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Resilience in maltreated children: implications for special needs adoption.

Children in the child welfare system face renewed issues of loss as they enter adoptive placements. Every move is a loss and an exercise for the child in establishing the perception of a "safe" environment. Resilient children who have been abused develop coping skills to adapt to their abusing "unsafe" environments. When these children become part of an adoptive family, these coping skills need to be recognized as providing important cues to the child's world, rather than as challenging behaviors. The author deconstructs the words of resilient children into five themes that can help provide access into the children's world, a fresh viewpoint from which to assess the adopted children's reactive behaviors, and a foundation on which an adoptive relationship can be built.

Adaptation, Psychological↗

Experiences, concerns, and service needs of families adopting children with prenatal substance exposure: summary and recommendations.

Parents who adopted children from out-of-home care with prenatal substance exposure were interviewed four months after the child's placement in the home, and again after the first year regarding their experience with adoption and their concerns about their child's development, attachment, and behavior; aspects of parenting and the adoption process; effects of prenatal substance exposure; and availability and helpfulness of resources. Adoptive parents found parenting children with prenatal substance exposure to be both more rewarding and more difficult than they had imagined.

Adoption↗

Openness: a critical component of special needs adoption.

Openness in adoption is both a philosophical concept and a description of relationships. Regardless of the age of the adoptee or the circumstances of the adoption, the goal of openness is to minimize loss and to maintain connections. This article presents a model for expanding the principles learned from openness in infant adoptions to the field of special needs adoptions.

Adoption↗

Elevated blood lead levels among internationally adopted children--United States, 1998.

Lead poisoning has been reported recently among Chinese children adopted by U.S. citizens. However, little is known about the prevalence of elevated blood lead levels (BLLs) among adoptees from China and other countries. Persistent sources of lead exposure outside the United States include leaded gasoline exhaust; industrial emissions; cottage industries (e.g., battery breaking and recycling plants); traditional medicines; and some cosmetics, ceramic ware, and foods. In 1998, approximately 15,000 orphans from countries outside the United States who were adopted abroad or were to be adopted in the United States by U.S. citizens were issued U.S. immigrant visas-a nearly two-fold increase over 1988 (L. Lewis, Immigrant and Visa Control and Reporting Division, VISA Office, Bureau of Consular Affairs, U.S. State Department, personal communication, August 1999). Some orphans have been abandoned for extended periods and have no obtainable medical history. Immigrants aged <15 years are not required to have serologic or blood tests either in their country of origin or on entry into the United States unless exposure to syphilis or human immunodeficiency virus is suspected. To obtain reports on the prevalence of elevated BLLs (> or =10 microg/dL) among international adoptees, CDC contacted 12 international adoption medical specialists identified through the Joint Council on International Children's Services and two collaborating medical specialists. This report summarizes the results of that investigation, which suggest that international adoptees may arrive in the United States with elevated BLLs.

Adoption↗

Disturbances of attachment in young children adopted from institutions.

In this article, the author describes a discrepancy between popular media accounts of reactive attachment disorder (RAD) and its clinical and scientific description. The literature on serious disturbances of attachment in children adopted out of institutions is reviewed. The author concludes that children adopted from institutions are at dramatically increased risk for disturbances, although the majority of such children do not demonstrate problems. Both the duration of deprivation and the postinstitutional caregiving environment seem to be importantly related to outcome. Inhibited/withdrawn RAD is exceedingly uncommon in children adopted from institutions (at least after 1 or more years), but disinhibited/indiscriminate RAD is quite persistent. Long after children become attached to adoptive parents, a number of them continue to exhibit indiscriminate sociability. Three explanations for this divergence of recovery curves are considered. It is likely that future systematic studies will illuminate many areas that are unclear at this time.

Adaptation, Psychological↗

Are associations between parental divorce and children's adjustment genetically mediated? An adoption study.

