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.

Internalizing Problems in Adopted Eastern European Adolescents: The Role of the Informant, Early Adversity and Post-Adoption Processes

BACKGROUND

Internationally adopted children who suffered early institutionalization are at risk of a late onset of internalizing problems in adolescence. Both pre-adoption, adversity-related, and post-adoption factors predict variability in internalizing problems in this population. Previous studies have suggested different patterns of parent-adolescent informant discrepancies in adoptive dyads

METHOD

We analyzed internalizing problems among 66 adolescents internationally adopted from Russia to Spanish families using both the parent- and self-report version of the Strengths and Difficulties Questionnaire and comparing them with a low-risk, community group (n = 30). We assessed pre-adoption and post-adoption factors and evaluated cross-informant discrepancies.

RESULTS

Internationally adopted adolescents exhibited more internalizing problems by parent-report than community adolescents, but there were no differences by self-report. Adopted youth showed no discrepancies between parent and self-report, whereas community adolescents reported more internalizing symptoms than their parents. Pre-adoption adversity-related factors predicted parent-reported internalizing problems, while post-adoption factors predicted self-reported internalizing problems.

CONCLUSIONS

Parent-adolescent informant discrepancies in adopted adolescents from Eastern Europe for internalizing symptoms were lower than in community adolescents. Both adversity-related factors and the lived experience of adoption may influence the development of internalizing symptoms in internationally adopted adolescents.

An examination of early socioeconomic status and neighborhood disadvantage as independent predictors of antisocial behavior: A longitudinal adoption study

The present study examined early socioeconomic status (SES) and neighborhood disadvantage (ND) as independent predictors of antisocial behavior (ASB) and addressed the etiology of the associations (i.e., genes versus the environment) using a longitudinal adoption design. Prospective data from the Colorado Adoption Project (435 adoptees, 598 nonadopted children, 526 biological grandparents of adoptees, 481 adoptive parents, and 617 nonadoptive parents including biological parents of unrelated siblings of adoptees) were examined. SES and ND were assessed during infancy and ASB was evaluated from ages four through 16 using parent and teacher report. Associations between predictors and ASB were compared across adoptive and nonadoptive families and sex. Early SES was a nominally significant, independent predictor of antisocial ASB, such that lower SES predicted higher levels of ASB in nonadoptive families only. ND was not associated with ASB. Associations were consistent across aggression and delinquency, and neither SES nor ND was associated with change in ASB over time. Nominally significant associations did not remain significant after controlling for multiple testing. As such, despite nonsignificant differences in associations across sex or adoptive status, we were unable to make definitive conclusions regarding the genetic versus environmental etiology of or sex differences in the influence of SES and ND on ASB. Despite inconclusive findings, in nonadoptees, results were consistent-in effect size and direction-with previous studies in the literature indicating that lower SES is associated with increased risk for ASB.

A four-year multi-wave prospective study on the role of parental reflective functioning and parenting stress in the development of socio-emotional problems in internationally adopted children

Parental reflective functioning (PRF) plays a protective role in the development of children with histories of early adversity, including adopted children. This is the first study to investigate the developmental trajectories of PRF and children's socio-emotional problems in the first 4 years after international adoption (N = 48 families, mean age (T1) = 20.7 months) and to examine the mediating role of parenting stress in the relation between PRF and child socio-emotional problems. Multilevel modeling indicated that age at adoption and parent gender moderated the development of PRF and child socio-emotional problems. Moreover, decreases in PRF were associated with more socio-emotional problems in the children. These relations were mediated by parenting stress, and particularly feelings of incompetence and marital dissatisfaction.

Facial emotion recognition in adopted children

Children adopted from public care are more likely to experience emotional and behavioural problems. We investigated two aspects of emotion recognition that may be associated with these outcomes, including discrimination accuracy of emotions and response bias, in a mixed-method, multi-informant study of 4-to-8-year old children adopted from local authority care in the UK (N = 42). We compared adopted children's emotion recognition performance to that of a comparison group of children living with their birth families, who were matched by age, sex, and teacher-rated total difficulties on the Strengths and Difficulties Questionnaire (SDQ, N = 42). We also examined relationships between adopted children's emotion recognition skills and their pre-adoptive histories of early adversity (indexed by cumulative adverse childhood experiences), their parent- and teacher-rated emotional and behavioural problems, and their parents' coded warmth during a Five Minute Speech Sample. Adopted children showed significantly worse facial emotion discrimination accuracy of sad and angry faces than non-adopted children. Adopted children's discrimination accuracy of scared and neutral faces was negatively associated with parent-reported behavioural problems, and discrimination accuracy of angry and scared faces was associated with parent- and teacher-reported emotional problems. Contrary to expectations, children who experienced more recorded pre-adoptive early adversity were more accurate in identifying negative emotions. Warm adoptive parenting was associated with fewer behavioural problems, and a lower tendency for children to incorrectly identify faces as angry. Study limitations and implications for intervention strategies to support adopted children's emotion recognition and psychological adjustment are discussed.

