Adolescence Can Sting Adopted Kids

"Identity issues are pretty intense for adopted kids, but for kids adopted transnationally there is an added identity issue," said Joyce Maguire Pavao, founder and chief executive of the Center for Family Connections, an educational and counseling center in Cambridge, Mass., that specializes in adoption. "It's another level of feeling 'different.' "

In the new study, described in the May issue of Archives of Pediatric and Adolescent Medicine, researchers conducted mental health assessments on 692 adolescents, ages 11 to 21, who were adopted as infants (514 born outside the United States) and 540 non-adopted adolescents.

Over all, adoptees scored significantly higher on measures of what psychologists call "externalizing behaviors," a reference to various pathological ways of "acting out." Contrary to the widely held notion that many foreign adoptees have serious psychological problems because of undisclosed gestational complications or difficult early-life experiences, most of that excess of problem behaviors was in domestically adopted adolescents.

Among boys, for example, 25 percent of domestic adoptees were diagnosed as having, at some point in their childhood, "oppositional defiant disorder" (excessive arguing and fighting with authority), compared with 12 percent of non-adoptees and 20 percent of international adoptees. Similarly, 29 percent of domestically adopted boys had ADHD, compared with 8 percent of non-adopted adolescents and 19 percent of international adoptees. And 15 percent of domestically adopted boys had "conduct disorder" (often manifesting as delinquency), compared with 6 percent of non-adoptees and 8 percent of international adoptees.

Among girls, the proportions were similar, though the prevalence of each of those syndromes was about one-third lower than for boys. For boys and girls, rates of depression and separation anxiety disorder (known as "internalizing disorders" because they involve more inward suffering than outward acting) were roughly the same for all adopted and non-adopted adolescents.

The results resemble those from a 2005 reanalysis of more than 100 previously published studies of adoptee mental health. But the new study has advantages over previous ones. For one thing, it gathered participants with the help of large adoption agencies. That avoided the problem that often comes up with random, population-based surveys: namely, that some people don't know or don't admit that they are adopted.

Also, the diagnoses were based not just on parental descriptions but also on detailed interviews with the adolescents themselves and their teachers. That means the results are less likely to be skewed by the views of the adoptive parents, who tend to be highly educated, wealthier than average and extremely attentive -- a combination that can lead to exaggerated concerns about their children's behaviors and an over-pathologizing of normal adolescence.

Parental hypersensitivity does seem to be playing something of a role, Minnesota psychology professor McGue said, perhaps especially for girls adopted internationally.

About 18 percent of those girls were diagnosed with at least one of the disorders covered by the study, but 27 percent had had contact with a mental health professional, suggesting some parental predisposition to seek help for those children. (Parents referred about the same percentage of boys to mental health professionals, even though far more of them, it turns out, met the criteria for having a behavioral disorder.)

But overall, McGue said, the study shows that, by objective measures, adolescent adoptees do struggle with extra burdens. Adoptive parents, he said, "should be aware of that and be prepared to deal with it."

The study says little about what is behind the higher incidence of problems among adoptees or about the especially high rates among those adopted domestically. The presumption among many experts is that the problem represents a mix of several contributing issues, including genetic factors, substance abuse by mothers during gestation, or abuse or deprivation after birth.

"Children from orphanages come from orphanages," said Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute in New York. "They experienced things that obviously had some impact on their developing psyche, on their being."