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Children who have been adopted internationally often exhibit persistent behavior problems. The current study assessed the efficacy of the Attachment and Biobehavioral Catch-up intervention (ABC; Dozier & Bernard, 2019 ) for reducing behavior problems in 122 children adopted internationally. Behavior problems were measured via parent-report using the Brief Infant Toddler Social Emotional Assessment at a pre-intervention visit and after the intervention when children were between 18 and 36 months. Children’s behavior problems were also observed using the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) after the intervention when children were 48 and 60 months. Parents who received ABC reported fewer child behavior problems than parents who received the control intervention immediately after the intervention through 1.5 years post-intervention. Additionally, children whose parents received ABC exhibited fewer behavior problems within the parent context of the DB-DOS when they were 48 months old (2 years post-intervention) than children whose parents received the control intervention. There were no significant intervention effects on children’s observed behavior problems within the examiner contexts. These results support the efficacy of ABC in reducing behavior problems among children adopted internationally. Trial registration: ClinicalTrials.gov NCT00816621.

Immigrant children are a diverse group and include refugees, asylees, and internationally adopted children. They have various infectious disease risk factors, depending on conditions within their country of origin, journey, and current living conditions. Infectious disease screening should take place within the framework of a comprehensive medical evaluation in the medical home. Some screening is recommended for all immigrant children including hepatitis B, syphilis, HIV, tuberculosis, and intestinal parasites; other diseases can be tested for based on individual risks. Although guidelines and resources are available, there is limited evidence supporting much of the care of immigrant children and youth.

Background After adoption, children exposed to institutionalized care show significant improvement, but incomplete recovery of growth and developmental milestones. There is a paucity of data regarding risk and protective factors in children adopted from institutionalized care. This prospective study followed children recently adopted from institutionalized care to investigate the relationship between family environment, executive function, and behavioral outcomes. Methods Anthropometric measurements, physical examination, endocrine and bone age evaluations, neurocognitive testing, and behavioral questionnaires were evaluated over a 2-year period with children adopted from institutionalized care and non-adopted controls. Results Adopted children had significant deficits in growth, cognitive, and developmental measurements compared to controls that improved; however, residual deficits remained. Family cohesiveness and expressiveness were protective influences, associated with less behavioral problems, while family conflict and greater emphasis on rules were associated with greater risk for executive dysfunction. Conclusions Our data suggest that a cohesive and expressive family environment moderated the effect of pre-adoption adversity on cognitive and behavioral development in toddlers, while family conflict and greater emphasis on rules were associated with greater risk for executive dysfunction. Early assessment of child temperament and parenting context may serve to optimize the fit between parenting style, family environment, and the child’s development. Impact Children who experience institutionalized care are at increased risk for significant deficits in developmental, cognitive, and social functioning associated with a disruption in the development of the prefrontal cortex. Aspects of the family caregiving environment moderate the effect of early life social deprivation in children. Family cohesiveness and expressiveness were protective influences, while family conflict and greater emphasis on rules were associated with a greater risk for executive dysfunction problems. This study should be viewed as preliminary data to be referenced by larger studies investigating developmental and behavioral outcomes of children adopted from institutional care.

The current study examined the attachment development of 92 internationally adopted Chinese girls, focusing on the influence of type of pre-adoption care (institutional versus foster care) and sensitive adoptive parenting. Although the children were more often insecurely attached than non-adopted children 2 and 6 months after adoption (Times 1 and 2, N = 92), they had similar levels of secure base script knowledge (SBS knowledge) as a non-adopted comparison group at age 10 (Time 3, N = 87). Furthermore, concurrently observed sensitive parenting was positively associated with SBS knowledge. Finally, a significant interaction between type of pre-adoption care and early-childhood sensitive parenting indicated that the post-institutionalized children showed a stronger increase in security than the post-foster children when parents were more sensitive. ispartof: Attachment & Human Development vol:23 issue:5 pages:1-21 ispartof: location:England status: Published online

Little research has investigated the experience of same-sex adoption from children's perspective. What does it feel like to be adopted by 2 dads or 2 moms? How do the challenges related to being adopted and the challenges related to growing up in a same-sex-parent family overlap in the identity construction of adoptees? This is the 1st European study giving voice to children adopted by same-sex couples focusing on their adoptive and family-related identities at four developmental stages: early childhood, middle childhood, preadolescence, and adolescence. In-depth interviews were conducted with a sample of 44 adoptees (36 males and 8 females; ages 3-18 years) and 62 adoptive parents (16 lesbian women and 46 gay men). Thematic analysis revealed that adoptees deal with unique developmental challenges connected to the intersection of both their adoptive and familial minority statuses. They often reported being confronted with heteronormative assumptions of family, which led them to question themselves regarding the way their family is perceived by others, to idealize the heteronuclear family form, and to increase their curiosity about their birth parents. Findings shed light on the evolution of adoptees' questions, feelings, and experiences related to their unique family arrangement from early childhood through adolescence, suggesting a better integration of their adoptive and minority group statuses at progressively more advanced developmental stages. Analyses underline the importance of open family communication for facilitating the integration of such complex elements in adoptees' emerging identity. Practice implications of the findings are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social–emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social–emotional competence. Participants included 131 parent–child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent–child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social–emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social–emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social–emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social–emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social–emotional competence among children adopted internationally.

