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Adoption Awareness Month: Teens Adopted as Infants Have Slightly Greater Risk for Behavioral Issues

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Attachment, Adoptive Families, and Adolescent Development

In 1976, Massachusetts Governor David Dukakis introduced a statewide initiative called Adoption Awareness Week as part of a comprehensive plan to advocate for children in foster care waiting for adoption. Then, in 1984, President Ronald Reagan picked up where Governor Dukakis left off and created the first National Adoption Week. Finally, in 1995, President Bill Clinton picked up where President Reagan left off and expanded National Adoption Week to National Adoption Month, which occurs every year in the month of November.

According to the ChildWelfare.Gov, the child welfare website maintained by the U.S. Department of Health & Human Services, during National Adoption Awareness Month:

“National, State, and local agencies – as well as foster, kinship care, and adoptive family groups – help educate their communities through programs, events, and activities that help raise awareness about the thousands of children currently in foster care who are waiting for their own permanent, loving families.”

This year, organizers identified a timely theme for Adoption Awareness Month 2021:

“Every Conversation Matters”

This year, the focus is on teenagers. That’s why we call the theme timely. As 2021 winds down and we approach 2022, we need to keep a close eye on our teenagers and their well-being. Adolescence is tough enough on its own. For many adolescents across the country, the added stress and pressure of 2020 and early 2021 made the parts of life most adolescents take for granted – school, sports, extracurricular activities, socializing – seem like luxuries. Their absence, compounded by the general stress associated with a once-in-a-century pandemic, had an adverse impact on the mental health of our adolescent population.

Proactive Communication With All Teens is Essential

The current vulnerability of our teens to mental health issues is why every conversation you have with your teen matters. It’s also why – in this article about the long-term behavioral effects of adoption during infancy – we want to offer you a quick set of pointers about how to engage teens in honest and productive conversation.

These tips are important for talking to adolescents adopted as infants, who, as the title of this article implies, are at greater risk of developing behavior disorders during adolescence than their non-adopted peers, but they’re also important for talking to all teenagers, after the collective trauma we all experienced over the past eighteen months.

We’ll offer these tips, then discuss adoption in the U.S. in general, move on to the behavioral disorders common to children and teens adopted during infancy, and end with a list of resources that can help adopted teens and their families navigate the ups and downs of adolescence.

First, the refresher on how to engage teens in open, honest, and direct conversation. We adapted these tips directly from the National Adoption Awareness Month resource page here.

Talking to Teens: Five Tips

  1. Acknowledge and be real about everything that has happened and is happening in their lives.
  2. Understand the power of trauma. By default, most adopted kids have a history of grief and loss over their birth parents. In 2021, all our teens share the collective trauma of the pandemic. Trauma can cause changes in behavior, emotion, communication, and trust, among other things.
  3. Be honest in your feedback about their behavior, but focus on and leverage the strengths of each adolescent, as opposed to deficiencies.
  4. Pose questions that are relevant and meaningful. Wait for their answers, and listen with understanding, compassion, and empathy.
  5. Prioritize quality time in the form of shared activities, shared tasks, and family goal setting.

If you have trouble talking to your adopted teen – or any teen, for that matter – try these five tips. They work. They can help you initiate important conversations about the issues teens face – including issues around mental health – before those issues become problems.

Now let’s take a big picture look at adoption in the U.S.

The Facts and Figures on Adoption

Most of us know someone who’s adopted or know a family with an adopted child. However, most of us don’t think much about adoption unless it directly touched our lives. We share the figures below because adoption touches more lives than most of us realize. Once you read and understand these statistics, you’ll understand

Adoption in the United States: Basic Facts

  • There are close to 7 million adopted people in the U.S.
  • About 1 in every 50 kids in the U.S. is adopted.
    • That’s around 1.5 million children
  • In 2014 – the latest year with reliable data – around 110,000 children were adopted.
    • That’s down from 140,000 in 2007.
  • Among the 110,000 children adopted in 2014:
    • 59% adopted from foster homes or the child welfare system
    • 37% adopted by relatives
    • 26% adopted from other countries
    • 15% were put up for adoption voluntarily by birth parents/mother
  • In 2014, over 18,000 infants were adopted.
    • 62% were adopted within a month of birth
  • Average age at adoption: 5 years old.
  • Average age of a child in foster care waiting for adoption: 8 years old.
  • The average wait for adoption for a child in foster care: 3 years
    • 11% wait for over five years.
  • There are over 400,000 kids in foster care
  • Close to 100 million U.S. citizens have an adopted family member
    • That’s about 31% of the total U.S. population

