LOOKING FOR CLUES, RECENT RESULTS IN ADOPTION RESEARCH An overview of the ADOC presentation at the EurAdopt Conference Open Days, April 28th 2012, based on scientific publications from 2010 - 2012 G.R. B. ter Meulen Detective stories: institutions and the brain Before birth the development of the brain is mostly under genetic control (except e.g. alcohol, smoke and drugs), after birth the child’s experiences have a major impact on further development. Adverse experiences or lack of stimuli may lead to underspecification and miswiring of circuits in the brain. Vulnerability to an adverse environment may partly be genetic, as is found for the serotonin promotor gene 5HTT. Scientists have found that this gene has two varieties, one of which protects against vulnerability to adverse environment. However, this vulnerability can be influenced by adverse circumstances such as living in an institution where neglect and abuse is experienced: this may cause methylation of the protective gene and an increase in vulnerability. Several large studies have shown the adverse effects of institutional deprivation on the brain. Examples are the ERA study: English and Romanian Adoptees (Rutter, Mehta et al, comparison between English and Romanian adoptees) and the BEIP: Bucharest Early Intervention Project (Zeanah et al ; comparison between institutional and foster care). Early life deprivation in institutions may cause reduction or alteration of brain development, changes in select areas of the brain , and impact on the communication between brain structures. Effects have been found on emotional, cognitive and executive functions, on attachment, stress, behaviour, and motor development. Sensitive periods An important finding is that for several features studies suggest a kind of stepwise mechanism in which the system is ‘open’ to change and adaptability during a sensitive period. After that the capacity for change may remain, but more energy is required (adoption/foster care, therapy). In institution from birth till Adverse effects found 4-6 months no increase in rate of long-term adverse effects 6, 12, or 18 months parent-rated behaviour problems, security of attachment 15 months language (speaking and understanding) 18 months parent-reported executive functioning 24 months IQ, security of attachment, EEG coherence From Zeanah et al, 2011. 1
This implies important consequences for policy and practise: While rules increase and become more complicated – in order to prevent child trafficking and illegal adoptions – they at the same time increase delay, whereas results from scientific studies show, that the children’s interests are best served by a sense of urgency: the sooner the children are out of institutions, the better. Foster care versus institutional care Several studies have shown that foster care had positive effects on the children in various developmental areas. This was clearly shown in the Budapest Early Intervention Project with well trained foster parents. A study on Chinese adoptees raised in institutions or in foster families before adoption has shown advantages in the latter with respect to aspects as responsiveness, security of attachment and cognitive development. Not however with respect to disorganized attachment, physical development and hormonal stress regulation. A study on foster care showed that lack of resources and shortcomings in quality may counteract positive results. A comparison between long- term foster care and adoption showed better performance of adoptees as compared to foster children. The importance of racial, ethnic and cultural background A review of the literature shows no overall evidence on the importance of ethnic, racial and cultural identity for adoptees; it is considered to be one aspect of the total identity. In minorities the feeling of marginality because of racial identity, but not because of ethnic identity may lead to decreased self esteem. However, exposure to diverse cultural experiences increased ethnic identity and was positively related to personal growth and self esteem. Parental support plays a fundamental role. Several authors show that awareness about racial, cultural and ethnic background may be important, but it is not easy for adoptive families to implement this within the families. Research shows that there is little or no integration with people of the children’s race/ethnicity; adoptive families use post adoption support groups, education or online resources. The families show more cultural than racial socialization. Their cultural socialization may be like a kind of cultural tourism, a selective appropriation and consumption of renovated cultural symbols, artefacts and events. This may result in a ‘staged authenticity’. Adoption children often fail to develop hybrid identities and adult adoptees may feel that they exist on the margin of two cultures. Medical issues Hepatitis A To prevent transmission of hepatitis A, the American Academy of Pediatrics recommends a Hepatitis A vaccination for adoptee household members and close contacts, when children are adopted from countries with high or intermediate rates of hepatitis A infection. 2
