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PubMed2003

Families and adoption: the pediatrician's role in supporting communication.

Each year, more children join families through adoption. Pediatricians have an important role in assisting adoptive families in the various challenges they may face with respect to adoption. The acceptance of the differences between families formed through birth and those formed through adoption is essential in promoting positive emotional growth within the family. It is important for pediatricians to be informed about adoption and to share this knowledge with adoptive families. Parents need ongoing advice with respect to adoption issues and need to be supported in their communication with their adopted children.

Adoption↗
PubMed1988

Amendment to the Ordinance on the activity of intermediaries with respect to adoption, 21 December 1988.

Among other things, this Amendment modifies the Ordinance of 28 March 1973 to strengthen the requirements for intermediaries facilitating the adoption in Switzerland of foreign children. Such persons are to be aware of the principal legal rules on adoption of the country from which the children come, as well as the cultural and social conditions of the country, and are to give advice to the adopting parents up until the moment of adoption. In addition, intermediaries for all adoptions are required to give information to adopting parents on the difficulties that may result from the adoption and, if asked, to give advice to parents from the time of placement until the moment of adoption.

Adoption↗
PubMed1995

Adoption study demonstrating two genetic pathways to drug abuse.

BACKGROUND: Studies of adoptees have demonstrated that there are two genetic factors leading to alcohol abuse and/or dependence (abuse/dependence). In addition, environmental factors found in the adoptive family also predict alcohol abuse/dependency independently. One study has found evidence that a similar model of two genetic factors and independent adoptive family factors were involved in drug abuse. Our study was designed to test the hypothesis that genetic factors defined by alcohol abuse/dependency and anti-social personality disorder in biologic parents were etiologic in drug abuse/dependency and that psychiatric problems in adoptive parents were an additional factor associated with drug abuse/dependence. METHODS: A sample of 95 male adoptees, separated at birth from their biologic parents, were followed up as adults to determine their psychiatric diagnosis and their substance use/abuse in a structured interview administered blind to biologic parent diagnoses. A high-risk, case-control design was used wherein half of the adoptees came from biologic parents known to be alcohol abuser/dependent and/or have antisocial personalities (diagnoses from hospital or prison records). These adoptees were matched for age, sex, and adoption agency to a control group of adoptees whose biologic parents were not found in the hospital and prison record search. Adoptive home environment was assessed by structured interviews, including psychiatric assessment of both adoptive parents. RESULTS: Data were analyzed by log-linear modeling, which showed evidence of two genetic pathways to drug abuse/dependency. One pathway went directly from a biologic parent's alcoholism to drug abuse/dependency. The second pathway was more circuitous, and started with anti-social personality disorder in the biologic parent and proceeded through intervening variables of adoptee aggressivity, conduct disorder, antisocial personality disorder, and, eventually, ended in drug abuse/dependency. Environmental factors defined by psychiatric conditions in adoptive families independently predicted increased antisocial personality disorder in the adoptee. Adoptees born of alcohol-abusing mothers showed evidence of fetal alcohol syndrome, but controlling for this did not diminish the evidence for the direct genetic effect between an alcohol-abusing biologic parent and drug abuse/dependency in offspring. CONCLUSIONS: This study confirms the model of two independent genetic factors involved in drug abuse/dependence and previous findings that disturbed adoptive parents are associated with adoptee drug abuse/dependency.

Adolescent↗
PubMed1997

Adaptation of adopted foreign children at mid-adolescence as indicated by aspects of health and risk taking--a population study.

PURPOSE: There is very little data available on adaptation at adolescence after "visible adoptions" (children adopted from abroad), in terms of mental health, risk-taking and problem behaviour in comparison with nonadopted adolescents. This study describes such an outcome. MATERIAL AND METHOD: Data derived from self-reports from 125 adolescents aged 13-18 years who identified themselves as adopted, and who participated in two epidemiological surveys of 9329 adolescents. Their number was representative for children adopted from abroad. The other adolescents served as controls. RESULTS: Family life styles showed no differences between groups. Health was similar to that of the controls. Foreign adopted adolescents significantly often evaluated themselves as shorter and with early puberty. The proportion of adopted girls with suicidal thoughts was significantly larger, they also reported school truancy, not using safety belts, sexual intercourse, unpleasant sexual encounters, and contact with illicit drugs more often than the controls. The stress of early puberty could only partly explain this. CONCLUSIONS: Girls adopted from abroad, representing "visible adoptions", need additional attention and study during adolescence to expose causes for maladaption among some of them.

