A seminar presentation I made on the role mental health professionals are expected and required to play in adoption. The presentation was made for an Indian setting, covering briefly the Hindu Adoption Act and the Guardianship Act, but the major of the presentation is on why adoptees tend to have higher percentages of psychiatric problems, what adoption competent mental healthcare entails, and special emphasis on the process of disclosure to the child.

1. The Role of Mental Health Professionals in
Adoption

2. • Kunti: Son, I did not come simply in
the happy hope of clutching you to
my breast, but to take you back
where you by right belong. You are
not a charioteer’s son, but of royal
birth – so cast aside the insults that
have been your lot and come where
they all are – your five brothers
• Karna: But Mother, I am a
charioteer’s son, and Radha’s my
mother – glory greater than that I
have none. Let the Pandavs be
Pandavs, the Kauravs Kauravs – I
envy nobody.
• Kunti: With the puissance of your
arms recover the kingdom that’s your
own, my son. You, vanquisher of foes,
will live with your kinsmen, sole ruler
in your kingdom, sitting on your
jewelled throne, sharing power with
none.

3. • Karna: Throne, indeed! To one who’s
just refused the maternal bond are
you offering, Mother, assurances of a
kingdom? The riches from which you
once disinherited me cannot be
returned – it’s beyond your powers.
When I was born, Mother, from me
you tore mother, brothers, royal
family – all at one go.
• If today I cheat my foster-mother, her
of charioteer caste, and boldly
address as my own mother a royal
materfamilias, if I snap the ties that
bind me to the lord of the Kuru clan,
and lust after a royal throne, then fie
on me!

4. The Role of MHPs in Adoption
• Psychopathology in Adoptees: Fact or Artifact?
• Nature of Psychiatric Problems in Adoptees
• Etiological Factors
• Adoption Competent Clinical Practice
• Developmental Challenges in Adoption
• Telling the Adopted Child
– Laws on Adoption in India

5. Is there a Problem?
• Although it is estimated that only about 1-2 percent of all children
under 18 years of age are nonrelated adoptees, studies have shown
that the incidence of referral of this group for psychological/
psychiatric services significantly exceeds this figure
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)
• Adopted children comprise about 8-10% of all patients seen in
outpatient settings
Jerome, L. (1993). A comparison of the demography, clinical profile and treatment of adopted and non-adopted children
at a children’s mental health centre. Canadian Journal of Psychiatry, 38: 290-294.

6. INCREASED PSYCHOPATHOLOGY IN ADOPTEES: FACT OR ARTIFACT?
Are these elevated referral figures
1. An accurate reflection of the incidence of psychiatric problems
among adoptees?
2. Are figures so high that an ascertainment bias should be
suspected?
3. Do adoptive parents have a “lower threshold” for referral such
that they seek assistance for minor problems?
4. Since adoptive parents are better educated/ more affluent,
perhaps they are in a better position to recognize psychological
problems and obtain intervention?
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp
22-47 (1987)

7. Epidemiological data supports both hypotheses that
• The rate of psychiatric problems among the population of
adopted children and adolescents is lower than data from
clinic samples, lending support to the notion that adoptive
parents do have a relatively low threshold for psychiatric
referral
(Deutsch, 1990; Warren,1992)
AND
• Ascertainment bias notwithstanding, the bulk of the
evidences indicates that the rate of psychiatric problems
among adopted children and adolescents is still greater
than in the non-adopted population
(Brodzinsky, Schechter, Braff, & Singer, 1984; Brodzinsky, Radice, Huffman, & Merkler, 1987; Deutsch,
1990; Lindholm & Touliatos, 1980; Lipman, Offord, Racine, & Boyle, 1992 Verhulst, Versluisden Bieman,
& Althaus, 1990; Warren, 1992)

8. Referral Bias for Psychiatric Disorders in Adopted Children
• Higher Socio-economic Status
– More affluent / better educated than general population
– “Even when SES was controlled for, adoptees still are more likely
to be referred for Psychiatric treatment than non-adopted
children”
Warren, S.B. (1992). Lower threshold for referral for psychiatric treatment for adopted adolescents. Journal of the American Academy of
Child and Adolescent Psychiatry, 31: 512-527.
• Adoptive parents are simply more anxious about the health
and welfare of their children
– Expect to find adopted children disproportionately represented in
all medical settings
– “Adoptees were not significantly more likely to receive medical
services than non-adoptees”
Dalby, J.T., Fox, S.L., and Haslam, R.H.A. (1982). Adoption and foster care rates in pediatric disorders. Developmental and Behavioral Pediatrics, 3, 61-64.

9. Referral Bias for Psychiatric Disorders in Adopted Children
• Familiarity with Social-Service Agencies during adoption
process
– “Many adoptive parents do not use agencies, and among those
who do, contact is generally not extended”
Deutsch, C.K., Swanson, J.M., Bruell, J.H., Cantwell, D.P., Weinberg, F., and Baren, M. (1982). Overrepresentation of adoptees in children with the
Attention Deficit Disorder. Behavioral Genetics, 12: 231-238.
“In summary, we cannot satisfactorily account for the lower
threshold for psychiatric referral among adoptive families by
focusing on parent characteristics.
Perhaps, then, there is something about the nature and/or the
severity of psychiatric problems of adoptees that causes their
adoptive parents to be more likely to seek professional
intervention.”
Barbara D. Ingersoll (1997) Psychiatric Disorders Among Adopted Children, Adoption Quarterly, 1:1, 57-73

10. Nature of Psychiatric Problems Among Adoptees
• Studies done before DSM-III (1980) did not identify specific
diagnoses most characteristic of adoptees
– Consensus that adoptees were prone to acting-out behaviour
• parental defiance
• running away
• sexual acting out
• aggressive and antisocial behavior
• (Austad and Simmons, 1978; Bohman and Sigvardsson, 1980; Borgatta and Fanshel, 1965; Goodman, Silberstein, & Mandell, 1963; Menlove, 1965;
Schechter et al., 1964)
• Some investigators also specifically noted
– increased motor activity (Goodman et al., 1963; Menlove, 1965; Nichols and Chen, 1981)
– impulsivity (Nichols and Chen, 1981)
• “These descriptors suggest diagnoses of attention deficit
hyperactivity disorder (ADHD), oppositional defiant
disorder (ODD), and conduct disorder (CD)”
• Deutsch, C.K. (1990). Adoption and attention deficit disorder. In L.M. Bloomingdal and J.W. Swanson (Eds.), Attention deficit disorder IV: Current
concepts and emerging trends in attentional and behavioral disorders of childhood. New York: Pergamon Press, p. 67-79.

