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Social-Emotional Issues
with Internationally Adopted Children
Beth Troutman, PhD, ABPP,
Clinical Associate Professor
Department of
Psychiatry, University of Iowa Hospitals and Clinics
Summer 2005
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In
2004, more than 38,000 families in the US and Europe adopted a child from
another country; the majority of these internationally adopted children were
from China and Russia. In the US, significant numbers of children were also
adopted from Guatemala, South Korea, Kazakhstan, and Ukraine. Today in the
US, international adoptions account for one-fifth of all adoptions. As
international adoptions have increased, more information has become
available about the potential for social-emotional and mental health
problems in this population of children and adolescents. |
Factors contributing to risk
Much of the research on children adopted internationally has focused on the
risk associated with prior emotional deprivation, such as that experienced
by children being adopted from orphanages in Romania and Russia. Many of
these children had no opportunity to form an attachment with a primary
caregiver prior to adoption. This may have been due to the number of
children per caregiver, lack of a consistent caregiver, and the number of
different caregivers.
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Reactive
attachment disorder. The risk of reactive
attachment disorder, a psychiatric disorder involving
significant impairments in interpersonal relationships resulting
from emotional deprivation or repeated changes in caregivers during
infancy or early childhood, has been of particular concern to
providers and adoptive families. |
Reactive
attachment disorder
may result in
impaired interpersonal relationships.
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A clear
relationship exists between the quality of the child's early
caregiving environment and the risk of reactive attachment disorder. A lower rate of this disorder is found in
institutions where caregivers and children have more physical contact, and
in more "homelike" settings where children are placed in smaller groups with
fewer changes of caregivers.
The
majority of children adopted after early institutional rearing and emotional
deprivation are able to form attachment relationships with their adoptive
parents. However, adoptees with a history of deprivation are more likely to
have an insecure attachment relationship; that is, they are less likely to
depend on their parents for emotional support, and more likely to withdraw
or become angry when distressed, rather than seeking comfort from their
parents. These insecure patterns of parent-child attachment relationships
are associated with an increased risk for problem behaviors in the child and
increased risk for parenting stress in their adoptive parents.
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Children
institutionalized
during infancy
and early childhood may exhibit more aggression and more
stereotypies (persistently repeated behaviors, such as rocking,
hand-waving, head-banging). |
Aggression,
stereotypy. In addition to the risk for
reactive attachment disorder, children reared in institutions during
infancy and early childhood exhibit more aggression and stereotypies
than home-reared children. Although such behaviors typically
decrease following placement in the
adoptive home,
children with early deprivation continue to be at greater risk for
emotional and behavioral problems than other international adoptees
and are more likely to be referred for mental health problems. |
Indiscriminate friendliness. The most persistent difficulty
seen in children adopted following institutional placement is
indiscriminately friendly behavior. Although sometimes viewed by adoptive
parents and providers as an indication that the child is "not attached,"
recent research indicates many children with early deprivation continue to
be unusually affectionate and friendly toward all adults although the child
has formed a secure attachment relationship with the adoptive parents.
Other factors
Age at adoption does not appear to be a risk
factor for social-emotional problems. Among international adoptees, children
who are adopted when they are older (past infancy or toddlerhood), do not
exhibit more emotional, behavioral, or mental health problems than children
adopted at a younger age.
However, length of time in the adoptive home is a significant factor.
Children and adolescents who have been in the adoptive home longer exhibit
fewer problems. Thus, when evaluating social-emotional functioning in
international adoptees, it is important for providers to consider the amount
of time the child has been in the adoptive home and the significant
adaptation required of children adjusting to a new language, culture, and
family.
International adoptions are often transcultural and transracial, and this
may create an additional risk factor for international adoptees. Adoptive
parents must often strike a difficult balance. While it is important to
recognize and celebrate each child's cultural and racial background, parents
must also recognize that children's interest in these issues may wax and
wane over the course of development. For example, children in middle
childhood are often more interested in "fitting in" with the cultural group
of their families and peers than in exploring their cultural and racial
differences. Then, during adolescence, internationally adopted children may
express increased interest in exploring their cultural and racial background
as they struggle with identity issues.
Family factors
Compared to the amount of research on preadoptive factors, relatively little
research has been devoted to characteristics of adoptive families that may
increase the risk for social-emotional problems. The country in which
adoptive families reside may have some impact; studies of international
adoptees conducted in North America find slightly higher rates of behavioral
problems than studies conducted outside North America.
Consistent with research on biological children, aspects of the mother-child
relationship have a significant impact on the child's social development.
Specifically, international adoptees whose adoptive mothers respond with
more sensitivity are more likely to be socially competent, have good peer
relationships, and behave appropriately at school.
Overall, the rate of emotional problems, behavioral problems, and referrals
for mental health services is higher among international adoptees than other
children and adolescents, but somewhat lower than that of within-country
adoptees. Although it is important for providers and adoptive parents to be
aware of the factors associated with increased risk for social-emotional and
mental health problems in international adoptees, it is also important to
note that the majority of international adoptees are well adjusted and enjoy
mutually rewarding relationships with their adoptive families.
Resources
Connor T et al.
(2003). Child-parent attachment following early institutional deprivation.
Dev & Psychopathology, 15, 19-38.
Juffe, F et al.
(2004). Adopted children's problem behavior is significantly related to ego
resiliency, ego control, and sociometric status. J Child Psychol & Psychi,
45(4), 697-706.
_______ (2005). Behavior
problems and mental health referrals of international adoptees. JAMA,
293(20), 2501-2515.
Smyke A et al.
(2002). Attachment disturbances in young children. J Amer Acad Child &
Adol Psych, 41(8), 972-982.
Stams G et al.
(2002). Maternal sensitivity, infant attachment, and temperament in early
childhood predict adjustment in middle childhood: The case of adopted
children and their biologically unrelated parents. Dev Psych, 38(5),
806-821.
Sullivan S et al.
(2004). Cultural and Socio-Emotional Issues of Internationally Adopted
Children. Internat Peds, 19(4), 16-24.
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