Disentangling nature from nurture in examining the interplay between parent-child relationships, ADHD, and early academic attainment

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is highly heritable and is associated with lower educational attainment. ADHD is linked to family adversity, including hostile parenting. Questions remain regarding the role of genetic and environmental factors underlying processes through which ADHD symptoms develop and influence academic attainment.

METHOD

This study employed a parent-offspring adoption design (N = 345) to examine the interplay between genetic susceptibility to child attention problems (birth mother ADHD symptoms) and adoptive parent (mother and father) hostility on child lower academic outcomes, via child ADHD symptoms. Questionnaires assessed birth mother ADHD symptoms, adoptive parent (mother and father) hostility to child, early child impulsivity/activation, and child ADHD symptoms. The Woodcock-Johnson test was used to examine child reading and math aptitude.

RESULTS

Building on a previous study (Harold et al., 2013, Journal of Child Psychology and Psychiatry, 54(10), 1038-1046), heritable influences were found: birth mother ADHD symptoms predicted child impulsivity/activation. In turn, child impulsivity/activation (4.5 years) evoked maternal and paternal hostility, which was associated with children's ADHD continuity (6 years). Both maternal and paternal hostility (4.5 years) contributed to impairments in math but not reading (7 years), via impacts on ADHD symptoms (6 years).

CONCLUSION

Findings highlight the importance of early child behavior dysregulation evoking parent hostility in both mothers and fathers, with maternal and paternal hostility contributing to the continuation of ADHD symptoms and lower levels of later math ability. Early interventions may be important for the promotion of child math skills in those with ADHD symptoms, especially where children have high levels of early behavior dysregulation.

Pubertal recalibration of cortisol-DHEA coupling in previously-institutionalized children

As a period of heightened plasticity, puberty may provide a window of opportunity for recalibration of the hypothalamic-pituitary-adrenal (HPA) axis to current conditions. Our group has recently documented evidence for pubertal recalibration of HPA axis reactivity among children internationally adopted as infants from institutions into supportive, well-resourced homes. As a first step at examining potential mechanisms by which puberty may facilitate recalibration of the HPA axis, the current study assessed whether previously-institutionalized (PI) children differed from non-adopted (NA) comparison children in levels of the adrenal steroid hormone dehydroepiandrosterone (DHEA) and in its intra-individual covariation (coupling) with cortisol by adrenal pubertal stage. In an accelerated longitudinal design, 7- to 15-year-olds completed up to 3 annual assessments, which included nurse-conducted pubertal staging and the Modified Trier Social Stress Test for Children (TSST-M). Adrenal (pubic hair) rather than gonadal pubertal stage scores were used in the analysis. Paired salivary cortisol-DHEA samples were available at 60-80 min post-TSST-M. NA and PI children did not differ in DHEA levels, which were higher among children at more advanced pubertal stages (averaged across the sessions) for both groups. For NA children, post-stressor cortisol and DHEA were positively coupled across sessions at all average adrenal pubertal stages. For PI children who were, on average, at earlier adrenal pubertal stages, post-stressor cortisol and DHEA were not coupled, but PI children who were at later pubertal stages demonstrated positive cortisol-DHEA coupling similar to that of the NA children. We suggest that these findings provide insights into processes which may underlie pubertal recalibration of the HPA axis.

Children adopted by same-sex couples: Identity-related issues from preschool years to late adolescence

Little research has investigated the experience of same-sex adoption from children's perspective. What does it feel like to be adopted by 2 dads or 2 moms? How do the challenges related to being adopted and the challenges related to growing up in a same-sex-parent family overlap in the identity construction of adoptees? This is the 1st European study giving voice to children adopted by same-sex couples focusing on their adoptive and family-related identities at four developmental stages: early childhood, middle childhood, preadolescence, and adolescence. In-depth interviews were conducted with a sample of 44 adoptees (36 males and 8 females; ages 3-18 years) and 62 adoptive parents (16 lesbian women and 46 gay men). Thematic analysis revealed that adoptees deal with unique developmental challenges connected to the intersection of both their adoptive and familial minority statuses. They often reported being confronted with heteronormative assumptions of family, which led them to question themselves regarding the way their family is perceived by others, to idealize the heteronuclear family form, and to increase their curiosity about their birth parents. Findings shed light on the evolution of adoptees' questions, feelings, and experiences related to their unique family arrangement from early childhood through adolescence, suggesting a better integration of their adoptive and minority group statuses at progressively more advanced developmental stages. Analyses underline the importance of open family communication for facilitating the integration of such complex elements in adoptees' emerging identity. Practice implications of the findings are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Enhancing Parenting Quality for Young Children Adopted Internationally: Results of a Randomized Controlled Trial

