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The Varying Effects of Adoption on Mental Health // What is the effect of adoption on mental health in

Of the 318.9 million people in the United States, over 1.8 million of them are adoptees
(“Adoption Statistics”). As early as 1997, 58% of Americans reported knowing someone who had been
involved in the adoption process in some way (PBS). An action that once was considered secretive has
become fairly common worldwide; but with what consequences? Many stereotypes exist about adoptees,
but almost all of them pertain to their psyche. Historically adoption has been viewed as having a negative
effect on the mental health of adoptees. One would expect that someone who believes they have been
rejected by those that are meant to care for them may have serious self-confidence problems, but is that
true? Studies done on the mental health of adoptees versus non-adoptees provide a wide range of
conclusions, and leave many questions unanswered. Adoptees make up a unique population, including
children from almost every continent. The uncommon childhood that adoptees go through also creates a
group of individuals with highly unique mental health concerns. With the prevalence of adoptees among
the general population, the need to understand the psychological risks adoptees face is incredibly
important. Adoptees are consistently burdened with the social and mental baggage of their adoption. The
stigma surrounding adoption can support concepts that claim adopted children were unwanted by their
birth mothers and that adoptive families are not a child’s “real” family (Watson 1995). It is this stigma
that aids the belief that adopted children are prone to internalizing mental illnesses, and it is that concept
that has led to the study of adoptee mental health. While such studies can prove to be insightful, it is
impossible for someone who has been involved in the adoption process or worked with adoptees to
completely disregard the stereotypes that are applied to adoptees before they even begin to show signs of
mental illness. The issue of pre-formed views doesn’t only apply to studies, but also to mental health
treatment. A major concern in studies that analyze the mental health of adoptees, is the potential for
adoptees to be overrepresented in mental health institutions (Fergusson and Horwood 1998). It is not
uncommon for adoptive parents to fall victim to adoption stereotypes either; the belief that adoptees are
more likely to be mentally ill can create extra concern over small issues (Grenke 2012). Adoption studies
commonly use information from clinics and mental health treatment centers without always taking into
consideration the overrepresentation of adoptees. In addition, many adoption studies utilize questionnaires
and interviews with parents and teachers of adoptees, rather than the adoptees themselves (Brodzinsky
1993). The combination of these factors represents a key flaw in the study of adoptees’ mental health. It is
because of this flaw that the conclusions of these studies cannot be taken as the absolute truth or as
entirely accurate; however adoptee studies can still be valuable sources. Ultimately the majority of
adoption studies come to one result: adoptees are at higher psychological risk than non-adoptees, but
barely. The margin of difference between the psychological risks of adoptees versus non-adoptees is not
large, but this does not change the fact that yes, adoptees are at higher risk. It must be noted however, that
the origins of mental disorders in adoptees can be very different from that of non-adoptees, which can
cause them to manifest differently. The differences in root and manifestation of disorders is a crucial part
in the treatment of adoptees, and ought to be examined further. It is through the discussion of studies and
the factors that go into them that the adoption community will be able to get a better grasp on the question
of how adoption affects the mental health of adoptees.

The origins of adoption-related mental disorders:

A crucial part of the study of adoptee mental health is discovering what affects it. While it may
seem that the adoption process itself is the answer, what is it about the process that causes lifelong
psychological distress? Adoption studies often focus on the presence or absence of disorders, listing
adoption as the cause, rather than looking into why adoption can have such a profound effect on children.
In “Nature versus Nurture” Courtney Grenke examines the causes of externalizing disorders in adoptees.
Grenke found that while many adoptees exhibit externalizing behaviors, these behaviors are caused by
internalized issues that stem from their feelings towards their adoption, “These behavioral problems are
only outwards signs of emotional problems that have not yet been resolved including fear of becoming
attached, unresolved grief, a poor sense of identity, and depression.” Kenneth Watson takes the issue even
further, giving examples of things adoptees often say about their adoption:

They never ask, “Why did my birth parents arrange for my care by another set of parents?” or,
“Why did my birth parents transfer parental responsibility through legal action?” Instead they ask,
“Why did my parents give me away?”

