosocial experience of adults who have learnt that an assumed parent is not a biological parent via a Direct-to-Consumer DNA ancestry test. Specific objectives include investigating and understanding impact on mental health, familial relationships and subsequent resources mobilized.

METHODS

To meet these objectives, we conducted an inductive qualitative study, allowing for the documentation of common experiences and perspectives. This involved 52 semi-structured interviews with affected individuals, analyzed using thematic analysis.

RESULTS

This resulted in five overlapping themes, namely (i) participants typically described their experience as an extraordinary shock that had a negative impact on their mental health, with some exceptions; (ii) the experience typically led to a severe and troubling disruption of their self-identity, with some exceptions; (iii) the news often ruptured extant familial relationships, especially with the mother, and any experiences with the new biological family were mixed; (iv) participants sought support from a variety of resources including spouses, siblings, and online peer support groups, which were generally considered helpful, with some exceptions; and (v) many participants consulted mental health professionals, who were sometimes considered supportive, but some participants noted that they were ill-equipped to help. Common across these themes were issues of grief, loss and trauma.

CONCLUSIONS

This study reveals an expanding, vulnerable, and under-researched population facing unique stressors, that may be at high risk of developing a psychiatric disorder. There is a need for new services and supports for this population including tailored clinical interventions and specific self-care resources.

Understanding Parenting Stress in Adoptive Parents: A Longitudinal Multilevel Study of Parents' Self-Criticism, Child Negative Emotionality, and Child Age at Placement

INTRODUCTION

Research on parenting stress in adoptive parents during the early years post-placement reveals significant variability, yet few studies examine both parent- and child-related factors. This study investigates the role of the personality dimension of self-criticism and perceived negative child emotionality in relation to parenting stress during the first four years after transnational adoption. Additionally, it explores the moderating effect of child age at placement, a key factor associated with early adversity.

METHODS

Drawing upon a longitudinal five-wave dataset in the first 4 years after the child arrived in the adoptive family, this study used multi-informant data of 96 adoptive mothers and fathers of transnationally adopted children (mean child age at placement = 13.48 months). Data were analyzed using a multilevel structural equation modeling approach.

RESULTS

Parents' self-criticism was positively associated with parenting stress at the between-parent level. At the within-parent level, year-to-year fluctuations in both parents' self-criticism and perceived child's negative emotionality were positively associated with corresponding fluctuations in parenting stress. Child age at placement did not moderate any of these associations.

CONCLUSIONS

Overall, this study yielded convincing evidence for the dynamic nature of parenting stress in the first years after child placement, the role of parental self-criticism, and the child's perceived negative emotionality herein.

The romantic relationships of adopted adolescents

INTRODUCTION

There is a gap in the literature on the romantic relationships of adopted adolescents. To address this issue, the present study has three aims: (1) to explore differences between adopted and non-adopted adolescents in terms of their involvement in and the length of their romantic relationships; (2) to explore the quality of these relationships; and (3) to analyze associations between affective relationships and well-being in both groups.

METHOD

The sample comprised 276 adopted (64.5% girls; mean age 16.3 years, 73.9% international adoptees) and 276 non-adopted (48.3% girls; mean age 16.3 years) adolescents, all of whom participated in the Spanish Health Behaviour in School-aged Children survey.

RESULTS

Similar romantic relationship rates and lengths were found among adoptees and non-adoptees, as well as between international and domestic adoptees. Adoptees reported more emotional support and conflicts in their romantic relationships than their non-adopted peers. Finally, associations between the quality of the romantic relationships and well-being were similar for both groups, with more conflicts being linked to lower levels of well-being, and more emotional support and affection correlating with higher levels of well-being.

DISCUSSION

The data suggest more similarities than differences between adopted and non-adopted adolescents. However, although this indicates that romantic relationships are yet another example of recovery for adopted boys and girls, further research is required, with larger and more diverse samples from multiple countries, to explore the differences observed in more detail.

Family-based psychological interventions for domestically adoptive families: a systematic review

Adopted children are often at a risk of experiencing several neurobiological and psychosocial difficulties. Adoptive parents must support these difficulties whilst managing their own idiosyncratic challenges. Family-based psychotherapeutic interventions which promote adoptive family functioning, environments and relationships can mediate these difficulties for adopted families. This review synthesises evidence exploring family-based psychological interventions for adoptive families, appraises the literature's strengths and weaknesses, and reports characteristics of promising interventions. Included studies recruited domestically adoptive families receiving psychotherapeutic interventions delivered to at least one adoptive parent and child. The authors searched seven electronic information databases, four grey literature databases, two journals and five relevant websites up to 12.12.2022. The quantitative Risk of Bias in Non-Randomised Studies of Interventions tool and the qualitative Critical Skills Appraisal Programme checklist assessed risk of bias. The narrative synthesis presents 20 papers detailing 18 studies involving at least 729 adopted children and 829 adoptive parents. Findings provide preliminary support for integrative interventions which include aspects of sensory activities, attachment-based play, Dyadic Developmental Psychotherapy and Eye Movement Desensitisation and Reprocessing with Therapeutic Input provided to adopted children and adoptive parents separately, alongside the adoptive family. However, risk of bias was high, limiting the conclusions. Future research should examine the feasibility, acceptability and efficacy of integrative therapeutic approaches for adoptive families to further direct clinical practice.