Children adopted internationally are often dysregulated biologically and behaviorally due to prior experiences of institutional care or caregiving changes and thus are in need of enhanced parental care. The present study assessed whether parents randomized to receive Attachment and Biobehavioral Catch-up (ABC) demonstrated significant improvements in parenting quality when compared to parents receiving a control intervention. Participants were 120 internationally adopted children and their adoptive parents. Sixty-three (52.5%) of the children and 113 (94.2%) of the primary caregivers were female. Children were adopted from several countries and predominantly from China, Russia, South Korea, and Ethiopia. The majority of parents identified themselves as White/non-Hispanic (95.0%). At the start of intervention, parents ranged in age from 26.2 to 51.1 years old (M= 39.7, SD = 6.0), and children ranged in age from 6.8 months to 48.4 months (M = 21.9, SD = 9.0). Sensitivity (i.e., contingent responsiveness to a child's cues), intrusiveness (i.e., physical and/or verbal behavior that interferes with a child's autonomy), and positive regard (i.e., positive affect expressed towards a child) were assessed at preintervention, immediately postintervention, and at annual follow-up visits. Parents who received ABC showed better parenting quality at postintervention than parents who received a control intervention, and these effects persisted at a 2-year follow-up. Findings add to the growing evidence that ABC improves parenting abilities, extending findings to adoptive parents and demonstrating that improvements in parenting quality were sustained several years after completion of the intervention. Trial registration: ClinicalTrials.gov NCT00816621.

Conceived Through Rape/Incest? Adoptive Parents' Experiences Managing Uncertainty and Disclosure Surrounding their Children's Origins

Adoptive parents may be placed with children conceived under difficult circumstances, such as via rape or incest. At the same time, adoptive parents are generally encouraged to communicate openly with their children about their adoption stories and birth families. No research has examined the experiences of parents who adopt children who were conceived through rape or incest. This exploratory study examines how parents discuss their decision-making when adopting children conceived via rape or incest, how they manage varying levels of uncertainty about their children's origins, and whether and how they plan to disclose this information to children. The researchers used thematic analysis to examine the experiences of 11 couples (22 parents) interviewed at four time points after adopting children who were reportedly conceived via rape or incest. Findings revealed that even soon after adopting, parents discussed the need to eventually talk to their children about their conception circumstances. Parents generally struggled to determine how and when to disclose this information, particularly when they felt uncertain about the veracity of the conception stories they had been told. Some hoped to rely on professionals or birth mothers to guide them in these communications. Findings have implications for supporting adoptive families as they navigate the complexity of managing sensitive information and uncertainty when adopting children conceived through rape or incest. Practitioners should provide ongoing guidance to adoptive parents about how and when to disclose developmentally appropriate information to children about difficult conception circumstances.

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.

Attachment to Parents and Aggressiveness in Adopted Adolescents: A Multi-Sample Comparison Study

This study examined adopted adolescents' levels of attachment security to parents and aggressiveness as compared to those of community nonadopted adolescents and of clinical nonadopted adolescents. Three different subsamples participated (n = 262): 101 community nonadopted adolescents (48.5% girls), 80 community adopted teens (65.0% girls), and 81 nonadopted counterparts (35.8% girls) who participated in a treatment program for youth with behavioral problems. There were no differences between community groups in attachment security or aggressiveness, whereas clinical nonadopted adolescents showed less attachment security and more aggressiveness than the other two groups. The implications of these results are discussed in terms of the potential healing impact that living with adoptive families could have on adopted teenagers' risk of maladaptive outcomes.

Family conflict observations and outcomes among adopted school-age children with lesbian, gay, and heterosexual parents

Children's externalizing problems are associated with family conflict among children and their biological parents, yet these linkages have remained unexamined among adoptive or lesbian and gay parent families. Investigating family processes facilitative of adjustment among adoptees, who face unique developmental challenges, is warranted. This multimethod study of 96 (26 lesbian, 29 gay, 41 heterosexual parent) adoptive families examined observations of adoptive family conflict and associations with child adjustment and feelings about adoption (children's M_age = 8 years). The sample was recruited from 5 private, domestic infant adoption agencies across the United States. Parents and children reported about children's externalizing problems and feelings about adoption, respectively. Observations of family conflict interaction were rated from videotaped family discussions. Family interactions were associated with children's behavioral and adoption-specific adjustment, yet analysis of variance and hierarchical linear modeling analyses revealed no differences by parental sexual orientation in family dynamics (i.e., negativity/conflict, positive affect, cohesiveness) or child outcomes. Parents generally reported children to have few externalizing behaviors. Children reported positive feelings, moderate preoccupation, and low negativity about their adoption. These findings extend the family systems literature about conflict and child development among diverse families with sexual minority parents and adopted children. Practitioners who work with adoptive and sexual minority parent families can encourage positive and cohesive family interactions in supporting children's adjustment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emotional and behavior problems in adopted children - The role of early adversities and adoptive parents' regulation and behavior