Adaptation, Psychological↗
PubMed2004

Physical well-being and school enrollment: a comparison of adopted and biological children in one-child families in China.

Adoption has increased in China since 1980 when the government started the one-child policy. There were approximately six million adopted children living in China in 1988. The objective of this study was to compare adopted and biological children in one-child families across a number of measures of physical well-being and school enrollment. The 1992 National Sample Survey on the Situation of Children provided data on 2458 adopted and 194,760 biological children aged 0-14 years living in one-child families. Logistic regression models were used to adjust for confounders. We found that adopted children were not significantly different from biological children in reported diarrhea and nutritional outcomes (stunting, underweight, wasting) after controlling for other known demographic, socioeconomic and geographic correlates. However, there was evidence of significantly higher odds of never being immunized and not being currently enrolled in school, and evidence of slightly lower odds of having fever or acute respiratory infections among adopted children compared to biological children. These results suggest that adopted children were as healthy and well-fed as biological children, but adopted children aged 7-14 years were less likely to be enrolled in school than biological children.

Adolescent↗
PubMed2003

Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities.

Child adoption in the face of reproduction gone awry continues to remain an under researched aspect of contemporary Indian reality. This paper seeks to unpack some of the critical cultural issues underscoring the deep-seated reluctance towards adoption. Drawing on a larger multi-sited research project examining the experience of infertility and assisted conception in India, the paper sheds light on the state of current adoption practices in India. Thus, when faced with infertility, couples in this research emerged as favouring secret gamete donation as a means of bypassing infertility rather than the option of adoption. Invoking the concept of systematic misrecognition, the paper situates the modalities of salvaging infertility, either through medically assisted conception or adoption, as structuring infertile people's quest for children. The paper relates the perceived stigma associated with infertility treatment and adoption with the inclusion of a "third party" that fractures the culturally conceptualized boundaries of family as inextricably tied to the conjugal bond. It is therefore argued that secrecy is born out of a need to obfuscate a "public and visible" violation of a culturally priced ideal that views an intimate connection between the "married body" and the progeny. Adoption continues to remain an undesirable option because the links between an adopted child and the social parent become a public, vocal, and visible admission of infertility that cannot be subsumed, like donated gamete conception, under a conspiracy of silence.

Adoption↗
PubMed1999

[Children of foreign origin adopted in France. Analysis of 68 cases during l2 years at the University Hospital Center of Tours].

BACKGROUND: The number of children of foreign origin adopted in France has increased in the past 15 years. The aim of this study was to analyse distinctive features and medical problems associated with international adoption. PATIENTS AND METHODS: The files of 68 foreign-origin adopted children who attended or were admitted to the Medical and Nutrition Unit of the Pediatric Hospital in Tours between January 1st 1986 and December 31st 1997, were studied retrospectively. Various parameters were analysed: age at first consultation, age at adoption, country of origin and health problems, especially nutritional status, infectious diseases, growth and development. RESULTS: In the majority of cases, children were adopted before 12 months of age (61.2%), particularly before six months of age (49.3%). The children came mainly from Africa and countries in the Indian Ocean (48.5%), and from Southeastern Asia (33.9%). Malnutrition was frequent in children from Africa. Twenty-one children (30.9%) presented with severe malnutrition characterized by weight less than the mean-2SD for height and required hospitalization. No children had congenital hypothyroidism, hyperphenylalaninemia, nor were HIV positive. Some patients had infectious diseases: 11 Hepatitis B, four congenital syphilis and six tuberculosis, with favorable outcomes after treatment. The other most frequent diseases were acute diarrhea, chronic diarrhea, intestinal parasites, and scabies, varying according to countries. Three girls adopted from southern Asia developed precocious puberty. Growth and psychomotor development were satisfactory overall, but abnormalities were observed in 15 children (22.1%), which is higher than in the general population. CONCLUSION: The expansion of international adoption with distinctive diseases proves the importance of a checkup as soon as possible after the arrival of these children in France. This checkup has to include nutritional and general evaluation and supplementary tests, especially for specific serology and vaccination status. Following this, it would be possible to propose a suitable follow-up to the adoptive parents.

