International adoptees have fewer behavior problems than domestic adoptees

May 24, 2005

Most international children who are adopted are well-adjusted and have fewer behavioral problems than children who are adopted domestically, according to an article in the May 25 issue of JAMA.

"International adoption is an increasing phenomenon involving more than 40,000 children a year moving between more than 100 countries," according to background information provided by the authors. "Before adoption, international adoptees often experience insufficient medical care, malnutrition, maternal separation, and neglect and abuse in orphanages."

Femmie Juffer, Ph.D., and Marinus H. van IJzendoorn, Ph.D., from Leiden University, Leiden, the Netherlands, conducted a search of the medical literature from 1950 to January 2005 to estimate the effects of international adoption on behavioral problems and mental health referrals. The authors' meta-analyses compared the international adoptees to children who had not been adopted (controls) and to children who had been adopted within their own countries (domestic adoptees).

"In sum, our series of meta-analyses showed that the majority of international adoptees are well-adjusted although more adoptees are referred to mental health services compared with nonadopted controls," the authors write. "Contrary to common opinion, international adoptees present fewer behavior problems than domestic adoptees, and they have lower rates of mental health referral. Unexpectedly, age at adoption does not appear to be important for the development of behavioral problems." The authors add, "Clinicians should be aware of higher risks for problem behaviors in domestic adoptees and in international adoptees who experienced neglect or maltreatment in the preadoptive period."

(JAMA. 2005; 293:2501-2515. Available pre-embargo to the media at

Editor's Note: The Adoption Meta-Analysis Project (ADOPTION MAP) is supported by grants from Stichting VSBfonds, Stichting Fonds 1818, Nationaal Fonds Geestelijke Volksgezondheid, and Stichting Kinderpostzegels in cooperation with the Adoptie Driehoek Onderzoeks Centrum. Dr. van IJzendoorn is supported by the NWO/Spinoza prize of the Netherlands Organization for Scientific Research.

Editorial: International Adoption, Behavior, and Mental Health

In an accompanying editorial, Laurie C. Miller, M.D., from Tufts-New England Medical Center, Boston, writes "the authors convincingly demonstrate that international adoptees have more behavioral problems than nonadopted controls, although the effect sizes were small. On the other hand, when compared with domestic adoptees, international adoptees had fewer total, externalizing, and internalizing behavioral problems and fewer mental health referrals."

"Clearly, this report represents an important step toward the goals of reducing behavioral problems and promoting positive mental health outcomes for this vulnerable group of children," the author concludes.

(JAMA. 2005; 293:2533 - 2535. Available pre-embargo to the media at

Editor's Note: Dr. Miller is supported in part by the Jaqueline Munroe Noonan Foundation and by a grant from the National Institutes of Health (National Institute on Drug Abuse).

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