11. Nature of Psychiatric Problems Among Adoptees
• “Rate of adoption among ADHD children was approximately eight
times the prevalence of adopted children in the general population,
indicating that adopted children are, in fact, disproportionately
represented among children with ADHD”
Deutsch, C.K., Swanson, J.M., Bruell, J.H., Cantwell, D.P., Weinberg, F., and Baren, M. (1982). Overrepresentation of
adoptees in children with the Attention Deficit Disorder. Behavioral Genetics, 12: 231-238.
• “In the Colorado Adoption Project adopted boys were more likely to
be classified as at-risk for CD than non-adopted boys”
Coon, H., Carey, G., Corley, R., and Fulker, D.W. (1992). Identifying children in the Colorado Adoption Project at risk for
conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 503-511.
• A large-scale study of 2,148 international adoptees found that
adopted adolescent boys
– obtained particularly high scores on the Delinquent and Hyperactive scales of
the Child Behavior Checklist
– were more likely to have clinically severe externalizing disorders
Verhulst, F.C., and Versluis-den Bieman, H.J.M. (1995). Developmental course of problem behaviors in adolescent
adoptees. Journal of the American Academy of Child and Adolescent Psychiatry, 34: 151-159.

12. Nature of Psychiatric Problems Among Adoptees
• “Elementary school-age adopted children were rated higher by
teachers in conduct disorders, personality problems, and socialized
delinquency, but not in inadequacy-immaturity or psychotic signs”
Lindholm. B. W., & Touliatos. J. (1980). Psychological adjustment of adopted and nonadopted children.
Psychological Reports, 46, 307-3 10
• “Adopted children were rated by both mothers and teachers as
higher than non-adopted children in psychological and school-related
problems and lower in social competence and school achievement”
Brodzinsky et al (1984) Psychological and academic adjustment in adopted children. Journal of
Consulting and Clinical Psychology 52, 582-590

13. Nature of Psychiatric Problems Among Adoptees
• Most empirical work on adoption has been atheoretical in
nature
– making it difficult to interpret the patterns emerging from the
research.
• Failure to differentiate between related and nonrelated
adoptees
• Failure to control for mediating variables like
– age of placement
– pre-placement history
– Socioeconomic status
– family composition
• Frequent use of measures and procedures that are of
questionable reliability and validity
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47
(1987)

14. Nature of Psychiatric Problems Among Adoptees
“On the average, adopted children are more likely to manifest
psychological problems than nonadopted children.
On the other hand, it is also clear that only a minority of adopted
children manifest clinically significant symptomatology.”
“An examination of the relationship between children’s age and
patterns of adjustment suggests that the higher incidence of
psychological problems associated with adoption is restricted to
children in the middle childhood years and adolescence.”
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)
“Adopted children come to professional attention at higher-than-
expected rates in part because:
(a) they manifest a higher incidence of psychiatric problems than
do non-adopted children; and,
(b) their problems are mainly of the externalizing kind, which adults
find annoying and aversive.
Barbara D. Ingersoll (1997) Psychiatric Disorders Among Adopted Children, Adoption Quarterly, 1:1, 57-73

15. Etiology of Psychiatric Illnesses in Adoptees
• Environmental Factors
–Pre-Adoption Events
–Post-Adoption Events
• Genetic Factors

16. Environmental Factors: Pre-adoption
• Pre & Peri-natal events may adversely affect adoptees as
– most adopted children (at least those on whom most studies to
date are based) are born to young, unmarried mothers, a group
who often do not receive adequate prenatal care
Adams, H.M., and Gallagher, U.M. (1993). Some facts and observations about illegitimacy. Children, 10, 43-47.
– “Teenage pregnancies are associated with low birth-weight which
in turn is associated with behavioral and emotional problems in
childhood”
Breslau, N., Klein, N., and Allen, L. (1988). Very low birthweight: Behavioral sequelae at nine years of age. Journal of the American
Academy of Child and Adolescent Psychiatry, 27: 605-612.
– substance abuse during pregnancy places children at clear risk for
emotional and behavioral problems
– “birth parents of adoptees tend to be impulsive risk-takers so we
expect at least some to be substance abusers“
Smith, P.B., Nenney, S.W., Weinman, M.L., and Mumford, D.M. (1982). Factors affecting perception of pregnancy risk in the
adolescent. Journal of Youth and Adolescence, 11: 207- 217.

17. Environmental Factors: Pre-adoption
• “early environmental adversities were associated with
higher levels of later problems
Verhulst, F.C., Althaus, M., and Versluis-den Bieman, H.J.M. (1992). Damaging backgrounds: Later adjustment of international adoptees.
Journal of the American Academy of Child and Adolescent Psychiatry, 31: 518-524.
• “Such events have a deleterious effect not only on a child’s
psyche, but on the developing nervous system itself, thus
paving the way for later learning, behavior, and emotional
problems”
Barbara D. Ingersoll (1997) Psychiatric Disorders Among Adopted Children, Adoption Quarterly, 1:1, 57-73
•Abuse Neglect
•Malnutrition Poor medical care
•Lack of adequate stimulation
•Weak or ruptured relations with caretakers