Adoption↗
PubMed2005

Gender differences and dynamics shaping the adoption life cycle: review of the literature and recommendations.

The role of gender in the experiences of adoptive family members has received little systematic attention. Gender differences in response to different tasks and phases of the adoption life cycle are described. Gendered dynamics within the adoptive family, for birth parents, and in the field of adoption are highlighted. Birth fathers and adoptive fathers are typically marginalized, which leaves women to address emotion, connection, and communication, and family dialogues about adoption may engage daughters more successfully than sons. The article reviews reasons why differential rates of problem behavior for adopted boys and girls may result from gender differences in emotional expressiveness, social support seeking, and identity formation. Implications of the feminization of adoption are explored, and recommendations for practice and research are proposed.

Adolescent↗
PubMed1998

Adoption study of environmental modifications of the genetic influences on obesity.

BACKGROUND: Adult body mass index (BMI weight (kg)/height2 (m2)) usually shows familial correlations below 0.3, which are almost entirely due to genetic influences. The considerable remaining non-familial individual variation may be due to non-shared environmental influences which, however, may interact with or modify the genetic influence. OBJECTIVE: To investigate whether the genetic influence on adult BMI is modified by various obesity-related environmental conditions during childhood and adulthood. DESIGN: Adoption study, in which the genetic influence is assessed by the correlations in adult BMI between adoptees and their biological fathers, mothers and full siblings. These correlations were compared between groups of families characterized by differences in rearing or adult environment of the adoptees and/or their biological relatives. SUBJECTS: Height, current weight and greatest weight ever, were obtained in 3651 subjects, who were adopted by non-related families in Copenhagen between 1924 and 1947. Groups representing thin, medium weight, overweight and obese proband adoptees were selected by current BMI (n = 540) and by maximum BMI (n = 524). The members of the biological and adoptive families of the proband adoptees were identified and their BMI was computed from height and weight obtained by mailed questionnaires. MAIN VARIABLES: Indicators related to the rearing environment of the adoptees were age of the adoptee at transfer to the adoptive family, region of residence, presence of adoptive siblings and, for the adoptive parents, year of birth, age at time of adoption, occupational rating, smoking habits and BMI. Indicators of the environment of both the adoptee and the biological relatives were: year of birth; occupational rating and smoking habits, and, of the environment of the biological parents, age and parity at birth of the adoptee. RESULTS: The correlations in BMI between adoptees and the biological fathers, mothers and siblings were 0.11, 0.15 and 0.26 for adoptees selected by current BMI, and 0.13, 0.16, and 0.27 for adoptees selected by maximum BMI, respectively (all P < 0.001), demonstrating the previously reported genetic influence. None of the environmental indicators showed consistent and significant effects on these six correlations. The same negative results were obtained in analysis of environmental indicators applied to the two adoptive parents together or to the adoptee and the biological relatives together. CONCLUSION: The genetic influence on BMI was unaffected by several different environmental conditions otherwise associated with obesity.

Adoption↗
PubMed2006

Health before and after adoption from Eastern Europe.

DESIGN: A population-based study of pre-adoption, arrival and post-adoption health. AIM: To report prenatal and postnatal background factors, morbidity, growth and development in adoptees from Eastern Europe. SUBJECTS AND METHODS: All 99 children born in Eastern Europe between 1990 and 1995 and adopted to western Sweden during 1993-1997 were invited to participate in the study. Altogether, 76 (77%) participated. Medical records from the birth countries, from the examination at arrival and from medical reports made during a mean post-adoption period of 5 years were evaluated. RESULTS: Low birth weight (< or = 2500 g) occurred in 48%. Congenital malformations were found in 22%. The biological mothers of 33% of the children had been considered alcoholics, and 16% of the children's mothers had been diagnosed with a psychiatric disability. A high incidence of infectious diseases, neurodevelopment disorders and growth retardation had been noted during the pre-adoption period. Upon arrival in Sweden 75% were diagnosed with a medical condition, most often an infection. After a 5-year post-adoption period, small head circumference was associated with alcohol exposure during pregnancy and 46% had at least one neurodevelopment or behavioural disorder. CONCLUSION: Adverse prenatal and perinatal factors, congenital malformations and post-adoption neurodevelopment disorders were common. Adoptees and adopters have complex needs for health support and information.

