mental health issues in adopted children

We received a question for the Creating a Family show on Mental Health Issues with Adopted Kids with Dr. David Brodzinsky, one of the great minds in the field of psychology and adoption, that asked what I think a lot of adoptive parents deep down want to know: will my adopted child have all sorts of emotional problems?

I get it. As an adoptive parent and as someone who has read a lot of the research, I stumble when I try to answer this question. Quite frankly, I find the whole body of adoptee mental health research to be somewhat confusing or at least hard to summarize succinctly. Dr. Brodzinsky was able to add some welcomed clarity.

Do Adopted Kids Have More Mental Health Problems

One of the reasons for what may look like contradictory research results is that adopted children are a very broad and varied group, including kids adopted a birth, kids adopted after experiencing abuse, kids who were exposed prenatally to alcohol and drugs, and kids who had great prenatal care. We see different results depending with different types of adoption: domestic infant, foster care, and international.

I should note that what Dr. Brodzinsky and I talked about were diagnosable learning and mental health issues. He acknowledged that adoption itself can color a person’s sense of self and who they are, but this is not what we were discussing as a mental health issue.

The most useful research looks at similar groups of adoptees, although even with these groups, we can see great variations. For example, some expectant mom who are considering adoption get great prenatal care and scrupulously follow all the recommendations on diet, supplements, etc. Others… not so much. Clearly, we would expect different outcomes for the children of these two different types of birth mothers.

Adopted kids across the board are at an increased risk for mental health issues. As Dr. Richard Barth, Dr. Richard Barth, Dean of the School of Social Work at the University of Maryland School of Social Work and a prodigious adoption researcher and author, said on a recent Creating a Family radio show: “On average, kids who are adopted have more variation in what their long term outcomes will be than kids who were not adopted. There is simply more risk for adopted kids.”

Most Common Mental Health Issues in Adopted Children

It is important to note that most of the studies cited by Dr. Brodzinsky included learning difficulties and Attention Deficit Hyperactivity Disorder (ADHD) in their definition of mental health issues. In fact, these were by far the most commonly found issues in adopted kids.

Depending on the type of adoption and the child’s post birth/pre-adoption environment we also see a greater incidence of:

  • Externalized behavior problems, which are negative behaviors that are directed toward the external environment, such as acting out, breaking rules, disrupting classmates, fighting, etc.
  • Depression
  • Anxiety
  • Attachment difficulties

Why Do Adopted Kids Have More Mental Health Issues

Adopted kids are at an increased risk for mental health issues for a host of reasons, and again these reasons vary by the type of adoption (domestic infant, foster care and international adoption).

  • Stress during pregnancy
  • Prenatal exposures to alcohol and drugs
  • Poor nutrition during pregnancy
  • Genetics
  • Neglect/abuse
  • Attachment problems

There is no evidence from the research that indicates that mental health issues are caused by the act of adoption itself.

Mental Health Risks with Domestic Infant Adoption

Children placed for adoption at birth are at greater risk for mental health issues, with the most predominant concerns being learning differences and ADHD. About 15% of children in the general US population will be diagnosed with some type of learning disability, ADHD, or diagnosable mental health condition. With children adopted as infants that percentage increases to about 25-30%.

I specifically asked Dr. Brodzinsky how common attachment issues were with children adopted as infants because occasionally we see comments pop up in the Creating a Family Support Group claiming that attachment issues are inherent in all types of adoption, including domestic infant adoption. According to Dr. Brodzinsky, research has shown that attachment problems are rare with children adopted as infants.

Mental Health Risks with Foster Care Adoption

The risk of learning disabilities, ADHD, and a diagnosable mental health condition increases significantly with children adopted from foster care. The exact risk is hard to pin down because the sample sizes vary considerably in the research, but approximately 50-75% of children adopted from foster care will be diagnosed with some type of learning disability, ADHD, or diagnosable mental health condition.

Mental Health Risks with International Adoption

It is particularly difficult to assess the mental health risks in international adoption because it varies greatly by country and because there has not been a lot of research specific to children adopted from individual countries, other than China, South Korea, and Russia. These three countries are illustrative of the variation we see.

Mental Health Risks for Children Adopted from China

Generally speaking the children adopted from China have shown no increased risk for learning or mental health issues. A few studies have shown a slight increased risk for anxiety and some studies have found that children adopted at an older age were at an increased risk for language processing problems that showed up as the language demands in school increased.

Keep in mind that most of these research results were based on the population of kids adopted between 1990 and 2010. These kids were almost all girls and were adopted at a relatively young age—6 to 18 months. Most of them were the result of a much wanted pregnancy that resulted in the “wrong” gender. Most did not have birth defects or developmental issues. The population of children being adopted from China now looks quite different with more boys and most of the children have some type of special need.

Mental Health Risk for Children Adopted from Korea

The research that focused on kids adopted from Korea has found no increased risk for learning or mental health issues. Korea has a history of children being in high quality foster care prior to adoption. In the past the children were adopted at a young age—many were younger than 12 months. Things have now changed. According to the Creating a Family Korea Adoption Chart the majority of children are now between 18 months and 24 months at placement. We also know that more children are being exposed to alcohol in utero.

Mental Health Risk for Children Adopted from Russia

Although Russia in now closed for international adoptions to the US, the research on kids adopted from Russia shows that they are at an increased risk for learning and mental health issues. These children were usually in an orphanage before adoption and are at a higher risk for prenatal alcohol exposure—both of which increase the risk for mental health problems.

Adoption is a Healing Experience

Dr. Brodzinsky pointed out that adoption is a healing experience for kids being adopted from adverse circumstances. A loving stable home can go a long way towards helping children reach their full potential, but can not completely reverse the risk factors of prenatal alcohol and drug exposure, genetics, and abuse/neglect.

Other Creating a Family resources you will enjoy:

I LOVED LOVED this Creating a Family show I did with Dr. David Brodzinsky. I can’t recommend it enough.




Image credit: Bill Gracey