18. Pre-Adoption Biological Ramification-1
• “ It is common to observe elevated levels of cortisol (which indicate
increased activation of the HPA axis) in individuals experiencing many
types of chronic stress.
• Looked-after children more commonly display a pattern of blunted
cortisol production”
Kertes, D.A., Gunnar, M.R., Madsen, N.J., & Long, J.D. (2008). Early deprivation and home basal cortisol levels: A study of internationally adopted
children. Development and Psychopathology, 20, 473–491.
• Typically, cortisol levels diurnally peak shortly after awakening in the
morning. These levels then decrease rapidly throughout the morning
and are extremely low by bedtime.
• In contrast, the pattern of HPA dysregulation for looked-after children
involves low morning cortisol levels that remain low throughout the day
Bruce, J., Fisher, P.A., Pears, K.C., & Levine, S. (2009). Morning cortisol levels in preschool-aged foster children: Differential effects of maltreatment
type. Developmental Psychobiology, 51, 14–23.
• May be a ‘down regulation’ of the system as a protective response to
the absence of responsive care
van der Vegt, E.J.M., van der Ende, J., Kirschbaum, C., Verhulst, F.C., & Tiemeier, H. (2009). Early neglect and abuse predict diurnal cortisol patterns in
adults: A study of international adoptees. Psychoneuroendocrinology, 34, 660–669.

19. Pre-Adoption Biological Ramification-2
• “On neuropsychological tests that tap domains of executive
functioning, such as working memory and inhibitory control, foster
children perform poorly”
Lewis, E.E., Dozier, M., Ackerman, J., & Sepulveda-Kozakowski, S. (2007). The effect of placement instability on adopted children's inhibitory control
abilities. Developmental Psychology, 43, 1415–1427.
Pears, K.C., Kim, H.K., & Fisher, P.A. (2008). Psychosocial and cognitive functioning of children with specific profiles of maltreatment.Child Abuse and
Neglect, 32, 958–971.
• “We found differential patterns of brain activation for foster and
for non-maltreated children on a computer task that requires
children to exhibit inhibitory control”
Bruce, J., Fisher, P.A., Graham, A.M., Moore, W.E., III, Peake, S.J., & Mannering, A.M. (2013). Patterns of brain activation in foster children and
nonmaltreated children during an inhibitory control task. Development and Psychopathology, 25, 931–941.
• “Lower levels of activation (ERP) in the prefrontal cortex in
response to feedback were found among foster children during an
error-monitoring task”
Bruce, J., McDermott, J.M., Fisher, P.A., & Fox, N.A. (2009). Using behavioural and electrophysiological measures to assess the effects of a preventive
intervention: A preliminary study with preschool-aged foster children. Prevention Science, 10, 129–140.

20. Environmental Factors: Post-Adoption
• “A poor fit between an adoptee’s innate abilities and parental
expectations might lead to emotional problems among some adopted
children”
Jerome, L. (1994). Adoption and psychiatric referral: Letter to the editor. Journal of the American Academy of Child and Adolescent Psychiatry, 33: 906.
– Adoptees perceive parent expectations to be higher than biological
children do
Scarr, S., and McAvay, G. (1990). Predicting the occupational status of young adults: a longitudinal study of brothers and sisters in adoptive and
biologically related families. Cited in Deutsch, C.K. (1990)
– Adoptive parents of children with conduct problems are more
achievement oriented than adoptive parents of children without
conduct problems
Coon, H., Carey, G., Corley, R., and Fulker, D.W. (1992). Identifying children in the Colorado Adoption Project at risk for conduct disorder. Journal of the
American Academy of Child and Adolescent Psychiatry, 31, 503-511.
WHY THE EXTERNALISING DISORDERS?
• “One could argue that children who are unable to live up to parental
expectations would be more likely to become anxious, demoralized,
and depressed, which is not the way in which adoptees with
psychiatric disorders present”
Barbara D. Ingersoll (1997) Psychiatric Disorders Among Adopted Children, Adoption Quarterly, 1:1, 57-73

21. Genetic Factors

22. GENETIC FACTORS
• Strong heritability factor for externalizing behavior disorders
– “First-degree relatives of probands with ADHD are up to five times
more likely to have ADHD than relatives of control subjects”
Biederman, J., Faraone, S.V., Knee, D., Tsuang, M.T. (1990). Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the
American Academy of Child and Adolescent Psychiatry, 29, 526-533.
– “A high familial aggregation is seen for CD and aggressive,
antisocial behavior.”
Lahey, B.B., Piacentini, J.C., McBurnett, K., Stone, P., Hartdagen, S. and Hynd G. (1988). Psychopathology in the parents of children with conduct disorder and
hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 27: 163-170
– “These findings on adopted-away children of antisocial biological
parents provide evidence for a genetic factor in the etiology of CD
and aggressive, antisocial behavior”
Cadoret, R.J., Yates, W.R., Troughton, E., Woodworth, G., and Stewart, M.A. (1995). Genetic environmental interaction in the genesis of aggressivity and conduct disorders.
Archives of General Psychiatry, 52, 916-924
– 526 identical twin pairs and 389 fraternal twin pairs
– “Much greater concordance for ADHD in identical (monozygotic)
twins than in fraternal (dizygotic) twins.”
– Gjone, H., Stevenson, J., and Sundet, J.M. (1996). Genetic influence on parent-reported attention-related problems in a Norwegian general population twin sample. Journal of
the American Academy of Child and Adolescent Psychiatry, 35: 588-596.
– “Much greater concordance for delinquency and aggressive
behavior, in MZ than in DZ twins”
Edelbrock, C., Rende, R., Plomin, R., and Thompson, L.A. (1995). A twin study of competence and problem behavior in childhood and early adolescence. Journal of Child
Psychology and Psychiatry, 36, 775-785.

