Have you considered adopting a child or becoming a foster parent? Maybe you’ve recently welcomed a child into your home and have some questions about what they might be feeling. Psychologist Dr. Annie Wright specializes in helping children with adjustment, attachment, anxiety, depression and trauma, and has focused her research on helping children who have been adopted or in foster care.

Dr. Wright offers insight into nurturing children through adoption and fostering

1. What are some ways that adoption can impact a child’s mental health?

The experience of adoption can have an impact on a child’s attachment and identity development, which can affect mental health. We see increased rates of anxiety and depression among individuals who’ve been adopted. Separation from a pre-adoption caregiver can be traumatic as well, resulting in trauma responses from youth as they cope with their post-adoption life.

2. Do the impacts of adoption vary depending on the age of the child?

The age at adoption can influence the child through the timing of pre-adoption experiences. For example, institutional care (orphanages, children’s homes, etc.) can be associated with deprivation and lack of opportunities to form healthy attachments. If children are exposed to this when they’re very young it can cause long term effects such as developmental delays and attachment difficulties. Children adopted at an early age can recover from the deprivation they experienced if provided with substantial supports to foster healthy development.

Kids who experience trauma that results in their adoption at a later age (e.g. orphaned during their teen years) may have had positive experiences that buffer the effect of trauma. Conversely, children who are adopted at a later age and have experienced chronic trauma or abuse prior to the adoption may have much more significant mental health needs following adoption. Every situation is unique.

3. How does the experience of foster care compare to adoption?

Each type of adoption (private domestic, foster care, international) has unique aspects to consider when it comes to a child’s mental health. Children who experience foster care have faced some sort of trauma and/or abuse that resulted in their removal from their home. This could include direct abuse toward the child, indirect trauma through witnessing violence and substance use in an unsafe home, or the trauma of separation from a caregiver who is incarcerated, among other possibilities. This isn’t to say that children adopted out of other circumstances have not experienced these things.

Youth adopted internationally have likely experienced traumatic loss of a caregiver, institutionalized care prior to adoption, and then immigration into a foreign country and culture. This comes with a host of unique experiences that pose risks to their mental health.

Children who are adopted privately and domestically at birth haven’t experienced immigration or early abuse and neglect, but they still face separation from their biological mother which is significantly stressful. It results in potential loss of information regarding their history (health, family lineage, etc.), disconnection from family culture, and the missed experience of being raised in a family that looks like them. All of these can impact an individual’s identity development and mental health across all stages of their life.

4. What are some difficulties adopted children and their families may face?

Adopted children face a host of difficulties that many non-adopted individuals don’t experience or even consider.

• Adopted children are often “outed” as being adopted when they don’t look like their adoptive parents. They may experience other children or adults asking them questions about their “real family” which prompts them to frequently reflect on their experience of being adopted, including trauma/abuse/neglect/separation.
• Throughout their life, adopted individuals may wrestle with the reasons their biological family couldn’t care for them.
• They face frequent challenges in medical settings, being asked for health history that they don’t know. This can have significant negative impact on their lifelong health if family health concerns aren’t known.
• Adopted children are often told “how lucky they are” for being adopted, and they may witness their adoptive parents receive praise for choosing to adopt. This dismisses the many negative circumstances they experienced that resulted in their need for an adoptive home.

Bringing a child into a new setting can pose some challenges for families as well.

• Adoptive families may struggle with disruptive behaviors a child demonstrates in their new adoptive home.
• Children may have learned strategies that were adaptive for coping with negative environments they lived in prior to adoption, which they continue to use but are no longer adaptive. For example, hoarding food or stealing other items if they experienced resource insecurity, or lying if they learned it’s unsafe to be honest with adults.
• Adoptive families may also struggle to connect and form healthy attachment with an adopted child if the child didn’t have the opportunity to develop a secure attachment style early on.

5. How can adults help nurture resilience among children who are adopted or in foster care?

Fostering a stable, consistent, safe, predictable, loving home is key for building resilience and positive relationships among family members. Parents who balance providing love and warmth through their parenting while also outlining clear rules and expectations for the child and being consistent in how they respond to a child’s behavior will help to build resilience. Parents need to be highly informed when it comes to trauma and adoptive identity development before pursuing adoption, so they’re ready to understand the context to their child’s behaviors and emotional struggles once a child is placed in their home. Being well-versed in emotion coping skills that they can model and teach a child will help set the child up for success.

