[Paleopsych] SW: International Adoptees and Mental Health

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Public Health: International Adoptees and Mental Health

    The following points are made by F. Juffer and M.H. van IJzendoorn (J.
    Am. Med. Assoc. 2005 293:2501):
    1) International adoption is an increasing phenomenon involving more
    than 40,000 children a year moving between more than 100
    countries.[1,2] By setting uniform norms and standards, the 1993 Hague
    Convention[3] endorsed and facilitated international adoption.
    International adoption may offer the advantage of a permanent family
    to a child for whom a family cannot be found in the country of origin.
    In 2004, most international adoptions in the United States (22,884)
    were from China, Russia, Guatemala, South Korea, and Kazakhstan,[4]
    whereas most international adoptions in Europe (15,847 in 2003) were
    from China, Russia, Colombia, Ukraine, and Bulgaria.[2] Since the
    1970s, domestic adoptions in North America and Europe drastically
    decreased, whereas at the same time the number of international
    adoptions increased.[1]
    2) International adoptees often experience inadequate prenatal and
    perinatal medical care, maternal separation, psychological
    deprivation, insufficient health services, neglect, abuse, and
    malnutrition in orphanages or poor families before adoptive
    placement.[5] Animal models have shown that early maternal separation
    and deprivation can seriously harm infant functioning and later
    development. Psychological deprivation in orphanages can result in
    maladjustment in children. In addition, after adoptive placement,
    adoptees have to cope with integrating the loss of their culture and
    birth family into their lives. In contrast to domestic adoptees who
    are adopted within the same country, international adoptees may face
    problems regarding their divergent identity, as most international
    adoptees are raised by parents who do not share their racial and
    cultural background.
    3) Adoption usually offers improved medical, physical, educational,
    and psychological opportunities for institutionalized children, and
    research has documented children's substantial recovery from
    deprivation after adoption, which may partly be due to the possibility
    that some adopted children were selected for adoption because they
    seemed brighter or had better social skills. Nevertheless, several
    studies found that adopted children were overrepresented in mental
    health populations and showed more externalizing disorders. Some
    studies found more mental health problems in international adoptees
    compared with nonadopted controls, in particular in male adoptees, in
    adolescence, and in children placed beyond infancy. However, the
    majority of adoptees were functioning well. In a large national cohort
    study in Sweden involving more than 11,000 international adoptees, a
    significantly higher risk of suicide, psychiatric illness, and social
    maladjustment was found compared with nonadopted controls, although
    most adoptees were doing well.
    4) The authors report the first meta-analyses on behavior problems and
    mental health referrals of international adoptees comparing them to
    nonadopted controls and domestic adoptees. The authors hypothesized
    that international adoptees present more behavior problems and are
    referred to mental health services more often than nonadopted
    controls16 or domestic adoptees.[5] The authors hypothesized that
    those with preadoption adversity, older ages at international adoptive
    placement (greater than 12 months), and males would have an increased
    risk for behavior problems and mental health referrals. International
    adoptees were also expected to show more behavior problems in
    adolescence compared with the years before adolescence. The authors
    studied domestic adoptions in Western countries only because the
    increasing domestic adoptions in developing countries, eg, India, have
    not been systematically studied yet.
    5) From their results, the authors conclude: Most international
    adoptees are well-adjusted, although they are referred to mental
    health services more often than nonadopted controls. However,
    international adoptees present fewer behavior problems and are less
    often referred to mental health services than domestic adoptees.
    References (abridged):
    1. Selman P. Intercountry adoption in the new millennium; the "quiet
    migration" revisited. Popul Res Policy Rev. 2002;21:205-225
    2. Selman P. The demographic history of intercountry adoption. In:
    Selman P, ed. Intercountry Adoption: Developments, Trends and
    Perspectives. London, England: British Agencies for Adoption and
    Fostering; 2000
    3. Duncan W. The Hague Convention on protection of children and
    co-operation in respect of intercountry adoption. In: Selman P, ed.
    Intercountry Adoption: Developments, Trends and Perspectives. London,
    England: British Agencies for Adoption and Fostering; 2000
    4. Immigrant visas issued to orphans coming to the U.S. US State
    Department Web site. Available at:
    Accessed April 3, 2005.
    5. Gunnar MR, Bruce J, Grotevant HD. International adoption of
    institutionally reared children: research and policy. Dev
    Psychopathol. 2000;12:677-693
    J. Am. Med. Assoc. http://www.jama.com

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