23. GENETIC FACTORS
• Evidence for Externalising Disorders in Parents
– Biological mothers of adoptees have elevations on five of nine
clinical scales of the MMPI, most notably the psychopathic deviate
subscale
Horn, J.M., Green, M., Carney, R., and Erickson, M.T. (1975). Bias against genetic hypotheses in adoption studies. Archives of General Psychiatry, 32, 1365-1367.
– “In our experience with four adoption agencies over several years,
the most common psychiatric diagnosis among biological parents
relinquishing children for adoption was antisocial behavior or
antisocial personality”
Cadoret, R.J. (1990). Biologic perspectives of adoptee adjustment. In D.M. Brodzinsky & M.D. Schechter (Eds.), The psychology of adoption. New York: Oxford University Press,
25-41.
GENE-ENVIRONMENT INTERACTION
“…..this vulnerability is compounded in some adoptees
who have experienced pre-, peri-, and post-natal
adversity”
Barbara D. Ingersoll (1997) Psychiatric Disorders Among Adopted Children, Adoption Quarterly, 1:1,
57-73

24. Gene-Environment Interaction
• “Concluding that adopted children from a compromised genetic
background are inevitably destined to a poor outcome is
patently false and amounts to therapeutic nihilism”
Faraone, S.V., Biederman, J., Keenan, K., and Tsuang, M.T. (1991). A family genetic study of girls with DSM-III attention deficit disorder. American Journal of
Psychiatry, 148: 112-117.
– “the very fact that concordance between monozygotic twins is less than
1.00 for all psychiatric disorders indicates that environmental factors
play a significant role in the expression of genetic potential
– Adverse home environments (those in which SES is low and there is
much family turmoil, dysfunction, and psychopathology) have been
shown to produce a much higher incidence of adolescent CD than would
be predicted by either genetic or environmental factors acting
independently
Cadoret, R.J., Yates, W.R., Troughton, E., Woodworth, G., and Stewart, M.A. (1995). Genetic-environmental interaction in the genesis of aggressivity and conduct disorders. Archives of General
Psychiatry, 52, 916-924.

25. Clinical Implications
• Eschew the assumption that psychological problems in
adopted children and adolescents are primarily attributable
to the fact of adoption, per se
• If behavioral and emotional problems appear, early
intervention would seem preferable to a ‘‘watch-and-wait’’
strategy
– Problems to which adoptees are prone tend to worsen over time
– CD in its full-blown form is notoriously refractory to treatment
• Risk factors which should alert adoptive parents to the
need for early intervention include
– a difficult temperament in infancy
– early poor school performance

26. Clinical Implications
• Hyperactivity and attention problems by themselves do not
predict the development of CD, although they are certainly
troublesome in their own right and clearly merit professional
intervention
• Patterns of aggression and oppositional defiant behavior,
however, especially in combination with restlessness and
overactivity, tend to be stable over time and are important
predictors of later CD and antisocial behavior
• Avoid assuming that the source of all problems resides within
the child’s genes and/or early history of adversity
• Parents and professionals must be willing to explore all factors
which might bear on the child’s adjustment, including past and
current patterns of dysfunction within the parents and other
family members

27. Adoption Competent Clinical Practice
• “Adoptive parents consistently report that their greatest post-adoption support
need is mental health services provided by someone who understands
adoption”
Smith, S. L. (2010). Keeping the promise: The critical need for post-adoption services to enable children and families to succeed. New York, NY: Evan B. Donaldson
Adoption Institute.
• A review of literature failed to produce any formal definitions of adoption
competence or lists of specific practices defined as reflecting adoption
competency.
• “Since 2008, the Center for Adoption Support and Education (C.A.S.E.) has
provided leadership for a multiyear initiative, Training and National
Certification for Adoption Competent Mental Health Practitioners, funded by
multiple private foundations.
• C.A.S.E. convened a group of nationally recognized experts, including parents,
who specified the knowledge, skills, and values competencies in 18 domains
that mental health practitioners need to be adoption-competent.
• The expert panel also developed the following definition of an adoption-
competent mental health professional:
Anne J. Atkinson , Patricia A. Gonet , Madelyn Freundlich & Debbie B. Riley (2013) Adoption Competent Clinical Practice: Defining Its Meaning and
Development, Adoption Quarterly, 16:3-4, 156-174,

28. • An adoption-competent mental health professional has
– The requisite professional education and professional
licensure
– A family-based, strengths-based, and evidence-based
approach to working with adoptive families and birth
families
– A developmental and systemic approach to understanding
and working with adoptive and birth families
– Knowledge, clinical skills, and experience in treating
individuals with a history of abuse, neglect, and/or trauma
– Knowledge, skills and experience in working with adoptive
families and birth families.

29. • An adoption-competent mental health professional
understands:
– The nature of adoption as a form of family formation
– The clinical issues that are associated with separation
and loss and attachment
– The common developmental challenges in the
experience of adoption
– The characteristics and skills that make adoptive families
successful.

30. • An adoption-competent mental health professional is :
– Culturally competent with respect to the racial and
cultural heritage of children and families
– Skilled in using a range of therapies to effectively engage
birth, kinship, and adoptive families toward the mutual
goal of
• helping individuals to heal
• empowering parents to assume parental entitlement and
authority
• assisting adoptive families to strengthen or develop and
practice parenting skills that support healthy family
relationships
– Skilled in advocating with other service systems on
behalf of birth and adoptive families.
(Center for Adoption Support and Education, 2009)

31. • A total 485 persons responded to the survey
– 87% were adoptive parents
– 9.1% were adopted persons
– 8.1% were members of an adoptive family
– 7% were birth parents
– 17.2% reported themselves as “other” (typically a
professional role related to adoption)

32. #1 Understands the impact of
separation and loss on individuals
and families and the importance
of attachment in creating healthy
relationships.
#2 Understands that adoptive
families and adopted persons
experience developmental
challenges and is able to work
effectively with families and
individuals on these issues.
#3 Works with adoptive families and
adopted persons with a clear
understanding of individual and
family development and the
multiple service systems with
which families and individuals are
involved.