In internationally adopted children disorders of linear growth, puberty development, thyroid function, and bone metabolism are frequently reported. It is important that these children receive careful auxological and endocrinological evaluations and follow-up.Pediatricians and other healthcare providers should be aware that auxological and endocrinological problems are common in newly arrived international adoptees.

To assess the outcome of HIV-infected individuals attending one of the largest French pediatric HIV centers in 2016-2017 and to compare the rates of antiretroviral coverage and virological suppression with the UNAIDS targets.The clinical and immuno-virological status of 163 HIV-1-infected children and adolescents attending Necker Hospital in Paris, France, were investigated. Virological suppression was defined as an HIV-1 viral load50 copies/mL for at least six months. All genotypic resistance tests performed since birth were analyzed.Most patients were born in Sub-Saharan African countries (41.7%) or in France (38.0%). Their median age was 14 years [IQR 7.3-17.0]. Although 33.7% of individuals had a history of AIDS-defining clinical event(s), 86.5% of children/adolescents were free from HIV-related symptoms at their most recent evaluation. Antiretroviral coverage was high (98.2%; mainly including one integrase inhibitor [42.3%] or one protease inhibitor [23.9%]). At the last visit, most patients (82.8%) had normal CD4T lymphocytes counts (≥25%). Although 61.7% of antiretroviral-experienced children had resistance to≥1 drug class and 9.2% had triple-class resistance, 80.3% of patients receiving antiretrovirals for≥6 months (126/157) were virologically suppressed. International adoptees were more frequently virologically suppressed than other patients (96.0% versus 74.6%, P=0.02).Antiretroviral coverage exceeded the second UNAIDS 90 target aimed at ending the AIDS epidemic. The rate of virological suppression, one of the highest reported in children in high-income countries, is approaching the third UNAIDS 90 target and the rate observed in French HIV-infected adults on antiretrovirals.

The overall number of international adoptions has dropped in the last 20 years, but a relative increase in the proportion of these children with special and surgical needs has occurred. Cleft lip/palate and anorectal malformations are two common surgical pathologies for internationally adopted children. Internationally adopted children with cleft lip/palate have high rates of speech impairment and frequent need for reoperation, and children with anorectal malformation commonly need multiple reoperations. For both groups, surgery prior to adoption may have actually contributed to morbidity. Both speech impairment and anorectal malformation negatively affect quality of life, independent of adoption. Additionally, internationally adopted children frequently have experienced trauma, single or complex, and institutionalization. Each of these can independently contribute to impaired psychosocial and behavioral development. These children face surgery, sometimes multiple surgeries, while adapting to a new culture, learning a new language, and bonding with a new family. The impact of prior medical experiences without the presence of a caregiver and/or while institutionalized is understudied. The surgical experience and perioperative outcomes within this population warrant research, and clinical coordination between teams may help improve care for this uniquely vulnerable population.

Objective: To compare consonant proficiency, consonant errors, and the perceived velopharyngeal (VP) competence in internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) and nonadopted (NA) children with the same cleft–palate type at age 5. Design: Case–control study based on phonetic transcriptions of standardized speech recordings of 5-year-olds at a tertiary hospital. Participants: Twenty-five IA children were compared to 20 NA children. All consecutive patients at a cleft lip and palate center participated. Main Outcome Measure(s): Consonant proficiency was measured using percentage consonants correct, percentage consonants correct–adjusted for age, percentage correct place, percentage correct manner, and consonant inventory. Cleft speech characteristics (CSCs), developmental speech characteristics (DSCs), and the perceived VP competence were also measured. Results: The IA children had significantly lower values for all consonant proficiency variables ( p < .05) and a smaller consonant inventory ( p = .001) compared to the NA children. The IA children had a higher frequency of CSCs (IA = 84%, NA = 50%, p < .05) and DSCs (IA = 92%, NA = 65%, p = .057), and twice as many IA children as NA children had perceived VP incompetence (IA = 52%, NA = 25%, p = .17). Conclusions: Severe speech disorder was more common in IA children than in NA children at age 5. Most importantly, the speech disorders seem to be not only cleft-related. More detailed speech assessments with a broader focus are needed for IA children with UCLP. Longitudinal studies are recommended to further investigate the impact of speech difficulties in IA children’s daily lives.

