October 1st, 2011

Adopted children at greater risk for health problems

Adopted children are more likely to develop deficits in physical and behavioral health than children reared in their birth families, 29 versus 12 percent, according to the 2007 National Survey of Adoptive Parents. The data are included in the report America’s Children: Key National Indicators of Well-Being 2011 compiled by the Federal Interagency Forum on Child and Family Statistics.

Researchers surveyed more than 2,000 families via telephone. The result was a point-in-time snapshot of the adoption experience. Among the results: children adopted from foster care and older children are more likely to experience moderate to severe problems, as characterized by the parent at the time of the interview. In the age 12 to 17 group, 45 percent of children adopted from foster care had been diagnosed with one or more conditions compared with 29 percent of children adopted privately, 27 percent adopted internationally, and 14 percent of all children. The top three conditions are learning disabilities, ADD/ADHD, and behavior/conduct problems. The most common physical condition is asthma.

“This survey contains the first nationally representative data on the health and well-being of the full population of adopted children across adoption types,” says Laura Radel, M.P.P., a research analyst at the U.S. Department of Health and Human Services and an author of the report. “We wanted to highlight these data for adopted children who because of their health issues and often turbulent personal histories are a vulnerable population.”

While most adopted children thrive, many experience deprivation, neglect or abuse prior to adoption that can contribute to preexisting health problems or problems that could surface as children reach adolescence and confront a variety of identity-related issues, Radel says.

“Adopted children grapple with those things differently than do children from biological parents,” Radel says.

The findings are a no-brainer for clinicians who work in the adoption field, such as Diane Kindler, LCSW, clinical director for Casey Family Services that operates in the six New England states plus Maryland. But Kindler believes the differentials could be closer than the survey indicates because birth parents are not as primed to identify or seek treatment for behavioral health issues as adoptive parents who are used to navigating the child welfare system.

“Parents adopting from foster care often see how kids have gotten treatment that’s been helpful, as opposed to a [birth] parent who hasn’t had the experience of seeking mental health services for a child,” Kindler says.

The key differentiator for all adopted children is that something happened that they couldn’t be raised by their birth family and they all have to deal with the question, why was I adopted?

“That’s a kind of trauma,” Kindler says. “It’s not necessarily mental illness, but it can be a stressor.”

To help families cope, Casey Family Services has adopted evidence-based Trauma
Focused Cognitive Behavioral Therapy that teaches constructive responses to emotional triggers.

Michael Pines, Ph.D., of Glastonbury, Conn., has been treating adoptive families in his private practice for 30 years and says adopted children are over-represented in emergency rooms and inpatient admissions for behavioral problems.

His take is that adopted children with difficulties have an attachment disorder stemming from such systemic disruptions as geographic moves, personal losses and multiple caregivers. As a result, they don’t trust the adults in their adoptive life and may feel the adults have to be tested before they can be relied upon to keep them safe.

“These kids view relationships as a source of hurt and pain,” Pines says. “So we teach parents that the key is consistency and predictability that will allow children to feel safer and thus closer to the family. It’s not a quick fix,” he adds. “My parents do a lot of reading, and I encourage them to join a support group to defray feelings of desperation and loneliness. They need to know the light at the end of the tunnel is not an approaching train.”

Citing federal statistics, Harold Grotevant, Ph.D., head of the Rudd Adoption Research Program at UMass Amherst, says the average length of stay in foster care is 37 months and the average age of children adopted out is 6.4 years.

“In the life of a six-year-old, living three years with a birth family being neglected or abused and then three years with a foster family or two, there’s a lot of room for developmental insults of various types. The majority of adopted kids come from that kind of situation.”

The Rudd program is one of the sponsors of an initiative in western Mass. called Re-Envisioning Foster Care that helps minimize the impact of transitions on foster children

in order to bolster stability.

“Each time they change families, they encounter different parents, neighborhoods, schools, siblings and friends. Each transition can be disruptive,” Grotevant says. “We’re working with stakeholders on ideas, for example, an educational passport so when kids switch school systems, they have all their records with them so they don’t start from scratch every time.”

The Rudd program is also working to increase the number of psychologists and social workers with adoption competency via training programs and post-licensure certification.

“The number of clinicians who understand adoption issues is relatively small,” Grotevant says. “We hear stories of people going to counselors who just didn’t get it.”

By Nan Shnitzler

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