Family Environments of Children Adopted from the Forme

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Family Environments of Children Adopted from the
Former Soviet Union http//www.adoption-research.
org teena_at_adoption-research.org

• Teena McGuinness, PhD, CRNP
• Professor, University of Alabama, Birmingham,
  School of Nursing
• For more on our distance accessible
• psych NP program, go to
• www.psychiatricnursing.com
• Cheryl Robinson, DNS, CRNP, Clinical Assistant
  Professor, University of South Alabama College of
  Nursing

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Objectives

• 1. Describe risks to development of children
  adopted from orphanages in the former USSR.
• 2. Define and describe the family environments of
  children adopted from the former USSR
• 3. Discuss components of family environments
  associated with resilient outcomes for families.

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Pertman, A. (2001). Adoption Nation. New
York Basic Books.

• Adoption, once a clandestine process shrouded in
  shame, is rapidly metamorphosing into a radically
  new process that is both sweeping the nation and
  changing it. It is accelerating our
  transformation into a more multicultural and
  multiethnic society, even as it helps redefine
  our understanding of family.
• Adoption is also a highly visible example of a
  social institution that has benefited from and
  been reshaped by both the Internet and the
  exponential growth of alternative lifestyles,
  from single to transracial to gay. -Adam
  Pertman, journalist and current director of Evan
  B. Donaldson Adoption Institute, NY, NY.

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Adoptive parent preparation is key to successful
parenting

• Adoptive parent preparation is available via
  webinar at the Evan B. Donaldson Adoption
  Institute.
• Webinar includes best-practice standards and
  training materials to assist professionals in the
  preparation and support of adoptive parents.
• Adoptive Parent Preparation - Understanding the
  Psychological, Developmental and Medical
  Challenges that Adopted Children May Experience
  in webinar format at http//www.adoptioninstitute.
  org/education/training_app1.php

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Adoption occurs as a result of Adversity

• The greatest terror a child can have is that he
  is not loved, and rejection is the hell he
  fears.-John Steinbeck, East of Eden
• Bonds with birth parents occur due to tragedy,
  abandonment, and termination of parental rights.

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Reasons for entry into institutions in
International Adoption

• Poverty
• Homelessness
• Mental illness of birth parents
• Substance use disorders of birth parents
• Incarceration of birth parents
• Abandonment of children
• Neglect
• Abuse

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History of International Adoption

• Following World War II, large numbers of
  displaced persons made possible the adoption of
  children from overseas
• Motivated by humanitarian reasons
• Approximately 6000 children were adopted from the
  battle-scarred countries of Europe after WWII
  (Pertman, 2000).

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History of International Adoption

• Romanian adoption laws were liberalized in 1990
  and thousands of Westerners traveled to Romania
  intent on adopting.
• Well-meaning Americans found an old nemesis known
  in the child development literature since 1915
  the hazards of institutionalization.
• Evaluation of these post-institutionalized
  children opened a unique window into development.
  
• Observing these institutionalized children who
  were exposed to such significant adversity
  provided a unique opportunity to document changes
  within their adoptive families.

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Sensitive Periods of Development

• The period from conception to age 3 years is
  unparalleled in the human life cycle for the
  rapidity, complexity, and profundity of
  developmental changes.
• The completely dependent infant evolves into a
  child capable of communicating and participating
  in rule-bound social situations.
• A significant portion of postnatal brain
  structuring and neural patterning is thought to
  occur thru interactions of the child with the
  environment, including family environment.
• Zeanah, C. H., Nelson, C. A., Fox, N. A., Smyke,
  A. T., Marshall, P., Parker, S. W., Koga, S.
  (2003). Designing research to study the effects
  of institutionalization on brain and behavioral
  development the Bucharest Early Intervention
  Project. Development Psychopathology, 15(4),
  885-907.