Exploring the intersection of gender identity and homoparental family structure: Implications for educational, family and personal well-being in Spanish students

This study explores the relationship among self-perceived gender, family type (heteroparental or homoparental) and socioeconomic factors concerning various educational, family and personal well-being domains. The data are derived from a large sample of 69,088 students from 465 schools (65% public; 35% private or semi-private) in Spain. Five separate multi-level generalized mixed (logistic or linear) regression models were calculated. Key findings include that non-binary students from homoparental families reported lower evaluations in multiple dimensions, suggesting the need for additional support. Likewise, students from homoparental families exhibited lower personal well-being and family relationship assessments, possibly due to perceived social stigmatization and peer bullying. This study sheds light on the complexities of gender identity and family type in educational settings, emphasizing the importance of addressing these issues for students' well-being and academic success.

Psychosocial outcomes of children born via embryo donation

STUDY QUESTION

What are parents' perceptions of their relationships with and the psychosocial adjustments of their children who are born via embryo donation?

SUMMARY ANSWER

Families created through embryo donation have well-adjusted parent-child relationships and reassuring child psychosocial outcomes.

WHAT IS KNOWN ALREADY

Embryo donation is an effective and growing form of third-party reproduction, but there is limited research in this field. Prior studies suggest that families created through gamete donation function well regarding parent-child relationship quality and child behavioral and socioemotional adjustment.

STUDY DESIGN, SIZE, DURATION

This is a cross-sectional survey study with 187 total participants.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Parents of children born via embryo donation were recruited nationally by contacting all embryo donation programs registered with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) as well as medically directed embryo donation or 'embryo adoption' centers. Participants completed three online Qualtrics questionnaires. The first was a survey including 33 questions on demographics, the procurement process, and self-reported obstetric outcomes. Participants also completed two standardized measures assessing children's behavior and parents' adjustment to parenthood: the Strengths and Difficulties Questionnaire (SDQ) and the Parental Acceptance-Rejection Questionnaire (PARQ). Scoring of the SDQ and PARQ was totaled and compared to standardized values (SDQ) or previously published results on other forms of gamete donation (PARQ), such as oocyte donation and sperm donation.

MAIN RESULTS AND THE ROLE OF CHANCE

On the SDQ (n = 46), the average total difficulties scores by age were: 8.2 ± 0.98 for ages 2-4, 7.6 ± 0.93 for ages 5-10, and 3.5 ± 0.77 for ages 11-17; this is compared to the normal reported range of 0-13, which indicates that clinically significant psychosocial problems are unlikely. Across all ages and individual categories (emotional symptoms, conduct problem, hyperactivity, peer problem, prosocial), scores on the SDQ were within the normal ranges. The average PARQ score (n = 70) for all respondents was 27.5 ± 1.18 (range: 24-96), suggesting perceived parental acceptance.

LIMITATIONS, REASONS FOR CAUTION

Because this study was cross-sectional, it could not capture familial relationships over time. This survey-based study design allows for potential selection bias (parents of well-adjusted children may be more likely to participate). Additionally, the overall sample size is relatively small; however, it remains one of the largest published to date. Another significant limitation to this study is the lack of generalizability: most participants were recruited from private, faith-based, embryo donation programs who are demographically similar.

WIDER IMPLICATIONS OF THE FINDINGS

Though embryo donation is an established form of third-party reproduction, it is significantly less robustly studied compared to other forms of gamete donation (oocyte or sperm donation). This study provides a larger data set with a more expanded age range of children compared to the limited number of previously published studies. Furthermore, these findings indicate a high parental disclosure rate with respect to the use of embryo donation which contrasts previous findings.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding source was utilized for the completion of this study. No conflicts are disclosed.

TRIAL REGISTRATION NUMBER

N/A.