Adoption↗
PubMed1993

Follow-up of psychiatric and educational morbidity among adopted children.

OBJECTIVE: The purpose of this study is to evaluate longitudinally the strength of association between adoptive status and psychiatric and educational morbidity and substance use. METHOD: This study makes use of data from the 1983 Ontario Child Health Study and 1987 follow-up. This community survey of children (4- to 16-years-old in 1983, 8- to 20-years-old in 1987) included a subpopulation of adopted children. The primary outcomes measured were psychiatric disorder, poor school performance, and substance use. RESULTS: Adoption, identified in 1983, in boys was a significant marker for psychiatric disorder in 1987. Adoption was not a significant risk indicator for educational morbidity or substance use in 1987. In the multivariate analyses, adoptive status demonstrated no independent influence on 1987 educational morbidity or substance use. However, adoptive status, in the presence of poor school performance in 1983, was a significant risk indicator for psychiatric disorder in 1987. CONCLUSIONS: Adopted children did not do significantly worse than nonadopted children over time in terms of educational morbidity or substance use, but adopted boys demonstrated a significantly increased risk of psychiatric disorder versus nonadopted boys.

Adolescent↗
PubMedDate not supplied

Maternal stress during hospitalization of the adopted child.

PURPOSE: To identify and describe the experiences of mothers whose adopted children are hospitalized and to compare those experiences to those of mothers whose biological children are hospitalized. DESIGN: Comparative descriptive design. METHODS: Mothers of hospitalized children (n = 33 adopted; n = 19 biological) completed a slightly revised version of the Parental Stressor Scale: Pediatric Intensive Scale Unit (PSS:PICU). Adoptive mothers also completed a questionnaire related to their perceptions of the impact of their child's adoption on the hospitalization experience. RESULTS: Adoptive mothers perceived statistically significantly higher levels of stress related to their child's behavioral/emotional response to hospitalization. Children who had been with the family for less time perceived the hospitalization as more stressful. When both groups of mothers were considered, mothers of younger children perceived a higher level of stress. A majority of adoptive mothers felt the adoption had an impact on the hospitalization experience, especially related to their limited information about their child's medical history, staff lack of knowledge about legal issues, and concern about attachment to the child. CLINICAL IMPLICATIONS: Nurses need to be aware of adoptive mothers' concerns related to attachment issues, limited family medical history, and legal rights in order to provide sensitive and effective care. Inservice education programs could be designed to help teach all staff about these important issues.

Adoption↗
PubMedDate not supplied

Accumulation in tumor tissue of adoptively transferred T cells: A comparison between intravenous and intraperitoneal injection.

Accumulation of T cells at the tumor is essential in cancer immunotherapy based on adoptive transfer of tumor-specific T cells. To gain further insight into the accumulation process and to evaluate the effect of using different routes of cell transfer, we investigated the accumulation of ovalbumin-specific CD8+ T cells (OT-I) injected either intravenously (IV) or intraperitoneally (IP) into mice carrying a subcutaneous tumor of the ovalbumin-expressing melanoma cell line B16-OVA. Maximal accumulation of the adoptively transferred cells in tumor tissue was observed 5 days after injection, irrespective of the injection route. The route of injection affected neither the total number of adoptively transferred cells found in tumor tissue nor the kinetics of this accumulation. In the spleen, however, the accumulation of adoptively transferred cells was clearly dependent on the injection route. IP injections resulted in a large number of adoptively transferred cells in the spleen on all days analyzed. In comparison, IV injection resulted in significantly fewer adoptively transferred cells in the spleen, and this number decreased over time. The route of injection affected neither the activation status of the adoptively transferred T cells that accumulated at the tumor site, nor the ability of these cells to control tumor growth. Two cell populations, SIINFEKL-tetramer(Low)(Tet(Low))CD69+ CD25+ and Tet(high)CD69- CD25-, were present in tumor samples, whereas only Tet(High)CD69- CD25- cells accumulated in the spleen. In tumors, IV injection resulted in a higher fraction of adoptively transferred cells with an activated phenotype (Tet(Low)CD69+ CD25+) compared with IP injection.

Adoptive Transfer↗
PubMed1980

Evaluation of adoption of the intellectually handicapped: a retrospective analysis of 137 cases.