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95 years of literature on the hazards of
Institutionalization

• Detriments include
• delays in social and emotional development
• altered patterns of cognitive functioning
• nutritional and growth deficiencies (Bender
  Yarnell, 1941 Bowlby, 1951 Chapin, 1915
  Goldfarb, 1943 Spitz Wolf, 1946 Tizard
  Rees, 1975).
• Factors determining the magnitude of the effects
  of orphanage living on the behavior of young
  children are age of institutionalization
  (Goldfarb, 1945), duration of time spent in the
  institution and the quality of care while
  residing in the institution (Yarrow, 1961).

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Negative effects of Institutionalization

• Impairment of attachment (Ainsworth, 1961
  Bowlby, 1951 Rutter, 1981)
• Hyperactivity and conduct disorders (Rutter,
  Quinton, Hill, 1981 Hodges Tizard, 1989
  Rutter, Quinton, Hill, 1990)
• Cognitive impairments in problem-solving
  abilities and cause-and-effect thinking (Provence
  Lipton, 1962 Fahlberg, 1991)
• Death (Chapin, 1915 Goldfarb, 1945 R. Spitz,
  1945 Spitz, 1945)

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Negative effects of Institutionalization

• The detrimental effects of institutional living
  were the primary impetus for discarding the
  orphanage system in the U.S. for a foster care
  system of substitute care (Frank et al., 1996).
• Frank, D. A., Klass, P. E., Earls, F.,
  Eisenberg, L. (1996). Infants and young children
  in orphanages one view from pediatrics and child
  psychiatry. Pediatrics, 97(4), 569-578.
• Read the above article for an excellent overview
  of the first 80 years of scientific literature on
  the hazards of institutionalization.

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Orphanages are terrible places to raise children
Humanitarian efforts Down Syndrome Association
of Russia, Center for Curative Pedagogics, Loves
Bridge, the Children's Rights Division of Human
Rights Watch are a few of the humanitarian
organizations who do humanitarian work in Russian
orphanages. http//www.hrw.org/
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Categorization of risk to Development

• Prenatally
• alcohol/drug exposure, prematurity, and prenatal
  malnutrition.
• Postnatal
• Abuse
• Malnutrition
• Exposure to violence
• Neglect (lack of contact and stimulation) is a
  significant portion of the risk incurred in
  institutionalization which is a commonality to
  many children adopted from both China and the
  former Soviet bloc of countries since 1990.
• Indeed, children who spend time in orphanages
  experience multiple adversities across the risk
  continuum making them a natural experiment for
  child development.

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US Russian Cohort Aims of Study

• Aim 1
• Characterize the total competence of children
  adopted from the Former Soviet Union
• Aim 2
• Evaluate both risks as well as the protective
  influences of adoptive families and their
  relationship to competence via a longitudinal
  design

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Gap in Knowledge

• Strong familial attachments and positive family
  socialization can exert a protective influence
  for children, but this has not been studied for
  international adoptees
• Most studies of international adoption and
  adolescence have been conducted outside the
  United States, and focused on psychopathology
  instead of positive outcomes.

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The children in this study have
Been exposed to abuse and neglect (57)
Been exposed prenatally to alcohol (41)
Been Institutionalized (100)
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Variables of Study

• Independent Variables
• Risk Factors
• Birth weight
• Length of time in orphanage
• Age at institutionalization
• Birth mother's exposure to alcohol
• Protective Factors
• Family Environment
• Cohesion
• Expressiveness
• Conflict

• Dependent Variable
• Competence

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Risk Factors

• Conditions or variables that can be associated or
  linked to a higher probability of a negative
  outcome are considered risk factors (Jessor, Van
  Den Bos, Vanderryn, 1995 McGrath Sullivan,
  2003 McGuinness, Ryan, Robinson, 2005).

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Risk Factors

• Birth weight
• Length of time in orphanage
• Age at institutionalization
• Birth mother's exposure to alcohol

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Birthweight

• A lower birth weight is associated with cognitive
  deficits and increasing levels of morbidity for
  children (Breslau, 1995 Klein, 1998 Lindeke,
  Stanley, Else, Mills, 2002 Lucina,, Lindeke,
  Georgieff, Mills, Nelson, 1999 Saigal,
  Szatmari, Rosenbaum, Campbell, King, 1991 Vhor
  Msall, 1997).