Schizophrenia A disease like schizophrenia in the birth family of an adoptee increases the risk of the adoptee suffering from schizophrenia later in life. The adoptive family environment is usually a protective factor, but a disadvantageous adoptive family environment may increase the risk, especially in adoptees with genetic vulnerability. Literature from the ADOC database ���������� ��������������� Bakermans-Kranenburg M.J. et al. 2012 Impact of institutional care on attachment, disorganization and insecurity of Ukrainian preschoolers: Protective effect of the long variant of the serotonin transporter gene (5HTT). INT J BEHAV DEV, 36: (1). Basow S.A. et al. 2008. Identity Development and Psychological Well-Being in Korean-Born Adoptees in the US.American Journal of Orthopsychiatry 78:4. Berbery M., and K. O´Brien 2011, Predictors of White Adoptive Parents’ Cultural and Racial Socialization Behaviors With Their Asian Adopted Children: Adoption Quarterly, v. 14, no. 4. Bos, K. et al. 2011, Psychiatric Outcomes in Young Children with a History of Institutionalization: Harvard Review of Psychiatry, v. 19. Brady M.T. et al. 2011. Policy Statement: Recommendations for administering Hepatitis A Vaccine to contacts of international adoptees. Pediatrics 128: (4). Castle H. et al. 2011, Ethnic Identity as a Protective Factor for Looked After and Adopted Children From Ethnic Minority Groups: A Critical Review of the Literature: Adoption Quarterly, v. 14, no. 4. Fox N.A. et al. 2011. The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project: Journal of Child Psychology and Psychiatry, v. 52, no. 9. Jelsma J. et al. 2011. The motor development of orphaned children with and without HIV: Pilot exploration of foster care and residential placement. - art. no. 11: Bmc Pediatrics, 11. Juffer et al. 2011. Development of adopted children with histories of early adversities. Monographs of the Society for Research in Child Development 76:4. Kumstra R. et al. 2010. 5HTT genotype moderates the influence of early institutional deprivation on emotional problems in adolescence: evidence from the English and Romanian Adoptee (ERA) study. Journal of Child Psychology and Psychiatry, v. 51, no. 7. McLaughlin K.A. et al. 2010. Delayed Maturation in Brain Electrical Activity Partially Explains the Association Between Early Environmental Deprivation and Symptoms of Attention-Deficit/Hyperactivity Disorder: Biological Psychiatry, v. 68, no. 4. McLaughlin K.A. et al. 2012. Attachment security as a mechanism linking foster care placement to improved mental health outcomes in previously institutionalized children: Journal of Child Psychology and Psychiatry, v. 53, no. 1. Mohanty J. & C. E. Newhill 2011. Asian adolescent and young adult adoptees' psychological well-being: Examining the mediating role of marginality. Children and Youth Services Review 33 (7). Naumova O.Y. et al. 2012. Differential patterns of whole-genome DNA methylation in institutionalized children and children raised by their biological parents: Development and Psychopathology, v. 24, no. 1. Nelson C.A. 2011.The neurobiological toll of human early deprivation. Monographs of the Society for Research in Child Development. 76:4. Quiroz P.A. 2012. Cultural Tourism in Transnational Adoption: "Staged Authenticity" and Its Implications for Adopted Children: Journal of Family Issues, v. 33, no. 4. Skovdal 0. M. 2010. Children caring for their "caregivers": exploring the caring arrangements in households affected by AIDS in Western Kenya. Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv, v. 22, no. 1. Smyke A.T. et al. 2010. Placement in Foster Care Enhances Quality of Attachment Among Young Institutionalized Children: Child Development, v. 81, no. 1. Storsbergen H. E. et al. 2010, Internationally adopted adults who did not suffer severe early deprivation: The role of appraisal of adoption. Children and Youth Services Review, v. 32, no. 2. Suter E.A. et al. 2011. Parental management of adoptive identities during challenging encounters: Adoptive parents as 'protectors' and 'educators'. Journal of Social and Personal Relationships 28: 2. Sweet K. et al. 2011. Hepatitis A Infection in Recent International Adoptees and Their Contacts in Minnesota, 2007-2009: Pediatrics, v. 128, no. 2. 3
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