Associations of Duration of Preadoption Out-of-home Care, Genetic Risk for Schizophrenia Spectrum Disorders and Adoptive Family Functioning with Later Psychiatric Disorders of Adoptees

The objective was to examine the impacts of duration of preadoption out-of-home care and adoptive family functioning on later psychiatric morbidity of adoptees with high (HR) and low (LR) genetic risk for schizophrenia spectrum disorders. The study uses nationwide data from the Finnish Adoptive Family Study of Schizophrenia. The study population in this substudy consisted of 43 h adoptees and 128 LR adoptees. Of these adoptees, 90 had spent 0-6 months and 81 over 6 months in preadoption out-of-home care. The family functioning of adoptive families was assessed based on Global Family Ratings and psychiatric disorders on DSM-III-R criteria. The results showed that among the adoptees with over 6 months in preadoption out-of-home care, the likelihood for psychiatric disorders was significantly increased in HR adoptees compared to LR adoptees. In adoptees with 6 months or less in preadoption out-of-home care, an increased likelihood for psychiatric disorders was found among those living in adoptive families with dysfunctional processes. These findings indicate that especially for HR children, a well-functioning early caregiving environment is crucial in terms of subsequent mental wellbeing. The results emphasize that when adoption is necessary, early placement and well-functioning adoptive family environment are beneficial to children.

Birth Family Contact from Childhood to Adulthood: Adjustment and Adoption Outcomes in Adopted Young Adults

Experiences of contact between adopted persons and birth family members have implications for psychological adjustment of adopted persons. The current study utilizes four contact trajectory groups, spanning from middle childhood to young adulthood and encompassing three aspects of birth family contact, in predicting psychological adjustment and adoption-related outcomes in adopted young adults. Data come from a longitudinal study of adoptive families in which adopted persons were domestically adopted in infancy by same-race parents in the United States. Adopted young adults in the group characterized by sustained high levels of contact and satisfaction with contact over time ('Extended Contact') displayed lower levels of psychological distress and higher levels of psychological well-being than adopted persons in the group characterized by contact that increased over time but remained limited ('Limited Contact'). Generally, adopted persons within the group characterized by consistent lack of contact ('No Contact') and the group characterized by contact that was initially present but ended ('Stopped Contact') did not differ in distress and well-being from those in the 'Extended Contact' group. No group differences were found on adoption dynamics and identity, however young adults in the 'Extended Contact' group generally reported more positive relationships with their birth mothers than those in the other groups. Findings are discussed in the context of heterogeneity in contact experiences and implications for policy and practice.

Family outcome disparities between sexual minority and heterosexual families: a systematic review and meta-analysis

BACKGROUND

The number of children in sexual minority parent families has increased. This systematic review aims to synthesise the evidence of disparities in family outcomes between sexual minority and heterosexual families and to identify specific social risk factors of poor family outcomes.

METHODS

We systematically searched PubMed, the Web of Science, Embase, the Cochrane Library and APA PsycNet for original studies that compared family outcomes between sexual minority and heterosexual families. Two reviewers independently selected studies and assessed the risk of bias of included studies. Narrative synthesis and meta-analysis were conducted to synthesise evidence.

RESULTS

Thirty-four articles were included. The narrative synthesis results revealed several significant findings for children's gender role behaviour and gender identity/sexual orientation outcomes. Overall, 16 of 34 studies were included in the meta-analyses. The quantitative synthesis results suggested that sexual minority families may perform better in children's psychological adjustment and parent-child relationship than heterosexual families (standardised mean difference (SMD) -0.13, 95% CI -0.20 to -0.05; SMD 0.13, 95% CI 0.06 to 0.20), but not couple relationship satisfaction (SMD 0.26, 95% CI -0.13 to 0.64), parental mental health (SMD 0.00, 95% CI -0.16 to 0.16), parenting stress (SMD 0.01, 95% CI -0.20 to 0.22) or family functioning (SMD 0.18, 95% CI -0.11 to 0.46).

CONCLUSION

Most of the family outcomes are similar between sexual minority and heterosexual families, and sexual minority families have even better outcomes in some domains. Relevant social risk factors of poor family outcomes included stigma and discrimination, poor social support and marital status, etc. The next step is to integrate multiple aspects of support and multilevel interventions to reduce the adverse effects on family outcomes with a long-term goal of influencing policy and law making for better services to individuals, families, communities and schools.

Profiles of Adoptee Adjustment in Young Adulthood

The developmental stage of young adulthood, the period from one's late twenties through thirties, has grown in attention and research focus among general populations. However, little is known about the adjustment of adopted individuals during this phase. The present study sought to expand our understanding of the various patterns of adoptee adjustment in young adulthood. Latent profile analysis was used to identify profiles across eight domains of functioning spanning physical and mental health to relationships, achievement, and engagement. Three profiles were identified, demonstrating varying levels of adult functioning. Adoption related and non-adoption related variables were explored using a series of multinomial logistic regressions to determine which factors differentiated between profiles. It appears that, although some adoption related variables remain significant in young adulthood, non-adoption related variables are more strongly linked to adoptee adjustment at this developmental stage. Implications and future directions for clinical care and research are discussed.

