Health Care Support Issues for Internationally Adopted Children: A Qualitative Approach to the Needs and Expectations of Families

International audienceBACKGROUND: Families of internationally adopted children may face specific problems with which general practitioners (GPs) may not be familiar. The aim of the study was to explore problems faced by families before, during and after the arrival of their internationally adopted child and to assess the usefulness of a specific medical structure for internationally adopted children, which could be a resource for the GP. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study using individual semistructured guided conversations and interviewed 21 families that had adopted a total of 26 children internationally in the Puy de Dome department, France, in 2003. Quantitative data were used to describe the pathologies diagnosed and the investigations performed.Our study showed that the history of these families, from the start of the adoption project to its achievement, is complex and warrants careful analysis. Health-care providers should not only consider the medical aspects of adoption, but should also be interested in the histories of these families, which may play a role in the forming of attachments between the adoptee and their adoptive parents and prevent further trouble during the development of the child. We also showed that adoptive parents have similar fears or transient difficulties that may be resolved quickly by listening and reassurance. Most such families would support the existence of a specific medical structure for internationally adopted children, which could be a resource for the general practitioner. However, the health-care providers interviewed were divided on the subject and expressed their fear that a special consultation could be stigmatizing to children and families. CONCLUSIONS/SIGNIFICANCE: A specific consultation with well-trained and experienced practitioners acting in close collaboration with GPs and paediatricians may be of help in better understanding and supporting adopted children and their families

Attachment states of mind and couple relationships in couples seeking to adopt

We present the results of a study carried out in Italy with 39 Italian couples seeking to adopt, aged between 35 and 45 years, and 39 matched non-adoptive couples which compared their attachment states of mind with respect to caregivers and partners and quality of couple relationship. Both partners of the couples completed individually measures of attachment to caregiver (Adult Attachment Interview; AAI), attachment to partner (Current Relationship Interview; CRI and Experiences in Close Relationships Scale-Revised; ECR-R) and marital quality (Dyadic Adjustment Scale; DAS). The results showed that couples seeking to adopt did not differ from the control group with respect to attachment to caregivers (AAI). However potential adoptive fathers were more likely to show secure attachment classifications with respect to partner (CRI) than non-adoptive fathers. Finally, couples seeking to adopt expressed higher levels of positive feelings and thoughts within the couple relationship (ECR-R) and better perceived quality of marital relationship (DAS) than the control group. Overall, these findings suggested that couples seeking to adopt placed a high value on attachment relationships, which is considered a relevant factor for positive outcome of adoption

Precocious Puberty in Internationally Adopted Girls

peer reviewedIn internationally adopted girls a high frequency of precocious puberty has been reported in series of patients, and a low age at menarche has been reported from retrospective cohort studies. Data estimating the risk of precocious pubertal development suggests a highly increased risk in internationally adopted girls, possibly related to country of origin and age at adoption. Genetic factors, intrauterine growth retardation, nutritional status prior to adoption, pre- and post adoption growth patterns as well as environmental exposures and psychological stress has been hypothensized to trigger early puberty. However, the mechanism behind precocious and early puberty in adopted girls is still unknown, and central as well peripherally mediated puberty has been suggest. In daily clinical practice, the challenge is therefore to establish guidelines that ensure appropriate recognition of those adopted children who need medical examinations for precocious puberty and to identify the subgroup of patients who will benefit from treatment with GnRH analogs. Prospective, longitudinal studies on growth and development in internationally and domestic adopted children are neaded to disentangle these questions and to understand the pathophysiology