Psychiatric Problems Of Adopted Persons

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psychiatric problems of adopted persons

Mental health experts disagree among themselves on whether adopted persons evince a greater level of mental illness than nonadopted persons. Vastly differing percentages of adopted persons in the institutionalized population have been reported, ranging from 5% to as high as 25% or more, depending on which study is used.

In looking at the nonclinical population, however, the picture appears to be very different and many studies find little or no difference between adopted people in the general population and nonadopted people.

Many adoptive parents enjoy a higher socioeconomic level than the average person and can thus afford psychiatric treatment, both inpatient and outpatient. (And also may have insurance coverage for such treatment.) Another issue is an element of the self-fulfilling prophecy among those seeking psychiatric help for their children, i.e., if an adopted child seems to be having emotional difficulties, then adoptive parents might seek psychiatric help specifically because of a presumption that adopted children are more likely to have psychiatric problems. These visits to the psychiatrists are then, in turn, used by researchers to "prove" that adopted children are more disturbed than the general population.

In a study on depression in childhood, reported in a 1998 issue of the Journal of Child Psychology & Psychiatry, the researchers looked at a sample of 180 adopted children and 227 nonadopted children and their mothers. The adopted children were drawn from the Colorado Adoption Project, a longitudinal study. The researchers had information on the biological mothers, who were tested before the child was born. The adoptive mothers answered questions about the children and the children responded to questions at ages 9, 10, 11 and 12. The researchers also sought to find if depression was more common among males than females. They ultimately found no difference.

The researchers found no difference between the adopted and nonadopted individuals' rate of depression, nor did they find evidence of a genetic linkage of depression. They concluded, "At the very least these findings raise doubts about genetic influence on depressive symptoms in middle childhood and warrant more than usual the maxim that more research is needed."

In an article in a 1998 issue of Child and Adolescent Psychiatric Clinics of North America, the authors said they believed adopted children had more emotional difficulties than nonadopted children, but they also believed problems are often accentuated and blown out of proportion by well-meaning but overly worried adoptive parents.

Said the authors, "Adopted children exhibit more psychopathology than nonadopted ones, but not as much as their adoptive parents think they do. Adoptive parents are predisposed to seek help regarding their children, and tend to be socioeconomically advantaged. This predisposition can be a mixed blessing. On the one hand, adoptive parents have an awareness of problems and the energy and resources to seek help when the need for help is perceived. On the other hand, their overconcern regarding problems generates some of the problems about which they are concerned."

Problems with Finding Competent Therapists

Some authors insist that mental health professionals tend to blame the family too frequently or blame adoption itself for a problem when the underlying problem may have resulted from experiences the child had before he came to his adopted family. In addition, the adoptive family may be struggling mightily to succeed and stay together, yet receive little credit from therapists for their efforts.

In his 1994 article for the Journal of the American Academy of Child and Adolescent Psychiatry, psychiatrist Steven Nickman said sometimes therapists make problems worse through their own ignorance. Nickman says many therapists don't realize that children adopted as infants are a different population from children adopted as older children. Nor do they understand or acknowledge the strong bonds between child and parent. Nickman says therapists often shut out adoptive parents from therapy and wish to see only the child. He urged therapists to work with, rather than against, adoptive parents. (See THERAPY AND THERAPISTS.)

The Schecter Study

One of the earlier studies on adopted persons and mental disturbances was reported in 1960 by psychiatrist Marshall Schecter, who concluded about 13% of his psychiatric patients over five years of age had been adopted. His findings were used as a basis for concluding that adoption causes or contributes to psychiatric problems, and this study is still cited some 40 years later.

Schecter studied a small population of adopted persons, 16 of 120 mental patients. Of these, at least three were over age nine at the time of adoption. Studies by Dr. Richard Barth and others have revealed the older the child is at the time of adoption, the more likely there will be problems with the adoptive placement. As a result, it is almost certainly unfair to include children adopted as infants with those adopted as older, SPECIAL NEEDS children.

In addition, it is fairly evident that practices prevalent at the time of the Schecter study in the 1950s, and which were hardly intrinsic to the institution of adoption, contributed greatly to the adopted child's problems.

For example, a child studied by Schecter who was adopted at only 14 months from a foster home was not toilet trained. Today, it is rare that parents expect an infant to be toilet trained at this early age; however, at that time, it was commonly accepted by some physicians as possible and desirable. Schecter reported that a pediatrician told the parents they must "insist on complete control of the excretory functions immediately and forcibly. This, then, seemed to become the condition for acceptance into the family."