The current shortage of babies for adoption has led increasingly to the adoption of infants with evident as likely handicaps. An analysis of 137 infants surrendered for adoption over a period of thirty years who suffered from some degree of intellectual handicap provides information on the outcome of this type of adoption. An objective rating scale was used to examine the relationship of the child in the adoptive family (or in the foster family if this was the alternative to adoption). It was shown that a third of the adoptees had a good or belonging relationship in the family. In less than a quarter the relationship had failed badly. The remainder had problems which were being handled in a satisfactory manner, considering the difficulty of the situation. The measured variables which worsened the outcome were a severe or profound degree of retardation, the presence of a genetic disorder in the child, increasing age and difficult behaviour, particularly when a child of borderline or dull normal intelligence was placed with an "intellectual" family. The knowledge of the natural parents family medical history, even in the presence of a genetic disorder, favoured the adoptive relationship. The presence of a congential anomaly in the child led to deferral of adoption but did not increase the likelihood of institutionalisation in this series. All these families required continuation of advice and support and suitable facilities for the care and education of the child.

Adoption↗
PubMed1997

Parent-reported problems in 211 adopted children: some risk and protective factors.

Parents of 211 adopted children, now young adults, were interviewed about their children's behaviour and development during childhood and adolescence. The children were placed for adoption at different ages. The quality of children's pre-placement care also varied, older-placed children generally experiencing adverse backgrounds prior to joining their adoptive parents. Depending on their quality of pre-placement care, the children were placed in one of three groups for the purposes of analysis: (a) baby adoptions, (b) older-children adoptions in which children had enjoyed satisfactory care as babies, and (c) older-children adoptions in which children had experienced adverse care as babies. The rate of adolescent problem behaviours varied between the three groups, with the older-children adoptions/adverse baby care group showing the highest rates. Two subgroups were identified. A quarter of the baby-adopted children were reported to have had problem behaviours during adolescence. In contrast, no problem behaviours were reported in 28% of the older-adopted/adverse baby care children. Some possible risk and protective factors are explored.

Adolescent↗
PubMed1977

The deprived child in adoption.

There has been an increasing number of older children adopted in Manitoba, Canada, often with adverse results because of early deprivation of the children concerned. 33 children from adoption "breakdowns" and 12 control adoptions were studied. Assessment was made of the time of placement, number of previous moves, development and intelligence quotients, and the behaviour pattern of the children. There were no differences between the control and adoptive breakdown groups with regard to the motivation of the adopting parents, the degree to which the adopted child was considered at risk, or the manner in which placement was carried out. Common to both groups was the difficult behaviour of the children which appeared to stem from early experiences of deprivation. Adopting parents should be told about the possible problems arising from environmental deprivation and appropriate counselling should be given before adoption and after placement. Specific policies in the placement of such high-risk children are given.

Adoption↗
PubMed1978

Adoption: legal resolution or legal fraud?

Adoption, long considered a binding social contract, is under attack because it separates the adopted from their biological family. The attitudes and practices of secrecy by the courts, agencies, and adoptive families have intensified the adoptees' feelings of being different and cut off from their roots. In a changing climate of greater openness about sensitive subjects, less tension in discussing adoption can be a significant prophylactic factor. In this sense, adopted people, collectively and individually, are making a meaningful contribution to a complex area of human relations. However, if adoption records are unsealed by legislative acts, the primary needs of the adoptive and biological parents can be undermined by the needs of the adopted adult.

Adoption↗
PubMed1988

Open and closed adoption: a developmental conceptualization.

Given the annual increase in the multiple forms of adoptive practices within contemporary American society, research aimed at assessing the effects on the adoptees, their families, and the community of "open" versus "closed" adoption (communication versus no communication between biologic and adoptive parents) of healthy infants is sorely needed. Before this can be done, researchers and mental health professionals need to make sense of the myriad of findings in the adoption literature. With the goal of stimulating such research, the present article is comprised of: (a) a review of the contemporary, social scientific literature on adoption, which has focused for the most part on traditional, closed adoption; and (b) a description of a program of research on adoption that is generated from a theoretical orientation, which has already proven valuable in the examination of other developmental life transitions. Based on a holistic, developmental, systems orientation to person-in-environment functioning, this approach provides a developmental conceptualization of both open and closed adoption. Hopefully, the literature review and the research program described here will stimulate other investigators to conduct research on this important problem from their own perspective or from variations of research described in this article.

Adoption↗