BACKGROUND

Early adversity and negative experiences in the adoptive family can put adopted children at risk for emotional and behavior problems.

OBJECTIVE

This study analyzes the influence of children's preadoptive history and adoptive parents' characteristics on the psychosocial adjustment of nationally and internationally adopted children in Germany.

PARTICIPANTS AND SETTING

The survey included 172 adopted children aged between 24 and 145 months and their adoptive parents.

METHODS

Parents provided information about preadoptive history. Information about emotional and behavior problems was obtained from the parental version of the Strengths and Difficulties Questionnaire (SDQ). Parental well-being was obtained through a composite score of three standardized measures (self-efficacy questionnaire, Perceived Stress Scale PSS-4, Brief Symptom Inventory BSI); parenting behavior was assessed with the Alabama Parenting Questionnaire (DEAPQ).

RESULTS

12.5% of the adopted children scored in the clinical range of the SDQ. In a multiple regression analysis, the experience of maltreatment and neglect was the most important predictor of emotional and behavior problems at time of assessment, followed by pre- and perinatal risk and parental stress regulation difficulties, R² = .423, F(4, 128) = 28.539. Increases in the number of risk factors present were associated with a greater odd of children scoring in the clinical range of the SDQ.

CONCLUSIONS

Most of the nationally and internationally adopted children in this sample were well-adjusted. Prenatal and preadoptive risk as well as stress regulation capacities of the main caregiver contributed to the child's development. An accumulation of risks increased the likelihood of adjustment problems in adopted children.

Parenting stress of adoptive mothers, mother-child conflict, and behavior problems during adolescence among international adoptees

International adoptees show more behavior problems than their nonadopted peers do during childhood and adolescence. Although conditions of deprivation experienced prior to adoption have been found to have a long-lasting impact on child psychosocial adjustment, the influence of adoptive families tends to increase over age. The aim of this study was to investigate the impact of parenting stress and parent-child conflict on international adoptees' behavior problems in adolescence. Our sample consisted of 60 adolescents adopted during infancy and their mothers. Adolescents' behavior problems were assessed using the Dominic Interactive Adolescent, a self-report measure, and the Child Behavior Checklist, completed by mothers. Parenting stress was assessed using the Stress Index for Parents of Adolescents. Adolescents and their mothers were also observed during a discussion to evaluate parent-child conflict. Structural equation modeling revealed that parent-child conflict mediated the association between parenting stress and externalizing symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A comparison between a Neuro-Physiological Psychotherapy (NPP) treatment group and a control group for children adopted from care: Support for a neurodevelopmentally informed approach to therapeutic intervention with maltreated children

BACKGROUND

Little evidence exists regarding outcomes of therapeutic interventions for maltreated children who are removed from their birth families and then adopted. This study follows on from a previous evaluation of the Neuro-Physiological Psychotherapy (NPP) model, which found significant, positive and sustained post-treatment change.

OBJECTIVE

To compare the outcomes for the NPP intervention group to those of a control group.

PARTICIPANTS AND SETTING

Participants were families who received the NPP intervention and families who, following assessment, did not receive the NPP intervention as recommended.

METHODS

Groups were matched in terms of demographics and presentation at assessment. A comparison of outcomes took place using ANCOVA.

RESULTS

Significant differences were found between group measures of Behavioral Regulation Index (moderate effect size, Cohen's d = .435; F(1, 1505) = 14.476, p = .000) and Global Executive Functioning (BRIEF) (small effect size, Cohen's d = .147; F(1, 3506) = 7.771, p = .008); mental health difficulties common in maltreated children (ACC/ACA) (small effect size, Cohen's D = .212; F(1, 1100) = 6.197, p = .020) and externalizing behavior (CBCL) (small effect size, Cohen's D = .025; F(1, 686) = 5.420, p = .025). A comparison of parent responses on quantitative aspects of a structured interview using chi-square analysis revealed significant differences between the groups on relationship quality (x2 (2, N = 53) = 10.453, p = .005 with a medium effect size, Cramer's V = .444), disruption (x2 (1, N = 54) = 4.998, p = .025. The effect size was medium with Cramer's V = .304), parental separation rates (x2 (1, N = 45) = 9.474, p = .002. The effect size was moderate with Cramer's V = .459) and several indicators for longer-term social inclusion. The results are discussed in the light of the model's neurodevelopmental and sequential approach, which focuses on sensory integration, affect regulation and therapeutic life story work alongside parent and school support.

