There seems to be a great deal of debate in the adoption world about the mental health of adoptees. Are they as a group more prone to mental health issues? If so, is it because of the act of adoption, the genetics they’ve inherited from their birth families, the adoptive family environment or parenting styles, prenatal exposure, the willingness of adoptive parents to seek and afford counseling, poor intrauterine conditions or nutrition, maternal stress during pregnancy, or some combination of the above?
I hear these concerns expressed by adoptive parents worried about their kids, and by people considering adoption. I’ve heard mental health issues of adopted people thrown about by the anti-adoption forces as proof that adoption is inherently harmful to kids.
I’ve also received emails, Facebook messages, and blog comments by adult adoptees concerned about what they believe is the misconception that adoptees “have all these issues”.
I grew up healthy and happy and didn’t know that I was supposed to have all these mental problems because of my adoption until I got online. Everytime I read an article about the mental health of adoptees I want to scream. Adoptees are a huge group and we can’t all be lumped into a big pile to be analyzed. It would be like talking about the mental health of blonds. Lots of factors affect mental health—why the focus on adoption????
Why indeed focus on adoption?
Every adoptive parent, birth parent, adoptee, or anyone who knows an adoptee has anecdotal evidence to support their view on the mental health of adoptees. The only way to truly assess a group as large and diverse as the adopted population is by studying large groups of adoptees. As a research geek, I’ve been trying to sort through and make sense of the studies on mental health of adoptees for years. The problem is that the studies often seem contradictory or have selection bias or a small sample size. ARGHHH.
Summary of Research on Mental Health of Adoptees
I read one of the best summaries of the current status of research on mental health of adoptees in the great book Adopting Older Children: A Practical Guide to Adopting and Parenting Kids Over Age Four. (You will also thoroughly enjoy the interview I did with the authors.) Their assessment is focused on older child adoption, but the general summary is applicable to all types of adoptions.
Another great resource is an interview I did with one of the pioneers in research on adoption and adoptees –Dr. David Brodzinsky, author of hundreds of journal articles and book chapters, and the book Being Adopted: The Lifelong Search for Self. To get more info about upcoming interviews and to submit questions in advance, sign up for our weekly adoption newsletter.
There are inconsistent findings on the relationship between adoption and mental health. Some studies of adoptees suggest greater self-reported drug use, antisocial behavior, negative emotions and other behavioral problems compared to non-adoptees. Other researchers such as Anu Sharma and colleagues report that adoptees engage in more pro-social behavior than non-adopted adolescents, such as helping disadvantaged populations.
In a meta-analysis of sixty-six studies, Michael Wierzbicki reported that adopted children scored higher than non-adopted children on measures of maladjustment, externalizing disorders and academic problems. Ann E. Brand and Paul M. Brinich found mixed results regarding whether adopted children have more behavior problems than nonadopted children. In their meta-analysis of over twenty-five thousand adoption cases and eighty thousand controls (non-adopted children), Linda van den Dries, Femmie Juffer, Marinus van IJzendoorn and Marian Bakermans-Kranenburg found small differences in behavior problems between adoptees and non-adopted persons (although they did find differences between domestic and intercountry adoptions, with domestic adoptees having more difficulties). However, several studies have found adoptees are more likely to be in counseling than non-adopted individuals.
Several studies suggest that adoptees are more likely to attempt or complete suicide but the number of cases, while statistically significant, is actually quite small. Still, this finding has been a cause of concern.
Adoptees More Likely to Be in Counseling
It is clear that adoptees are more likely to be in counseling than general child populations but there could be multiple reasons for this. One, adoption is unique and brings unique issues to development across the lifespan. Adoptees encounter different issues from children born and raised by their biological families. As such, adoptees may need counseling more often than non-adopted children. Two, most adoptive families have had contact with social service agencies in order to adopt, so there is less stigma about going to counseling and getting social service assistance. We encourage adoptive families to seek professional help if they need it.
Most adoptees don’t need or want counseling about their adoption and they should never be forced into counseling to address adoption issues. Sometimes that is at sixteen, sometimes it is at thirty-six and sometimes it is never. However, if you have a child with a mental health diagnosis, you will need to obtain professional help.
Adoption in Not a Mental Health Diagnosis
Nevertheless, we offer a caveat. Adoption is not a diagnosis. Many older children who have spent time in foster care obtained a diagnosis; it may or may not be accurate (but you want to know this information before adoption). Many intercountry adoptees have been in socially or globally depriving institutional care before adoption. These pre-adoptive experiences put children at more risk for mental health problems, Brodzinsky suggests.
Yet a diagnosis is not a child. It is based on the medical model that assesses/diagnoses /treats problems. The diagnosis is a way to communicate with other professionals about the problems the child may have. It is not unusual for children to have multiple diagnoses or different diagnoses – it is very difficult to adequately diagnose children and, as the child’s context changes (for example, she moves from a foster to adoptive family), her diagnosis may change.
There is great concern that children in foster care are over-diagnosed and over-medicated. In some low-resource countries from which children are adopted, medical training and access to the newest thinking about physical and mental health are hard to find. Sometimes diagnoses are used that are made up in that country without universal recognition of the diagnosis. If your child has mental health problem, it may take some time after the adoption to determine the diagnosis and treatment plan. The history of the child in other settings may or may not be helpful in understanding his or her mental health in your family. It is complicated.
Be Careful of Fad Diagnosis
An additional caution is that in some periods certain diagnoses become popular and many children get that trending diagnosis. Both Reactive Attachment Disorder and BiPolar Disorder are popular at this time. This creates a problem when a diagnosis becomes almost a fad; you don’t know if your child has a disorder or if the prism used by the mental health professional is swayed by the popularity of a diagnosis. This is the same with prescription medications for mental health problems; some prescriptions become heavily marketed and consequently are used too frequently, including being used for problems for which they were never intended.
That is not to say that some adopted children do not have serious or persistent mental health problems. Rather, we want parents to be careful about accepting historical or even current diagnoses if their experience with the child does not match the diagnosis. Treat children as individuals, not as their diagnoses.
Other Creating a Family resources you will enjoy:
- Mental Health of Adopted Adolescents
- Mental Health of Adolescents Adopted in Infancy
- Evaluating Physical and Mental Health Risks in Domestic Infant Adoption
- Mental Health of International Adoptees
Image credit: Michael Yan