33. Psychosocial Understanding of Adoption
• “The experience of adoption exposes parents and children to a
unique set of psychosocial tasks that interact with and complicate the
more universal developmental tasks of family life (described by
Erikson)”
• “For family members to move forward to more advanced, mature
levels of adoption adjustment there must be an adequate (although
not necessarily complete) resolution of the crises associated with
adoption-related tasks.”
• “The degree to which adoptive parents and their children
acknowledge the unique challenges in their life, and the way in which
they attempt to cope with them, largely determines their pattern of
adjustment”
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)

34. Age Period Psychosocial Crises
Infancy Trust vs Mistrust
Toddler
Preschool years
Autonomy vs Shame&Doubt
Initative vs Guilt
Middle Childhood Industry vs Inferiority
Adolescence Ego Identity vs Identity Confusion

35. Infancy
• Parents are more likely to meet the baby’s needs in ways that
promote a basic sense of security if
– The general caretaking atmosphere is characterized by warmth and low
anxiety
– Parents are secure in their parental roles
– Parents have realistic expectations concerning their child’s behavior and
development
• Inadequate caretaking, where the baby’s needs are met
inconsistently and in an unsatisfying way (promoting a sense of
mistrust or insecurity in the infant) is likely if
– Heightened parental anxiety
– A mismatch between parental expectations and infant characteristics
and behavior
• Several factors can complicate the development of basic trust
– All of which relate to the transition to adoptive parenthood

36. 1. Infertility
• Relates to self-image and one’s basic sense of masculinity and
femininity (Kraft, Palombo, Mitchell, Dean, Meyers, & Schmidt, 1980; Shapiro, 1982)
– Inadequate resolution
– unconscious use of adoption as a way of avoiding the issue
• individual and/or marital adjustment problems - general
anxiety, depression, a devalued self-image, resentment of one
partner for another, disruptions in marital communication,etc,
• This threatens the development of a caretaking atmosphere
conducive to the emergence of trust and security in the infant
2. Uncertainty of Placement timing
• Uncertain length of wait
• In-depth evaluation process is an “intrusive”, anxiety
provoking experience

37. 3. Absence of appropriate role models
• Realistic perspective of adoption process unavailable
• Likely to develop unrealistic expectations about transition to
adoptive parenthood
4. Social Stigma surrounding Adoption
• adoption still is seen as a “second best route to parenthood”
• adoptive parents frequently must justify to others why they have
made their particular decision
– likely to facilitate parental anxiety and resentment.
5. Developing attachments in late placements
• Children placed for adoption early in their lives (within first 06
months or so) develop identical secure attachment relationships
with mothers as do non-adopted infants (Singer et al, 1985)
• Maladjustment likelier in later placements
– acute distress accompanying the severing of a previously established
attachment relationship
– child has never developed a secure attachment due to multiple foster
placements.

38. Toddlerhood and the Preschool Period

39. Toddlerhood and the Preschool Period
• Child is primarily concerned with developing a sense of autonomy
and initiative; being able to
– separate from parents physically, (and psychologically)
– do things for oneself in ways that bring about
• Self-satisfaction
• Approval from others
• Parents are more likely to facilitate positive socio-emotional
adjustment if they meet child’s strivings for independence with
– Patience, understanding & Self-confidence
• Parents are more likely to facilitate negative socio-emotional
adjustment if they meet child’s strivings for independence with
– Anxiety, Insensitivity & Insecurity
• “The hallmark of secure attachment to caregivers is the infant’s and
young child’s ability to use these individuals
– To reduce their stress level
– Regain their security
– Provide them with sufficient confidence to resume constructive activity,
including renewed separation from the caregivers

40. • “Parents experience ambivalence when they recognize that their
children have begun the process of becoming psychologically
independent human beings; individuals with their own needs,
desires, thoughts, & fantasies. “
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)
• In most adoptive families the telling process begins during the
preschool years, usually between two and four years of age
Mech. EV. (1993). Adoption: A policy perspective. In B. Caldwell 8 H. Ricciuti (Eds.). Review of Child Development Research. Vol 3. Chicago: University of
Chicago Press.
• Telling creates a psychological gap or separation between parents and
child where none existed before.
– Acknowledges openly to all family members that the basic biological link
between parents and children, is absent in their particular family
– This process accentuates the growing gulf between parents and children and
creates anxiety in many adoptive parents in an area that already is fraught with
ambivalent feelings

41. School Age Years

42. School Age Years
• “As children enter the school age years, a new psychosocial theme emerges
: the need to be industrious, to master things, to understand.” (Erikson, 1963)
• A positive sense of self emerges when parents/teachers
– Pose tasks for children that they that they recognize as interesting and worthy , and
can accomplish
– When children’s efforts are reinforced
• A sense of inadequacy or inferiority emerges when
– children are made to feel that their efforts and achievements are insignificant
– when their thoughts, desires, fantasies, and actions are not taken seriously, or are
actually discouraged
• “This is the time when adopted children actively attempt to master /
understand their adoptive status- and all of its implications.
• “Although most children are informed of their adoptive status in the
preschool period, our research suggests that these young children actually
have little awareness of what adoption means” (Brodzinsky, Singer, & Braff, 1984)

43. • I: What I want to ask you about is adoption. Have you heard that word before?
• A: Sure, I’m adopted.
• I: What does that mean? What’s adoption mean?
• A: Well mommy told me that when I was a baby I came out of another lady . . .she
made me. After I was born, my mommy and daddy came and got me and took me
home.
• I: So first you came out of one lady and then you went home with another lady,
your mommy . . and of course your daddy too.
• A: Yep. That’s how it happens.
• I: So your mommy and daddy became your parents after they got you . . . I mean
after they adopted you and brought you home.
• A: (nods yes)
• I: Is there any other way that grown-ups can become parents besides adopting a
child?
• A: What do you mean?
• I: How do grown-ups become parents? How do they become a mommy or daddy?
• A: They get a child . . . adopt him.
• I: Is there any other way of becoming a mommy or daddy?
• A: (shakes head no)
• I: Do all kids come into their families after they are adopted?
• A: Yep . . that’s the way they do it.
• I: So, all kids are adopted then?
• A: (shakes head yes)