Background Children and adolescents with a genetic risk for schizophrenia are often found to have poorer social functioning compared to their controls. However, less is known about high-risk offspring who have not been reared by a biological parent with schizophrenia. The purpose of this study was to examine deficits in social functioning in adolescence as a possible factor related to genetic vulnerability to schizophrenia spectrum disorders, and also to examine possible gender differences in these associations. Method The present sample consisted of 88 genetic high-risk (HR) adoptees whose biological mothers were diagnosed with schizophrenia spectrum disorders and 83 genetic low-risk (LR) adoptees with biological mothers with non-schizophrenia spectrum disorders or no psychiatric disorders. Adoptees’ social functioning at ages 16–20 was assessed using the UCLA Social Attainment Survey. Results Compared to LR adoptees, HR adoptees displayed statistically significant deficits in their peer relationships, involvement in activities and overall social functioning during adolescence. HR males were distinguished from LR males by their significantly poorer overall social functioning. Compared to HR females, HR males showed significant deficits in their romantic relationships. Of marginal significance was that HR females displayed more social functioning deficits relative to LR females, mainly in the areas of peer relationships, involvement in activities and overall social functioning. Conclusions These results from the adoption and high-risk study design suggest that deficits in social functioning in adolescence may be related to genetic vulnerability to schizophrenia spectrum disorders and that some of these deficits may be gender-specific.

The relative roles of genes and environment (not intra-familial environment) and interactions thereof continue to confound better understanding of the pathogenesis of multiple sclerosis (MS) and can also impact recurrence risks for family members as well as genetic family studies. Strong evidence for non-familial environmental factors is suggested by the change in the sex ratio (female:male) of MS patients over the last four decades.

Previous studies have found correlations between parent input and child language outcomes, providing prima facie evidence for a causal relation. However, this could also reflect the effects of shared genes. The present study removed this genetic confound by measuring English vocabulary growth in 29 preschool-aged children (21 girls) aged 31-73 months and 17 infants (all girls) aged 15-32 months adopted from China and Eastern Europe and comparing it to speech produced by their adoptive mothers. Vocabulary growth in both groups was correlated with maternal input features; in infants with mean-length of maternal utterance, and in preschoolers with both mean-length of utterance and lexical diversity. Thus, input effects on language outcomes persist even in the absence of genetic confounds.

ObjectiveTo explore the experiences of lesbian parents accessing healthcare for their adopted children in England.DesignA qualitative inductive design, using narrative inquiry with a critical incident recall interview approach. Interviews were analysed using merged tools of critical event analysis and broadening, burrowing, storying and restorying.SettingParticipants were recruited from a British lesbian, gay, bisexual and transgender fostering and adoption charity.ParticipantsSix lesbian adoptive parents with experience of accessing healthcare for their adopted children in England.ResultsFollowing data analysis, five themes were identified: navigating heteronormativity, navigating healthcare settings and professionals and having an ‘adopted’ status, intersectional identity of lesbian-parented adoptive families accessing healthcare, reflective imagery of lesbian parents and adoptive families and professional expectations. Self-imposed strategies instigated by the parents to strengthen and protect their familial identities were also discovered.ConclusionsThe needs and challenges of lesbian adoptive families may be different to those of heterosexual and biological families when accessing healthcare. There was an undercurrent of discriminatory practice, shown by various healthcare professionals, and a lack of understanding of the adoption process, knowledge surrounding the child’s history and legal stance with regards to parental responsibility. Further training is needed for healthcare professionals.

BACKGROUND Following initial adversities, most internationally adopted children arrive with significant growth delays. Postplacement recovery has been widely documented, but research about risk or protective factors is still limited. Even less is known about the relationship between growth recovery and the quality of the family environment. METHODS Twenty-eight children in 26 adoptive families were involved in this longitudinal study. A comprehensive evaluation (including anthropometry, cognitive assessment [using the Leiter International Performance Scale-Revised], and completion by both parents of the Parenting Stress Index - Short Form) was done at arrival of the child, and 1 year later. RESULTS Results evidenced that on arrival nearly half of children had growth measurements in the normal range. All the children showed a significant recovery in height and weight at 6 and 12 months postplacement. Initial and follow-up growth measurements correlated strongly. Growth recovery was related to the age of the child at adoption, the proportion of time the child had resided in institutional care, as well as parenting stress. Results suggested that the higher the parenting stress experienced the less improvements occurred in children: for mothers for height and weight, for fathers for all the growth indicators. CONCLUSIONS Results suggested the critical importance of family factor in influencing children's growth recovery.

BACKGROUND Nearly half of pediatric homicides under age 5 are attributable to child abuse. Parents are most commonly the perpetrators, but less is known about incidents involving biological vs. surrogate parents. We sought to evaluate the characteristics of fatal child abuse involving biological and surrogate parents using the Georgia National Violent Death Reporting System (NVDRS), which we believe may differ in demographics and incident characteristics. METHODS This database was used to examine all homicides of children under age 18 from 2011-2017. Demographics and incident characteristics were analyzed using existing NVDRS variables and incident narratives. Chi-squared and nonparametric tests were used to compare fatal child abuse incidents involving biological and surrogate parents (e.g., adoptive, foster, step-parents, intimate partners of biological parent). RESULTS There were 452 pediatric homicides and 219 cases of fatal child abuse. Of all cases of fatal child abuse, 60% involved biological and 29% involved surrogate parents. Compared to children killed by biological parents, children killed by surrogate parents were older (4 vs. 3 years old), more often male (71% vs. 51%), more likely to survive the initial injury and present to the ED before death (96% vs. 69%), and less likely to have a medical comorbidity (2% vs 11%), all p < 0.05. Surrogate parents were more likely to be male (90% vs. 48%) and use a firearm (20% vs. 13%) to inflict the injury, both p < 0.05. The race/ethnicity of the child was not associated with the parent's relationship. CONCLUSIONS Child abuse accounts for half of all pediatric homicides. Parents are the most common perpetrators of fatal child abuse, but surrogate parent perpetrators are almost exclusively male and more likely to use firearms. Most children have a history of abuse, leaving an opportunity to intervene on potentially preventable deaths if abuse is identified in a timely fashion. LEVEL OF EVIDENCE Level IIIStudy TypeRetrospective cohort study.