The hypothesis that the association between parental divorce and children's adjustment is mediated by genetic factors was examined in the Colorado Adoption Project, a prospective longitudinal study of 398 adoptive and biological families. In biological families, children who experienced their parents' separation by the age of 12 years exhibited higher rates of behavioral problems and substance use, and lower levels of achievement and social adjustment, compared with children whose parents' marriages remained intact. Similarly, adopted children who experienced their (adoptive) parents' divorces exhibited elevated levels of behavioral problems and substance use compared with adoptees whose parents did not separate, but there were no differences on achievement and social competence. The findings for psychopathology are consistent with an environmentally mediated explanation for the association between parent divorce and children's adjustment; in contrast, the findings for achievement and social adjustment are consistent with a genetically mediated explanation involving passive genotype-environment correlation.

Adaptation, Psychological↗

Using administrative data to reward agency performance: the case of the federal adoption incentive program.

This article explores the history of the federal Adoption Incentive Program, the first federal child welfare outcome-based incentive program to rely solely on administrative data, and discusses it within the context of other prior and ongoing federal child welfare incentive programs. Various data-related issues are also examined, including the use of data to project program utilization and costs, set baselines for the number of adoptions, and award funds. Challenges in the legislatively required use of AFCARS data for determining the amount of incentive funds awarded and the impact of the program on AFCARS reporting are also discussed. The article concludes with a look at the impact of the Adoption Incentive Program on adoption and predictions for the future.

Adoption↗

The postadoption experience: child, parent, and family predictors of family adjustment to adoption.

Eighteen to 24 months after they adopted children in state custody, 159 parents were surveyed regarding their postadoption experiences. Most children remained with their new families, with parents reporting the adoption experience to be "about as hard as expected," and rating the past year of caring for the child as being more "smooth" than "stressful." Parents saw how the child contributed positively to their lives, were less positive about available social supports, and expressed dissatisfaction with the speed of the adoption, the availability of community supports, and the ability to link with supports. Children's special needs (e.g., older age at adoption) were predictive of postplacement adjustment.

Adaptation, Psychological↗

Synergistic enhancement of antitumor immunity with adoptively transferred tumor-specific CD4+ and CD8+ T cells and intratumoral lymphotactin transgene expression.

The lack of efficient T-cell infiltration of tumors is a major obstacle to successful adoptive T-cell therapy. We have shown that transplanted SP2/0 myeloma tumors that have been engineered to express lymphotactin (Lptn) invariably regress under the influence of infiltrating XCR1+T cells and neutrophils. Herein, we characterize these T cells and investigate their therapeutic efficacy, either alone or with Lptn gene therapy. After stimulation with SP2/0 cells, these T cells were CD25+FasL+L-selectin-, expressed XCR-1, and were chemoattracted by Lptn in vitro. They comprised 66% CD4+ Th1 and 33% CD8+ Tc1 cells, both of which expressed significant amounts of IFN-gamma, perforin, and tumor necrosis factor-alpha, but not interleukin-4. The CD4+ Th1 and CD8+ Tc1 cells, which were inhibited and stimulated, respectively, for proliferation with Lptn signaling, displayed 38 and 84% specific killing, respectively, for Ia(d)/H-2K(d)-expressing SP2/0 tumor cells (E:T ratio, 100). In vivo, combined intratumoral Lptn gene transfer and adoptive immunotherapy with these CD4+ and CD8+ T cells eradicated well-established SP2/0 tumors in six of eight mice, and dramatically slowed tumor growth in the other two mice. Cell tracking using labeled T cells confirmed that these cells infiltrated better into the Lptn-expressing tumors than non-Lptn-expressing ones. Control or Lptn adenoviral treatments by themselves did not alter the lethal outcome for tumor-bearing mice, nor did T-cell therapy by itself, although the latter two treatments did slow its time frame. Combined Lptn gene transfer and adoptive CD4+ or CD8+ cell transfers were not nearly as efficacious as the combined Lptn gene and unfractionated T-cell transfers. Taken together, our data provide solid evidence of a potent synergy between adoptive CD4+ and CD8+ T-cell therapy and Lptn gene transfer into tumor tissues, which culminated in the eradication of well-established tumor masses.

Adenoviridae↗

Psychological stress in adoptive parents of special-needs children.