44. School-Age Years
• Between 8 and 11 years, however, children’s understanding of
adoption broadens remarkably
– Part of the more general process of cognitive and social-cognitive development
that emerges at this time (Brodzinsky, Schechter, & Brodzinsky, 1986; Brodzinsky et al., 1984).
• “To be adopted means not only that one has been ‘chosen’ but also
that one has been relinquished or “given up”.
• Children begin to fantasize about the circumstances surrounding their
relinquishment
• Begins to see possible solutions to the problems that once
confronted the birth parents; problems that the birth parents were
unable to solve themselves
– Anger and resentment toward the birth parents
– Concern that the birth parents’ circumstances have changed and that they are
now considering reclaiming their child

46. • “As they mature intellectually and their knowledge of adoption broadens,
children come to understand the many complications associated with their
family status that their parents either have ignored or downplayed in family
conversations.
– A sense of uncertainty / confusion may emerge
• “At times, adoptive parents interpret the child’s concerns as indicating that
they (the parents) have done a poor job in handling the telling process.
• Parental anxiety may then lead them to
– deny that the child actually is confused or has genuine concerns, or
– it may lead them to believe that the child is seriously disturbed
• Children’s confusion during this period most often is a normal
part of coping with adoption
– Reflects an increasing awareness of what it means to be adopted
– Represents the beginning of a normal process of adaptive grieving
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)

47. • Adoption involves loss
– for the biological parent it is the loss of the relinquished child
– for the adoptive parent it is the loss of fertility and the biological child they
wanted
– adopted children, it is the loss of their birthparents and origins, and
sometimes siblings as well
Ward. M. (1984). Sibling ties in foster care and adoption planning. Child Welfare. 63, 321-332.
• “The behavioral and emotional patterns associated with this
realisation of loss are well known.
– Shock. denial, protest, despair, and eventually recovery or reintegration are
commonly observed

48. • “Adoptive parents need to recognize that as their children
become more aware of what it means to be adopted, a certain
amount of confusion and uncertainty is bound to be manifested
– These behaviors and reactions are usually part of an adaptive
grieving process
• Ignoring their children’s concerns or treating them as
insignificant may very well foster feelings of inadequacy or
inferiority
• It is important for parents to
– Acknowledge to their children that they recognize and accept their
concerns
– Encourage them to explore and resolve what one 9-year-old boy called
“the master question of my life - Why was I given up for adoption?”
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)

49. Adolescence

50. Adolescence
• “Adolescence is the time when all young people actively take up the
issue of identity.
• “Who am I?” becomes the central question for the developing
teenager.
• “Identity provides a subjective sense of invigorating sameness and
continuity”
• As part of the struggle for self-definition, adolescents seek to link their
– current sense of self with
– perceptions of self from earlier periods, and with
– their cultural and biological heritage
• A sense of confidence emerges with respect to identity when
adolescents are able to
– maintain a feeling of inner sameness and continuity across time
and across the many situations in which they find themselves
– when they are able to integrate their self-perceptions with
• the feedback they receive from others
• a known genealogical past
Erikson, E. (1968). Identity, Youth and Crisis. New York: W.W. Norton.

51. • “Adoptive parents need to recognize that for the adoptee this
universal psychosocial task is often complicated by
– a lack of information regarding the birth parents and the reasons
underlying the original relinquishment
– by feelings of disloyalty to adoptive parents because of the
curiosity and desire for such information”
• Adopted adolescents and youth need considerable emotional
support, and at times, practical guidance, from their parents,
relatives, and friends in their search for identity.
• They need to feel free to explore the question of who they
really are, in all of its ramifications.
• Without the support from others and without this sense of
freedom to explore identity issues, adoptees are much less
likely to develop
– a stable and positive view of themselves
– a healthy balance between individuality and autonomy
– continuing connectedness to the family
David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review Vol 7 pp 22-47 (1987)

52. Age Period Psychosocial Crises Adoptive Family Tasks
Infancy Trust vs
Mistrust
Resolving feelings regarding infertility
Coping with uncertainty and anxiety related to the placement process
Finding appropriate role models and developing realistic expectations
regarding adoptive parenthood
Coping with the social stigma surrounding adoption
Developing secure attachment relationships in cases of delayed
placement
Toddler &
Preschool
Yrs
Autonomy vs
Shame&Doubt
Initative vs Guilt
Coping with the anxiety and uncertainty surrounding the initial telling
process
Creating an atmosphere in which questions about adoption can be
freely explored
Middle
Childhood
Industry vs
Inferiority
Helping the child master the meaning of adoption
Helping the child in the initial stages of adaptive grieving
Maintaining an atmosphere in which questions about adoption can
be freely explored in light of the complications brought about by the
grief process
Adolescenc
e
Ego Identity vs
Identity
Confusion
Helping the adolescent cope with genealogical bewilderment
Helping the adolescent grieve for the lost self (in addition to the loss
of birth parents and origins)
Maintaining an atmosphere in which questions about adoption can be
freely explored in light of the complications associated with the grief
process (including support for the adolescent’s/ young adult’s search
for origins)

53. Telling the Adopted Child
• “There is broad consensus in the academic and practice literature that
communicative openness is desirable, if not essential”
• Chris Jones & Simon Hackett (2008) Communicative Openness Within Adoptive Families: Adoptive Parents' Narrative Accounts of the Challenges of Adoption Talk and
the Approaches Used to Manage These Challenges, Adoption Quarterly, 10:3-4, 157-178
• Associations between communicative openness and the
– Well-being of the child (Brodzinsky, 2006),
– Development of a positive identity as an adopted person (Howe&Feast, 2003),
– Higher levels of satisfaction with the adoption expressed by the adoptee in
adulthood (Howe & Feast, 2003; Raynor, 1980)
• “It is generally agreed that the child should be told of the adoption, but
there is disagreement on when the information should be given”
• The Pediatrician's Role in Supporting Adoptive Families Veronnie F. Jones, Elaine E. Schulte and the Committee on Early Childhood and Council on Foster Care,
Adoption, and Kinship Care Pediatrics; originally published online September 24, 2012;
• “Late-placed children finding communicative openness more
difficult.”
Howe, D., & Feast, J. (2003). Adoption, search and reunion: The long-term experience of adopted adults. London: BAAF.