6. How can adults help mitigate risks for these children while building positive relationships?

There’s a lot of work parents can do before adopting to set themselves and their future adopted child up for the best outcomes possible, such as:

• Being highly trauma and adoption informed
• Seeking their own counseling to explore their motivations for adopting
• Understanding their own emotion-regulation skills and building those so they can be modeled in a health way for a child
• Identifying their own attachment style so they understand how it will influence their parenting and their reactions to a child’s attachment style
• Immersing themselves in the adoption community so they deeply understand the adopted experience before setting out to become an adoptive parent

Other adults in an adoptee’s life can help to mitigate risk and build positive relationships by becoming more adoption-informed themselves (and parents can help educate the network around a child).

• Schools can be mindful of assignments they give that may trigger a child or be difficult given their adoption status (e.g. a family tree assignment).
• Health care providers can be mindful that asking for health history at every visit because it is missing from the chart can be highly triggering for a child. Documenting that a patient is adopted, and health history is unknown (if that is the case), is helpful so the patient doesn’t have to continue to explain this at every visit.
• Family friends, neighbors, community members, etc. can remember not to ask overly intrusive or personal questions about a child’s adopted status, but also not glaze over this aspect of their experience if a child brings it up.  

7. What are some ways to help a child adjust to a new or temporary home? How long does this adjustment process usually take?

• Gathering as much info from past caregivers or known adults to a child regarding the child’s preferences, habits, environment, routine, etc. and then integrating as much of that as possible into the new home can be a good place to start (e.g. serving familiar foods, listening to familiar music, maintaining a similar routine).
• Creating a stable, consistent, safe, predictable, loving home will also help to foster a smoother adjustment. The more quickly a child can understand what to expect from the individuals around them the easier it will be for them to adjust.
• Parents need to recognize that this experience of transitioning to a new home is inherently stressful and may be traumatic, so they should build expectations gradually. It can be helpful to schedule a window of several weeks in which the family is just home together, getting to know each other and building trust before the child is introduced to other adoptive relatives/family friends or exposed to their new community and school.

The adjustment time can range from months to years and really varies based on the child and the expectation for what it means to have adjusted to a new home. There may be a “honeymoon phase” in which the child appears to have adjusted quickly and well; this is a trauma response, and adoptees will later describe this period as highly stressful – not at all a honeymoon from their end. New and potentially disruptive or difficult behaviors may begin to appear months after an adoption, indicating that the adopted child has finally become comfortable enough in their new home to truly express how they’re feeling. This can feel jarring for parents who thought things had transitioned smoothly, and then may worry this is a different side that the child was masking. This is just another stage of the transition, and with ongoing consistency/love/safety from parents, the child will learn how to cope with their feelings in a safe and appropriate way in the new home.

8. How can parents balance fun and discipline, especially if challenging behaviors are in the mix?

As with any child, it’s important to be consistent. The best parenting comes from a balance of warmth and control. Adoptive parents shouldn’t reduce rules or expectations to seem more fun or win affection. However, they should be aware that certain caregiver approaches to discipline or expression of negative emotion when a challenging behavior is displayed may be triggering for a child and escalate things further.

It's important for parents to learn how to remain emotionally regulated throughout stressful parenting interactions. For children who have experienced trauma or neglect, it is also important for parents to be able to evaluate the underlying need beneath a behavior and work to meet that need. As parents get to know a child they can also predict when these needs will appear, so they can adjust to meet the needs before they result in challenging behaviors.

9. Is there anything else you’d add?

Adoption is not a singular event, and the adoptee will spend their life processing and adjusting/adapting to this aspect of their history. A child may seem well-adjusted during one stage of childhood and then enter a new stage of development and begin to struggle in ways they hadn’t (or didn’t seem to) previously – even into adulthood. Parents shouldn’t internalize their adopted child’s struggles as criticism or rejection of the adoptive family, but give their adopted child the space, grace and loving support to process and explore this significant aspect of their individual identity.

Did you know CHoR has a foster care clinic offering coordinated medical and psychiatric care? Learn all about it.