Longitudinal Studies of International Adoption

	International adoption research has been called a natural experiment by many child development researchers. Studies of severe early deprivation can inform us about risk factors experienced by many of these children and their impact on developmental outcomes. There are three longitudinal studies conducted by British and American researchers since the 1990s.  Each year over 40,000 children are internationally adopted and significant numbers have entered adolescence; the impact of their prenatal risk factors, early institutionalization, and post-adoptive environments are discussed below.

The English and Romanian Adoptees (ERA) Study Team have followed 165 Romanian children adopted into the United Kingdom (U.K.) after having lived in orphanages for varying lengths of time (Rutter, 1998; O'Connor, Rutter, Beckett, Keaveney, & Kreppner, 2000). The ERA team (led by Sir Michael Rutter) found severe developmental impairments (below the third percentile in height, head circumference and cognitive abilities) in about half of their sample of 111 Romanian children adopted before age 2 years. However, those children who were adopted before age 6 months nearly caught up with a comparison U.K. sample when physical growth and cognitive level were measured. Those adopted after six months of age but prior to 2 years also made gains but were significantly delayed as compared to the U.K. adoptees. Their average McCarthy General Cognitive Index (McCarthy, 1972) was 92 for Romanian children adopted after six months as compared to 109 for U.K. adoptees. Rutter and members of the ERA study team concluded that “psychological privation” was the greatest predictor of cognitive deficit (Rutter, 1998, p. 465). Follow-up assessments two years later revealed that the late-placed Romanian children continued to exhibit lower scores on measures of cognitive development (as compared to those adopted from Romania before six months of age as well as the U.K. comparison group) (O'Connor et al., 2000).

Many papers have been published as a result of Dr. Rutter's team. Here's a link to some of the articles.

The Canadian-Romanian Adoption Study is the second longitudinal study of developmental outcomes of internationally adopted children (Morison, Ames, & Chisholm, 1995). Dr. Elinor Ames led the initial study before her retirement. Forty-four children adopted from Romanian orphanages were divided into two groups: 29 children who would have gone to orphanages had they not been adopted at 4 months or younger (early adopted [EA]) and 46 Romanian orphanage children (RO) who had spent at least eight months in institutions (range: 8-68 months). The comparison group was comprised of Canadian-born (CB), non-adopted children matched on parental education, age, occupation, family income, and number of children in the family. At time of entry into adoptive homes, 78% of the RO group exhibited delays in motor, personal-social, and language development.  Eleven months post adoption (on average), these children showed significant developmental catch-up but scored significantly lower than both the EA and CB groups (who were similar in terms of development) (Morison et al., 1995). Reassessment of the children several years later revealed that, on scales of intellectual performance (overall IQ, verbal comprehension, and nonverbal reasoning), RO children continued to have the lowest scores (Morison & Ellwood, 2000). Within the RO group, children adopted after 2 years of age exhibited the lowest scores on the Revised Denver Prescreening Developmental Questionnaire (M=71) (R-DPDQ) (Frankenberg, 1986). Children adopted from Romanian orphanages between 8 and 24 months of age had higher scores: (M=89). Their non-institutionalized counterparts (EA) scored higher (M=99) whereas the Canadian born group scored highest (M=108).

Children Adopted From the Former USSR is a study of children adopted by families in the U.S. (McGuinness et al., 2000). This cohort has been studied through the lens of risk and protective factors; the study group was comprised of 105 children adopted from the former Soviet Union. This study found something slightly different: later age at institutionalization had a positive association with higher levels of risk (McGuinness et al., 2000).  Approximately one-third of children had experienced abuse, neglect, and abandonment prior to their entry into the orphanage. Additionally, mean birth weight was low (2637 grams) and alcohol abuse by birth mothers was common (41%). The investigators hypothesized and found that a longer duration of institutionalization was associated with a higher risk. What was not expected, however, was that a later age at institutionalization was positively associated with higher risk. McGuinness and colleagues (2000) speculated that the finding reflected the impact of early abuse, neglect or abandonment on these children in their birth families before entry into an institution at a comparatively later age. Although not consistent with longer institutionalization, the later age of entry into the orphanage was associated with later age of adoption as well.

At the time the U.S.-Russian cohort was first assessed (average age 7.7 years), 56% of the children had received speech and language therapy (McGuinness et al., 2000). At a second look, four years later, the parents of 57 children were re-interviewed and a similar proportion (54%) continued to receive speech and language therapy (McGuinness, Ryan, & Broadus, 2007). By comparison, in the general American population, approximately six percent of children experience speech and language delays (Law, Garrett, & Nye, 2003).

Time 3 results will be posted soon.

Here are some papers published describing some of what we have learned:

Beverly, B., McGuinness, T., & Blanton, D. (2008). Communication challenges for children adopted from the former Soviet Union. Language, Speech, and Hearing Services in Schools, 39, 1-11.

McGuinness, T. & Pallansch, L. (2007). Problem behavior of children adopted from the former Soviet Union. Journal of Pediatric Health Care, 21, 171-179.

McGuinness, T. & Dyer, J. (2006). International adoption as a natural experiment. Journal of Pediatric Nursing, 21(4), 276-288.

McGuinness, T., Ryan, R. & Robinson, C. (2005). Protective influences of families for children adopted from the former Soviet Union. Journal of Nursing Scholarship, 37 (3), 216-221.

McGuinness, T. (2000). A quiet migration: Cultural influences impacting children adopted from the former Soviet Union. Journal of Cultural Diversity, 7 (3), 59-64.

McGuinness, T. & Pallansch, L. (2000). Competence of children adopted from the former Soviet Union. Family Relations: Interdisciplinary Journal of Applied Family Studies, 49 (4), 457-464.

McGuinness, T., & McGuinness, J. (1999). Speech and language difficulties of internationally adopted children. [Letter to the editor]. American Family Physician 60, 1322-1333.

McGuinness, T. (1999, May/June). Mitigating the effects of institutionalization: Factors in adoptive families that make a difference. Adoptive Families Magazine, 32, 66-69.

Email Dr. Teena McGuinness for reprints.

Here's a recent presentation

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