Watson states that “It is the inexplicable ‘primal’ rejection that leaves adopted children with a weak core
at the center of their self-image,” which coordinates with Grenke’s finding that the presence of
externalizing behaviors is often linked to unresolved internalized issues.

In addition to a feeling of rejection, adoptees often feel that something is missing due to a lack of
knowledge about their past. The study “Adoptees in Search of Their Past: Policy Induced Strain on
Adoptive Families and Birth Parents” emphasized the importance finding information about their past can
hold for adoptees. The study found that when given access to a genetic search through Minnesota’s Open
Birth Record, 82.9% of adoptees requested more information about their origins, making “background or
genetic information,” the second most common request (Mark Simpson et al. 1981). The study included a
quote from Rod McKuen’s Finding My Father in regards to his own search for information about his
birth family:
It is impossible to understand how much some of us… need to know about our origins. Not to know
and to be aware that something happened back there is to feel not only unwanted, but incomplete.
To know. However painful the knowledge might be, is everything.

The “stress and coping model of adoption adjustment” theorizes that disorders and problematic behaviors
in adoptees are “determined largely by how they view or appraise their adoption experience and the type
of coping mechanisms they use,” (Brodzinsky 1993). Based on this model, it can be argued that it is not
just the fact that they were adopted, but the way that adoptees cope with feelings of loss and rejection,
that causes observable psychological differences between adoptees and non-adoptees.

The differences between the mental health of adoptees and non-adoptees:

While adoptee studies are littered with problems, evidence points to a correlation between
adoption and mental health. For many adopted children, adoption means a chance to enter a higher social
class and a more privileged life (Fergusson & Horwood 1998). When compared to other children in a
similar class and living a similar lifestyle, Fergusson & Horwood’s study found that “these children
entered relatively privileged home environments but… had rates of problem behaviors that were
atypically high for children reared in such environments.” However these behaviors and disorders are not
necessarily debilitating, and many adoptees function normally, but express problematic behaviors with
higher frequency than non-adoptees (Brodzinsky 1993). Notably, in a study conducted in the Netherlands,
it was found that “adoptees with high parental socioeconomic status were 2.17 times as likely to meet the
criteria for a disorder as non-adoptees with high parental socioeconomic status,” (Tieman et.al 2005).
Similarly, while many children, particularly teenagers, may lack self-esteem or feel as if they are
misunderstood, the chance of this being seen in adoptees is greater (Watson 1995). The feeling of
rejection that adoptees may face can seriously damage self-esteem and be detrimental to their sense of
self. Because many adoptive parents do not understand how their children could feel that way, they often
attempt to deny the child’s feelings, which can make the child misunderstood. Watson notes the
importance of breaking that habit:

“It means letting children ‘own’ their feelings of pain and despair, even if things do not appear to
us as the children see them…. Children who are hurting must sense that those adults who wish to
help them are not denying them the pain they are experiencing.”

Tieman’s study in the Netherlands found that adopted teenagers were 1.52 times as likely to meet the
criteria for an anxiety disorder as non-adopted teenagers, 2.05 times as likely to meet the criteria for
substance abuse and male adoptees were 3.76 times as likely to have a mood disorder. Based on the 13.9
year follow-up period and use of DSM-IV based diagnoses, this study is able to provide more accurate
results than others may (Tieman et.al 2005).

While studies will continue to debate the correlation between adoptees and non-adoptees, the
majority of results indicate a positive correlation, showing an increased chance of mental disorders in
adoptees, likely due to the traumatic experiences and emotions that come with the adoption process.

Differential treatment of adoptees:

It is not uncommon for adoptees to be referred to mental health professionals that specialize in the
treatment of adoptees. In nearly every aspect of mental health treatment, adoptees are treated differently,
“Adoptees are distinguished from non-adoptees in clinical settings in terms of several admission,
discharge, and treatment characteristics,” (Brodzinsky 1993). This difference in treatment brings up the
question: should adoptees be treated differently than non-adoptees? While yes, adoptees face different
psychological issues than non-adoptees, they should not be diagnosed with their adoption taken into
consideration. The overrepresentation of adoptees in clinical studies and populations is due to the fact that
adoptees have a higher likelihood of coming in contact with mental health services (Fergusson &
Horwood 1998). The stigma applied to adoptees can cause adoptive parents to seek psychological
treatment preemptively and with less prompting than non-adoptive parents may for their children (Grenke
2012). By entering the clinical world with assumed problems, one risks not being assessed adequately.
Adoptees are often assumed to have certain problems, and are thus assessed primarily for those issues,
making many adoption studies “not generalizable to the broader population of adoptees,” (Brodzinsky
1993). Adoptive parents and those that interact with the children have pre-conceived notions about what
issues the children may have, and those can created biased studies. In order to get more accurate results, it
would be helpful to assess adoptees as they would any other child, and interview the child, rather than
only speak to those around them, a flaw that is pointed out in a number of meta-analyses. As Grenke aptly

