Study: Behavioral Adjustment of Adopted Chinese Girls, Two Year Followup

Reported in the journal Child and Adolescent Mental Health, a study by Tony Xing Tan, looking at changes in behavioral adjustment of adopted Chinese girls.  The children were sorted into three groups -- preschool age for both phases, preschool in phase I and school age in phase 2, and school age in both phases. He reports that adopted Chinese girls  do not seem to have a higher risk for suboptimal adjustment than non-adopted children. The non-adopted U.S. sample for maladjustment pegs it at about 18% for all three age groups, and all three age groups of Chinese adoptees averaged below 18% -- 10.3% in Phase I and 16.9% in Phase II for internalizing problems (internalizing behaviors include anxious, depressive, and overcontrolled behaviors), 9.0% in Phase I & 11.3% in Phase II for externalizing problems (externalizing behaviors include aggressive, hyperactive, noncompliant, and undercontrolled behaviors), 9.6% in Phase I and 13.8% in Phase II for all problems (note the increase over 2 years). The behaviors are determined via the Child Behavior Checklist, which you can see here for preschool and here for school age if you're interested.

When the results are broken down into the three age groups, there are some significant differences.  For the preschool age group, the "average internalising problem score and the rate of suboptimal internalising problems increased significantly. The trend of increase in the average internalising problem scores seems to resemble clinical girls rather than the healthy girls, from the normative sample."  In fact, the rate of girls with internalizing problems nearly doubled over two years. The study's author opines that the increase might be attributable to these preschool children moving toward school attendance -- many moved from no school to preschool over the two years. "[T]he school setting might be a source of stress for some children as it somewhat resembled the orphanages (e.g. large number of children, non-relative caregivers, eating and napping in a group setting), in addition to separation from the parents and the usual stress associated with learning. Of course, this speculation requires extensive research (especially qualitative inquiries) to verify."

For children in the transition group -- moving from preschool age to school age -- there were significant increases in internalizing, externalizing and total problem behaviors. This was different from same-age girls in the non-adopted population, who experience an increase in internalizing problems but a decrease in externalizing problems and total problems over these years. The author speculates that "the adopted children’s pattern of increase in behaviour problems during this developmental stage might be an indication that they were undergoing marked cognitive changes that enable them to better understand the meaning and implication of adoption, " citing David Brodzinsky's The Psychology of Adoption.

In the older school-age group (from average age 8 in Phase I and 10 in Phase II), there was little change
between the two phases.  However, this age group reported higher suboptimal scores than the two younger groups.  And for internalizing behaviors, this group was significantly higher than the normative sample for the population at large.

Also, the results showed that adopted Chinese children who showed "suboptimal adjustment" in the first phase were highly likely to show suboptimal adjustment in the second phase two years later -- in fact, the odds of suboptimal adjustment in Phase II ranged from about 10 to 15 times higher among the children who scored suboptimally in Phase I -- maybe that says something about whether you should wait to get help when you identify problems. . . .

The study concludes:

Overall, the current study found that as the children got older, their behavioural adjustment worsened, especially during early and middle childhood. While suboptimal adjustment seemed to persist over time, internalising problems became more serious among the adopted Chinese girls. These findings point to the critical need for early detection and early treatment of suboptimal adjustment problems. As middle childhood appeared to be a particularly vulnerable stage of development for the adopted Chinese girls, parents, teachers and mental health professionals should work closely with these children to process their experience of early abandonment and to promote a positive attitude towards being adopted transracially.

Certainly some good news -- better adjustment than the non-clinical general population. But also some worrisome news that adoptive parents should pay attention to early.