Associations between attachment‐related symptoms and later psychological problems among international adoptees: Results from the FinAdo study

We examined the associations between attachment‐related symptoms (symptoms of reactive attachment disorder (RAD), symptoms of disinhibited social engagement disorder (DSED), and clinging) and later psychological problems among international adoptees. The study population comprised internationally adopted children (591 boys and 768 girls, 6–15 years) from the ongoing Finnish Adoption (FinAdo) study. Data were gathered with self‐administered questionnaires both from adoptive parents and from adoptees aged over 9 years. Attachment‐related symptoms were measured using of a short (8‐item) questionnaire and later behavioral/emotional problems were assessed using the Child Behavior Checklist (CBCL) and the Five to Fifteen (FTF) scale for attention‐deficit/hyperactivity disorder (ADHD) symptoms. RAD and DSED symptom subscales were associated with an increased risk of emotional and behavioral problems and ADHD. Especially the mixed type of attachment‐related symptoms was strongly associated with later emotional and behavioral problems.     

Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms in Children Adopted from Poland and their Atypical Association Patterns: a Bayesian Approach

Although high rates of attention-deficit hyperactivity disorder (ADHD) symptoms have been observed among internationally adopted children, research on these symptoms in Polish adoptees is lacking. Therefore, we examined ADHD symptoms in Polish adoptees and their relationship to pre-adoptive risk factors, that is, time in institutional care, early deprivation, and prenatal alcohol exposure. We further compared the association patterns and gender distribution of ADHD symptoms in children adopted from Poland to those reported in the literature for ADHD symptoms in non-adopted children. Dutch adoptive parents of 121 Polish adoptees (52% boys; M _age = 10.9 years, range 6.2–15.6; M _ageadoption = 3.0 years, range 0.8–6.9) completed questionnaires regarding ADHD symptoms, pre-adoptive risk factors, attachment problems, conduct problems, and executive functioning deficits. Bayesian evaluation of informative hypotheses showed that Polish adoptees had increased levels of ADHD symptoms, compared to Dutch children in the general population. Time in institutional care, early deprivation, and prenatal alcohol exposure were not associated with ADHD symptoms. ADHD symptoms in Polish adoptees were more strongly associated with attachment problems and executive functioning deficits, but less strongly with conduct problems, compared to ADHD symptoms in non-adoptees. Furthermore, ADHD symptoms were more equally distributed among boys and girls than they are in non-adopted children. The findings indicate that Polish adoptees and their adoptive parents need special attention and support. The dissimilarities between ADHD symptoms in Polish adoptees and non-adoptees might indicate a different underlying causal mechanism, which may have important implications for clinical practice.     

Child and family‐related predictors of psychological outcomes in children adopted from abroad; what is the role of caregiver time?

International adoptees need to cope with stressful transitions and to develop secure attachment with their caregivers at the same time. Although most children adopted from abroad adjust fine, they are at increased risk of psychological problems. We investigated whether both child and family‐related factors are associated with later psychological problems and whether the length of time spent at home after adoption before daycare moderates these associations among internationally adopted children in Finland (FinAdo, Finnish Adoption Study). The sample consisted of 1,265 children (708 girls, 557 boys) who arrived in Finland before they started school (mean age 2 years at arrival). Later behavioral problems were measured using the Child Behavior Check List (CBCL). According to our results, male gender, older age, child's early clinical symptoms (problems of sensory processing) and single parenthood were associated with later behavioral problems measured by CBCL scores. Longer stay at home before the start of daycare or school modified these results. Longer stay at home was associated with less later behavioral externalizing problems in girls but not in boys compared to those who spent a shorter time at home.     

Psychological and Sociocultural Adaptation of Children Adopted from Russia and their Associations with Pre-Adoption Risk Factors and Parenting

We investigated academic and behavioral outcomes of internationally adopted children and the associations between these outcomes and age at adoption, time spent in the adoptive family, and parenting. At two time points (T1 and T2, ~15 months apart), we examined early academic skills (school readiness), and parent-reported behavioral adjustment (internalizing and externalizing behavior) and adaptive functioning of a sample of 75 children (45.9% boys, mean age?=?5.17 years) adopted from Russia into US families. We also collected parents’ self-assessments of their parenting at T1. Children who were adopted at a younger age showed higher levels of early academic skills. Correlations between age at adoption and other outcomes were overall small and mostly non-significant. However, adoptees’ academic and behavioral progress differed notably in several respects. Specifically, adoptees improved in early academic skills over time, whereas, as a group, their adaptive functioning and behavioral adjustment remained stable within the normal range. Early academic skills were not related to behavioral adjustment at each time point and over time. The time spent in the adoptive family was positively related to early academic skills at T2. Whereas outcomes showed little to no relation to parenting as reported by mother and father separately, higher discrepancies between mothers' and fathers' reports of positive parenting were related to higher levels of behavioral symptoms and lower levels of adaptive skills at T2. These differential results may be explained in part by drawing upon the notion of dissociated domains of psychological and sociocultural adaptation and acculturation, outlined in the immigration literature. These results also bring to light the possible importance of between-parent consistency in parenting for adoptees’ behavioral outcomes.     