AIM To show the prevalence of selected infectious diseases among internationally adopted children (IAC) in Denmark. BACKGROUND Each year approximately 200 IAC arrive in Denmark. These are at increased risk of infectious diseases rarely seen in Danish children. Studies from the 1990s showed that 60% of IAC had infectious diseases and that the majority of these were undetected without screening. METHODS The study is a prospective study of medical records from children seen in the adoption clinic at Copenhagen University Hospital in the period 2009-2013. Screening was done for hepatitis A (HAV), B (HBV) and C (HCV), syphilis, HIV, tuberculosis (TB) and intestinal parasites. RESULTS In 245 IAC tested, 2% had evidence of recent HAV infection, 3% with HBV and one child with HCV, and no cases of HIV were found. One child had antibodies against syphilis (anti-Trpa AB positivity), and 2% were latently infected with tuberculosis. We found 30% infected with pathogenic intestinal parasites. Only 46% had serologic evidence of immunisation against HBV. CONCLUSION The prevalence of infections in IAC was lower than previously reported but compared to the general population, a higher prevalence of intestinal parasites, hepatitis and tuberculosis was found. We recommend that IAC are offered screening shortly after arrival.

Intestinal parasitic infections (IPIs) represent one of the leading causes of morbidity in the world. Children involved in international adoptions constitute a special group of subjects with specific problems and specific healthcare needs. Nevertheless, in current literature there are insufficient data on IPI in this subset of children. This study aims to evaluate the prevalence of IPI in a cohort of internationally adopted children and to investigate epidemiologic factors and clinical features related to IPIs.A retrospective study involving internationally adopted children18 years old for which results from 3 fecal parasitologic tests were available, evaluated between September 1, 2008 and April 31, 2018 at a tertiary level university hospital in Rome. Univariate and multivariate logistic regression analyses were carried out to identify demographic factors and clinical features associated with IPIs. Two comparisons were performed, the first one according to the positivity of the parasitologic examination of the feces and the second one according to the pathogenicity of the identified strains.Of 584 children evaluated, 346 (59.3%) had a positive parasitologic examination (143 pathogenic parasites and 203 nonpathogenic parasites) and 238 (40.8%) had a negative parasitologic examination. About 28.9% of children were positive for 2 or more parasites. A statistically significant positive association was found between IPIs and age, macroarea of origin (Africa and Latin America), living in institutions before adoption and vitamin D deficiency (P0.05).Intestinal parasites represent a widespread infection among internationally adopted children, especially in school-age children and those from Latin America and Africa. Importantly, the parasites found in adopted children were not pathogenic in most cases and did not cause significant alterations in growth, major micronutrient deficits or malnutrition.

