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US teens adopted as infants appear to have moderately increased odds of mental health problems

May 06, 2008

Although most adopted American teens are psychologically healthy, adoptees appear to be at greater risk for emotional and behavioral problems than non-adoptees, according to a report in the May issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals. They are also more likely to have contact with a mental health professional.

Approximately 120,000 American children are adopted each year and there are about 1.5 million adoptees under age 18 in total, according to background information in the article. As domestic adoptions have decreased, the number of international adoptions has increased. "Worldwide, approximately 40,000 children per year are moved between more than 100 countries through adoption. Despite the popularity of adoption, there is a persistent concern that adopted children may be at heightened risk for mental health or adjustment problems."

Margaret A. Keyes, Ph.D., of the University of Minnesota, Minneapolis, and colleagues assessed 540 non-adopted adolescents, 514 internationally adopted adolescents and 178 domestically adopted adolescents (ages 11 to 21) to determine if adopted adolescents were at a higher risk for behavioral and emotional problems. Assessments were based on child and parent reports of attention-deficit/hyperactivity, oppositional defiant, conduct, major depressive and separation anxiety disorders, teacher reports of psychological health and contact with mental health professionals.

Adoptees scored moderately higher on continuous measures of behavioral and emotional problems. "Nevertheless, being adopted approximately doubled the odds of having contact with a mental health professional and of having a disruptive behavior disorder [attention-deficit/hyperactivity, oppositional defiant, or conduct disorder]. Relative to international adoptees, domestic adoptees had higher odds of having [a disruptive] disorder," the authors write. "Focusing on internalizing problems, teachers reported that international adoptees were significantly more anxious than non-adopted adolescents and their parents reported significantly more symptoms of internalizing disorders, specifically major depressive disorders and separation anxiety disorders."

"Although most adopted adolescents are psychologically healthy, they may be at elevated risk for some externalizing disorders, especially among those domestically placed," the authors conclude. "This excess of clinically meaningful behavioral problems in adopted adolescents has significance for researchers who examine the effect adoption has on individual functioning, for adoption agencies and their workers who counsel and advise members of the adoption triad and for physicians who are dealing with an overrepresentation of adoptees in their clinical practices."

JAMA and Archives Journals