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Age at Adoption and Length of Institutionalizatio
n

• Children adopted from institutions generally
  focus on the mental and physical challenges
  (Nakashima, 1996 Talbot, 1998).
• Risk for psychopathology (Bimmel, Juffer,
  Ijzendoorn, Bakermans-Kranenburg, 2003 Groza
  Ryan, 2002, Rutter et al., 1999),
• Risks to child competence in all salient domains
  of development (academic, social, and conduct
  competence) (Wilson, 2003),
• Higher rates of maladaptive behavior in later
  adolescence (Bimmel, et al Verhulst
  Versluis-den Bieman, 1995).

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Alcohol Exposure

• Children whose mothers consumed alcohol during
  pregnancy are largely placed at various risks for
  development.
• Studies report
• A critical impact in the first few weeks of
  conception (Overholser, 1990)
• Teratogenic effects within the first 8 weeks of
  pregnancy (Michaelis Michaelis, 1994)
• Growth and cognitive impairment effects with use
  later in pregnancy (Young, 1997).
• 47 of Time 3 cohort had exposure to alcohol

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Protective Factors

• Protective factors are internal and external
  processes, independent of risk, that exert a
  positive force on an outcome and contribute to
  competence in the face of adversity (Fraser,
  Kirby, Smokowski, 2004 Luthar Zigler, 1991
  Masten, 2001 McGrath Sullivan, 2003).

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Protective Factors

• In the family environment
• Cohesion
• Expressiveness
• Decreased conflict

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Protective Factors

• Family environments, characterized by low
  interpersonal conflict and involving members who
  easily express their feelings (also known as the
  relationship dimension of the FES), are
  considered an important protective factor for
  adolescents attempting to navigate the adolescent
  years (Galaif, Stein, Newcomb, Bernstein, 2001
  Johnson et al., 1998 R. H. Moos, 2003).

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Demographic Questionnaire

• A demographic questionnaire was developed in 1998
  for the Time 1 study of the international
  adoptees from the former USSR.
• Collected demographic, background, and risk
  factor information.

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Tools

• Family Environment Scale
• A combined picture of the social and
  psychological perspectives of the family, the
  trend of personal growth within members of the
  family, and the nature of the interpersonal
  relationship among family members is assessed by
  the FES
• Moos Moos, 1994.
• Range of FES scales 20-80 higher scores
  indicate greater expressiveness cohesion.
  Lower scores on conflict subscale indicates less
  conflict.

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• The Family Environment Scale (FES) (Moos Moos,
  2002) gathers information on the stability of
  system and to identify strengths and weaknesses
  that might facilitate optimal functioning.
• A stable family environment has been reported to
  be important for school adjustment (Ketsetzis, B.
  A. Ryan, Adams, 1998) and the general positive
  adaptation of children and youth (Harvey Byrd,
  1998).

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Competence

• Adaptational success in the developmental tasks
  expected of individuals of a given age in a
  particular cultural and historical context
  (Masten Curtis, 2000, p. 533).
• Competence, effective adaptation in the
  environment, can either be broadly defined in
  terms of global achievement of major development
  tasks, or more specifically be related to
  achievement domains (Masten Coatsworth, 1998).

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Competence as assessed by Child Behavior
Checklist

• Competence defined
• Effective patterns of behavior at with respect to
  conduct, socially, and at school
• Total Competence (conduct, social, school) score
• Time I assessments (n105) 45.75 (SD10.55)
  (Non-adopted US 40-80)
• Time II assessments (n51) 43.40 (SD9.77)
• Time III (n30) 45.37 (SD10.86)

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Question

• What were the relationships between protective
  factors (environment of the adopted family to
  include cohesion, conflict and expressiveness) as
  measured by the Family Environment Scale (FES)
  and competence of a group of adolescents
  internationally adopted from the former USSR?

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Descriptive Statistics for Protective Factors
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Pearsons Correlations Coefficients- Protective
Factors and Competence
p .05. p .01. Two-tailed test used.
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Question

• What were the changes in risk and protective
  factors as they relate to competence through time
  international adoptees studied at 6-9 years of
  age (Time 1), at 9-12 years of age (Time 2), and
  at 13-17 years old (Time 3)?

