To assess the social and emotional well-being of adopted children, this section reports on whether children have ever been diagnosed with any of four psychological disorders, including attachment disorder, depression, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), or behavior/conduct disorder. Additionally, we report on the percentages of children who exhibit positive and negative social behaviors. See Appendix Table 8 on page 66 for detailed data on each indicator.
Most adopted children fare well, according to six measures of socio-emotional well-being, but a small minority experience serious problems. Parents’ responses indicate that the majority of adopted children have never been diagnosed with each of the four psychological disorders included in the survey. Twelve percent of adopted children have ever been diagnosed with attachment disorder. The survey did not ask about the severity of the disorder. Most adopted children diagnosed with attachment disorder have parents who report a “very warm and close” relationship with their child, although such reports are rarer than among adopted children without attachment disorder (64 compared with 84 percent). Overall, 4 percent of adopted children both have been diagnosed with attachment disorder and have a parent who reported the relationship as not being very warm and close.
The incidence of the other three disorders examined here is lower than for attachment disorder. Fourteen percent of adopted children ages 6 and older have been diagnosed with ADD/ADHD and have parents who rated the condition as moderate or severe. Eight percent of adopted children ages 2 and older have moderate or severe behavior or conduct problems, according to their parents. Parents of 2 percent of adopted children report their child has been diagnosed with depression and currently has symptoms that are moderate or severe. Also based on parent responses, 14 percent of adopted children have problems with social behaviors. However, parents also reported that 88 percent exhibit positive social behaviors.
Compared to the general population of children, adopted children are more likely to have ever been diagnosed with—and to have moderate or severe symptoms of—depression, ADD/ADHD, or behavior/conduct disorder.24 For example, 9 percent of adopted children ages 2 and older have ever been diagnosed with depression, compared with 4 percent of children in the general population. Additionally, 26 percent of adopted children ages 6 and older have ever been diagnosed with ADD/ADHD, compared with 10 percent of children in the general population. A similar pattern of differences emerges for behavior/conduct disorder: 15 percent of adopted children have ever been so diagnosed compared with 4 percent of children in the general population. Adopted children are also somewhat more likely than the general population of children to exhibit problems with social behaviors, and are somewhat less likely to exhibit positive social behaviors; see Figure 19.
Differences in social and emotional well-being by adoption type are apparent for five out of six measures, with children adopted from foster care more likely to have problems. Children adopted from foster care are more likely than those adopted privately from the United States or internationally to have been diagnosed with ADD/ADHD (38 percent compared with 19 and 17 percent, respectively), behavior/conduct problems (25 percent compared with 11 and 7 percent), and attachment disorder (21 percent compared with 6 and 8 percent). Furthermore, children adopted from foster care are more likely to have problems with social behaviors than privately adopted U.S. children (18 percent compared with 10 percent), and they are somewhat less likely to exhibit positive social behaviors (83 percent compared with 91 percent);i see Figure 20. However, depression is rare among all adopted children regardless of the type of adoption.
Figure 19. Percentage of children according to measures of social and emotional well-being, by adoptive status
Figure 20. Percentage of adopted children according to measures of social and emotional well being, by adoption type
SOCIAL AND EMOTIONAL WELL-BEING MEASURES
For each of the first four disorders listed below, parents reported whether “a doctor or other health care provider ever told them that the child had the condition, even if he/she does not have the condition now.” It is important to note that, while these represent clinical psychological problems, data are based on parents’ recollections of doctors’ diagnoses, rather than actual diagnoses or direct observation of children. With the exception of attachment disorder, parents also reported whether children still had each condition at the time of the survey, and, if so, whether it was mild, moderate, or severe.
Attachment disorder (or reactive attachment disorder, RAD): This is a disorder of infancy/early childhood that can severely harm children’s abilities to develop appropriate social relationships. Children may be excessively inhibited; alternatively, they may be indiscriminately sociable. By definition, it begins before age 5; it is associated with severe neglect of children’s basic emotional needs. If parents had not heard of attachment disorder, we assumed children had not been diagnosed with it. This question was asked in the NSAP, so comparable data are not available for the general child population.
Depression: Depressive disorders can include relatively brief episodes (e.g., 2 weeks) of chronically depressed or irritable mood, changes in appetite or weight, changes in sleep patterns, and difficulty concentrating. It can be associated with separation anxiety, problems with social interactions, academic problems, substance use, and in serious cases, suicide. If parents were unfamiliar with depression, interviewers told them that “Depression is an illness that involves the body, mood, and thoughts. It is marked by persistent sadness or an anxious or empty mood. It affects how a person feels, and the way a person eats, sleeps, and functions.”
Attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD): ADD/ADHD involves inattention and/or hyperactivity or impulsivity that occurs more severely and frequently than in other children of similar ages and that impairs children’s social or academic functioning. It is difficult to establish a diagnosis prior to age 4 or 5, although it develops prior to age 7. When asked, interviewers explained that “a child with attention deficit disorder or attention deficit hyperactivity disorder has problems paying attention or sitting still. It may cause the child to be easily distracted.”
Behavior or conduct disorder: Children with conduct disorders repeatedly and persistently violate the basic rights of others or social rules or norms. Children may threaten to or actually harm others, or engage in vandalism or theft. Parents reported whether their child had ever been diagnosed with behavior or conduct disorder, such as oppositional defiant disorder. Interviewers could explain to parents that “oppositional defiant disorder is an ongoing pattern of defiant and hostile behavior that interferes with a child’s life and daily activities.”
Positive social behaviors: Children are classified as exhibiting positive social behaviors if their parent reported that their child “usually” or “always” engaged in all four of the following behaviors: “[shows] respect for teachers and neighbors,” “[gets] along well with other children,” “[tries] to understand other people’s feelings,” and “[tries] to resolve conflicts with classmates, family, or friends.”
Negative social behaviors: Children are described as exhibiting negative social behaviors if their parent reported that their child “usually” or “always” engaged in two out of the four behaviors: “[argues] too much,” “[bullies or is] cruel or mean to others,” “[is] disobedient,” and “[is] stubborn, sullen, or irritable.”
Note: Detailed information on the symptoms of attachment disorder, depression, attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD), or behavior or conduct disorder are available in: American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.