International adoption: Symptoms of attachment disorders and their associations with the child’s background and developmental outcome

Many internationally adopted children have lived their first years of life in an environment with limited opportunities for primary caregiving. The lack of consistent care increases the prevalence of attachment disorders among them. Less is known about the influences of attachment disorders on a child’s later course of life. This study is part of the Finnish Adoption Study. Parents of all Finnish children who had been internationally adopted by legal adoption organisations between 1985 and 2007 were sent questionnaires (N=1450). Parental evaluations of the children’s symptoms of reactive attachment disorder (RAD) at the time of adoption, their later learning or language problems using a screening scale, and children’s self-reported school bullying experiences were evaluated. Each child’s attachment-related behavioural problems were requested in a follow-up survey 1.9 and 3.8 years after adoption and compared with a Finnish reference group. This study indicated that Finnish internationally adopted children have at least three-fold prevalence of learning and language problems compared with their age-mates. A child’s symptoms of attachment disorders were associated with learning or language problems at school age as well as with his/her school bullying experiences. The adopted children had more attachment-related behavioural problems two years after adoption than their age-mates, but the difference was no longer evident four years after adoption. In conclusion, this study showed that the symptoms of attachment disorder indicate a risk for an adopted child’s later developmental outcome. The findings demonstrate the need for comprehensive clinical examinations and planning of treatment strategies for children with symptoms of RAD.Monet ulkomailta adoptoidut lapset ovat eläneet ensimmäisen elinvuotensa ympäristössä, jossa ei ole ollut mahdollisuutta muodostaa suhdetta yhteen pääasiallisesti lasta hoivaavaan aikuiseen. Pysyvän hoivaajasuhteen puutteen tiedetään lisäävän kiintymyssuhdehäiriöiden esiintyvyyttä. Vähemmän kuitenkin tiedetään näiden häiriöiden vaikutuksista lapsen myöhempään kehitykseen. Tämä tutkimus on osa suomalaista FinAdo- tutkimusta (Finnish Adoption Study). Tutkimuksessa lähetettiin kyselylomakkeita kaikille vuosina 1985-2007 adoptiojärjestöjen kautta adoptoitujen lasten vanhemmille ja lapsille itselleen (N= 1450). Vanhemmat arvioivat lapsen reaktiivisen kiintymyssuhdehäiriön oireita adoption jälkeen, lapsen senhetkisiä oppimiseen ja kielenkehitykseen liittyviä ongelmia, sekä lapsilta itseltään kysyttiin heidän koulukiusauskokemuksistaan. Tämän lisäksi arvioitiin muutosta osalle lapsista toteutettavassa kiintymyssuhdekäyttäytymisen seurantatutkimuksessa 1,9 ja 3,8 vuotta adoption jälkeen. Tuloksia verrattiin suomalaiseen verrokkiryhmään. Tutkimus osoittaa, että suomalaisilla adoptiolapsilla on vähintään kolme kertaa enemmän oppimisen ja kielenkehityksen ongelmia kuin heidän ikätovereillaan. Oppimisen ja kielenkehityksen ongelmia sekä koulukiusauskokemuksia oli enemmän niillä lapsilla joilla oli tulovaiheessa kiintymyssuhdehäiriön oireita. Adoptoiduilla lapsilla oli enemmän kiintymyssuhdekäytöksen ongelmia kuin verrokkilapsilla kaksi vuotta adoption jälkeen, mutta ero ikätovereihin ei ollut nähtävissä enää neljä vuotta adoptiosta. Tutkimuksen johtopäätöksenä voidaan todeta, että adoption jälkeiset kiintymyssuhdehäiriön oireet ovat merkki riskistä myöhemmille kehityksen ongelmille. Tutkimus osoittaa laaja-alaisen kehityksellisen arvion ja hoitosuunnitelman tarpeellisuuden mikäli lapsella on näitä oireita.Siirretty Doriast

Miksi ja miten autismin diagnostiset kriteerit muuttuvat?

Vertaisarvioitu. English summary• Laaja-alaisiin kehityshäiriöihin luokitellut erilliset diagnoosit, kuten autismi ja Aspergerin oireyhtymä, on poistettu diagnostisista luokituksista DSM-5 ja ICD-11. • Ne on korvattu diagnoosinimikkeellä autismikirjon häiriö. • ICD-11:ssä häiriön alatyypit luokitellaan tarkentavilla koodeilla älyllisen kehityksen ja kielenkäytön häiriön mukaan. • Ydinoireet jaetaan 1) pysyviin puutteisiin kyvyssä vastavuoroiseen sosiaaliseen vuorovaikutukseen ja kommunikointiin sekä 2) rajoittuneisiin, toistaviin ja joustamattomiin käyttäytymismalleihin ja kiinnostuksen kohteisiin.Peer reviewe

Do the Temperamental Characteristics of Both Mother and Child Influence the Well-Being of Adopted and Non-Adopted Children?