Narrating Displacement Adoptees' Challenges Due to Minority Stress

The experiences and the stories of adopted individuals cannot be understood apart from the social context that shapes them. Interpretative phenomenological analysis was used as the aim of this study was to assess the impact of the adoption of dominant social discourse on adoptees. Four themes relating to the aims of the current research emerged from the data: (1) adoptees' deviant construction of themselves, (2) experiences of invalidation and marginalization, (3) rationalization of adoption, and (4) adoption-related un-acknowledged losses. This study's results show that participants' individualized and/or societal distressing experiences can be considered within the context of minority stress. For clinical and counseling purposes it is important to understand whether these minority identities result in extra social stresses as a result of their social stigma.

Beyond Abortion: The Consequences of Overturning Roe

The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy.

What about trauma? Accounting for trauma exposure and symptoms in the risk of suicide among adolescents who have been adopted

BACKGROUND

Research suggests that individuals who have been adopted are at increased risk for suicidal behaviors, but this research does not account for the role of trauma.

OBJECTIVES

The study provided rates of trauma exposure among individuals who were adopted with child welfare involvement. The study also examined risk of suicidal ideation (SI) and behaviors (SB) based on adoption status, first as bivariate associations and then in context of trauma exposure and symptoms.

PARTICIPANTS AND SETTING

Participants in the LONGSCAN study were recruited at multiple US sites based on various risk factors for maltreatment. The current study included only those individuals with adequate information at key timepoints (n = 894), 106 (11.9%) of whom were adopted.

METHODS

Measures were collected at multiple timepoints, including caregiver-report, self-report, and review of child welfare records. Data were analyzed through logistic regression and descriptive statistics.

RESULTS

High rates of potentially traumatic experiences were found among individuals who were adopted (over 93%). The bivariate logistic regression replicated previous findings that adolescents who were adopted had increased likelihood of endorsing SI (OR 2.14, 95% CI 1.27-3.60, p = .004) and SB (OR 2.40, 95% CI 1.24-4.63, p = .009) compared to non-adopted peers. However, when polytrauma and traumatic stress symptoms were added to the model, adoption was no longer a significant predictor for SI (OR 1.35, 95% CI 0.70-2.60, p = .369) or SB (OR 1.46, 95% CI 0.68-3.13, p = .332).

CONCLUSIONS

Although much remains to be explored about the association between adoption and risk for suicidal thoughts and behaviors, the current study indicates that traumatic stress plays a critical role.

Emotional-behavioral problems, attachment and verbal skills in late-adopted adolescents: The role of pre-adoption adversities and adoption variables

BACKGROUND

There are few studies on late-adopted adolescents' outcomes -e.g., emotional-behavioral problems, attachment and cognitive status- and their possible predictive factors, none from Italy.

OBJECTIVE

This paper aimed to investigate emotional-behavioral problems, attachment representations, and verbal skills in late-adopted adolescents in Italy and to explore the predictive role of pre-adoption adversities and adoption variables for worse adoptees' outcomes.

PARTICIPANTS AND SETTING

The study included N = 79 late-adopted (mean age at adoption = 6 years) adolescents, between 11 and 18 years, placed via both intercountry and domestic adoption.

METHODS

Parents provided information about pre-adoption and adoption history and filled the Children's Behavior Checklist 6-18 for measuring participants' emotional-behavioral problems. Attachment representations were assessed through the Friend and Family Interview administered directly to adolescents, like the verbal comprehension index of the Wechsler Intelligence Scale for Children (4th edition) for measuring participants' verbal IQ.

RESULTS

Maltreatment and its interaction with multiple placements were the main predictors of other problems-i.e., social, thought, and identity difficulties (respectively, p = .007 and p = .029)-while intercountry adoption was the unique predictor of both externalizing and total problems (respectively, p = .047 and p = .015). However, domestic adoption was the most important predictor both for higher insecurity and disorganized attachment representations and lower verbal skills (all p < .044); even stronger if domestic adoption interacted with pre-adoptive institutionalization.

CONCLUSIONS

Pre-adoption adversities as well as domestic vs. intercountry adoption, but not the age at placement, contributed to adolescent adoptees' developmental outcomes.

Advocating the need for neuro-informed working with intercountry adoptees

BACKGROUND

Intercountry adoption is declining and many adoptees at any point of their life are in search of therapeutic services. Specialized care is scare and regular services seem to be missing the point. Regular therapeutic services do not cater to the specific needs of adoptees because they often forget to take the early adversity into account. Adoption specific therapeutic services are called for worldwide, this needs not be very difficult. Affective neurobiology, trauma and attachment research next to adoption studies have given practitioners many tools to design a sustainable therapeutical practice for both adoption aware assessment as well as adoption aware treatment.

OBJECTIVE

Advocating a neuro-informed approach to treatment when intercountry adoptees present developmental or other mental health problems. This approach is based on a combination of professional reflection as well as on theory and the idea is that it can be used broadly by clinicians, even when not specifically trained or focused on intercountry adoptions.

PARTICIPANTS AND SETTING

Theoretical insights are combined with clinical experience in De Adoptiepraktijk, a private, specialized mental health practice, making the argument for embracing a neuro informed approach in working with intercountry adoptees in the Netherlands.