Associations Between Maternal Mental Health and Child Emotional and Behavioral Problems: Does Prenatal Mental Health Matter?

This study examined associations between elevated symptoms of prenatal depression or anxiety and offspring emotional and behavioral problems during mid to late childhood taking into account the impact of later maternal mental health symptoms. The sample consisted of 2,891 women and their children (49 % male) from a prospective, community-based study, the Avon Longitudinal Study of Parents and Children. Women completed measures of depressive (Edinburgh Postnatal Depression Scale) and anxious (Crown Crisp Experiential Index) symptoms at regular intervals beginning in pregnancy. Mothers and teachers assessed offspring emotional and behavioral problems using the Strengths and Difficulties Questionnaire when children were 10–11 years old. Multivariable regression models were fit to address study hypotheses. Exposure to elevated symptoms of maternal depression during pregnancy was associated with increased total offspring emotional and behavioral problems, even after controlling for later maternal mental health problems and a range of sociodemographic and psychosocial characteristics, according to mothers’ but not teachers’ reports. Similarly, children exposed to elevated symptoms of maternal anxiety during pregnancy were reported to have increased total emotional and behavioral problems by mothers but not by teachers. We found support for modest associations between elevated symptoms of maternal depression and anxiety during the prenatal period and certain domains of offspring emotional and behavioral problems in mid to late childhood above and beyond the impact of later maternal mental health problems. These findings highlight the need for additional clinical and research attention to the prenatal period and to both maternal depression and anxiety.     

Brief cognitive behavioral intervention for children and adolescents with persistent post-concussive symptoms: A pilot study

This study aims to evaluate the efficacy of a brief cognitive behavioral intervention program for children and adolescents experiencing persistent post-concussion symptoms. A total of 31 patients aged 10 to 18 years participated in the intervention. The median time since injury at treatment onset was 95 days though the range was large (23–720 days). Treatment was on average four sessions in duration. Sessions included concussion education, activity scheduling, sleep hygiene relaxation training, and cognitive restructuring. Outcomes were measured using symptom reports on the Sports Concussion Assessment Tool – Third Edition (SCAT-3) and parent-reported quality of life on the Pediatric Quality of Life Inventory (PedsQL). Mixed-effects models revealed that symptom reports did not decrease prior to the initiation of this treatment, though significant symptom improvement occurred following treatment. Quality of life scores significantly improved across domains, with the largest gains made in the emotional and school domains. Participant characteristics including age, sex, maternal education, and previous mental health problems were not found to be significantly related to treatment outcomes. Contrary to predictions, length of time since injury was not related to symptom changes. The primary limitation of this study is that it lacks randomization and an experimental control group. The results suggest that brief cognitive behavioral intervention may be a promising treatment for children and adolescents experiencing persistent post-concussive symptoms and warrants further investigation.     

International adoption: assessment of adaptive and maladaptive behavior of adopted minors in Spain

Research on adjustment of internationally adopted children indicates that, although they have adequate development, more emotional and behavioral problems are detected compared with nonadopted children. In this research, emotional and behavioral characteristics of a sample of 52 internationally adopted minors were examined with the BASC (Parent Rating Scales and Self-Report of Personality), comparing the outcomes with 44 nonadopted minors, all of them of ages between 6 and 11 years (mean age = 8.01 years). Results indicate differences between adopted and nonadopted children related to somatization, adopted minors are those that obtain lower scores in the scale, and in the adaptability scale, where nonadopted minors obtain higher scores. Significant differences were found in the adaptive abilities scales, suggesting that nonadopted boys show better abilities than adopted ones, and no differences were found among girls. In general, boys present higher scores in externalizing symptomatology and depression than girls. Among adopted children, time spent in an institution is a variable that has negative impact on the onset of externalizing and internalizing problems. Minors coming from Eastern Europe display more attentional problems, poorer adaptive abilities and poorer interpersonal relations than the rest of the minors. According to the age at placement, attentional problems appear in minors adopted after the age of 3 years.     