The child had difficulty with this demand. In addition, the adoptive parents changed her name. Even to a toddler, one's name is part of one's identity. Today social workers advise adoptive parents that children need time to adjust to their new surroundings, and may actually regress in their behavior for a while. It seems likely the trauma of relocating to a new family, hell-bent on potty training her, and also losing her name would ultimately cause behavioral and identity problems, and it did.

In another case, Schecter described a five-year-old girl who was phobic about going to school and had "severe temper tantrums."

Schecter concluded that the child was threatened because she had been "sent away" from her "original mother" at age 17 months. It would be interesting to speculate on how many nonadopted children of age five also experience severe difficulties surrounding entering school for the first time.

Another case cited by Schecter seems to be an obvious problem of attachment, wherein the child responded as well to strangers as to the adoptive parents. In yet another case, a child who was not hypothyroid had been placed on thyroid medication.

What is not revealed about these children and their families is fascinating to speculate, considering the disturbing information that is offered. It is hoped that social workers and others associated with adoption and children have gained from the mistakes of the past and that how adopted children of today are raised will not be viewed with amazement by future generations.

Other Studies

Since Schecter's work in the 1950s and 1960s, the psychiatric problems of adopted persons have been the focus of a considerable amount of research, some of which is reported below. For example, a Canadian study of 57 adopted children referred to a psychiatric service found a greater incidence of referrals than would be expected for the general population.

According to the researchers, adopted children "presented more with conduct disorders and less with anxiety disorders and were significantly more impaired than the controls."

The researchers also discussed apparently conflicting findings of researchers on the incidence of mental problems among adopted persons.

Their explanation was that "while adopted children and adolescents may experience psychosocial problems at a relatively increased rate, these are early problems that are probably not associated with increased risk for mental illness in adulthood."

The researchers found a significant number of the adopted children came from families of a higher socioeconomic level than the control patients' families. The researchers stated, "This probably reflects the selection policy for would-be adoptive families by the adoption agencies." Other researchers have speculated that perhaps adoptive families are more likely to seek assistance when their child has a problem than nonadoptive families, in part, because they can afford it.

A 1977 study by Melissa Norvell and Rebecca Guy compared and contrasted the self-concept of adopted persons to the self-concept of nonadopted persons. The hypothesis was that the adopted individuals would have a more negative self-concept than the nonadopted persons. Seven hundred twenty-one males and females were sampled from psychology and soiology students at two universities. Of these, 38 identified their adoptive status. The researchers drew 38 nonadopted subjects from the population, matching for age, marital status, race and sex. No significant differences were found between the self-concepts of the adopted subjects and the nonadopted subjects.

A 1985 study by Andrea Weiss compared the symptoms of adopted and nonadopted children who were admitted to a psychiatric hospital and found significant differences: most of the adopted children who were admitted were far less disturbed than were the nonadopted children. (There were no significant differences in age, gender or social class.)

According to Weiss, the adopted children did not receive diagnoses of personality disorders at greater frequency than the nonadopted children. In addition, they were not more likely to have been hospitalized because of exhibiting antisocial behavior. One difference Weiss did note, however, was that the adopted children were admitted to the hospital at younger ages than the nonadopted children. (15 to 16 years) In addition, the adopted children were diagnosed as psychotic in significantly fewer cases than the nonadopted children. Finally, the adopted children were more frequently (and statistically significantly) identified as suffering from adjustment reaction. Weiss reported that upon discharge only 25.5% of the 47 adopted persons had been diagnosed with psychoses compared to 46.2% of the 93 nonadopted persons who had been admitted.

One wonders to what extent psychiatrists themselves are biased about adoption and adopted persons. Would knowledge of an individual's adoptive status increase the probability that a child might be admitted to an institution?

In an earlier report Weiss found that psychiatrists limited visitations by adoptive parents more than they limited visitations by biological parents. They also labeled adoptive parents as "precipitants" to the hospitalization more frequently.

Said Weiss, "It was concluded that parent-child relations may be more problematic among hospitalized adopted, as compared with nonadopted adolescents. It was also suggested that psychiatric bias concerning "typical" adoptive family dynamics might have contributed to the observed differences."

Paul Brinich and Evelin Brinich studied 113 adopted persons who had received psychiatric services from 1969 to 1978 at the Langley Porter Psychiatric Institute (LPPI) in San Francisco, California, and compared them to nonadopted individuals who were also registered as patients.

The authors concluded, "Adoptees are not generally overrepresented in psychiatric samples, though it is true that they may be seen somewhat more frequently in child psychiatric clinics?.?.?. while adoption may serve as a focus for psychopathology in individual cases, adoption itself cannot be seen as specifically pathogenic."