After reading those numbers, you probably realize adoption touches more families than you thought. Almost a third of families in the U.S. have a direct experience with adoption. And each adopted person – along with their families – have a unique set of issues they face that are part of the adoption experience. To learn about the major issues facing adopted individuals and their families, please read the article we published on the topic, back in 2018:

Adoption and Teens: Identity, Acceptance, and Trust

To learn about the effects of early trauma on adopted children when they reach adolescence, please read this article we published on the topic in 2019:

Adoption Awareness Month: Adoption and Early Trauma

These articles give you an idea of the core issues related to adoption and the specific issues relevant to adopted survivors of early trauma. Both articles will help you understand the information we share next: the relationship between infant adoption and behavioral issues that may arise when people adopted as infants enter adolescence.

Infant Adoption and Behavioral Disorders: Is There a Connection?

Research on adoption shows the core issues stem from the nature of attachment established during infancy. There are four main types of attachment:

  1. Secure attachment is associated with a sensitive, loving caregiver. Experts call this a secure, organized form of attachment since both the quality of attachment and the presence of the caregiver are consistent.
  2. Avoidant attachment is associated with an insensitive, caregiver who rejects the infant. Experts call this an insecure but organized form of attachment. The quality of attachment is consistent, but the support is not loving.
  3. Resistant attachment is associated with inconsistent support from the caregiver. One day the caregiver may be loving and supportive, and the next day the caregiver may not be loving and supportive. Experts call this an insecure but organized form of attachment. The quality of attachment is inconsistent, but the caregiver is a consistent presence.
  4. Disorganized attachment is characterized by aberrant behavior on the part of the caregiver, described as “frightening, frightened, dissociated, sexualized, or otherwise atypical.” Experts call this an insecure, disorganized form of attachment. Both quality of attachment and the behavior of the caregiver are inconsistent and not associated with common concepts of loving and supportive caregiving.

Adopted kids with secure attachment experiences during infancy show lower rates of mental health and behavioral disorders during adolescence, while adopted kids with disorganized attachment experiences show higher rates of mental health and behavioral disorders during adolescence. However, researchers make it clear that problems with early attachment do not automatically mean an adopted child will experience severe difficulties during adolescence. A loving and supportive adoptive family can help the adopted child meet and overcome initial attachment problems.

What Are the Behavioral Issues Common to Adopted Kids?

Large-scale studies show that on average – regardless of attachment patterns during infancy – kids adopted during infancy show an increased vulnerability to behavior problems during adolescence. The definitive work on this subject, published in 2008, is a paper called The Mental Health of U.S. Adolescents Adopted in Infancy. In this study, researchers examined the difference in the likelihood of developing behavioral disorders in adolescence between kids adopted as infants and their non-adopted peers.

Here’s what they found:

Adolescents Adopted During Infancy: Common Behavioral Disorders

  • Oppositional defiant disorder (ODD):
    • Adolescents adopted during infancy are 2.24 times more likely to develop ODD than non-adopted peers
  • Attention-deficit hyperactivity disorder (ADHD):
    • Adolescents adopted during infancy are 2.67 times more likely to develop ADHD than non-adopted peers
  • Conduct disorder:
    • Adolescents adopted during infancy are 1.64 times more likely to develop ADHD than non-adopted peers
  • Any behavior disorder:
    • Adolescents adopted during infancy are 2.34 times more likely to develop ADHD than non-adopted peers

Here’s how the study authors describe these results:

“Our findings imply that, while the majority of adopted adolescents are psychologically well adjusted, some adoptees may be at elevated risk for clinically significant problems.”

Their interpretation is important because it shows us that, despite the fact that almost all adopted kids have issues related to grief and loss surrounding their birth parents they need to resolve, most are mentally and emotionally stable and well-adjusted. In addition, to help teens who begin to show behavioral issues, adoptive parents can take steps to ensure their wellbeing.

The American Academy of Pediatrics advises adoptive families to create a home environment that’s stable, predictable, nurturing, supportive, understanding, and above all, loving. When a family culture has this type of foundation, a child who develops a behavioral disorder – or an emotional/mood disorder – has a greater chance of managing that disorder and living a full and productive life. And if we didn’t make the point yet, the thing that supports all these values is the same thing that supports nearly all resilient families and parent-child relationships: unconditional love.

Adopted Teens and Their Families: Online Resources

These websites and organizations offer a wide range of support and information for adoptive parents and adopted teens alike:

The National Child Traumatic Stress Network
The California Evidence-Based Clearinghouse for Child Welfare
The Adoption Network
The Adoption Council
The Children’s Action Network
The Center for Advanced Studies in Child Welfare

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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