Socioeconomic Status,Emotional/Behavioral Difficulties,and Social Competence among Preschool Children in Japan

Socioeconomic status (SES) is an important contextual factor influencing children’s development. However, there have been limited attempts to examine either the impact of relative poverty on child development or the relationships between specific SES indicators and mental health domains. This study elucidates these relationships in Japanese preschool children who experience high levels of relative poverty. Participants were 3218 Japanese children aged 5–6 years. Their mothers completed self-report questionnaires on SES indicators and the Strengths and Difficulties Questionnaire to measure emotional/behavioral problems. Children’s teachers evaluated children’s social competence using the Social Skills Questionnaire for Preschoolers. Each SES indicator had an inverse relationship with all emotional/behavioral problem domains in the univariate analysis. In the multivariate analysis, lower family income consistently predicted higher scores on all emotional/behavioral problem domains, whereas lower maternal and paternal education levels independently predicted higher scores in specific domains. Each SES indicator had positive relationships with all social competence dimensions in the univariate analysis. Higher family income consistently predicted higher social competence in the multivariate analysis. However, paternal education level only predicted self-control, and maternal education did not predict social competence. Family income and parental education levels were significant independent predictors of emotional/behavioral problems and social competence. Thus, this study suggests that SES does affect child outcomes in a country where there is a high level of relative poverty and underscores the importance of assessing income and education status separately in order to identify their potentially unique associations with development among preschool children.     

Assessing Psychiatric Symptoms in Youth Affected by HIV: Comparing a Brief Self-Administered Rating Scale with a Structured Diagnostic Interview

Brief psychiatric assessment tools are needed for evaluating children affected by HIV for emotional and behavioral problems. We compared a self-administered symptom rating scale (CASI-4R) to a semi-structured diagnostic interview (DICA-P) in 136 U.S. children affected by HIV. Agreement and performance measures for the two instruments were computed for attention deficit hyperactivity disorder, depression, anxiety, and disruptive behavior. Correlations and regression analyses were conducted to compare the two instruments, and to evaluate their associations with social, academic, and global function. Higher CASI-4R symptom severity scores were associated with DICA diagnoses (p?<?0.02 for all disorders). Agreement (κ) between DICA diagnoses and CASI-4R Clinical Cutoffs (which incorporated symptoms and impairment) was low to moderate (0.19–0.40 for all disorders). Thirty-two percent of cases with a DICA diagnosis were identified by the CASI-4R Clinical Cutoff (sensitivity), yet over 90% of DICA-negative cases were negative by the CASI-4R (specificity). Sensitivity was higher using CASI-4R Severity Score thresholds based on median scores compared to the DICA diagnoses. The presence and severity of psychiatric symptoms and impairment were associated with poorer academic, social, and global function. The CASI-4R symptom checklist can be used to inexpensively screen youth affected by HIV for emotional and behavioral problems, although it is important that there be appropriate mental health evaluation follow-up.     

Are associations between parental divorce and children's adjustment genetically mediated? An adoption study

The hypothesis that the association between parental divorce and children's adjustment is mediated by genetic factors was examined in the Colorado Adoption Project, a prospective longitudinal study of 398 adoptive and biological families. In biological families, children who experienced their parents' separation by the age of 12 years exhibited higher rates of behavioral problems and substance use, and lower levels of achievement and social adjustment, compared with children whose parents' marriages remained intact. Similarly, adopted children who experienced their (adoptive) parents' divorces exhibited elevated levels of behavioral problems and substance use compared with adoptees whose parents did not separate, but there were no differences on achievement and social competence. The findings for psychopathology are consistent with an environmentally mediated explanation for the association between parent divorce and children's adjustment; in contrast, the findings for achievement and social adjustment are consistent with a genetically mediated explanation involving passive genotype-environment correlation.     

The effects of family, school, and classroom ecologies on changes in children's social competence and emotional and behavioral problems in first grade

This study tested the independent and interactive influences of classroom (concentrations of peer prosocial behaviors and victimization), family (household moves, mothers' education), and school (proportion of students receiving income assistance) ecologies on changes in children's social competence (e.g., interpersonal skills, leadership abilities), emotional problems (e.g., anxious, withdrawn behaviors), and behavioral problems (e.g., disruptiveness, aggressiveness) in first grade. Higher classroom concentrations of prosocial behaviors and victimization predicted increases in social competence, and greater school disadvantage predicted decreases. Multiple household moves and greater school disadvantage predicted increases in behavioral problems. Multiple household moves and low levels of mothers' education predicted increases in emotional problems for children in classrooms with few prosocial behaviors. Greater school disadvantage predicted increases in emotional problems for children in classrooms with low prosocial behaviors and high victimization. Policy implications of these findings are considered.     