METHODS

Theoretical evaluation, argumentation and personal reflection illustrated by a small case study. Results Overview of problems, models and methods to be used in clinical work with intercountry adoptees.

CONCLUSIONS

Proposition to use theoretical and practical insights from the neurosequential network, dyadic developmental psychotherapy, sensorimotor psychotherapy¹ and the polyvagal theory to help clinicians assess the problems adopted clients encounter and plan interventions accordingly.

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.

Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China

Objective

Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population.

Design

Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis.

Setting

Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit.

Patients, Participants

Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents.

Results

Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme.

Conclusions

Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

Charting the trajectories of adopted children's emotional and behavioral problems: The impact of early adversity and postadoptive parental warmth

Children who are adopted from care are more likely to experience enduring emotional and behavioral problems across development; however, adoptees’ trajectories of mental health problems and factors that impact their trajectories are poorly understood. Therefore, we used multilevel growth analyses to chart adoptees’ internalizing and externalizing problems across childhood, and examined the associations between preadoptive risk and postadoptive protective factors on their trajectories. This was investigated in a prospective longitudinal study of case file records (N = 374) and questionnaire-based follow-ups (N = 96) at approximately 5, 21, and 36 months postadoptive placement. Preadoptive adversity (indexed by age at placement, days in care, and number of adverse childhood experiences) was associated with higher internalizing and externalizing scores; the decrease in internalizing scores over childhood was accelerated for those exposed to lower levels of preadoptive risk. Warm adoptive parenting was associated with a marked reduction in children's internalizing and externalizing problems over time. Although potentially limited by shared methods variance and lack of variability in parental warmth scores, these findings demonstrate the deleterious impact of preadoptive risk and the positive role of exceptionally warm adoptive parenting on children's trajectories of mental health problems and have relevance for prevention and intervention strategies.

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.

Adoptees facing adolescence: What accounts for their psychological well-being?

INTRODUCTION

In accordance with the "resilience paradigm", this study was aimed at exploring the role of the parent-child relationship in supporting internationally adopted adolescents' ability to develop a strong adoptive identity and a feeling of satisfaction with their own life.

METHODS

Participants were 105 Italian adopted adolescents (13-17 years) asked to complete a self-report questionnaire.

RESULTS

Results showed that adolescents generally feel fairly comfortable discussing adoption-related issues (especially with their mothers), have a medium-high level of adoptive identity, and appear to be quite satisfied with their life. Moreover, while adoptive identity mediates the association between openness in communication regarding adoption and adoptees' well-being with mothers, father-child communication openness has a direct influence on well-being.

CONCLUSIONS

Findings highlighted that the quality of mother-child and father-child relationship plays a crucial role in guiding the process of adoptees' identity formation and influencing their well-being. Recommendations for professionals working with adoptive families were discussed.

Direct-to-Consumer Genetic Ancestry Testing in Clinical Encounters: Perspectives From Psychotherapy Cases

Despite the fact that direct-to-consumer (DTC) genetic ancestry testing (GAT) has been available for two decades, there is a lack of evidence-based guidance for clinicians who may work with patients who raise the topic of DTC-GAT. Although DTC-GAT accounts for the majority of the DTC genetic testing marketplace, it has received less attention than health-related testing from scientific and clinical communities. Importantly, however, from our personal experience, patients have been raising the topic of DTC-GAT in clinical encounters, including psychotherapy sessions. In this viewpoint, we present two cases of patients seen by two of the authors to raise awareness of this issue. We describe the implications of DTC-GAT for patients and clinicians, offer recommendations, and suggest future directions.

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.

Relational Competence in Emerging Adult Adoptees: Conceptualizing Competence in Close Relationships

Little research has focused on the positive adjustment of emerging adult adoptees (Palacios & Brodzinsky, 2010). Given the developmental context of emerging adulthood (Arnett, 2000), it is important to select an indicator of adjustment that reflects the associated ambiguity. The present study aims to provide empirical support for the construct of relational competence, or competence in one's closest relationship regardless of relationship type (i.e., romantic vs. nonromantic) among emerging adult adoptees. Participants included 162 adoptees who had been adopted before the age of one in the United States through private domestic adoption in to same-race families. Relational competence was measured by adapting a measure of romantic competence in emerging adulthood (Shulman, Davila, & Shachar-Shapira, 2011). Indicators of relational competence were coded from interviews in which participants discussed their self-identified closest relationship (White, Speisman, Jackson, Bartis & Costos, 1986). Confirmatory factor analyses showed that the proposed model of relational competence was a good fit to the data and was invariant across relationship type and gender. No differences in relational competence scores were found by relationship type or by gender (all p's >. 552). Relational competence was positively associated with adaptive functioning (β = .325, p = .006) and negatively associated with internalizing (β = -.246, p = .035) and externalizing behavior (β = -.347, p = .003).