Adoptive parents may be placed with children conceived under difficult circumstances, such as via rape or incest. At the same time, adoptive parents are generally encouraged to communicate openly with their children about their adoption stories and birth families. No research has examined the experiences of parents who adopt children who were conceived through rape or incest. This exploratory study examines how parents discuss their decision-making when adopting children conceived via rape or incest, how they manage varying levels of uncertainty about their children's origins, and whether and how they plan to disclose this information to children. The researchers used thematic analysis to examine the experiences of 11 couples (22 parents) interviewed at four time points after adopting children who were reportedly conceived via rape or incest. Findings revealed that even soon after adopting, parents discussed the need to eventually talk to their children about their conception circumstances. Parents generally struggled to determine how and when to disclose this information, particularly when they felt uncertain about the veracity of the conception stories they had been told. Some hoped to rely on professionals or birth mothers to guide them in these communications. Findings have implications for supporting adoptive families as they navigate the complexity of managing sensitive information and uncertainty when adopting children conceived through rape or incest. Practitioners should provide ongoing guidance to adoptive parents about how and when to disclose developmentally appropriate information to children about difficult conception circumstances.Los padres adoptivos pueden recibir niños concebidos en circunstancias difíciles, por ejemplo, por violación o incesto. Al mismo tiempo, a los padres adoptivos generalmente se los anima a comunicarse abiertamente con sus hijos acerca de las historias sobre su adopción y sus familias biológicas. Ninguna investigación ha analizado las experiencias de los padres que adoptan a niños que fueron concebidos por violación o incesto. Este estudio exploratorio analiza cómo los padres debaten su toma de decisiones cuando adoptan a niños concebidos mediante violación o incesto, cómo manejan los diversos niveles de incertidumbre acerca de los orígenes de sus hijos, y si planean revelar esta información a los niños y cómo lo harán. Los investigadores utilizaron el análisis temático para analizar las experiencias de 11 parejas (22 padres) entrevistadas en cuatro momentos específicos después de adoptar a niños que supuestamente fueron concebidos por violación o incesto. Los resultados revelaron que incluso poco después de adoptar, los padres analizaron la necesidad de hablar finalmente con sus hijos acerca de las circunstancias de su concepción. A los padres generalmente les costó decidir cómo y cuándo revelar esta información, particularmente cuando se sentían inseguros acerca de la veracidad de las historias sobre la concepción que les habían contado. Algunos esperaban contar con profesionales o con las madres biológicas para que los guíen en estas comunicaciones. Los hallazgos tienen consecuencias para el apoyo a familias adoptivas que sortean la complejidad de manejar información sensible y la incertidumbre cuando adoptan a niños concebidos por violación o incesto. Los profesionales deberían proporcionar orientación constante a los padres adoptivos sobre cómo y cuándo revelar a sus hijos información adecuada para el desarrollo acerca de las circunstancias difíciles de su concepción.有些收养孩子的家长有可能被安排了在诸如被强奸或乱伦之类的特殊困境下怀上的孩子。与此同时,养父母通常被鼓励主动与其收养的孩子们公开谈论收养时的故事和其生父母家庭的情况。目前尚未有研究考察那些收养了因乱伦或强奸导致怀孕而生的孩子的家长们的经历。本文是一个探索性的研究,考察以下方面如:家长作出决定去收养因强奸或乱伦怀上的孩子时怎么思考的,他们如何管理面对关于孩子怎么被怀上的这件事的各种不确定水平,还有他们是否打算或如何跟孩子透露此类实情。研究者利用主题分析方法研究了11对夫妇(计22位家长)的经历,他们在收养孩子后四个不同时间点接受了采访,这些孩子都是被报告在被强奸或乱伦时怀上的。研究发现即便是在刚收养孩子不久,家长们就谈论了有必要最终还是要对孩子们讲述他们当初被怀上的情况。家长们总体而言都会遇到困难,不知道如何决定怎么样和什么时候跟孩子们讲述生身父母当时的情况,特别是当他们被告知的相关事实时也存在不确定。有些家长希望依靠专业人员的帮助或者生身之母来指导与孩子就这些方面的交流。研究的结果对于如何支持收养了因强奸或乱伦而生的孩子家庭有启示意义,帮助他们管理敏感信息和不确定话题的复杂性。治疗医师应该提供持续的指导以帮助养父母们决定以什么方式和选择什么时机对这些因特殊情况而生的孩子讨论适合他们年龄发展的信息。.

This study tested a web-based parenting course called FosterParentCollege.com (FPC) Culturally Competent Parenting (CCP) for transracial foster and adoptive parents. Research indicates that transracial children, whose parents practice culturally competent parenting, have positive outcomes. A mixed methods pretest posttest treatment and control group design were implemented to determine if there was a difference in parent scores on openness to cultural receptivity after completing the course in comparison to parents assigned the control group. Cultural receptivity is defined as the effort that parents are willing to put forth to learn about CCP. Additionally, parents who participated in the treatment course completed 2-month follow-up interviews on self-reported application of techniques. Results of the study showed that parents enrolled in the treatment course had significantly higher scores for openness to cultural receptivity after completing the course than before. Themes identified in follow-up interviews indicated parents' efforts to learn more about CCP.

Objective The aim of this study was to examine the association of family functioning to psychiatric disorders of adoptees with and without genetic vulnerability to schizophrenia. Methods The data is based on the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 346 adoptive families, of which 175 adoptees had high (HR) and 171 low (LR) genetic risk for schizophrenia. DSM-III-R was used for diagnostic criteria. Family functioning was assessed using the Global Family Ratings. Childhood adversities covered early parental divorce and death occurring before 18 years of age of the adoptees. Results Approximately two thirds of the adoptees had lived in families with mildly dysfunctional processes (30%) or dysfunctional processes (28.4%). An increased likelihood for psychiatric disorders of the adoptees was related to dysfunctional family processes both in HR (OR = 4.8, 95% CI 2–11.4) and LR (OR = 2.6, 95% CI 1.1–6.3) adoptees, but not to early parental death or divorce. Conclusions The risk for psychiatric disorders was increased for adoptees in families with dysfunctional processes, especially for those adoptees with genetic vulnerability to schizophrenia. These results emphasize the importance of policies and practices that aim to strengthen and support family functioning.