Is there a common pathway to maladjustment for internationally adopted and non-adopted adolescents?

The main purpose of the research was to test whether cumulative effects represent a common pathway to behavioral maladjustment for internationally adopted adolescents and controls. The findings of previous comparison and follow-up studies have been contradictory. The hypothesis was tested in an original multi-informant study with 74 adolescents: 40 adoptees and 34 controls. The analyses of the data provided arguments in favor of the existence of a common pathway for adoptees and controls. The accumulation of risk factors in the current characteristics of the adolescents and their family was significantly associated with behavioral outcomes of both adoptees and controls. Implications for research, policy and practice are discussed.     

Language difficulties in children adopted internationally: Neuropsychological and functional neural correlates

Children who have experienced deprivation as a result of orphanage care during early development are at increased risk for a number of cognitive, emotional, and social difficulties (MacLean, 2003). This study examined the neuropsychological and behavioral profile of internationally adopted children with language difficulties, one of the most common cognitive challenges (Behen et al., 2008). In addition to neuropsychological testing, fMRI was utilized to examine activation patterns during expressive fluency and receptive language tasks. In comparison to internationally adopted children without language difficulties and nonadopted controls, participants with language difficulty had worse performance on tasks of verbal memory and reasoning, academic skills, and working memory. Behaviorally, all internationally adopted participants, regardless of language ability, had more parent-reported hyperactivity and impulsivity compared with controls. The fMRI tasks revealed reduced activation in traditional language areas in participants with language difficulty. The impact of early adverse experience on later development is discussed.     

Attachment Security,Personality, and Adjustment of Elementary School Children

Children's development is assumed to be closely related to their attachment security and their personality. The authors’ aim was to examine the joint contribution of attachment security and personality traits to children's adjustment by examining diverse children's outcomes (emotional symptoms, social functioning, and behavioral problems) and using various perspectives (children, parents, and teachers). The sample comprised 247 8–12-year-old children from low socioeconomic status neighborhoods. Personality and attachment contribute to the different domains of adjustment. In cases of moderation, attachment security moderates the implications of personality traits on children's adjustment. The findings highlight the contribution of positive personality tendencies in playing down the difficulties of insecurely attached children.     

Specific extreme behaviors of postinstitutionalized Russian adoptees

Behavior problems reported by parents on the Child Behavior Checklist (Achenbach & Rescorla, 2001) were studied in 316 children adopted from social-emotionally depriving Russian institutions as a function of age at adoption (18-month cutoff), age at assessment (6-11 and 12-18 years), and gender. Children adopted after 18 months had higher problem scores predominately when assessed at 12-18 years. Although most children had no behavior problems, 59.0% of later adoptees assessed in adolescence had at least 1 subscale score and 48.7% had 2 or more subscale scores in the clinical/borderline range. A factor analysis of items that significantly related to age at adoption for older children revealed 1 broad factor, encompassing different antisocial behaviors, social difficulties, and withdrawal. These results may suggest a somewhat broader deficiency produced by orphanage experience beyond the first 18 months of life that underlies a range of behavioral problems displayed later.     

Emotional/Behavioral Problems and Functional Impairment in Clinic- and Community-Based Children with Attention-Deficit/Hyperactivity Disorder in Taiwan

Using a sample of 268 patients and 137 community-based children with DSM-IV ADHD, and 268 school controls, aged 6–15, this study aimed to compare the emotional/behavioral problems and functional impairment between clinic- and community-based children with ADHD. Children’s ADHD-related symptoms, a wide range of emotional/behavioral problems, and functional impairments were assessed by the psychiatric interviews and self-, parent- and teacher-reported questionnaires. Both ADHD groups scored higher in parent- and teacher-reported ADHD-related symptoms, wide-ranging emotional/behavioral problems, and impairments in the school, peer, family, and leisure time domains than school controls. However, clinic-based children with ADHD had more physical/developmental problems, more severe functional impairments and teacher-reported hyperactivity/impulsivity symptoms, and higher family burdens than their community counterparts. Our findings suggest that a higher maternal educational level, parent’s perceived child functional impairment, teacher’s perceived impaired peer relationship and hyperactivity-impulsivity, and child physical and developmental problems may be related to the psychiatric referrals of children with ADHD.     