The Rearing Environment and Risk for Major Depression: A Swedish National High-Risk Home-Reared and Adopted-Away Co-Sibling Control Study

OBJECTIVE

The authors sought to clarify the role of rearing environment in the etiology of major depression.

METHODS

Defining high risk as having at least one biological parent with major depression, the authors identified a Swedish National Sample of 666 high-risk full sibships and 2,596 high-risk half sibships containing at least one home-reared and one adopted-away sibling. Major depression was assessed from national medical registries.

RESULTS

Controlling for sex, parental age at birth, and, for half siblings, history of major depression in the nonshared parent, the risk for major depression in the matched adopted compared with home-reared full and half siblings was reduced by 23% (95% CI=7-36) and by 19% (95% CI=10-38), respectively. This protective rearing effect was not influenced by the relative educational status of the biological and adoptive parents. However, in both full and half sibships, the protective effect of adoption disappeared when an adoptive parent or stepsibling had major depression or the adoptive home was disrupted by parental death or divorce.

CONCLUSIONS

In matched full and half sibships at high risk for major depression, compared with individuals raised in their home environment, those reared in adoptive homes (homes selected in Sweden for their high-quality rearing environment) had a significantly reduced risk for major depression. This protective effect disappeared if an adoptive parent had major depression or if the adoptive home experienced parental death or divorce during childhood/adolescence. The rearing environment has a meaningful impact on risk for major depression, and this effect is likely mediated both by parental depression and the continuity or disruption of the home environment.

Similar psychosis risks in adoptees and immigrants

BACKGROUND

There is a consensus that adoptees and immigrants both experience more mental health problems than their peers. The two groups share many risk factors for psychosis, but an increased risk for psychotic illness has only been demonstrated for immigrants.

AIMS

The aim of this review is to describe psychosis risk factors in adoptees, with a focus on difficulties with identity formation, identification with in-groups, attachment to parents, and coping with loss and with discrimination.

METHOD

The literature in these five areas is reviewed as it pertains to adoption and psychosis.

RESULTS

There are no clear findings because the relevant studies have not been done, but the literature suggests that adopted children face challenges very similar to those of immigrants to a new country.

CONCLUSION

The immigration field and the adoption field have much to learn from each other. It is recommended that a prevention strategy analogous to increased neighbourhood ethnic density be implemented with adoptees - that they be intentionally exposed from early childhood and throughout adolescence to age peers who share a similar background and with whom they can readily identify. It is also recommended that immigrants be welcomed into their host country with the same open arms as adoptive parents welcome their new children.

Influence of Communicative Openness on the Psychological Adjustment of Internationally Adopted Adolescents

This study evaluated the predictive relationship between the communicative openness and psychological adjustment of adopted adolescents, controlling for preplacement risk factors. One hundred Spanish international adoptees aged 12-18 took part in the study. Data were gathered with a structured interview, the Youth Self Report and the Adoption Communication Scale. A history of maltreatment prior to the adoption was associated with more closed communication between parents and children. Prenatal drug exposure shows a relationship with the presence of externalizing behaviors and attention problems in adolescents. Finally, a lower degree of communicative openness regarding the child's origins was significantly associated with the presence of all the adolescent behavioral problems studied.

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.

Challenging Oedipus in changing families: Gender identifications and access to origins in same-sex parent families created through third-party reproduction

Socio-cultural changes and advancements in assisted reproduction over the past 40 years have led to a rise in new family forms, including same-sex parent families formed through donor insemination or surrogacy, wherein the loving couple does not coincide with the generative couple and the parents do not embody sexual difference. Can we still understand the gender identification processes and the path of accessing one's origins through the lens of the Oedipal complex? In keeping with the Freudian concepts of "psychosexuality," "primal scene" and "family romance," as well as the more recent developments in psychoanalysis, attachment theory and infant research, this article aims at revisiting the Oedipal "complex" as Oedipal "complexity," which may apply irrespective of parents' anatomical characteristics. However, this "complexity" does not renounce parents' bodies and sexuality as important to children's development. Maintaining the concept of third following the parental couple, and position within generations in the idea of Oedipal complexity, the authors suggest that a child's development pathways will depend not only on the intersection of the child's Oedipal and pre-Oedipal levels, but also on the parents' early relational events and internalisation of their own parental figures, which are not necessarily pre-determined by their gender or sexual orientation.

Father-child attachment in adoptive gay father families

The attachment security of children in 30 gay father families, 29 lesbian mother families and 38 heterosexual parent families was investigated using the Friends and Family Interview (FFI) at the second phase of a longitudinal study. Children in gay father families showed significantly higher levels of secure-autonomous attachment than children in heterosexual parent families, significantly lower levels of preoccupied attachment than children in either lesbian mother or heterosexual parent families, and significantly lower levels of disorganised attachment than children in heterosexual parent families. For children in gay father families, stepwise multiple regression revealed that neither hyperactivity nor emotional symptoms at Phase 1 were predictive of disorganisation at Phase 2. However, when entered alone, Phase 1 emotional symptoms predicted Phase 2 disorganisation. The results indicate that adopted children in gay father families are at least as likely to be securely attached as children in lesbian mother or heterosexual parent families.