Background: Anxiety in parents is associated with anxiety in offspring, although little is known about the mechanisms underpinning these intergenerational associations. We conducted the first genetically sensitive study to simultaneously examine the effects of mother, father and child anxiety symptoms on each other over time. Method: Adoptive parent and child symptoms were measured at child ages 6, 7 and 8 years from 305 families involved in the Early Growth and Development Study, using a prospective adoption design. Children were adopted at birth to nonrelatives, and composite data on internalising problems within birth families were used as a proxy measure of offspring inherited risk for anxiety. Structural equation models were fitted to the data to examine prospective associations between adoptive mother, father and child symptoms, whilst accounting for individuals’ symptom stability over time. Results: Child anxiety symptoms at age 7 predicted adoptive mothers’ anxiety symptoms at age 8. No mother-to-child or child-to-father effects were observed. These results were consistent in sensitivity analyses using only paternal offspring reports and using a second measure of child anxiety symptoms. Fathers’ anxiety symptoms at child age 6 prospectively predicted child symptoms, but only when paternal offspring reports were included in the model. Composite data on birth family internalising problems were not associated with child anxiety symptoms. Conclusions: Results show environmentally mediated associations between parent and child anxiety symptoms. Results support developmental theories suggesting that child anxiety symptoms can exert influence on caregivers, and mothers and fathers may play unique roles during the development of child symptoms. Further research is needed on the role of genetic transmission associated with anxiety symptoms in biologically related families. In the meantime, researchers and clinicians should strive to include fathers in assessments and consider the effects of child symptoms on caregivers.

Individuals with fetal alcohol spectrum disorders (FASD) have high rates of health care service utilization. It is vital that health care professionals understand FASD and associated family experiences to strengthen their ability to respond to family needs and tailor family-focused interventions. This study included 24 foster and adoptive parents of children and adults (aged 3-33 years) with FASD. Data were collected via individual interviews and focus groups and analyzed thematically. Consistent with a developmental psychopathology perspective, parents’ experiences interacted with the individual (with FASD), family, and broader systems ecological levels. Parents undertook protective actions in an attempt to prevent secondary conditions, support their child and family, and mitigate systems barriers. They also experienced stressors at each level, and stress was increased by protective actions. The overall parenting experience was fueled by a protective parenting attitude. Findings can strengthen family-focused care practices with individuals with FASD and their families and inform novel family interventions.

Aim To collate prevalence estimates of fetal alcohol spectrum disorder (FASD) among special subpopulations (defined by service use). Design Systematic literature review and meta-analysis of original, quantitative studies published between 1 November 1973 and 1 December 2018. The PRISMAGATHER were adhered to. The review protocol [includes FASD prevalence in (a) general and (b) special populations] is available on PROSPERO (registration number: CRD42016033837). Prevalence estimates were collated for all included studies with country-, disorder- [FASD and fetal alcohol syndrome (FAS)] and population-specific random-effects meta-analyses conducted. Setting and participants A number of service-defined subpopulations globally (see Findings). Measurements The main outcome was the prevalence of FASD among special subpopulations. The critical appraisal of each study was conducted using the Joanna Briggs Institute tool. Findings We identified 69 studies, comprising 6177 individuals diagnosed with FASD from 17 countries: Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), eastern Europe (Moldova, Romania and Ukraine; n = 1), Germany (n = 1), Israel (n = 1), Lithuania (n = 1), the Netherlands (n = 1), Poland (n = 1), Russia (n = 9), South Korea (n = 1), Spain (n = 1), Sweden (n = 1) and United States (n = 25). FAS and FASD prevalence rates were collated for the following five subpopulations: children in care, correctional, special education, specialized clinical and Aboriginal populations. The estimated prevalence of FASD in these special subpopulations was 10-40 times higher compared with the 7.7 per 1000 (95% confidence interval = 4.9-11.7) global FASD prevalence in the general population. Conclusions Global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations have a significantly higher prevalence of fetal alcohol spectrum disorder compared with the general population, which poses a substantial global health problem.

Objective. The primary objective of this paper was to examine associations between sleep duration, body mass index (BMI), and cortisol levels across childhood. Methods. Participants included 361 children adopted domestically in the United States. Random-intercept cross-lagged panel models tested for between- and bi-directional within-person associations of sleep duration, BMI, and morning and evening cortisol from 4.5 to 9 years of age. Results. Sleep duration and BMI were stable during childhood, inversely associated at the between-person level, and unrelated to morning or evening cortisol. BMI at 6 years predicted longer sleep duration and lower evening cortisol at 7 years, and lower morning cortisol at 7 years predicted higher BMI at 9 years, within individuals. Conclusions. The association between sleep and BMI is more likely a stable between-person phenomenon, rather than a unidirectional association that develops within-individuals over time.

Although many children adopted internationally show remarkable recovery once placed in families, as a group they continue to exhibit persisting developmental deficits and delays in self-regulation. The current study uses a stratified, randomized, controlled trial to evaluate the effects of mindfulness-based and executive function trainings (EFTs) on internationally adopted (IA) children's self-regulation, including effortful/inhibitory control, attention, delay of gratification, and emotion-regulation. IA children ages 6–10 years were randomized into mindfulness training (MT), EFT, or no intervention (NI) groups. The MT and EFT groups attended 12 one-hour group sessions. Ninety-six children (MT, n = 33; EFT, n = 32; NI, n = 31) completed the study and were tested on computerized and non-computerized measures of self-regulation. Compared with the NI group, the MT group improved delay of gratification, and the EFT group improved inhibitory control and selective attention. There was no effect of either intervention on emotion regulation. MTs and EFTs show promise for improving self-regulation in IA children.

