Study: Adolescents adopted as infants are more likely to have psychiatric disorders
They face a greater risk for attention deficit-hyperactivity disorder and oppositional defiant disorder, researchers say
By Deborah L. Shelton and Bonnie Miller Rubin
6:25 PM CDT, May 5, 2008
Adolescents who were adopted as infants are significantly more likely to have a psychiatric disorder as those who were not adopted, a study released Monday has found.
While emphasizing that most of the adoptees in the study were psychologically healthy and faring well, the researchers said that as a group they faced a greater risk for two psychiatric conditions: attention deficit-hyperactivity disorder and oppositional defiant disorder.
For example, about 7 in 100 adolescents studied who were not adopted met the criteria for attention deficit-hyperactivity disorder, which is about half the number for adopted adolescents, said lead study author Margaret Keyes, of the University of Minnesota.
Attention deficit-hyperactivity disorder interferes with a person's ability to concentrate, sit still and control impulsive behavior. Young people with oppositional defiant disorder are uncooperative and hostile toward authority figures in a way that seriously impairs their day-to-day functioning.
The study, published in the May issue of the Archives of Pediatrics and Adolescent Medicine, compared a random sample of 540 adolescents who were not adopted, all born in Minnesota, with a representative sample of adoptees placed by the three largest adoption agencies in Minnesota. Of the latter group, 514 were foreign adoptions and 178 were domestic.
Researchers performed psychiatric assessments on all subjects as well as interviewing parents, teachers and the adolescents. Ages of those studied ranged from 11 to 21.
The researchers had thought that adoptees born overseas would be at higher risk of psychiatric disorders than those who were born and placed in the U.S., but they found the reverse was true.
"Our hypothesis was that international adoptees might have faced ethnic discrimination as they entered the school years and might have experienced a longer period of exposure to pre-adoption adversity in their country of origin, which would lead to a higher risk for psychiatric distress," said Keyes, a research psychologist at the Minnesota Center for Twin and Family Research.
The assessments did find higher levels of separation anxiety among international adoptees. Teachers also rated this group as significantly more anxious in general than their non-adopted peers.
Debbie Riley, executive director of the Center for Adoption Support and Education in suburban Washington, noted that teens who are adopted face added pressure at a vulnerable time of life.
"Adoption is a significant event in an adolescent's life which cannot be ignored," Riley said. "If ever there's a time when an adoptee is likely to enter therapy, it's during adolescence. . . . This is the time when you form your identity—when you're faced with, 'Who am I?'
"These kids have this extra layer, and the issues are very complex."
Adopted children tend to be overrepresented when it comes to seeing a mental health professional, experts said.
Dr. Peter Nierman, a child psychiatrist who formerly reviewed applications for financial assistance from the State of Illinois for children with serious mental health problems, said requests from parents of adopted kids ran 10 to 20 times higher than for biological children.
Adoptive parents may be quicker to seek out such help because as a group they are better educated, have higher incomes and are more accepting of counseling.
"These are the only people who have to be approved for parenthood, so they are already involved with child welfare . . . and have been prepared for a parenthood in a way that predisposes them to utilize professional mental health services—even when the problem is at a low level," said David Brodzinsky, a child psychologist and renowned adoption expert.
But Keyes said her study suggests the differences between adopted and non-adopted adolescents cannot be explained solely by parents' willingness to seek help.
Experts said other factors might include genetics, prenatal malnutrition, drug and alcohol exposure, and the post-natal environment, such as conditions in orphanages. Brodzinsky also pointed to the significance of being cut off from one's background and the anxiety the experience can provoke, even when it occurs at an early age.
"When we experience losses, we grieve . . . but too often, adoptees are told: 'You should be grateful.' They don't get to grieve . . . and blocked grief can result in pathology, such as depression," said Brodzinsky, research director of the Donaldson Institute in New York City.
Keyes stressed that her study should not alarm adoptive parents. About 1.5 million children and teens younger than 18 in the U.S. are adopted.
Being born male—adopted or not—also is a risk factor for disruptive behavior disorders, she noted, "but no one is overly concerned when they give birth to a son."