Ethical Considerations in Adoption Research: Navigating Confidentiality and Privacy Across the Adoption Kinship Network

Adoption research often includes multiple members of the adoption network, each of whom has distinctive perspectives. Participants may include adopted individuals and their siblings as well as adoptive parents, birth parents, and adoption professionals. Due to these multiple informants and the sensitivity of the topics explored in adoption research, researchers encounter several unique ethical concerns when working with populations impacted by adoption. The current paper addresses confidentiality and privacy issues that arise when conducting adoption research. Examples from a longitudinal study on openness in adoption are provided to highlight strategies that can be used to address these issues.

Minding the (Information) Gap: What do Emerging Adult Adoptees Want to Know about their Birth Parents?

The formation of an adoption information gap was examined for a group of 169 emerging adults (M= 25.0 years) who were adopted as infants. Participants completed interviews and questionnaires at adolescence and emerging adulthood (late teens to 20's). The Adoption Curiosity Pathway model guided research questions about formation of an adoption information gap, which exists when there is a difference between what an adopted person knows and what he or she desires to know, regarding his or her adoption. In addition, specific issues were identified about which emerging adults were curious. Differences in these specific issues were examined across gender and openness arrangement with birth parents at emerging adulthood. The most frequently sought information was medical and health history. Logistic regression analyses revealed that the formation of an adoption information gap, which contains the specific items of curiosity, was more likely for those who were less satisfied with the amount of openness with birth parents during both adolescence and emerging adulthood. Implications for practice are presented.

Working with Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD): A case study

Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), based on attachment theory and social learning theory, is an intervention aimed at enhancing sensitivity and firm limit setting in parents, and reducing behavior problems in children. The VIPP-SD program has been tested in populations of vulnerable children and parents at risk in twelve randomized controlled trials, and shows significant effects on both positive parenting and child outcomes. Here, we present a case study of an adoptive mother and her two-and-a-half-year-old adopted daughter. During the VIPP-SD program, including one introduction visit and six intervention sessions with video feedback, the mother-child interaction revealed important changes in positive parenting and child outcomes. By describing the intervention process in some detail we hope to shed light on how the VIPP-SD program can be used by clinicians and practitioners who support families in need of parenting support.

We wanted to choose us: how embryo donors choose recipients for their surplus embryos

OBJECTIVE

This study aimed to explore factors affecting donors' choice of recipients for their surplus embryos in the New Zealand context of conditional, known donations.

BACKGROUND

Internationally, embryo donation has a low uptake in spite of large numbers of cryopreserved embryos. Possible reasons include a lack of knowledge about and concern for the future welfare of the resultant offspring. In New Zealand, donors and recipients meet prior to donation and legislation supports disclosure and access to genetic knowledge.

METHOD

Twenty-two embryo donors (10 couples, two individuals) were interviewed between March 2012 and February 2013 about their experiences of donation and factors affecting their donation. Interview data were analysed thematically.

RESULTS

In the interests of the welfare of the child resulting from donation, donors were invested in choosing recipients who would make suitable parents. They attempted to choose recipients similar to themselves, as well as those that they trusted to disclose the manner of conception and facilitate agreed-upon information exchange and contact.

CONCLUSION

The interest of donors in ensuring offspring well-being may lend support to conditional forms of open donation, allowing for assessment of recipients' suitability to parent, and for negotiation around information exchange and contact.

Adopted daughters and adopted daughters-in-law in Taiwan: a mortality analysis

Adoption is sometimes considered paradoxical from an evolutionary perspective because the costs spent supporting an adopted child would be better spent on rearing one's own. Kin selection theory is commonly used to solve this paradox, because the adoption of closely related kin contributes to the inclusive fitness of the adoptive parent. In this paper, we perform a novel test of kin selection theory in the context of adoption by asking whether adopted daughters-in-law, who contribute directly (i.e. genealogically) to the perpetuation of their adoptive families' lineages, experience lower mortality than daughters adopted for other purposes in historical Taiwan. We show that both classes of adopted daughter suffer lower mortality than biological daughters, but that the protective effect of adoption is stronger among daughters who were not adopted with the intention of perpetuating the family lineage. We speculate as to the possible benefits of such a pattern and emphasize the need to move beyond typological definitions of adoption to understand the specific costs and benefits involved in different forms of caring for others' children.

