Early adversity predicts adoptees’ enduring emotional and behavioral problems in childhood

Abstract

Children adopted from the public care system are likely to experience a cluster of interrelated risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children's mental health post-placement are not well understood. We conducted a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Adoptive parents completed questionnaires at approximately 5, 21, 36, and 48 months post-placement. We used time series analysis to examine the impact of pre-adoptive risk factors [adverse childhood experiences [ACEs], number of moves, days with birth parents and in care] on children's internalizing and externalizing problems, and prosocial behavior over 4 years post-placement. Adoptees' internalizing and externalizing problems remained consistently high over the 4-year study period, but more ACEs predicted increases in internalizing and externalizing problems. Contrary to expectations, more pre-placement moves and time in care predicted fewer problems over time, but exploratory analyses of interactive effects revealed this was only the case in rare circumstances. We identify pre-and post-removal factors that may incur benefits or have a deleterious impact on adoptees' outcomes in post-adoptive family life. Our findings provide knowledge for front-line professionals in the support of adoptive families and underscore the vital need for effective early intervention.

The neurocognitive profiles of children adopted from care and their emotional and behavioral problems at home and school

“…As an intervention, adoption drastically alters a child's circumstances in a way which may compensate for adversity experienced in early life. However, adoptees remain more likely to experience emotional and behavioral problems that endure into later life [8][9][10]. Adopted children are also overrepresented within clinical settings [11] and lag behind their classmates academically [12,13].…”

“…Inferences cannot, however, be made about domestic adoptees' neuropsychological profiles from studies of non-adopted children or children adopted under drastically different circumstances (e.g., post-institutionalized children [25]). In addition to potential genetic risk for psychiatric problems [26], domestically-adopted children may have experienced exposure to stress and/or toxic substances in utero and early adverse experiences that occur during crucial stages in development, such as neglect (though often not as extreme as postinstitutionalized children), abuse, and household dysfunction [9,27,28]. By virtue of spending a longer time with their birth parents and in care, children who are older at the time of placement with their permanent family are more likely to have accumulated multiple preplacement risk factors [9,29].…”

“…In addition to potential genetic risk for psychiatric problems [26], domestically-adopted children may have experienced exposure to stress and/or toxic substances in utero and early adverse experiences that occur during crucial stages in development, such as neglect (though often not as extreme as postinstitutionalized children), abuse, and household dysfunction [9,27,28]. By virtue of spending a longer time with their birth parents and in care, children who are older at the time of placement with their permanent family are more likely to have accumulated multiple preplacement risk factors [9,29]. Following removal from their birth family, all children contend with the loss of their primary caregiver, and possibly other family members, friends, community, and possessions.…”

“…Many children adopted from care in the UK have enduring mental health problems and may be less able to fulfil their potential academically [9,10,12] but little is known about their neurocognitive profiles [37]. To address the gap in the literature regarding domestically adopted children's neurocognitive functioning, we aimed to profile areas of neurocognition in a sample of children adopted from the UK public care system.…”

“…Adoptive parents of 3/13 NDAU-referred children also reported on their child's experiences of pre-adoptive adversity. These experiences were coded for presence or absence of 10 categories of ACEs (see [9,44]) and included abuse (emotional, ADOPTEES' NEUROCOGNITION AND MENTAL HEALTH 8 physical, or sexual), neglect, and household dysfunction (domestic violence, parental separation, substance abuse, alcohol abuse, mental illness, or incarceration).…”