Last week the Archives on Pediatric and Adolescent Medicine published a new study on the comparative mental health of adoptees. The findings are of concern to everyone involved in the adoption process.
The study tracked children adopted in infancy. It compared results in a control group of non-adopted kids with kids adopted domestically as well as kids adopted internationally. The purpose was to determine whether kids adopted in infancy and lacking problem factors were more at risk for mental health issues:
Despite the popularity of adoption, there is a persistent concern that adopted children may be at heightened risk for mental health or adjustment problems.3 Previous research has shown that adopted children with a history of prenatal substance exposure4 or preplacement deprivation5 and those who were placed relatively late in their adoptive homes6 are at heightened risk of social, intellectual, and emotional problems. Nevertheless, existing research has not resolved the extent to which those adoptees with a good preplacement history and an early age at placement are at increased risk for clinically relevant mental health problems.
The linked article describes the methodology and results in considerable detail. In brief, the study found statistically significant differences in the prevalence of mental health issues between adopted and nonadopted adolescents. Adopted children — both domestic and international — were significantly more likely to have contact with a mental health professional. Adoptees were more likely to exhibit "externalizing" mental health issues such as Oppositional Defiant Disorder and Attention Deficit Hyperactivity Disorder. Domestic adoptees were more likely to exhibit such externalizing behaviors; international adoptees were more likely to exhibit internalizing behaviors like social anxiety disorder and depression.
The statistics are a matter of concern for any adoptive parent. I'm not a statistician, mental health professional, or social scientist, but I have some questions:
- To what extent does socioeconomic status impact the study? The study notes that adoptees' families averaged wealthier. Is it possible that more affluent parents are more likely to report concerns about mental status, whether or not they exist? Does higher socioeconomic status generally correlate with tendency to visit mental health professionals?
- The study is largely based on reported behavior by teachers, parents, and adoptees. I know it's not an exact science, but particularly with over-diagnosed conditions like ADHD, how reliable is that? Are there any more objective criteria that could be used? Is it possible that adoptive parents are conditioned to be hypervigilant, and that teachers are conditioned to see adopted children differently?
I'll see if I get my wife, the child psychologist, to read and discuss it. Meanwhile, the study emphasizes that most adopted kids are psychologically healthy. The statistical differences between domestic and international adoptees is fascinating; I'm wondering what theories they have for that disparity.
This has been picked up by the national press, which, being the press, has chosen to lead with the Brad and Angelina angle.
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