Several factors have been associated with increased risk of psychological maladjustment in adoptees. In a study of foreign adoptees by Verhulst and colleagues (1992), problem behaviors were seen in 24% of the children who had been severely neglected, in 31% of the severely abused children, and in 50% of the children who experienced at least five changes in caretaking environments.
The child's age at placement has also been associated with the outcome. Better psychological adaptation has been associated with adoption during the first six months of age. Studies generally conclude that the earlier the placement of the child in the adoptive home, the better the outcome. Adoption at a young age is thought to spare the child many adverse life experiences such as multiple temporary placements and changes in caretakers. Additionally, the older adopted child might have habits and behaviors to which adoptive parents could have difficulty adjusting (Kotsopoulos et al., 1993; Verhulst et al., 1992; Warren, 1992).
Interestingly, transracial adoption has not been found a risk factor for psychological maladjustment. In a study of transracially adopted black children in the United States, McRoy and colleagues (1982) found no difference in overall self-esteem between transracially and intraracially adopted children. The self-esteem of the transracial adoptees was as high as that reported among individuals in the general population.
Clinical studies show that adopted children present more frequently for both inpatient and outpatient psychiatric treatment compared with the general population. The percentage of adopted children in psychiatric treatment settings ranges from 2.4 to 17 (Rogeness et al., 1988). Despite their higher propensity for presenting for psychiatric treatment, the actual incidence of psychiatric illness in adopted children has not been found higher than the incidence in the general population, except for hyperkinesis in adopted boys. In fact, adopted children do not differ from nonadopted children in the incidence of educational problems or substance abuse (Lipman et al., 1993; Kotsopoulos et al., 1988).
Recent studies, therefore, do not support the commonly held belief that adopted children appear more often in psychiatric settings primarily because they are more troubled. Adoptive families have been until recently largely from socioeconomic strata at or above the median, thus allowing for more access to psychiatric care. Also, most adoptions in the United States are accomplished through agencies that attempt to provide many support services such as mental health consultation. Finally, the adoptive family might see the adoptee as at increased risk for problems and may more quickly identify even minor difficulties as warranting treatment (Warren, 1992; Brinich and Brinich, 1982).
Despite the risks and challenges of adoption, the vast majority of adoptees do not manifest long-term problems, nor do they require psychiatric treatment (Warren, 1992). Bohman and Sigvardsson (1982) followed a cohort of adopted children through adulthood and found that whereas adopted boys had increased difficulties compared with nonadopted boys at 10 and 11 years old, few differences were found from 15 years of age onward. This suggests that the adverse effects of early life events can be offset by the adaptive capability of the mind and the affirmative influences of the adoptive family (Verhulst et al., 1992).Perils Not Unlike Biologic Parenting
Adopted children and adoptive families are faced with many perils and difficulties. Despite the challenges that arise from working through adoption-related issues, most adopted children adjust well. We must be mindful, however, that being a member of an adopted family is a complex reality with which one must come to terms. Individuals assimilate that reality in different ways and with varying degrees of mastery.