Which Families Struggle: Families of International Adoptees with Medical vs. Emotional/Developmental Disabilities?

1. * * p< 0.01 * * * Source: US State Department Figure 8 “Have you changed physicians because you believed your child was not getting appropriate medical services?” P < .001 P < .001 How many times? Figure 2 “How have your child’s medical and or behavioral problems affected your family?” Figure 9 Does Professional Review Improve the Outcome of International Adoption? Children between 18 and 60 Months at Arrival p < .05 * * * Figure 5 “Based on the information given to you about your child at referral, medical/behavioral problems are:” % † Parental Expectations Figure 3 % Struggling to Adjust (p<.01 vs. Unafflicted Children for all Diagnoses) ADD/ADHD 26% to 14% Attachment 12% to 5% Learning 24% to 13% †p<.05 (33.8±12.9 mo, n=190) (32.1±12.2 mo, n=170) P < .001 Significant Behavioral Problems No Significant Behavioral Problems Figure 1 US Intercountry Adoptions 1963-2003 Figure 6 “Currently, how would you characterize your emotional attachment to your child?” Figure 4 Families Struggling to Adjust P < .001 No Significant Behavioral Problems Significant Behavioral Problems Externalizing Scores Figure 7 “Would you recommend international adoption as a way to build a family?” Internalizing Scores P < .001 Normal Range T score ≤ 61 Clinical Range T score > 61 Significant Behavioral Problems No Significant Behavioral Problems Which Families Struggle: Families of International Adoptees with Medical vs. Emotional/Developmental Disabilities? Dana E. Johnson, Sandra L. Iverson, Kay Dole and Maria Kroupina Department of Pediatrics, University of Minnesota, Minneapolis, MN Abstract Which Families Struggle: Families of International Adoptees with Medical vs. Emotional/Developmental Disabilities Dana E. Johnson, Sandra L. Iverson, Kathryn N. Dole and Maria Kroupina Department of Pediatrics, University of Minnesota, Minneapolis, MN Background: The number of international adoptions has increased dramatically in recent years. Anecdotally, the number of adoption disruptions has increased disproportionately. Since the majority of children being adopted internationally spend their early years within institutional care settings, it is not surprising that families face medical and developmental challenges that stress their coping abilities. Objective: This study was undertaken to see which medical/emotional issues are likely to tax a family’s ability to adjust. Design/Methods: Subjects (n=1,463) were drawn from a group of 2291 international adoptees (IA) whose adoption decrees were finalized in Minnesota between 1990 and 1998. Children were included when parents responded to questions about whether their child had been diagnosed with or treated for a variety of medical/behavioral problems commonly seen in international adoption. Parents were also asked whether their child's medical and/or behavioral problems affected their family (adjusted well or adequately vs. struggling to adjust). This study was approved by the Institutional Review Board at the University of MN. Results: Families whose children had major behavioral problems were far more likely (Pearson Chi-Square) to be struggling to adjust than families with chronic medical problems. Families listing other significant behavioral problems were more likely to not recommend international adoption or to recommend with reservation as a way to build a family; answer that they had a very weak or weak emotional attachment to their child; report more problems than expected; and change physicians because they believed their child was not getting appropriate medical services. Conclusions: Most families who adopt internationally are coping well. Health care professionals caring for the subgroup of international adoptees with significant behavioral problems must recognize that these parents are much more likely to be struggling to adjust and have a weaker emotional attachment to their child, placing them at risk for adoption disruption. These families also are more likely to change health care professionals because of their perception that their child is not getting appropriate medical services. • Objectives The present study was undertaken to determine: • Are families who adopt internationally adjusting well? • Which medical/behavioral issues are likely to tax a family’s ability to adjust and feel positive about their adoption experience? Study Design The study population was drawn from a group of 2,291 international adoptees whose adoptions were decreed in Minnesota between 1990-98 and whose parents completed a lengthy survey—International Adoption Project (56% of total decrees during that time). Data were analyzed for 1,463 children whose parents responded to the question: How have your child’s medical and/or behavioral problems affected your family? • Results • Most families were adjusting well or adequately. Only 8% of families were struggling to adjust (Figure 2). • Families whose children had typical “medical” problems were no more likely to be struggling than families whose children were unafflicted. However, the percentage of families struggling to adjust was significantly different when children were diagnosed with a variety of developmental/behavioral problems (Figures 2, 3). • Families with children who scored in the clinical range on the CBCL externalizing and internalizing scales were more likely to be struggling to adjust (Figure 4). • For children with significant behavior problems, the primary parent was more likely to: • Report somewhat more or many more problems than expected (Figure 5). • Report a very weak or weak emotional attachment to their child (Figure 6). • Not recommend international adoption as way to build a family (Figure 7). • Change physicians due to concerns about appropriate medical care (Figure 8). • For children at high risk for developmental/behavioral problems (18-60 months at the time of arrival), families who had referral information reviewed by a medical professional were less likely to have: • Negative recommendations about international adoption. • Incorrect expectations. • Children with ADD/ADHD, attachment issues and learning disabilities. Background • The number of children adopted from abroad has dramatically increased over the past four decades (Figure 1). • Most children are currently arriving from countries with poor health care. • A higher percentage of children live within institutional care settings prior to adoption. • More older children (1-4 years) are being adopted. Therefore: Children adopted from abroad constitute a group at high risk for both medical and developmental problems. Anecdotally, the number of adoption disruptions has increased disproportionately. Since the majority of children being adopted internationally spend their early years within institutional care settings, it is not surprising that families face medical and developmental challenges that stress their coping abilities. % Struggling • Conclusions • A clear majority of famlies (92%) are adjusting adequately or well. • Even in most situations where major behavioral problems exist, over 70% of familes report they are adjusting adequately or well. • Health care professionals caring for the subgroup of international adoptees with significant behavioral problems, particularly ‘relationship’ issues such as autism and attachment, are much more likely: • To be struggling to adjust. • To have mismatched expectations and reality. • To report a weaker emotional attachment to their child. • To change health care providers because of their perception that their child is not getting appropriate medical services. How can primary care professionals help? • Refer to professionals with the skills necessary to assist the child and the family. • Help facilitate adoptions where the resources of the family fit the likely needs of the child. • Assist adoptive parents in developing appropriate expectations prior to and after arrival of their child. % Struggling Supported in part by grant R01 MH59848-01 from the National Institutes of Health