CONCLUSIONS

Implications regarding current treatment guidelines for this population are discussed; and a call is made for interventions which actively consider and address the neurodevelopmental impact of maltreatment.

Fetal alcohol spectrum disorders from childhood to adulthood: a Swedish population-based naturalistic cohort study of adoptees from Eastern Europe

BACKGROUND

Fetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest.

OBJECTIVE

To describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children.

DESIGN

Prospective observational cohort study SETTING: Western Sweden PARTICIPANTS: A population-based cohort of 37 adoptees diagnosed with FASD in childhood.

OUTCOME MEASURES

Assessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist.

RESULTS

Out of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18-28) and a mean follow-up time of 15.5 years (range 13-17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately -1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5-21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = 'severely ill'.

CONCLUSION

Major cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.

Adopted children who kill their adoptive parents

The killing of parents, frequently referred to as parricide, is a disturbing phenomenon that often generates widespread media coverage. Most of the scholarly literature on this topic has focused on biological offspring who kill mothers and fathers. Some analyses have examined juveniles and adults who kill their stepparents. To date, virtually no research exists on children who kill their adoptive parents because this type of victim-offender relationship has been absent from available homicide databases, thereby preventing such analyses. The present study is a content analysis of news reports of 46 cases of adopted children who killed their adoptive parents in several different countries. Data pertaining to offender and victim demographics, incident characteristics, and the processing of offenders from the initial charge through conviction and sentencing are examined. To the extent possible, media accounts are used to classify cases according to motives or circumstances leading to the killings. The article concludes with a comparison of profiles of children who kill adoptive parents in relation to those who kill biological parents, important observations that emerged from these news accounts, and discussion of possible explanations of parricide by adopted children, including adopted children syndrome, reactive attachment disorder, and biological risk factors. Limitations of this study and directions for future research are addressed.

Pragmatic Language Performance of Children Adopted Internationally

Purpose Pragmatic language is important for social communication across all settings. Children adopted internationally (CAI) may be at risk of poorer pragmatic language because of adverse early care, delayed adopted language development, and less ability to inhibit. The purpose of this study was to compare pragmatic language performance of CAI from Asian and Eastern European countries with a nonadopted group of children who were of the same age and from similar socioeconomic backgrounds as well as explore the relationship among emotion identification, false belief understanding, and inhibition variables with pragmatic language performance. Method Using a quasi-experimental design, 35 four-year-old CAI (20 Asian, 15 Eastern European) and 33 children who were not adopted were included in this study. The children's pragmatic language, general language, and social communication (emotion identification of facial expressions, false belief understanding, inhibition) were measured. Comparisons by region of origin and adoption experience were completed. We conducted split-half correlation analyses and entered significant correlation variables into simple and backward regression models. Results Pragmatic language performance differed by adoption experience. The adopted and nonadopted groups demonstrated different correlation patterns. Language performance explained most of the pragmatic language variance. Discussion Because CAI perform less well than their nonadopted peers on pragmatic communication measures and different variables are related to their pragmatic performance, speech-language pathologists may need to adapt assessment and intervention practices for this population.

"I'm Doing My Part, I Just Need Help From the Community": Intervention Implications of Foster and Adoptive Parents' Experiences Raising Children and Young Adults With FASD

Individuals with fetal alcohol spectrum disorders (FASD) have high rates of health care service utilization. It is vital that health care professionals understand FASD and associated family experiences to strengthen their ability to respond to family needs and tailor family-focused interventions. This study included 24 foster and adoptive parents of children and adults (aged 3-33 years) with FASD. Data were collected via individual interviews and focus groups and analyzed thematically. Consistent with a developmental psychopathology perspective, parents' experiences interacted with the individual (with FASD), family, and broader systems ecological levels. Parents undertook protective actions in an attempt to prevent secondary conditions, support their child and family, and mitigate systems barriers. They also experienced stressors at each level, and stress was increased by protective actions. The overall parenting experience was fueled by a protective parenting attitude. Findings can strengthen family-focused care practices with individuals with FASD and their families and inform novel family interventions.