54. • “The majority of adoptive families in our sample discussed adoption
only once or on a very few occasions”
Palacios, J., & Sanchez-Sandoval, Y. (2005). Beyond adopted/nonadopted comparisons. In D. M. Brodzinsky & J. Palacios (Eds.), Psychological issues in
adoption: Research and practice (pp. 117–144). Westport, CT: Praeger.
• Successful adoption revelation cannot be measured by what, how
much, or even when information is revealed
• Only by what the child is capable of understanding and accepting at a
given point in time
• We believe that knowing and accepting these facts will contribute to
a reduction in anxiety in adoptive parents as they begin this
decidedly difficult task-
– which should facilitate psychological adjustment among all family
members.
Children's Understanding of Adoption Author(s): David M. Brodzinsky, Leslie M. Singer and Anne M. Braff Source: Child Development,Vol. 55, No. 3 (Jun.,
1984), pp. 869-878
• “We caution against extreme positions on openness such as denial or
insistence of difference in adoptive family life. Instead, a middle road
in acknowledging difference is recommended
• The most important factor to consider in relation to communicative
openness is the satisfaction of the adoptee(s) and adopter(s) with
adoption communication
Brodzinsky, D. M. (1987). Adjustment to adoption: A psychosocial perspective. Clinical Psychology Review, 7, 25–47.

55. • Adoptive parents face the dilemma of being
– proactive in adoption talk and risking the revelation of certain
details of the adoption story before the adopted child is
cognitively and emotionally able to deal with them
– reactive to children’s questioning and risking the perception that
they are withholding important information
• They face the challenge of communicating complex and sensitive
adoption stories in ways that
– Maintain the adopted person’s self-worth
– Give an honest account
Chris Jones & Simon Hackett (2008) Communicative Openness Within Adoptive Families: Adoptive Parents' Narrative Accounts of the Challenges of
Adoption Talk and the Approaches Used to Manage These Challenges, Adoption Quarterly, 10:3-4, 157-178

56. • Even before a child understands the words “adoption,” “adopted,”
and “biological family” or “birth family,” it is important that these
words be a part of a family’s natural conversation
• Families should be discouraged from “waiting until just the right
minute” to tell children that they were adopted
– This may leave children feeling betrayed and wondering what else their parents
may have hidden from them.
– Children may learn information from peers or neighbors, which may impair the
trust between parent(s) and child.
• It is important to share with even young children their adoption story,
starting with their birth, not the adoptive family’s initiation of the
adoption process.
• An honest approach in the discussion of a child’s biological family and
the adoption process is recommended
– Gives a child permission to ask questions or to make statements about
adoption
– Takes away the veil of secrecy which implies that being adopted is a negative
condition
• The Pediatrician's Role in Supporting Adoptive Families Veronnie F. Jones, Elaine E. Schulte and the Committee on Early Childhood and Council on Foster Care,
Adoption, and Kinship Care Pediatrics; originally published online September 24, 2012;

57. • Encouraged modeling of positive adoption language
– Adoptive families are “real” families; siblings who joined a family
through adoption are “real siblings.”
– Biological parents do not “give up a child for adoption”
• might imply to the child that he or she was of less worth and was given
away.
– Rather the biological parents made an adoption plan
• in the best interest of the child’s future
• to the best of their abilities at the time
– Biological mother should not be identified as a “natural parent”
• Implies that adoptive families are “unnatural.”
– A child’s racial identity, adoption, or birth in another country
should never be the identifying characteristics for any child
– It is NEVER appropriate to ask how much a child “cost.”
• The Pediatrician's Role in Supporting Adoptive Families Veronnie F. Jones, Elaine E. Schulte and the Committee on Early Childhood and
Council on Foster Care, Adoption, and Kinship Care Pediatrics; originally published online September 24, 2012;

59. • Create Openings for
Adoption Talk
– Families used life story
books as a reference point
for conversations about
adoption
– These were often kept in an
accessible location agreed
by both adoptive parents
and their adopted children
• Giving adopted children easy
access to them
– Children could choose
• when to look at them
• when to ask questions
• Chris Jones & Simon Hackett (2008) Communicative Openness Within
Adoptive Families: Adoptive Parents' Narrative Accounts of the
Challenges of Adoption Talk and the Approaches Used to Manage
These Challenges, Adoption Quarterly, 10:3-4, 157-178

63. Adoption Laws in India
• Adoption is not permitted in the personal laws of Muslims,
Christians, Parsis and Jews in India.
– They usually opt for guardianship of a child through the Guardians
and Wards Act, 1890.
• Indian citizens who are Hindus, Jains, Sikhs, or Buddhists
are allowed to formally adopt a child.
– The adoption is under the Hindu Adoption and Maintenance
Act,1956

64. HINDU ADOPTION AND MAINTENANCE ACT, 1956
Capacity to Adopt
• Any adult Hindu male who is of sound mind can adopt a
child.
If the said man is married, the consent of the wife is
necessary.
• A female adult Hindu of sound mind could adopt a child if
she is
• Unmarried
• Divorced
• Widowed or
• Her husband suffers from certain disabilities
– Ceased to be a Hindu
– Has renounced the World
– Has been declared to be of unsound mind by the court

65. HINDU ADOPTION AND MAINTENANCE ACT, 1956
• The following conditions must be complied with:
• (i) if any adoption is of a son, the adoptive father or mother
by whom the adoption is made must not have a Hindu son,
son's son or son's son's son (whether by legitimate blood
relationship or by adoption) living at the time of adoption
• (ii) if the adoption is of a daughter the adoptive father or
mother by whom the adoption is made must not have a
Hindu daughter or son's daughter (whether by legitimate
blood relationship or by adoption) living at the time of
adoption
• (iii) if the adoption is by a male and the person to be adopted
is a female, the adoptive father is at least twenty-one years
older than the person to be adopted
• (iv) if the adoption is by a female and the person to be
adopted is a male, the adoptive mother is at least twenty-one
years older than the person to be adopted

