Attention Deficit and Hyperactivity Disorder (ADHD)
in Internationally Adopted Children in Spain
Neus Abrines Jaume, email@example.com
Marre, D; Brun, C.; Fornieles, A.; Barcons, N.; Fumadó, V.
2010 Meeting of the Society for Cross-Cultural Research
SCCR/SASci/AAACIG. Albuquerque, New México.
1. Framework of the research project
Framework of the research project
Risk factors and Resilience in Internationally Adopted children
Research project MEC R+D SEJ 2006-2009 15286
International Adoption: social and familial inclusion of the
internationally adopted children. Interdisciplinary and comparative
Period 2010-2012: National and international adoption: family,
education and pertinence: interdisciplinary and comparative
perspectives. (CSO2009-14763-C03-01) (subprogram SOCI)
2. Theoretical Introduction
ADHD: Prevalence and Etiology
ADHD: Attention Deficit and Hyperactivity Disorder
Defined as a neurobiological disorder
Prevalence: 3 – 7% of children (higher among boys)
ADHD: Diagnostic criteria (DSM-IV)
(6 or more symptoms) IMPULSIVITY
(6 or more symptoms)
Often has difficulties with:
• Giving close attention to Often:
details. • Runs about excessively
• Sustaining attention • Acts as if “driven by a
• Listening motor”
• Following through • Talks excessively
instructions • Has difficulty waiting
• Organizing tasks and his/her turn
activities • Interrupt
• Symptoms must appear before the age of 7
• One of the symptoms is presented in two different situations
(for example, at home and in the school).
• Cognitive Behavior
• Methylphenidate • Social Abilities Training
• Parent training
A marked increase of ADHD diagnostics in
internationally adopted children it’s been observed
(Bimmel et al. 1990; Verrier, 2003), and this incidence seems to
be higher among children adopted from Eastern Europe
countries (Lindblad et al., 2010; Gunnar & Van Dulmen, 2007).
In International Adoption, there are several risk factors
which can favor the existence of Attachment Disorders
and these disorders seem to be related to the ADHD
symptomatology. (Franc et al., 2009; Niederhofer, 2009; Erdman,
Parenting styles are related with the ADHD symptomatology
and the attachment disorders (Finzi-Dottan, Manor, & Tyano, 2006;
The existence of pre-adoptive and post-adoptive factors,
which favor the appearance of ADHD-like symptoms, it’s
been observed (Bimmel et al., 2003). These symptoms can lead
to misdiagnosis of ADHD and can be followed by an
Hº 1: Differences in the frequency of ADHD-like symptoms,
depending on the country of origin, will be found.
Adopted in Adopted in
Europa de l’Est
With ADHD-like With ADHD-like
Hypothesis and objectives
Hº 2: The relation between some factors and the existence of
ADHD-like symptoms will be observed.
Attachment Age at
Children aged 7 and 8 years.
Inclusion requirement: Minimum of 2 years since the adoption date.
N = 58 (total sample 200)
More frequent countries of origin
Adopted in Russia Adopted in Adopted in
(n = 24) Ethiopia China
(n = 11) (n = 23)
Girls: 12 Boys: 6 Boys: 0
Girls: 5 Girls: 23
Family data questionnaire
• Behavioral Assessment System for Children (BASC) (Reynolds y Kamphaus, 1992)
o Attention problems
• Egna Minnen Beträffande Uppfostran (EMBU)
(Perris, Jacobsson, Lindström, Von Knorring, and Perris, 1980)
o Emotional warmth
• Friends and Family Interview (FFI) (Steele & Steele, 2006)
o Semi-structured interview (30 min.)
o Video-recorded and transcribed
o Double coded (Reliability inter-raters = 90%)
o Assess the attachment pattern according to:
1. Coherence 5. Peer relations
2. Reflective functioning 6. Sibling relations
3. Evidence of secure base 7. Anxieties and defense
4. Evidence of self esteem
1. Contact the Pediatric Service of the Hospital Sant Joan de Déu,
specialized in international adoption.
2. Select the sample, according to the age.
3. Invite the families to participate
4. Inform and give an appointment to the families who showed their interest.
5. Assess the child (45 min.)
6. Obtain the results of the assessment
7. Return to the families a Psychological report
8. Statistical analysis of the data
Hyperactivity and country of origin
15 Clinical scores
Russia China Ethiopia
Attention problems and country of origin
15 Clinical scores p: 0,02
Russia China Ethiopia
Girls from HYPERACTIVITY
Age at adoption (months)and country of origin Results
China Age at
Russia Ethiopia China
Hyperactivity and age at adoption (months)
10 21,97 p:0,02
Normal scores Clinical scores
Overprotection correlates with: Rejection correlates with:
• Hyperactivity. (Pearson’s r = .31; p: 0,05) • Attention problems.
(Pearson’s r = .31; 0.05)
• Attention problems. (Pearson’s r = .37; p: 0.01)
An Insecure attachment is related with more rejective parents (p: 0.04):
1. Girls adopted from China show less Hyperactivity symptoms.
2. When older adopted, the probability to show Hyperactivity symptoms
3. The secure attachment pattern seems to be related to less existence of
4. An overprotective parent style correlates with Hyperactivity and Attention
5. A rejective parent style correlates with Attention problems.
6. An Insecure attachment seems to be related with more rejective parents.
Limitations of the research project:
o Size of the sample
o Unequal distribution of the groups
o Absence of a control group from general population
To the Pediatric Service of the Hospital Sant Joan
de Déu, (Barcelona).
To all the families who participate in the research