Executive Function and Emotional,Behavioral, and Social Competence Problems in Children with Epilepsy

Many researchers have reported elevated rates of emotional, behavioral, and social competence problems (EBSP) in children with epilepsy. Although executive function has been found to be associated with EBSP in children with typical development, almost no research has looked at the individual components of executive function as potential predictors of EBSP in children with epilepsy. This is surprising given the deficits in executive function in children with epilepsy. We investigated EBSP and executive function in 42 children with epilepsy, aged 6.0 to 18.1 years and found, as expected, that EBSP were associated with executive function in these children even after epilepsy-related variables, such as seizure type, were accounted for. However, different components of executive function were related to different emotional, behavioral, and social competence problems in these children. Shifting of mental sets was a significant predictor of emotional, behavioral, and social competence problems whereas inhibition was a significant predictor of behavioral problems. This suggests that different executive function profiles in children with epilepsy may place them at-risk for developing different types of emotional, behavioral, and social competence problems. These results may help researchers and clinicians develop new techniques to identify and treat emotional, behavioral, and social competence problems in children with epilepsy.     

震后儿童创伤后应激障碍的症状网络演化

本研究借助网络分析方法,探讨儿童创伤后应激障碍(PTSD)症状的演化规律。以经历汶川地震的197名儿童为研究对象,在灾后4、29、40和52个月对其PTSD症状进行了历时4年的追踪测量。网络分析结果显示,闪回的中心性一直较高,而其他高中心性的症状随时间的推移发生了变化：侵入性想法和创伤线索引发生理性反应的中心性随时间推移呈上升趋势,线索引发情感反应和未来无望的中心性随时间推移呈下降趋势。本研究拓宽了学界对儿童PTSD症状学的认识, 并为建立灾后阶段性干预模式提供启示。     

CBCL Behavior Problems of Post-Institutionalized International Adoptees

With the increase in international adoptions during the last decade, many researchers have investigated the developmental outcomes of these adoptees, including their extreme behaviors. Collectively, these results have not always appeared consistent across studies, perhaps because studies have used children reared in institutions or not, the institutional environments vary in severity, children spend different lengths of time in the institution and are assessed at different ages, and studies use different outcome measures. In an attempt to discern more order in the literature, this review focuses on 18 studies, each of which used the Child Behavior Checklist, and their outcomes are viewed with respect to these parameters. Results suggest that the major factor contributing to extreme behaviors is age at adoption, with those adopted after 6/18 months having more behavior problems, especially Internalizing, Externalizing, and Attention problems. Generally, samples of post-institutional children have more problems than samples of mixed or non-institutional internationally adopted children, and some problems are more likely to be manifest in adolescence, suggesting the effects of deficient early experiences are not simply the persistence of learned behavior but more general dispositions that become more noticeable or severe during adolescence. Findings are discussed in terms of early deficient social–emotional caregiver–child interactions that characterize most institutional environments as a possible major cause of later difficulties in post-institutionalized children.     

A longitudinal investigation of children internationally adopted at school age

Most existing research on children adopted internationally has focused on those adopted as infants and toddlers. The current study longitudinally tracked several outcomes, including cognitive, behavioral, emotional, attachment, and family functioning, in 25 children who had been internationally adopted at school age (M = 7.7 years old at adoption, SD = 3.4, range = 4–15 years). We examined the incidence of clinically significant impairments, significant change in outcomes over the three study points, and variables that predicted outcomes over time. Clinically significant impairments in sustained attention, full-scale intelligence, reading, language, executive functioning, externalizing problems, and parenting stress were common, with language and executive functioning impairments present at higher levels in the current study compared with past research focusing on children adopted as infants and toddlers. Over the three study points, significant improvements across most cognitive areas and attachment functioning were observed, though significant worsening in executive functioning and internalizing problems was present. Adoptive family-specific variables, such as greater maternal education, smaller family size, a parenting approach that encouraged age-expected behaviors, home schooling, and being the sole adopted child in the family were associated with greater improvement across several cognitive outcomes. In contrast, decreased parenting stress was predicted by having multiple adopted children and smaller family sizes were associated with greater difficulties with executive functioning. Child-specific variables were also linked to outcomes, with girls displaying worse attachment and poorer cognitive performance and with less time in orphanage care resulting in greater adoption success. Implications for future research and clinical applications are discussed.