[Paleopsych] SW: International Adoptees and Mental Health
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Public Health: International Adoptees and Mental Health
http://scienceweek.com/2005/sw050617-6.htm
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:
http://www.travel.state.gov/family/adoption/stats/stats_451.html.
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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