Children who have been adopted from care are very likely to have experienced early adversity that may result in psychological trauma. A current debate in the field is whether adoption provides a pathway to healing for traumatised children, helping them to recover from past psychological harm, or creates trauma for children through the very nature of being an adopted child.This study aimed to use longitudinal data pertaining to children who had been adopted from care to examine the relationship between being adopted from care and psychological trauma.Seventeen adopted children had been interviewed in their adoptive homes during the third wave of the Care Pathways and Outcomes study (McSherry et al., 2013), when they were aged between nine and 14 years old. Ten of these children were selected for specific consideration in this article. Checklists for early adversities and psychological trauma were used to support the creation of case studies that highlighted the extent of psychological trauma in the children's lives.The adopted children either experienced possible pre-care psychological trauma, with the impact of this reducing over time, in utero developmental harm due to their mother's alcohol misuse during pregnancy, inherited an intellectual disability, with the resultant difficulties superseding any concern regarding possible pre-care psychological trauma, or possible psychological trauma when moving from an established foster placement to adoption. Recommendations for policy and practice are provided.

Background Children adopted from foster care are at heightened risk for emotional and behavioral challenges, potentially due to early trauma exposure and related risk factors. Research has demonstrated that adoptees with greater pre-adoptive risk exhibit higher rates of internalizing and externalizing problems across childhood and into adulthood. However, these studies have been limited by their use of individual risk factors or sum scores of cumulative risk and their measurement of internalizing and externalizing behaviors separately. Objective The current study aimed to examine effects of pre-adoptive risk on long-term functioning in children adopted from foster care. Method In a longitudinally-followed sample of 82 adoptees, we utilized latent growth curve modeling to examine effects of two latent indices of pre-adoptive risk, postnatal (i.e., trauma-related) risk and prenatal risk (not including prenatal substance exposure, since it was nearly ubiquitous in this sample), on adoptee internalizing, externalizing, and latent scores of dysregulation across childhood. Additionally, in three separate models, we tested whether baseline levels and change across childhood in internalizing, externalizing, and dysregulation mediated effects of prenatal and postnatal risk on adolescent/young-adult functioning. Results Greater postnatal risk, but not prenatal risk, predicted higher levels of internalizing and dysregulation across childhood. However, only dysregulation mediated the effect of postnatal risk on adolescent/young-adult functioning. Conclusions These results are consistent with prior research evidencing long-term effects of postnatal pre-adoptive risk, but not prenatal risk, in adoptees. Furthermore, they suggest that trauma exposure in this population may result in a profile of broad dysregulation that increases risk for maladjustment into adulthood.

Our results demonstrate that the early life home environment can significantly alter the gut microbiome in childhood, potentially altering health outcomes or risk for adverse health outcomes. A better understanding of the drivers of gut microbiome variation during childhood could lead to more effective intervention strategies for overall health starting in early life., The composition of the human gut microbiome is highly variable, and this variation has been repeatedly tied to variation in human health. However, the sources of microbial variation remain unclear, especially early in life. It is particularly important to understand sources of early life variation in the microbiome because the state of the microbiome in childhood can influence lifelong health. Here, we compared the gut microbiomes of children adopted in infancy to those of genetically unrelated children in the same household and genetically related children raised in other households. We observed that a shared home environment was the strongest predictor of overall microbiome similarity. Among those microbial taxa whose variation was significantly explained by our models, the abundance of a given taxon was more frequently explained by host genetic similarity (relatedness), while the presence of a given taxon was more dependent upon a shared home environment. This suggests that although the home environment may act as a species source pool for the gut microbiome in childhood, host genetic factors likely drive variation in microbial abundance once a species colonizes the gut.

BackgroundAttention deficit hyperactivity disorder (ADHD) is highly heritable and is associated with lower educational attainment. ADHD is linked to family adversity, including hostile parenting. Questions remain regarding the role of genetic and environmental factors underlying processes through which ADHD symptoms develop and influence academic attainment.MethodThis study employed a parent-offspring adoption design (N= 345) to examine the interplay between genetic susceptibility to child attention problems (birth mother ADHD symptoms) and adoptive parent (mother and father) hostility on child lower academic outcomes, via child ADHD symptoms. Questionnaires assessed birth mother ADHD symptoms, adoptive parent (mother and father) hostility to child, early child impulsivity/activation, and child ADHD symptoms. The Woodcock–Johnson test was used to examine child reading and math aptitude.ResultsBuilding on a previous study (Harold et al., 2013,Journal of Child Psychology and Psychiatry, 54(10), 1038–1046), heritable influences were found: birth mother ADHD symptoms predicted child impulsivity/activation. In turn, child impulsivity/activation (4.5 years) evoked maternal and paternal hostility, which was associated with children's ADHD continuity (6 years). Both maternal and paternal hostility (4.5 years) contributed to impairments in math but not reading (7 years), via impacts on ADHD symptoms (6 years).ConclusionFindings highlight the importance of early child behavior dysregulation evoking parent hostility in both mothersandfathers, with maternal and paternal hostility contributing to the continuation of ADHD symptoms and lower levels of later math ability. Early interventions may be important for the promotion of child math skills in those with ADHD symptoms, especially where children have high levels of early behavior dysregulation.