Adopted children and their parents are typical children and parents. Researchers need to begin to
view adoption as a normal way of life and begin to focus on the normal developmental issues that
arise in all types of families.

While it could be argued that adoptees do need to be treated differently because of their unique
circumstances, differential treatment can be harmful to adoptees and their families. In mixed race
adoptive families, the adopted child is a different race than their adoptive parents, and it is often clear that
the child is not the parent’s biological offspring. This noticeable difference between adoptees and their
parents can expose them to questions and statements that whether intentionally or not, can cause serious

It is also true that adopted children and their families encounter many probing questions that can
make them feel vulnerable. Questions such as “Is this your real mother?” to “Where did you get
your blonde hair?” can cause extreme frustration, hurt or problems within an adopted family
(Grenke 2012).

In certain medical situations it is important for adoptees to be treated differently, mainly due to a lack of
family medical history, but when it comes to psychological assessment and treatment, differential
treatment is not necessarily helpful and can lead to bias-based diagnoses.

To gain a more complete understanding of how adoption affects the mental health of adoptees, it
will be necessary to conduct more studies that take the time to interview and evaluate adoptees without
significant bias. This may be a difficult task, but by using standard psychological evaluation methods, it
can be done. By evaluating adoptees as people who may be at psychological risk rather than as adoptees
who they already think are at psychological risk, researchers will be able to gain insight into how different
the mental health of adoptees truly is.
Works Cited

"Adoption Statistics." American Adoptions - America's Adoption Agency,


Brodzinsky, David M. "Long-term Outcomes in Adoption." The Future of Children, vol. 3, no. 1,

Spring 1993, pp. 153-66.

Brodzinsky, David M., and Ellen Pinderhughes. "Parenting and child development in adoptive

families." Parenting Handbook, edited by Marc H. Bornstein, 2nd ed., Lawrence

Erlbaum Associates, pp. 279-312.

"Fact Sheet | Off and Running." POV - Acclaimed Point-of-View Documentary Films, 7 Sept.

2010, www.pbs.org/pov/offandrunning/fact-sheet/.

Fergusson, David M., and L John Horwood. "Adoption and Adjustment in Adolescence."

Adoption & Fostering, vol. 22, no. 1, 1998, pp. 1-18.

Grenke, Courtney Janaye. "Nature versus Nurture: A Study of Adopted and Biological Children

and their Behavioral Patterns." Liberty U, 2012. Manuscript.

Juffer, Femmie, and Marinus H. Van IJzendoorn. "Behavior Problems and Mental Health

Referrals of International Adoptees." Journal of the American Medical Association, vol.

293, no. 20, May-June 2005, pp. 2501-15.

Keyes, Margaret A., et al. "The Mental Health of US Adolescents Adopted in Infancy." Archives

of Pediatrics and Adolescent Medicine, vol. 162, no. 5, May 2008, pp. 419-25.

Schechter, Marshall D Sch, et al. "Emotional Problems in the Adoptee." Archives of General

Psychiatry, vol. 10, Feb. 1964, pp. 109-18.

Simpson, Mark, et al. "Adoptees in Search of Their Past: Policy Induced Strain on Adoptive

Families and Birth Parents." Family Relations, vol. 30, no. 3, July 1981, pp. 427-34.
Tieman, Wendy, et al. "Psychiatric Disorders in Young Adult Intercountry Adoptees: An

Epidemiological Study." American Journal of Psychiatry, vol. 162, no. 3, Mar. 2005, pp.


Watson, Kenneth. "Self Esteem and Adoption." Point of View, 1995, pp. 1-2.