Temperamental sensitivity to early maltreatment and later family cohesion for externalizing behaviors in youth adopted from foster care

Children in foster care frequently have histories of physical/sexual abuse and neglect, increasing their risk for externalizing behaviors (EB; e.g., aggression). According to the differential susceptibility theory, children with reactive temperaments (e.g., negative emotionality) may be particularly vulnerable to early maltreatment, but may also benefit the most from environmental enrichment such as family cohesion. In a high-risk longitudinal sample of 82 children adopted from foster care in Los Angeles County from 1996 and 2001, we examined predictions of EB from childhood to adolescence/young adulthood from temperament, preadoption maltreatment, and adoptive family cohesion. Overall, results from generalized linear models and generalized estimating equations (GEE) did not support differential susceptibility theory - specifically, youth with early reactive temperament did not exhibit heightened sensitivity to maltreatment nor to later adoptive family cohesion. Instead, reactive temperament was associated with higher EB at initial adoptive placement and escalating EB across childhood, controlling for age, gender, race-ethnicity, preadoption maltreatment, and adoptive family cohesion. Preadoption maltreatment history was unrelated to baseline EB, although sexual abuse history predicted escalating childhood EB post-adoption, whereas exposure to family violence (e.g., domestic violence) inversely predicted EB over time. By late adolescence/young adulthood 11-15 years post-adoption, rates of arrest and substance use in this sample were relatively comparable to normative populations of youth, although older age of adoption predicted more substance use in late adolescence/young adulthood. Findings highlight early reactive temperament and preadoption maltreatment as important risk factors to target for ameliorating patterns of EB growth in the first few years of adoption.

The emergence of team science: Understanding the state of adoption research through social network analysis

The notion of team science has recently gained popularity in European and American health sciences considering increasing evidence that scientific collaboration produces higher-impact research and that complex scientific problems are better investigated by interdisciplinary teams. While publication metrics indicate adoption research is expanding, the comprehensive structure of adoption studies as a scientific field has not been formally evaluated for collaborative and cross-disciplinary activity. This article aims to elucidate the structure, composition, and dynamics of scientific relationships within adoption research that may inform research and practice strategies, competencies, and cohesion within the field. Using social network analysis, we extracted bibliographic data on 2767 peer-reviewed adoption-related articles from 1930s to 2014 and evaluated the resulting co-authorship and co-citation networks. We found that adoption research has grown substantially over the last 25 years, and is conducted in varied disciplines, with increasing collaboration across geography and disciplinary areas. The co-authorship and co-citation networks are approaching numeric thresholds and structural configurations distinctive of well-established and more institutionalized fields of study. These findings reveal the maturation of adoption studies as a team science and argue for the development of institutional mechanisms that support such evolution. Implications for professional and research planning are discussed.

Late-adoptions in adolescence: Can attachment and emotion regulation influence behaviour problems? A controlled study using a moderation approach

A growing body of research suggests that, compared to normative adolescence, adoptive adolescence could be considered a specific risk condition characterized by more psychiatric problems, attachment insecurity, and emotional regulation difficulties as consequences of negative experiences in preadoption relationships. The current study explores (a) a moderation model of adoption status on the association between attachment representations (secure, dismissing, preoccupied, and disorganized) and behavioural problems and (b) a moderation model of adoption status on the association between emotion regulation processes (cognitive reappraisal and expressive suppression) and behavioural problems. Both the moderation models were controlled for verbal skills. Forty-six adopted adolescents and a control group of 34 nonadopted peers (12-16 years old) living with both their biological parents were assessed using the Friends and Family Interview, the Emotion Regulation Questionnaire for Children and Adolescents, the Child Behaviour Check List 6-18, and the verbal subtests of the Wechsler Intelligence Scale for Children, the latter as control measure. Results showed that adoption status (but not attachment) positively predicted externalizing and total behaviour problems, whereas attachment disorganization (but not adoption status) positively predicted internalizing problems in both group. Moreover, low cognitive reappraisal had a negative impact on externalizing problems only for adopted adolescents, but not for nonadopted youths. The clinical implications of these findings are discussed in order to enhance effective intervention with adopted adolescents and their parents.

Child and family-related predictors of psychological outcomes in children adopted from abroad; what is the role of caregiver time?

International adoptees need to cope with stressful transitions and to develop secure attachment with their caregivers at the same time. Although most children adopted from abroad adjust fine, they are at increased risk of psychological problems. We investigated whether both child and family-related factors are associated with later psychological problems and whether the length of time spent at home after adoption before daycare moderates these associations among internationally adopted children in Finland (FinAdo, Finnish Adoption Study). The sample consisted of 1,265 children (708 girls, 557 boys) who arrived in Finland before they started school (mean age 2 years at arrival). Later behavioral problems were measured using the Child Behavior Check List (CBCL). According to our results, male gender, older age, child's early clinical symptoms (problems of sensory processing) and single parenthood were associated with later behavioral problems measured by CBCL scores. Longer stay at home before the start of daycare or school modified these results. Longer stay at home was associated with less later behavioral externalizing problems in girls but not in boys compared to those who spent a shorter time at home.