This article focuses on the nature and extent of parental stress among adoptive parents of special-needs children. In-depth face-to-face interviews of adoptive parents of 35 children were conducted, on average, four months postplacement (but before adoption). One-year follow-up interviews were conducted with parents of 15 (43%) of these children. Qualitative and quantitative data were collected, including parenting stress scores. Results indicated higher than average levels of stress, particularly on subscales related to parent-child dysfunctional interactions and to raising a difficult child. Increased stress levels were associated with poorer family adjustment and with higher levels of child behavior problems. Stress levels remained mostly unchanged over the year. Responses to open-ended questions identified five stress categories: child characteristics, parent-child interactions, family cohesion, parental adjustment, and adoptions service issues. Practice and research implications are discussed.

Adaptation, Psychological↗

Pertussis in an infant adopted from Russia--May 2002.

On May 2, 2002, the North Carolina Department of Health and Human Services notified CDC about an infant aged 10 months adopted from Russia who had culture-confirmed pertussis diagnosed. On April 8, the adoptive parents picked him up in the orphan ward at hospital A in Bryansk and noticed that the child had upper respiratory congestion and cough. The adoptive parents reported that the infant had not received any vaccinations and that another infant living in the same room in hospital A had a severe cough. The adopted infant subsequently was examined by a local physician, who diagnosed his condition as a "cold," and the infant was taken to the U.S. Embassy in Moscow, where the parents were interviewed for an immigrant visa for the child.

Adoption↗

International adoptions: the quiet migration.

This study is concerned with the adoption of foreign children by persons in developed countries since World War II. Data from the United States and Sweden are used to illustrate the changes in countries of origin that have occurred over time. "In the 1940s most foreign children who were adopted came from Europe. During the next two decades a shift to adopting from Asia occurred, and in the 1970s Latin America became a major source area." The contribution of foreign adoption to international migration flows is considered.

Adoption↗

Use of human leukocyte antigen-mismatched allogeneic lymphokine-activated killer cells and interleukin-2 in the adoptive immunotherapy of patients with malignancies.

Clinical effects and side effects were investigated in the adoptive immunotherapy of patients bearing malignant diseases using human leukocyte antigen (HLA)-mismatched allogeneic lymphokine-activated killer (LAK) cells. Allogeneic LAK cells were induced from peripheral blood lymphocytes (PBL) of healthy donors with the same blood types as those of patients. Recently we succeeded in increasing the proliferation rate and enhancing the cytotoxic activity of LAK cells by means of initial stimulation with pokeweed mitogen (PWM, PWM-LAK cells). Five of 12 patients applied in the adoptive immunotherapy showed clinical effects such as partial or complete regression of pulmonary metastases and pleural effusion. All pulmonary metastatic lesions were eliminated in one case by this adoptive immunotherapy combined with chemotherapy. Toxic effects were chillness, fever and general fatigue which were reversible, and no allergic side effects occurred even though allogeneic LAK cells were injected frequently. In the patients who received more than 10(11) of allogeneic LAK cells, anti-HLA class I antibodies appeared without any evidence of autoantibody. However, immunological side effects were never experienced after injection of allogeneic LAK cells even when the anti-HLA class I antibodies existed in the patients; this phenomenon suggests the safety of the adoptive immunotherapy using allogeneic LAK cells. Taken together, allogeneic LAK cells could be considered as alternative therapy for patients with malignancies who could not supply sufficient materials of autologous LAK cells. Recently, LAK cells, particularly PWM-LAK cells were found to obtain significantly potent and prompt lectin-dependent cell-mediated cytotoxicity (LDCC). All tumor cells confluent in microtest plate well could be annihilated by PWM-LAK cells plus PWM less than 8 hours. New immunotherapy using PWM-LAK cells or lectin-stimulated LAK cells with PWM or other lectins is discussed.

Adult↗

When children cannot return home: adoption and guardianship.