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Participants at Time 1
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Participants at Time 2
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Participants at Time 3
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Total Competence did not change significantly
over time
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ANOVA Protective Factors
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Correlations of Risk Factors with Total Competence
p lt.05. p lt.01. Two-tailed test used
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Correlations Risk Factors and Competence Across
Time

• Total Competence no risk factors significant at
  Time 3. Birth weight was significant at Time 1
  and Time 2
• Academic Competence birth weight significant at
  Time 1, Time 2, Time 3
• Social Competence no risk factors significant
  at Time 3. Birth weight was significant at Time 1
  and Time 2
• Conduct Competence Age at Institutionalization
  significant at Time 3 only. Birth weight was
  significant at Time 1

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Descriptive statistics distribution of the
protective factors (cohesion, conflict, and
expressiveness from Time 1(N 105), Time 2 (N
47), and Time 3 (N 30)
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Correlations of Protective Factors with Total
Competence
p lt.05. p lt.01. Two-tailed test used.
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Correlations Protective Factors and Competence
Across Time

• Total Competence No protective factor
  significant at Time 3. Cohesion was significant
  at Time 1 and Time 2.
• Academic Competence No protective factor
  significant at Time 3. Conflict was significant
  at Time 1 only.
• Social Competence Cohesion was significant at
  Time 1, Time 2, and Time 3.
• Conduct Competence Cohesion and Conflict was
  significant at Time 1, Time 2, and Time 3

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Adoptive Families Matter

• Enriched environments provide corrective
  stimulation allowing substantial adaptive change
  to occur
• Significant emotional development is possible
  when childrens environments change
• Changes set the stage for the development of
  competence in other domains

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Conclusion

• The families continue to face challenges, but
  findings are consistent with other studies
  demonstrating that children who are adopted after
  early adversities generally fare well
  developmentally after their environments have
  improved

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Interesting but unsurprising findings Sir
Michael Rutter, SRCD

• Prolonged deprivation leads to psychological
  defects.
• Good quality rearing in an adoptive family
  environment results in significant catch-up.
• The longer the institutional deprivation, the
  more limited the psychological recovery.
• Prolonged deprivation has a lasting effects on
  the neuroendocrine system.

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Five interesting but unsurprising findings -Sir
Michael Rutter, SRCD,

• Relatively strong persistence of deficits up to
  age 11, at least 8 years after a radical change
  in rearing environment, implies some form of
  biological programming or neural damage.
• Nevertheless, heterogeneity in outcomes is
  present and cannot be fully explained.

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Society for Research in Child Development meeting
Quotes from Rutter What should adoptive
families do to foster normal development?

• There is no intervention that offers a magic
  bullet but that does not mean that nothing
  useful can be done.
• What can be expected in adulthood? We dont yet
  know.

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Take home messages

• The risks experienced by internationally adopted
  children are very similar to children who reside
  in our foster care system.
• It is important to examine resilience as well as
  vulnerability.
• Families make a difference.

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How should mechanisms of resilience be studied?

• Pay attention to individual differences
• Note and encourage the beneficial impact of
  adoptive families
• Some do okay despite gross deprivation

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Vera Nadya

• Twins adopted from Russia as toddlers, now live
  in California.
• Christmas card from parents
• The twins are 17 now and are wonderful human
  beings. Everyone loves them. Both have learning
  disabilities. Nadya uses pure determination to
  overcome. Vera charms her way out of almost
  anything. Nadya accepts responsibility
  appropriately Vera denies all responsibility.
  Two very different kids. All grown up but always
  our little ones.

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• Out of calamity and loss, children recover to
  become functionally and emotionally competent
  adults.Modest difficulties experienced by
  children who are adopted far outweigh the
  significant benefits they receive from having a
  permanent family.
• Johnson, D. E. (2002). Adoption and the effect on
  children's development. Early Human Development,
  68(1), 39-54.