66. HINDU ADOPTION AND MAINTENANCE ACT, 1956
Capacity to Give in Adoption
• Only the father can make the decision of giving a child in
adoption.
• The father can give the child in adoption only with the consent
of the mother
– unless the mother has
• ceased to be a Hindu,
• has renounced the world
• is of unsound mind
• The mother may give the child in adoption if
– the father is dead
– has completely and finally renounced the world
– has ceased to be a Hindu
– has been declared by a court of competent jurisdiction to be
of unsound mind

67. HINDU ADOPTION AND MAINTENANCE ACT, 1956
Effect of Adoption
• When once a child has been adopted, that child
severs all ties with his natural family.
– All the right and obligations of natural born children fall
on him.
• The wife of a Hindu male, who adopts is deemed to
be the adoptive mother.
– Where an adoption is made with the consent of more
than one wife, the senior most in marriage is deemed to
be the adoptive mother and the rest are given the title
of step mothers.

68. • Clause (c) of section 8 of the Hindu Adoptions and
Maintenance Act, 1956 incapacitates a married woman from
taking in adoption merely on the basis of her marital status
and is discriminatory in nature. Therefore, section 8 has been
amended to give similar right to a female Hindu, irrespective
of her marital status, as that of a male Hindu.
Similarly, sub-section (2) and (3) of section 9 curtails the right
of mother to give in adoption if father is alive or is of sound
mind or has not renounced the world completely and finally.
The rights of father and mother under sub-sections (2) and (3)
are discriminatory in nature. Therefore, section 9 of the Hindu
Adoptions and Maintenance Act, 1956 has been suitably
amended to give similar right to a female Hindu.

69. GUARDIANS AND WARDS ACT, 1890
• Applicable to all of India except the state of Jammu and Kashmir.
• Particularly outlined for Muslims, Christians, Parsis and Jews as their
personal laws don’t allow for full adoption, but only guardianship.
• It applies to all children regardless of race or creed.
• Any child who had not completed 18 years of age was to be a minor.
• This child would be appointed guardians by the court or any other
appointed authority.
• All these procedures took place only after an application had been
placed by the person who was willing to take a child under himself
and to act as his guardian.
• The applications should contain all the possible information that
would have been required, including the information about the
guardian and any reason as such for the guardianship.

70. GUARDIANS AND WARDS ACT, 1890
• Once the court admits the application, a date for a hearing
would be set. The court will hear evidence before making a
decision.
• Unlike in the procedures given in the Hindu Adoption and
Maintenance Act, 1956, where a person once adopted has
a single set of parent, here a minor and his property could
have more than one guardian.
• It was required under these cases of guardianship that
– the court use its discretionary power and considered the interests
of the minor.
– His/her age, sex, religion, the compatibility quotient with the
guardian, the death of the parent, etc. must be taken into
consideration.
– The minor’s preference may also be taken into consideration.

71. In conclusion…..
• The important roles of adoption practitioners are
– They can alert adoptive family members at the stage of
preparation and assessment to both the complexity of
the task as well as the potential rewards.
– They can ensure that adopters understand the value of
tools such as reports, life story books, photograph
albums, and later-in-life letters.
– They can assist adoptive family members to develop a
specific language, style, and set of skills that meet their
family’s needs over time.
– They can provide adoptive family members with support
to develop the confidence to use this language and to
deal with the emotional aspects of adoption talk.

72. #1 Understands the impact of
separation and loss on individuals
and families and the importance
of attachment in creating healthy
relationships.
#2 Understands that adoptive
families and adopted persons
experience developmental
challenges and is able to work
effectively with families and
individuals on these issues.
#3 Works with adoptive families and
adopted persons with a clear
understanding of individual and
family development and the
multiple service systems with
which families and individuals are
involved.

73. References
• Anne J. Atkinson , Patricia A. Gonet , Madelyn Freundlich & Debbie B. Riley (2013) Adoption
Competent Clinical Practice: Defining Its Meaning and Development, Adoption Quarterly,
16:3-4, 156-174,
• The Pediatrician's Role in Supporting Adoptive Families Veronnie F. Jones, Elaine E. Schulte
and the Committee on Early Childhood and Council on Foster Care, Adoption, and Kinship
Care Pediatrics; originally published online September 24, 2012;
• Chris Jones & Simon Hackett (2008) Communicative Openness Within Adoptive Families:
Adoptive Parents' Narrative Accounts of the Challenges of Adoption Talk and the Approaches
Used to Manage These Challenges, Adoption Quarterly, 10:3-4, 157-178
• Practitioner Review: Children in foster care – vulnerabilities and evidence-based
interventions that promote resilience processes Leve LD et al, J Child Psychol Psychiatry.
2012 December ; 53(12): 1197–1211.
• Nickman SL et al, Children in Adoptive Families: Overview and Update J. AM. ACAD. CHILD
ADOLESC. PSYCHIATRY, 44:10, OCTOBER 2005
• David M. Brodzinsky Adjustment to Adoption: A Psychosocial Perspective Clin Psychol Review
Vol 7 pp 22-47 (1987)
• Barbara D. Ingersoll (1997) Psychiatric Disorders Among Adopted Children, Adoption
Quarterly, 1:1, 57-73
• Lindholm. B. W., & Touliatos. J. (1980). Psychological adjustment of adopted and nonadopted
children. Psychological Reports, 46, 307-3 10
• Brodzinsky et al (1984) Psychological and academic adjustment in adopted children. Journal
of Consulting and Clinical Psychology 52, 582-590
• Children's Understanding of Adoption Author(s): David M. Brodzinsky, Leslie M. Singer and
Anne M. Braff Source: Child Development,Vol. 55, No. 3 (Jun., 1984), pp. 869-878

74. Thank You