Since the 1970s, finding alternative permanent families for children in foster care who could not return to their birth parents has been a primary goal of the child welfare system. Since that time, significant gains have been made in helping such children find permanent homes through adoption and guardianship. This article analyzes these trends and finds: A majority of states have doubled the number of adoptions from foster care over the 1995-97 baselines established by the federal government. Legal guardianship initiatives at the state level have been instrumental in helping thousands of children achieve permanence. Children who exit foster care to adoption tend to be younger than those who exit to guardianship. Postpermanency services and supports are important to the long-term success of these placements. Innovative efforts to find adoptive parents and legal guardians for children in foster care could transform the nature of foster care if the number of children permanently living with families who receive state subsidies begins to exceed the number of children living in foster care. Looking forward, these changes would require child welfare agencies to think creatively and thoughtfully about how best to serve families and the children in their care.

Adoption↗

[Long-term prognosis of hepatocellular carcinoma patients treated with adoptive immunotherapy].

Adoptive immunotherapy was performed for patients with multiple hepatocellular carcinoma (HCC) using LAK cells via the hepatic arterial catheter. One case study: A 45-year-old male patient was performed an absolute-non-cure operation. The operation was a success. However, some residual tumors remained in the liver. After the operation, adoptive immunotherapy was performed for 7 times in 5 weeks. The total inoculated LAK cells were 6.9x10(9). After the adoptive immunotherapy, no residual tumors were detected in the liver. He survived for 7 years in remission. Our results show that adoptive immunotherapy with LAK cells is useful and effective for patients with multiple HCC.

Aged↗

[Biotherapeutic efficacy of adoptive transfer of CD3AK cells in combination with cyclophosphamide and kappa-selenocarrageenan in P 388 leukemic mice].

OBJECTIVE: To study the antileukemia efficacy of a combination of adoptive transfer of CD3AK cells, cyclophosphamide (CTX), and kappa-selenocarrageenan (KSC) in P 388 leukemic mice. METHODS: CD3AK cells in normal DBA/2 murine splenocytes were induced with anti-CD3 antibody and low dose recombinant interleukin-2 (rIL-2). The P 388 murine leukemia model was induced by i.p. injection of P 388 cells into normal DBA/2 mice. The tumor-bearing mice were administrated with adoptively transferred CD3AK Cells and/or CTX and/or KSC. RESULTS: After tumor inoculation, the cellular immune function of P 388-bearing mice was supressed markedly. Adoptive transfer of CD3AK cells with low dose rIL-2 into the P 388 mice significantly enhanced the splenocyte proliferation (SP) induced by Con A, the NK cell activity and the splenocytic IL-2 production and prolonged their survival (45.19%); CTX (200 mg/kg) alone prolonged the survival of P 388-bearing mice (29.90%), but further decreased the immunodeficiency; combination of CTX and CD3AK passive transfer could prevent the reduction of SP, NK activity and IL-2 production in the leukemic mice and prolonged the survival (59.45%), combination of KSC and adoptively transfected CD2AK cells and/or CTX had a much better therapeutic efficacy for P 388 murine leukemia, 12.50%-75.00% of the leukemic mice were cured. CONCLUSION: KSC is a hopeful biological response modifier in cancer biotherapy, and tumor killing effector cells and chemotherapy plus BRM might be a promising candidate for human leukemia biotherapy.

Adoptive Transfer↗

[Health-related problems in adopted children].

International research shows that the standard of health among children adopted from abroad, especially those adopted by single parents, is not as good as that of other children. Danish studies indicate similar problems. The causes could be several, such as poor development in the embryonic and fetal stages, low birth weight, starvation, neglect, infections, and the lack of the natural bonds between mother and child. Surveys indicate that many adoptive parents, single parents in particular, receive children with health problems. There is no Danish research available, but it is important to be aware of these issues in order for both adoptees and adoptants to receive the most support.

Adoption↗

Becoming parents: feelings of adoptive mothers.

In a research study to determine feelings and reactions of first-time adoptive mothers, 24 adoptive mothers and 24 birth mothers were interviewed and the findings compared. Adoptive mothers react to their babies in much the same way that birth mothers do, but are often less prepared for parenting. Nurses can counsel them about the range of feelings normally experienced by both adoptive and birth mothers to allay many concerns and facilitate the process of becoming parents.

Adoption↗