The Relationship of Adoption and Attachment in Adolescence

1. The Relationship of Adoption and Attachment in Adolescence A Moderator for Risk for Borderline Features in Teens-A Comparison Study

2. Reasons for Study-General Previous adoption studies have focused on : • generalized studies comparing adoptees to their non-adoptee counterparts only across developmental domains: school achievement, physical health, social development capacity • current identity studies in adoption have included the adoption triad (birth parents, adoptive parents and adoptees) within a context of a family system, openness and access to information; not the individual adoptee • cross-cultural studies looking at impact of international adoptions • Use of attachment as a theoretical framework has been primarily in high risk, maltreated samples in late placement adoptions i.e. foster care system

3. Reasons for Study-Personal Clinical Experience • Intakes for adopted children & teens seemed to cluster into 2 groups: • Developmental disabilities -typically seen in very young children who were internationally adopted (possibly due to maltreatment in orphanages or neurodevelopmental etiology) • Teens referred for multi-problematic behaviors, adolescent DBT or anxiety/disruptive behavioral disorders in school-age children Self-Disclosure • Exploration of adoption literature over time revealed numerous difficulties for many adult adoptees: unresolved issues of identity, search-reunion. Social policy around privacy and symptomatic complaints of axis-I disorders (mood/anxiety) • NSSR adult adoption study on levels of anxiety in adult adoptees yielded very high levels of anxiety, preoccupation and unresolved conceptualization of adoption and the self, even in secures • survey monkey link on facebook numerous adoption groups

4. Toward a Hypothesis • my early perceptions of the effects of adoption continue to be demonstrated in both non-clinical and clinical samples • Empirical research that does exist does not typically examine the more normative adoption population found in our culture from an attachment framework • D. Brodzinsky-Identity development + Dev. Stages (Donaldson Institute; Rutgers University) • H. Grotevant (UMass; Univ. of MN)- Adoption Triad • M. Dozier (Univ. Delaware)-Attachment + Maltreatment in Foster Care • M. & H. Steele (NSSR)-Attachment + Maltreatment in late placement adoption (using attachment for placement as a means to bolstering developmental catch-up)

5. Current Study Hypothesis Examine whether or not adoption serves as a moderating risk factor for borderline features in adolescents Chose adolescents for: Their reflective capacity on their own experience Presenting problems have shown some relative stability over time, given their developmental age Younger school age children have lower ability to reflect on their experience, they may not know that they are adopted yet and parents would likely participate as informants which may not be so reliable

6. Sample n= (adoptees) n= n= (non-adoptees) Placement Date Criteria: Age Range: Ethnicity: Clinical sample: 126 total participants 38 (6 male; 32 females) 88 (27 males, 61 females) Adopted group participants all met criteria for being placed within family under 12 months of age, born in the U.S. 15.2 years -17.8 years (M= 16.3 years) 66% Caucasian, 11% African American, 20% Hispanic, 3% other Chosen from an adolescent DBT program at Mental Health Center in NYC Metropolitan Area

7. Measures Birth Status Attachment Classification Borderline Features Patient Intake Demographic Form *included forced choice question of adopted or non adopted (less than 20 minutes to complete) Adult Attachment Interview (AAI) (Main, M., Goldwyn, Hesse, 1985) 60-90 minute semi-structured interview assessing attachment classification in the 4 categories: S/Autonomous, I/Dismissing, I/Preoccupied & Unresolved Life Problems Inventory (LPI) (Miller, A., Wyman, S., Huppert, J., Glassman, S. & Rathus, J., 2000) Self report questionnaire that assesses BPD features in adolescents across 4 indices: confusion of self (CS), impulsivity (IM), emotional instability (EI) and interpersonal problems (IP) (Less than 30 minutes to complete)

8. Analyses and Results Significant Findings • 2-way ANOVA was used to assess the interaction effects of the relationship between birth status, preoccupied attachment and borderline features • p<.05 level for adoptees with preoccupied attachment and high levels of BPD features • p<.05 for both groups in unresolved attachment • p>.05 in autonomous and dismissing in both groups Insignificant Findings • 2-way ANOVA was used to assess the interaction effects of the relationship between birth status, preoccupied attachment and borderline features • p<.05 level for both groups with preoccupied attachment and high levels of BPD features • p<.05 for both groups in unresolved attachment • p>.05 in autonomous and dismissing in both groups

9. Results Matrix Attachment Classification (Significant findings) Attachment Classification (Insignificant findings)

10. Discussion Significant findings • Demonstrates an increased risk- possibly found in the double loss • early disruption in attachment, facilitated by negative adoptive environment (a/ambivalent infant + preoccupied parent= preoccupied teen) • We still expect to see significance in the preoccupation & unresolved status in the NA group because of the insecure attachment trajectory • stronger significance in the adoptive preoccupied group, indicating an additional risk involved; ambivalence in parent child dyad suggests a diathesis for either success or problems • A/Preoccupied group: possible problems within dyad in constructing dual narrative to build cohesive identity-promoting understanding of issues arising in adoption Insignificant findings • Attachment Theory continues to be supported • The balance of significance between attachment status in each group indicates that in the attachment relationship that may predict risk for children, regardless of birth status • Indicates further exploration on the etiology of increased risk for adopted individuals (see in prior research)

11. Study Limitations Sample was small; adoptee group was not large enough to get a clear understanding of moderating risk pertinent to them Clinical sample; broader, non-clinical sample might delineate the differences between groups more clearly Ethnicity is skewed to Caucasian group; broader reach for larger sample size would be better to capture larger range of ethnic groups Gender differences: clearly, larger numbers of females in both groups were present Study does not assess other contributing factors to these features, such as possible trauma post-adoption, relational violence, sibling relationships, substance use, etc.