International adoption involves both risk and protection for later adjustment. International adoptees often experience adverse conditions inthe time before adoption, placing them at risk of developing mentalhealth problems. Theadolescent years can be especially challenging, as questions related to identity and unknown origins emerge. Adoption can also be protective, with fewer problems among adoptees than among children who are left in subpar conditions inthe country where they were born. Such findings have led researchers to claim that international adoptees show remarkable resilience. Nevertheless, resilience factors and their associations with mentalhealth problems have not been investigated ininternationally adopted adolescents previously. Likewise, little is known in this group about alcohol and drug use, which is associated with mentalhealth problems inadolescence and which may be an important marker of maladjustment. The main objective ofthe present thesis was to investigate theadjustment ofinternational adoptees intheadolescent years, focusing on mentalhealth problems. More specifically, the objectives were to a) compare the occurrence ofmentalhealth problems ininternationally adopted adolescents to their non-adopted peers and b) investigate resilience (e.g. family cohesion and personal competence) and problematic alcohol and drug use, and whether these factors are related to mentalhealth problems.
To accomplish this, thementalhealthofinternationally adopted adolescents was investigated using a meta-analytic approach and by obtaining new data from an epidemiological study. Inthe meta-analysis, findings from a heterogeneous set of 11 studies were included. Inthe epidemiological study, data from the youth@hordaland-survey was linked to theNorwegian Central Adoption Registry. A total of 12,257 adolescents aged 16-19 years old participated, of whom 45 were identified as internationally adopted. Information on demographics, mentalhealth problems, resilience factors, and indicators ofalcohol and drug use were collected via self-report.
Results both from the meta-analysis and the youth@hordaland-survey indicated that internationally adopted adolescents reported more mentalhealth problems than non-adopted peers. The combined effect estimates for 11 studies included inthe meta-analysis were 0.16 (95% CI 0.03-0.28) for questionnaire-based studies and 0.70 (95% CI 0.50-0.90) for registry studies when comparing adoptees to their non-adopted peers. The results varied significantly according to outcome measure. Studies using categorical measures, indicating more serious mentalhealth problems, yielded larger effect estimates than studies investigating symptoms through the use of continuous measures. The sample ofinternational adoptees from the youth@hordaland-survey reported more symptoms of depression, obsessive compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD) and perfectionism than their non-adopted peers, while no difference was found foranxiety. Although they reported more mentalhealth problems, theadoptees displayed similar levels of resilience to their non-adopted peers and there were no significant group differences intheassociations between resilience and mentalhealth problems. Theadopted adolescents reported more problematic alcohol and drug use, although there were no significant differences inthe pattern and frequency of use. The differences in problematic alcohol and drug use could largely be explained by differences inmentalhealth problems, measured as symptoms of depression and ADHD.
These findings confirm adolescence as a potentially difficult period forinternationally adopted adolescents, who display more mentalhealth problems than their non-adopted peers and more problematic alcohol and drug use. Importantly, theinternational adoptees reported a similar level of resilience to their peers. The resilience factors identified in this thesis are strengths that can form the basis for preventive efforts. It is important to acknowledge both theincreased risk and the resilience these adolescents demonstrate, and to provide adequate help when needed.
All three papers were published ininternational peer-reviewed journal, and were also included in Kristin Gärtner Askeland?s PhD/doctoral thesis, which was publicly defended in January 2017.
Aforth paper using data from the HUNT3-study linked to theadoption registry was submitted for publication in January 2017, focusing on both somatic and mentalhealthamong adult national adoptees, compared to stepchild adoptees and non-adopted.
Adoption can be viewed as an intervention for children with a difficult start in life, with a goal of improving their potential for positive development. Prior studies report major improvements in children's early development following adoption, however, adoptees are considered to be at risk for developing mental disorders. They also show poorer school performances than their non-adopted peers, though their cognitive competence is similar. We suggest that mentalhealth problems can be one ofthe factors u nderlying these differences. There is little information available on mental distress among adoptees, and the possible relationships between mental distress, resilience and educational outcomes. Theaim of this project is to examine these relationships, and how they develop over time.
This project has theadvantage of identifying adoptees by utilizing theNorwegian Central Adoption Registry, ensuring that adoptees are correctly identified, which has traditionally been a challenge inadoption research. T he adoption registry will be linked to several large population-based health surveys. Four ofthe papers will be based on data from the longitudinal Bergen Child Study (BCS). The first waves of BCS include about 7000 participants, while the fourth wave (a lso called ung@hordaland) include 10 200 participants. Data from BCS will also be linked to official data on school absence and grade point averages provided by Hordaland County. Two papers will be based on data from the two most recent waves ofthe Nord- Trøndelag Health Studies, including about 74 000 participants in HUNT2 and 48 289 in HUNT3.
Findings from this project could help improve educational and health related services given to adoptees and adoptive parents, and form the basis for preventive int erventions aimed at helping adopted children. Inaddition, it can shed light on some ofthe factors that promote positive development inadopted children through thestudyof resilience.