Persistent skewing of the T-cell profile in adolescents adopted internationally from institutional care

The developing immune system is an adaptive system, primed by antigens, responsive to infectious pathogens, and can be affected by other aspects of the early rearing environment, including deviations from the normal provision of parental care. We investigated whether early rearing in an institutional setting, even when followed by years living in supportive and well-resourced families, would be associated with a persistent shift in T cell profiles. Immunophenotyping was used to enumerate CD4+ CD57+ and CD8+ CD57+ subsets, with gating strategies employed to differentiate naïve, central-memory, effector-memory, and terminally differentiated EM cells expressing CD45RA (TEMRA). Blood samples were collected from 96 adolescents, and PBMC isolated via Ficol gradient, followed by an optimized immunophenotypic characterization. CMV antibody titers were determined via ELISA. Adopted adolescents had lower CD4/CD8 ratios than did the control adolescents. Early rearing had a significant effect on the T cells, especially the CD8+ CD57+ CM, EM, and TEMRA cells and the CD4+ CD57+ EM cells. Adolescents who had spent their infancy in institutions before adoption were more likely to be seropositive for CMV, with higher antibody titers. CMV antibody titers were significantly correlated with the percentages of all CD8+ CD57+ cell subsets. In the statistical modeling, CMV antibody titer also completely mediated the relationship between institutional exposure and the ratio of CD4-to-CD8 cells, as well as the percentages of CD4+ CD57+ and CD8+ CD57+ subsets. These findings demonstrate that persistent immune differences are still evident even years after adoption by supportive American families. The shift in the T cells was associated with being a latent carrier of CMV and may reflect the role of specific T cell subsets in Herpes virus containment. In older adults, sustained CMV antigen persistence and immunoregulatory containment ultimately contributes to an accumulation of differentiated T cells with a decreased proliferative capacity and to immune senescence.

The slope of cortisol from awakening to 30 min post-wake in post-institutionalized children and early adolescents

This study examined the association between early life adversity, in the form of early rearing in an institution (orphanage), and the slope of cortisol in the first thirty minutes after waking in 277 children, aged 7 through 15 years old, who had either been adopted between 6 and 60 months of age into well-resourced homes in the United States or born into similar homes. The adopted youth were divided at the median (age 16 months) into those adopted earlier (earlier-adopted, EA) and later (later-adopted, LA). The purpose of this study was to examine the post-waking slope in cortisol in post-institutionalized youth, predicting that it would be blunted, especially in later-adopted youth, when compared to the non-adopted (NA) youth. A secondary goal was to examine whether there would be some evidence of less blunting of the first 30 min of the cortisol awakening response among the children further along in pubertal development (i.e., Pubertal Recalibration Hypothesis). Pubertal stage was determined by nurse exam. Salivary cortisol was assessed at 0 and 30-min post-awakening on three days. The results showed that LA children had a blunted wake-30 min cortisol slope relative to NA and EA children. Neither the age by group nor pubertal stage by group analyses were significant. However, the majority of the sample were in early stages of puberty (56% in stages 1 & 2), thus the power was low for detecting such an interaction. This is the first year of a cohort-sequential longitudinal study examining early experiences and pubertal influences on the HPA axis, so it will be important to re-examine this question as the sample ages.

Risk taking, decision-making, and brain volume in youth adopted internationally from institutional care

Early life stress in the form of early institutional care has been shown to have wide-ranging impacts on the biological and behavioral development of young children. Studies of brain structure using magnetic resonance imaging have reported decreased prefrontal volumes, and a large literature has detailed decreased executive function (EF) in post-institutionalized (PI) youth. Little is known about how these findings relate to decision-making, particularly in PI youth entering adolescence-a period often characterized by social transition and increased reliance upon EF skills and the still-maturing prefrontal regions that support them. As decision-making in risky situations can be an especially important milestone in early adolescence, a clearer knowledge of the relationship between risky decision making and prefrontal structures in post-institutionalized youth is needed. The youth version of the Balloon Analogue Risk Task and a two-deck variant of the Iowa Gambling Task were used to assess risky decision-making in post-institutionalized youth and a community control group (N = 74, PI = 44, Non-adopted = 30; mean age = 12.93). Participants also completed a structural MRI scan for the assessment of group differences in brain structure. We hypothesized that participants adopted from institutions would display poorer performance on risky-decision making tasks and smaller brain volumes compared to non-adopted youth. Results indicated that later-adopted participants made fewer risky decisions than those experiencing shorter periods of deprivation or no institutional rearing. Further, decreased prefrontal volumes were observed in later-adopted youth and were significantly associated with task performance. Our results suggest that changes in risky-decision making behavior and brain structure are associated with the duration of early institutional care.