Unfortunately, most of the psychiatric studies that compare and contrast adopted and nonadopted persons concentrate on institutionalized or clinical populations rather than on individuals in the general population. In addition, most studies fail to include any data on the age of the children at the time of adoption, a very significant factor.

If a child was sexually abused and lived in five foster homes prior to his adoption at age 12, it seems likely that he would face a higher probability of adjustment problems and the need for therapy than would an infant placed for adoption at the age of three weeks.

Genetic Factors and Psychiatric Problems

A genetic predisposition is an important factor to consider in psychiatric ailments, and increasing evidence is revealing there are genetic markers for schizophrenia, Alzheimer's disease and other psychiatric ailments. (See also GENETIC PREDISPOSITIONS.)

As a result, even a child adopted as a healthy infant may ultimately develop psychiatric problems. These problems may have nothing to do with adoption per se but instead have to do with the child's genetic inheritance, or the problems could be a combination of adjustment and hereditary factors.

Some studies indicate that adoption may decrease the likelihood of a mental illness developing. For example, the rate of schizophrenia in the general population is about 1%; however, if a child has a parent with schizophrenia, the likelihood the child will develop schizophrenia rises to 10%. Yet in a study by Lowing et al. in 1983, researchers found that when the child of a schizophrenic parent was adopted, the probability of the child developing schizophrenia fell to 3%-still higher than the rate for the general population but much lower than the rate for the nonadopted child of a parent with schizophrenia.

It seems apparent that much more scientific research is needed on psychiatric problems and adopted persons, and it would also be interesting to study psychiatrists and their attitudes toward adopted persons in a blind study. (See also ADOLESCENT ADOPTED PERSONS; ADULT ADOPTED PERSONS; EXPLAINING ADOPTION; MEDIA.)

Paul M. Brinich, Ph.D, and Evelin B. Brinich, M.A., "Adoption and Adaptation," The Journal of Nervous and Mental Disease 170, 8 (1982): 489-493.

Andre P. Derdeyn, M.D., and Charles L. Grave, M.D., "Clinical Vicissitudes of Adoption, Child and Adolescent Psychiatric Clinics of North America 7, no. 2 (April 1998): 373-388.

Thalia C. Eley, et al., "An Adoption Study of Depressive Symptoms in Middle Childhood," Journal of Child Psychology & Psychiatry 39, no. 3 (1998): 337-345.

Pamela V. Grabe, ed., Adoption Resources for Mental Health Professionals (Butler, Pa.: Mental Health Adoption Therapy Project, 1986).

Sotiris Kotsopoulos, M.D., Ph.D, Andre Cote, M.D., Llewelyn Joseph, M.D., Neomi Pentland, M.D., Chryssoula Stavrakaki, M.D., Patrick Sheahan, M.S.W., Louise Oke, B.A., "Psychiatric Disorders in Adopted Children: A Controlled Study," American Journal of Orthopsychiatry 58 (October 1988): 608-612.

P. Lowing, et al., "The Inheritance of Schizophrenia Disorder: A Reanalysis of the Danish Adoption Study Data," American Journal of Psychiatry 1400 (1983): 1167-1171.

Steven L. Nickman, M.D., and Robert G. Ewis, M.Eld, M.S.W., "Adoptive Families and Professionals: When the Experts Make Things Worse," Journal of the American Academy of Child and Adolescent Psychiatry 33, no. 5 (June 1994): 753-755.

Melissa Norvell and Rebecca F. Guy, "A Comparison of Self-Concept in Adopted and Non-Adopted Adolescents," Adolescence 12 (fall 1977): 443-448.

Herbert Pardes, M.D., Charles A. Kaufmann, M.D., Harold Alan Pincus, M.D., and Anne West, "Genetics and Psychiatry: Past Discoveries, Current Dilemmas, and Future Directions," American Journal of Psychiatry 146 (April 1989): 435-443.

Marshall D. Schecter, "Observations on Adopted Children," Archives of General Psychiatry 3 (July 1960): 21-32.

Naomi Thiers, "Controversy Surrounds Adoption's Effects," Guidepost, May?29, 1989.

Andrea Weiss, "Parent-Child Relationships of Adopted Adolescents in a Psychiatric Hospital," Adolescence 19 (spring 1984): 77-88.

Andrea Weiss, "Symptomology of Adopted and Nonadopted Adolescents in a Psychiatric Hospital," Adolescence 20 (winter 1985): 763-774.

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