Mental health and behavioural difficulties in adopted children: A systematic review of post-adoption risk and protective factors

Abstract

Previous research suggests that adopted children are at a greater risk of experiencing psychological and behavioural difficulties or accessing mental health services than non-adopted peers and that post-adoption variables are significant risk and protective factors producing this situation. This review seeks to summarise the post-adoption variables associated with adopted children’s mental health or behavioural difficulties to inform future research and shape interventions. A search for publications that assess associated risk and protective factors using Web of Science, Psychinfo, Medline and Sociological Abstracts identified 52 studies that met rigorous methodological criteria. Children’s and adolescents’ mental health and behavioural outcomes were associated with parent, parent–child and wider family factors and by contextual variables. The findings highlight the importance of focusing on the multitude of systemic factors surrounding a child following adoption. Clinical implications and direction for future research are discussed.

How Do Changes in the Family Structure and Dynamics Reflect on Health

“…In accordance with Manning, children from blended families are more likely to be neglected and abused and develop long-term behavioural and mental health problems that can persist into 73 , and they can also have various health problems 19 . Duncan et al noticed that adopted children are at greater risk of developing mental and behavioural difficulties or using psychiatric services than their non-adopted peers 74 . Also, children from single-parent families may face additional challenges and be more vulnerable to certain adverse influences that can be negatively reflected increase the likelihood of emotional, behavioural and health difficulties for children 79 .…”

One piece of the puzzle: Treatment of fostered and adopted children with RAD and DSED

“…Children who are placed in foster care or adoptive homes after experiencing early-life adversities are at greater risk of psychosocial, behavioural and cognitive difficulties than youth without histories of neglect, maltreatment or disrupted caregiving (Dahmen et al., 2012; Duncan et al., 2021; Fraley et al., 2013; Kocovska et al., 2012; Oswald, Heil and Goldbeck, 2010; Rutter et al., 2010). Contributing factors include the cumulative effects of multiple adverse experiences (Oswald, Heil and Goldbeck, 2010; Stirling and Zilberstein, 2021), genetics (Drury et al., 2012; Fraley et al., 2013), in utero and postnatal exposure to toxins, malnutrition or poverty (Reuben et al., 2019; Kim and Wessling-Resnick, 2014; Stirling and Zilberstein, 2021) and the quality of caregiving in the foster or adoptive home (Duncan et al., 2021; Kerr et al., 2013; Zeanah et al., 2016). Among the difficulties shown by a subset of children in this population are reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) (DSM-5; American Psychiatric Association [APA], 2013).…”

Parenting Practices, Communication about Adoption and Children’s Behavior Problems in Adoptive Families

“…Adoption research has concluded that adopted children are at greater risk of experiencing psychological, behavioral and academic difficulties and they experience more mental health referrals than their nonadopted peers (Duncan et al, 2021). This is primarily explained by exposure to various risk factors prior adoption, such as heritable factors, prenatal adversity, adverse childhood experiences etc., but also by post-adoption influences (Paine et al, 2020).…”

“…Research also suggests that adoption as an intervention has a beneficial effect on children's physical, cognitive and psychosocial development after experienced adversity (Duncan et al, 2021, Juffer & Van Ijzendoorn, 2005, Palacios et al, 2011, Rutter, 1998, significantly improving developmental outcomes of adopted children (Paine et al, 2020). At the same time, research has concluded (Duncan et al, 2021) that adoptive parenting can be both a protective and a risk factor for adopted children's mental health and behavioral problems, depending on its nature. Research has found that this can be a significant protective factor when parenting practices moderate the impact of adverse childhood experiences.…”