Externalizing behaviors among adopted children: A longitudinal comparison of preadoptive childhood sexual abuse and other forms of maltreatment

Previous research has established that child sexual abuse (CSA) and other forms of child maltreatment can have lasting and profound implications for survivors in terms of externalizing symptomatology. Few studies, however, have examined long-term consequences of CSA and maltreatment among adopted children. Guided by a polyvictimization framework, the present study investigated: (a) rates of co-occurrence of pre-adoptive CSA and maltreatment among adopted children, and (b) the relative impact of pre-adoptive CSA and maltreatment on externalizing behaviors at 14 years post-adoption. Analyses were based on four waves of data from the California Long-Range Adoption Study (CLAS) (n = 522); outcomes were measured using an adapted version of the Behavioral Problems Index (BPI). The diverse sample (36% non-White) was evenly divided by gender (50% female/male) and included a large number of children adopted from foster care (42.1%). Results indicated that 24.3% (n = 127) of children experienced at least one form of maltreatment; of those children, nearly half (46.5%; n = 59) experienced multiple abuse types (e.g., neglect, sexual, physical). Among cases of CSA (7.7%; n = 40), the vast majority (92.5%; n = 37) occurred with other forms of maltreatment. Hierarchical linear mixed models indicated that pre-adoptive CSA was associated with nearly a full unit increase in BPI scores (.92; p<.01). Neglect was associated with nearly a half unit increase in BPI (.48; p<.05). Gender was also significant; girls had lower BPI scores than boys (-0.57; p< .001). Implications for future research and practice are discussed.

Ethnic socialization and ethnic identity development among internationally adopted Korean American adolescents: A seven-year follow-up

The relationship between ethnic socialization by parents, peers, and ethnic identity development was examined over a 7-year time span in a sample of 116 internationally adopted Korean American adolescents. Parent report data was collected in 2007 (Time 1 [T1]) when the adopted child was between 7 and 13 years old and again in 2014 at ages 13 to 20 years old (Time 2 [T2]). Adolescent report data also was collected in 2014. We examined differences in parent and adolescent reports of parental ethnic socialization at T2, changes in parent reports of ethnic socialization from T1 to T2, and the relationship among ethnic socialization by parents at T1 and T2, ethnic socialization by peers at T2, and ethnic identity exploration and resolution at T2. Results indicated parents reported higher levels of parental ethnic socialization than adolescents did at T2. Parent reports of parental ethnic socialization also decreased between childhood and adolescence. Adolescents reported higher parental ethnic socialization than peer ethnic socialization at T2. Path analysis demonstrated positive indirect pathways among parental ethnic socialization at T1, parental ethnic socialization and peer ethnic socialization at T2, and ethnic identity exploration and ethnic identity resolution at T2. The study highlights the cultural experiences of transracial, transnational adopted individuals, the role of both parents and peers in ethnic socialization and ethnic identity development, and the importance of longitudinal and multi-informant methodology. (PsycINFO Database Record

Adult psychosocial outcomes of men and women who were looked-after or adopted as children: prospective observational study

OBJECTIVE

To investigate whether men and women who were looked-after (in public care) or adopted as children are at increased risk of adverse psychological and social outcomes in adulthood.

DESIGN, SETTING

Prospective observational study using the Avon Longitudinal Study of Parents and Children, which recruited pregnant women and their male partners in and around Bristol, UK in the early 1990s.

PARTICIPANTS

8775 women and 3654 men who completed questionnaires at recruitment (mean age: women 29; men 32) and 5 years later.

EXPOSURE

Childhood public care status: looked-after; adopted; not looked-after or adopted (reference group).

OUTCOMES

Substance use (alcohol, cannabis, tobacco) prepregnancy and 5 years later; if ever had addiction; anxiety and depression during pregnancy and 5 years later; if ever had mental health problem; social support during pregnancy; criminal conviction.

RESULTS

For women, 2.7% were adopted and 1.8% had been looked-after; for men, 2.4% and 1.4%, respectively. The looked-after group reported the poorest outcomes overall, but this was not a universal pattern, and there were gender differences. Smoking rates were high for both the looked-after (men 47%, women 58%) and adopted (men 44%, women 40%) groups relative to the reference group (both 28%). The looked-after group were at increased risk of a high depression score (men: 26% vs 11%, OR 2.9 (95% CI 1.5 to 5.6); women: 24% vs 9%, 3.4 (2.2 to 5.0)). A high anxiety score was reported by 10% of the reference women, compared with 26% of those looked-after (3.0 (2.0 to 4.5)) and 17% of those adopted (1.8 (1.2 to 2.6)). Looked-after men and women reported the lowest social support, while criminal convictions and addiction were highest for looked-after men. Adjustment for adult socioeconomic position generally attenuated associations for the looked-after group.