(1) Background: For decades, the temperaments of infants and small children have been a focus of studies in human development and been seen as a potential contributor to children’s developmental patterns. However, less is known about the interplay between the temperamental characteristics of mothers and their children in the context of explaining variations in developmental outcomes. The aim of our study was to explore the associations—with or without genetic links—of the temperaments and psychological distress of mothers and the temperaments of children with behavioral problems in a group of internationally adopted children and their adoptive mothers and in a group of non-adopted children and their mothers. (2) Methods: Data (n = 170) were derived from the ongoing Finnish Adoption (FinAdo) follow-up study. The children included were under the age of 7 years; 74 were adopted internationally through legal agencies between October 2010 and December 2016, and the remaining 96 were non-adopted children living with their birth parents (biological group) recruited from day-care centers. We used Mary Rothbart’s temperament questionnaires to assess temperament, the Child Behavior Checklist (CBCL) to obtain data on the children’s behavioral/emotional problems and competencies, and the General Health Questionnaire (GHQ) to assess parental psychological distress. The study was approved by the Ethics Committee of the Hospital District of Southwest Finland, and written informed consent was obtained from the parents and the children themselves. (3) Results: The negative affectivities of both mothers and children were associated with the total CBCL and with both internalizing and externalizing problem behaviors after adjusting for age, gender, and adoption status. Both relationships remained significant when tested simultaneously, suggesting additive effects. Maternal negative affect was associated with problem behavior irrespective of child extraversion/surgency. Child extraversion/surgency was associated with lower levels of all internalizing behavioral problems when adjusted for maternal sociability. Child negative affect was associated with all behavioral problem measures irrespective of maternal sociability or maternal psychological distress. Maternal distress was associated with child problem behaviors only in children with low extraversion/surgency. (4) Limitations: The sample size was relatively small, and the information was gathered solely with questionnaires. (5) Conclusions: The results of the study may be clinically significant. Child negative affect, maternal negative affect, and maternal experienced distress, combined with low child extraversion/surgency, may increase the risk of child problem behaviors in both adoptees and non-adoptees

Do the Temperamental Characteristics of Both Mother and Child Influence the Well-Being of Adopted and Non-Adopted Children?

(1) Background: For decades, the temperaments of infants and small children have been a focus of studies in human development and been seen as a potential contributor to children’s developmental patterns. However, less is known about the interplay between the temperamental characteristics of mothers and their children in the context of explaining variations in developmental outcomes. The aim of our study was to explore the associations—with or without genetic links—of the temperaments and psychological distress of mothers and the temperaments of children with behavioral problems in a group of internationally adopted children and their adoptive mothers and in a group of non-adopted children and their mothers. (2) Methods: Data (n = 170) were derived from the ongoing Finnish Adoption (FinAdo) follow-up study. The children included were under the age of 7 years; 74 were adopted internationally through legal agencies between October 2010 and December 2016, and the remaining 96 were non-adopted children living with their birth parents (biological group) recruited from day-care centers. We used Mary Rothbart’s temperament questionnaires to assess temperament, the Child Behavior Checklist (CBCL) to obtain data on the children’s behavioral/emotional problems and competencies, and the General Health Questionnaire (GHQ) to assess parental psychological distress. The study was approved by the Ethics Committee of the Hospital District of Southwest Finland, and written informed consent was obtained from the parents and the children themselves. (3) Results: The negative affectivities of both mothers and children were associated with the total CBCL and with both internalizing and externalizing problem behaviors after adjusting for age, gender, and adoption status. Both relationships remained significant when tested simultaneously, suggesting additive effects. Maternal negative affect was associated with problem behavior irrespective of child extraversion/surgency. Child extraversion/surgency was associated with lower levels of all internalizing behavioral problems when adjusted for maternal sociability. Child negative affect was associated with all behavioral problem measures irrespective of maternal sociability or maternal psychological distress. Maternal distress was associated with child problem behaviors only in children with low extraversion/surgency. (4) Limitations: The sample size was relatively small, and the information was gathered solely with questionnaires. (5) Conclusions: The results of the study may be clinically significant. Child negative affect, maternal negative affect, and maternal experienced distress, combined with low child extraversion/surgency, may increase the risk of child problem behaviors in both adoptees and non-adoptees

The effects of maternal depression on their perception of emotional and behavioral problems of their internationally adopted children

Background Even though child psychopathology assessment guidelines emphasize comprehensive multi-method, multimodal, and multi-informant methodologies, maternal-report symptom-rating scales often serve as the predominant source of information. Research has shown that parental mood symptomatology affects their reports of their offspring's psychopathology. For example, the depression-distortion hypothesis suggests that maternal depression promotes a negative bias in mothers' perceptions of their children's behavioral and emotional problems. We investigated this difference of perception between adoptive mothers and internationally adopted children. Most previous studies suffer from the potential bias caused by the fact that parents and children share genetic risks. Methods Data were derived from the Finnish Adoption (FinAdo) survey study (a subsample of adopted children aged between 9 and 12 years, n = 222). The Child Behavior Checklist (CBCL) was used to assess emotional and behavioral problems and competences of the adopted children. The CBCL was filled in by the adopted children and the adoptive mothers, respectively. Maternal depressive symptoms were measured using the short version of the General Health Questionnaire. Results On average, mothers reported less total CBCL symptoms in their children than the children themselves (0.25 vs 0.38, p-value < 0.01 for difference). Mothers' depressive symptoms moderated the discrepancy in reporting internalizing symptoms (beta = - 0.14 and p-value 0.01 for interaction) and the total symptoms scores (beta = - 0.22 and p-value < 0.001 for interaction) and externalizing symptoms in girls in the CBCL. Limitations The major limitation of our study is its cross-sectional design and the fact that we only collected data in the form of questionnaires. Conclusions The results of our research support the depression-distortion hypothesis concerning the association of maternal depressive symptoms and child internalizing symptoms and externalizing symptoms in girls in a sample without genetic biasPeer reviewe

Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders

Background: Our study addressed the gap in research on the effectiveness of cognitive behavioral therapy (CBT) in treating children with mixed psychiatric disorders. We examined the immediate and long-term effects of group CBT (GCBT), delivered in naturalistic clinical settings, on reducing internalizing and externalizing symptoms in children with mixed psychiatric disorders. Further, we compared the effectiveness of cost-effective, manualized GCBT to treatment as usual (TAU) consisting of individually tailored psychiatric outpatient services delivered by mental health care specialists. Methods: Children aged 6–12 years (n = 103) diagnosed with psychiatric disorders, more than 70% with psychiatric comorbidity, were assigned either directly to GCBT (GCBT group; n = 52) or TAU for approximately 3 months, after which they received GCBT (TAU + GCBT group; n = 51). Internalizing and externalizing symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Results: Parent- and teacher-rated internalizing symptoms and parent-rated externalizing symptoms were reduced immediately after GCBT. Long-term GCBT gains were prominent for parent-rated externalizing symptoms. No differences were observed between the effectiveness of GCBT and TAU. Conclusions: Our results suggest that GCBT and TAU services are equally effective in treating internalizing and externalizing symptoms in children with mixed psychiatric disorders, providing support for the broader use of cost-effective manualized GCBT. Manualized GCBT, which requires relatively short training, can also be delivered at primary healthcare levels. Our results are of relevance to cost-effectiveness and global mental health staff shortages

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families

Background Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study. Objective To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents. Methods To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age. Results Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls. Conclusions The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.Peer reviewe

Poor parental sleep did not predict future sleep problems in children aged 2-6 years

Peer reviewe

Child Eveningness as a Predictor of Parental Sleep

Child eveningness has been associated with many adverse outcomes for children. The aim of this study was to assess whether child eveningness poses a risk to parental sleep quality in follow-up. A total of 146 children (57% adopted, 47% boys, mean age at follow-up 5.1 years [standard deviation 1.7]) completed a 1-week actigraph recording to analyze their sleep twice, 1 year apart. The parents completed the Child ChronoType Questionnaire for their child and a short version of the Morningness–Eveningness Questionnaire for themselves and the Jenkins Sleep Scale for their sleep quality. Linear regression analyses showed that subjective parental sleeping problems at baseline were associated with subjective parental sleeping problems at follow-up. A morning-type child decreased the risk of parental sleeping problems at the 1-year follow-up compared to the child evening chronotype. Additionally, the child intermediate chronotype decreased the risk of maternal sleeping problems at the 1-year follow-up compared to the evening chronotype of the child. Parents of evening-type children experienced more sleeping problems in the follow-up, compared to parents of morning-type children. This finding encourages parents and professionals to steer the diurnal rhythm of evening-type children toward an earlier daily routine

Intestinal parasites may be associated with later behavioral problems in internationally adopted children

Aim At arrival in new home country, internationally adopted children often have intestinal parasites. International adoptees also exhibit more behavioral problems than their biological peers. We examined whether intestinal parasite infections in international adoptees on arrival in Finland are associated with their later behavioral and emotional problems. Methods Data for this study were sourced from the Finnish Adoption Study (FinAdo) based on parental questionnaires for all internationally adopted children under 18 years (n = 1450) who arrived in Finland from 1985 to 2007. A total of 1293 families provided sufficient information on the adoptee's background, parasitic status on arrival, and behavioral symptoms at the median time of 5 years after arrival (mean age = 7.8 years). Behavioral and emotional disorders were evaluated with the Child Behavior Checklist (CBCL). Statistical analyses were conducted using linear regression. Results Of the 1293 families, parents of 206 adoptive children reported intestinal parasites in their adopted children on arrival. Parasite-infected children had subsequently higher CBCL problem scores than the children without parasites (p <0.001). The association between intestinal parasites and later behavioral problems was stronger than that between intestinal parasites and any other factors measured in this study, except disability. Limitations The control group was naturally provided by the adopted children without parasite infections, but we could not compare the adopted children to non-adopted children without a defined parasite infection. We were unable to specify the effects associated with a specific parasite type. It was not possible either to include multiple environmental factors that could have been associated with behavioral problems in the models, which indicated only modest explanatory values. Conclusions In this study, intestinal parasite infections in early childhood may be associated with children's later psychological wellbeing, even in children who move to a country with a low prevalence of parasites. Our findings may support further developments pertaining to the gut-brain theory.Peer reviewe