The prevalence of substance use among transracial and international adoptees is higher than that of non-adopted persons, and yet no specialized treatment modalities exist for this underserved population. Our purpose is to propose a substance use disorder (SUD) prevention program for transracial adoptive families that addresses the specific issues that face this community. There are several pre- and post-adoption factors which position transracial and international adoptees (TRIAs) to be at higher risk to develop SUDs. Some of these factors include adoption identity, trauma, loss, genetics, and racial discrimination. The biopsychosocial (BPS) model (Engel, 1977) is used to conceptualize SUDs in adoptees, and theories that focus on adoption-related development issues such as the Adoptee Stress and Coping Model (Brodzinsky, 1990) are also presented. Our proposed program, Strengthening Transracial Adoptive Families (STAF), utilizes the Guiding Good Choices (GGC) prevention program as its foundation to integrate a culturally responsive adoption-focused curriculum to best serve transracial adoptive families.

Fetal alcohol spectrum disorders; Adopted children; Cognitive disorder Trastornos del espectro alcohólico fetal; Niño adoptado; Trastorno cognitivo Trastorns de l'espectre alcohòlic fetal; Nens adoptats; Trastorn cognitiu Fetal alcohol spectrum disorder (FASD) is a leading cause of neurodevelopmental disorders. Children adopted internationally from countries where alcohol consumption during pregnancy is very high are at greater risk for FASD. Lack of expertise in diagnosing FASD and mixed neurodevelopmental and behavioral signs due to abandonment complicate a timely diagnosis. The aim of this study was to determine the prevalence of FASD in adopted children. Children between the ages of 8 and 24 adopted from Russia and Ukraine were evaluated for clinical and historical features of FASD. Of the 162 children evaluated, 81 (50%) met FASD diagnostic criteria. Thirty-three (20.4%) children had fetal alcohol syndrome (FAS), 28 (17.2%) had partial FAS, 2 (1.2%) had alcohol-related birth defects (ARBD) and 18 (11.1%) had alcohol-related neurodevelopmental disorder (ARND). Of the 81 children in which fetal alcohol exposure could not be confirmed, many had manifestations that would have established a diagnosis of FASD if a history of maternal alcohol consumption was confirmed. In a population of children with a high risk of prenatal alcohol exposure (adoptees from Eastern European countries), at least 50% showed manifestations associated with FASD. The reported prevalence in this study is in line with the results obtained in a previous study as well as in orphanages of origin.

Adoptive parricide, the killing of adoptive parents by their adoptive children, is a phenomenon that garners much media attention but remains elusive in the extant literature. Previous studies on adoptive parricide have largely consisted of clinical case studies with limited theoretical explanations. The current study uses Bowlby's attachment theory as a theoretical framework to explore adoptive parricide. A content analysis was conducted of news sources to obtain data on adoptive parricide cases. Hypotheses were generated per attachment theory in the context of Heide's (2013b) parricide offender typology. Early adoptees (n = 27) were compared to late adoptees (n = 29) using Fisher's exact tests. Early adoptees were more likely to kill multiple victims, kill for selfish motives, be overindulged by adoptive parents, and not have limits set and enforced by adoptive parents. Late adoptees were more likely to report having been abused by their adoptive parents. The results were not consistent with attachment theory. Implications for the adoption process and adoptive parenting practices are presented.

Adoptees’ mental health problems in childhood and later life are well described, but little attention has been paid to domestically adopted children’s emotional and behavioral problems and neurocognitive profiles. The aim of this study was to describe the neurocognitive profiles of domestically adopted children in the UK and their parent- and teacher-rated emotional and behavioral problems. Forty-five children (M age = 75.96 months, SD = 12.98; 51.1% female) who were placed for adoption from public care at a M age of 22.14 months (SD = 14.21) completed a battery of age standardized neurocognitive tests, and adoptive parents and school teachers rated their emotional and behavioral problems. Children had more emotional and behavioral problems than the general population and over a fifth scored low (> 1 SD below the expected range for their age) in 5/6 neurocognitive tasks. Children who scored low on the non-verbal reasoning task were more likely to have more parent- and teacher-rated behavioral problems, and children’s performance on the inhibitory control and cognitive flexibility tasks were associated with parent-rated behavioral problems. Children’s verbal reasoning scores were positively associated with both parent- and teacher-rated emotional problems. Children who were adopted later in childhood scored significantly lower in non-verbal reasoning. Although longitudinal studies are needed to clarify the nature of neurocognitive functioning as a marker for later mental health problems, our findings underscore the importance of using comprehensive assessments to better recognize adopted children’s difficulties and inform appropriate intervention initiatives.