CONCLUSIONS

The needs of those who experience public care as children persist into adulthood. Health and social care providers should recognise this.

Speech production in 3-year-old internationally adopted children with unilateral cleft lip and palate

BACKGROUND

In the last decade, a large number of children with cleft lip and palate have been adopted to Sweden. A majority of the children were born in China and they usually arrive in Sweden with an unoperated palate. There is currently a lack of knowledge regarding speech and articulation development in this group of children, who also have to deal with a late first language switch.

AIMS

To study consonant proficiency in 3-year-old internationally adopted children with unilateral cleft lip and palate (UCLP) compared with peers with UCLP born in Sweden. Also to study the type and frequency of consonant errors and to perceptually compare velopharyngeal competence between the groups.

METHODS & PROCEDURES

Thirty-two children born between 2006 and 2010 with UCLP participated in the study-14 adopted from China and 18 children born in Sweden. Both groups were treated by the same cleft palate team. Audio recordings at 3 years of age were perceptually analysed by blinded listeners. Consonant proficiency was measured via per cent consonants correct adjusted for age (PCC-A), per cent correct manners (PCM) and per cent correct places (PCP). The prevalence of audible nasal air leakage and velopharyngeal competence were judged and compared between groups. The type and frequencies of consonant errors related to place and manner of articulation were also analysed.

OUTCOMES & RESULTS

The internationally adopted children had significantly fewer correct consonants compared with the Swedish-born children. This was true for PCC-A, PCP and PCM. This group also had significantly higher prevalence of glottal stops/fricatives and deleted target consonants more often. Also the internationally adopted children had a higher prevalence of incompetent velopharyngeal function. The only outcome variable with similar results in the groups was audible nasal air leakage.

CONCLUSIONS & IMPLICATIONS

The present study indicated that there were significant differences regarding consonant proficiency and velopharyngeal competence between internationally adopted children with a UCLP and their Swedish-born peers with UCLP at the age of 3 years. Internationally adopted children with UCLP should be considered an at risk group for a higher prevalence of speech difficulties than non-adoptees. Thus, it is particularly important to follow this group of children over time. Longitudinal studies of speech and language development in internationally adopted children with UCLP are needed.

To trust or not to trust: social decision-making in post-institutionalized, internationally adopted youth

Chronic parental maltreatment has been associated with lower levels of interpersonal trust, and depriving environments have been shown to predict short-sighted, risk-averse decision-making. The present study examined whether a circumscribed period of adverse care occurring only early in life was associated with biases in trust behavior. Fifty-three post-institutionalized (PI) youth, adopted internationally on average by 1 year of age, and 33 never-institutionalized, non-adopted youth (Mage  = 12.9 years) played a trust game. Participants decided whether or not to share coins with a different anonymous peer in each trial with the potential to receive a larger number of coins in return. Trials were presented in blocks that varied in the degree to which the peers behaved in a trustworthy (reciprocal) or untrustworthy (non-reciprocal) manner. A comparison condition consisted of a computerized lottery with the same choices and probabilistic risk as the peer trials. Non-adopted comparison youth showed a tendency to share more with peers than to invest in the lottery and tended to maintain their level of sharing across trials despite experiencing trials in which peers failed to reciprocate. In contrast, PI children, particularly those who were adopted over 1 year of age, shared less with peers than they invested in the lottery and quickly adapted their sharing behavior to peers' responses. These results suggest that PI youth were more mistrusting, more sensitive to both defection and reciprocation, and potentially more accurate in their trusting decisions than comparison youth. Results support the presence of a sensitive period for the development of trust in others, whereby conditions early in life may set long-term biases in decision-making.

False Belief Performance of Children Adopted Internationally

PURPOSE

The purpose of this study was to explore relationships among adoption, individual, and family variables on false belief performance of children adopted internationally (CAI).

METHOD

Using a quasiexperimental design, thirty-five 4-year-old children adopted from Asian and Eastern European countries before age 2 years were compared with a U.S. group of 33 nonadopted 4-year-old children on a standardized English-language measure, 3 false belief tasks, and a go/no-go inhibition measure.

RESULTS

The adopted group differed significantly from the U.S. nonadopted group in expressive language and false belief performance. For the adopted group, inhibition measures were significantly correlated with core language scores. Core language scores and number of older siblings predicted false belief performance.

CONCLUSIONS

Similar to children who are not adopted, language competence and living with older siblings positively influenced social understanding in CAI. Because CAI experience interrupted language acquisition and live with fewer older siblings, they are at risk of having weaker language competence and social understanding in their adopted language. When working with CAI, practitioners should assess social communication, language competence, and inhibition skills. They should assist adoptive families in providing socially mentored opportunities for their children to observe and interact with older children.