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Objectives. 1. Describe risks to development of children adopted from orphanages in the former USSR.2. Define and describe the family environments of children adopted from the former USSR3. Discuss components of family environments associated with resilient outcomes for families.. Pertman, A. (2001). Adoption Nation. New York: Basic Books..

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1. Family Environments of Children Adopted from the Former Soviet Union http://www.adoption-research.org [email protected] Teena McGuinness, PhD, CRNP Professor, University of Alabama, Birmingham, School of Nursing For more on our distance accessible psych NP program, go to: www.psychiatricnursing.com Cheryl Robinson, DNS, CRNP, Clinical Assistant Professor, University of South Alabama College of Nursing

3. Objectives 1. Describe risks to development of children adopted from orphanages in the former USSR. 2. Define and describe the family environments of children adopted from the former USSR 3. Discuss components of family environments associated with resilient outcomes for families.

4. Pertman, A. (2001). Adoption Nation. New York: Basic Books. “Adoption, once a clandestine process shrouded in shame, is rapidly metamorphosing into a radically new process that is both sweeping the nation and changing it. It is accelerating our transformation into a more multicultural and multiethnic society, even as it helps redefine our understanding of ‘family’. Adoption is also a highly visible example of a social institution that has benefited from and been reshaped by both the Internet and the exponential growth of alternative lifestyles, from single to transracial to gay.” -Adam Pertman, journalist and current director of Evan B. Donaldson Adoption Institute, NY, NY.

5. Adoptive parent preparation is key to successful parenting Adoptive parent preparation is available via webinar at the Evan B. Donaldson Adoption Institute. Webinar includes best-practice standards and training materials to assist professionals in the preparation and support of adoptive parents. Adoptive Parent Preparation - Understanding the Psychological, Developmental and Medical Challenges that Adopted Children May Experience in webinar format at http://www.adoptioninstitute.org/education/training_app1.php

6. Adoption occurs as a result of Adversity “The greatest terror a child can have is that he is not loved, and rejection is the hell he fears.”-John Steinbeck, East of Eden Bonds with birth parents occur due to tragedy, abandonment, and termination of parental rights.

7. Reasons for entry into institutions in International Adoption Poverty Homelessness Mental illness of birth parents Substance use disorders of birth parents Incarceration of birth parents Abandonment of children Neglect Abuse

8. History of International Adoption Following World War II, large numbers of displaced persons made possible the adoption of children from overseas Motivated by humanitarian reasons Approximately 6000 children were adopted from the battle-scarred countries of Europe after WWII (Pertman, 2000).

9. History of International Adoption Romanian adoption laws were liberalized in 1990 and thousands of Westerners traveled to Romania intent on adopting. Well-meaning Americans found an old nemesis known in the child development literature since 1915: the hazards of institutionalization. Evaluation of these post-institutionalized children opened a unique window into development. Observing these institutionalized children who were exposed to such significant adversity provided a unique opportunity to document changes within their adoptive families.

10. Sensitive Periods of Development “The period from conception to age 3 years is unparalleled in the human life cycle for the rapidity, complexity, and profundity of developmental changes.” The completely dependent infant evolves into a child capable of communicating and participating in rule-bound social situations. A significant portion of postnatal brain structuring and neural patterning is thought to occur thru interactions of the child with the environment, including family environment. Zeanah, C. H., Nelson, C. A., Fox, N. A., Smyke, A. T., Marshall, P., Parker, S. W., & Koga, S. (2003). Designing research to study the effects of institutionalization on brain and behavioral development: the Bucharest Early Intervention Project. Development & Psychopathology, 15(4), 885-907.

11. 95 years of literature on the hazards of Institutionalization Detriments include delays in social and emotional development altered patterns of cognitive functioning nutritional and growth deficiencies (Bender & Yarnell, 1941; Bowlby, 1951; Chapin, 1915; Goldfarb, 1943; Spitz & Wolf, 1946; Tizard & Rees, 1975). Factors determining the magnitude of the effects of orphanage living on the behavior of young children are age of institutionalization (Goldfarb, 1945), duration of time spent in the institution and the quality of care while residing in the institution (Yarrow, 1961).

12. Negative effects of Institutionalization Impairment of attachment (Ainsworth, 1961; Bowlby, 1951; Rutter, 1981) Hyperactivity and conduct disorders (Rutter, Quinton, & Hill, 1981; Hodges & Tizard, 1989; Rutter, Quinton, & Hill, 1990;) Cognitive impairments in problem-solving abilities and cause-and-effect thinking (Provence & Lipton, 1962; Fahlberg, 1991) Death (Chapin, 1915; Goldfarb, 1945; R. Spitz, 1945; Spitz, 1945)

13. Negative effects of Institutionalization The detrimental effects of institutional living were the primary impetus for discarding the orphanage system in the U.S. for a foster care system of substitute care (Frank et al., 1996). Frank, D. A., Klass, P. E., Earls, F., & Eisenberg, L. (1996). Infants and young children in orphanages: one view from pediatrics and child psychiatry. Pediatrics, 97(4), 569-578. Read the above article for an excellent overview of the first 80 years of scientific literature on the hazards of institutionalization.

14. Orphanages are terrible places to raise children

15. Categorization of risk to Development Prenatally: alcohol/drug exposure, prematurity, and prenatal malnutrition. Postnatal: Abuse Malnutrition Exposure to violence Neglect (lack of contact and stimulation) is a significant portion of the risk incurred in institutionalization which is a commonality to many children adopted from both China and the former Soviet bloc of countries since 1990. Indeed, children who spend time in orphanages experience multiple adversities across the risk continuum making them a “natural experiment” for child development.

16. US Russian Cohort: Aims of Study Aim 1 Characterize the total competence of children adopted from the Former Soviet Union Aim 2 Evaluate both risks as well as the protective influences of adoptive families and their relationship to competence via a longitudinal design

17. Gap in Knowledge Strong familial attachments and positive family socialization can exert a protective influence for children, but this has not been studied for international adoptees Most studies of international adoption and adolescence have been conducted outside the United States, and focused on psychopathology instead of positive outcomes.

18. The children in this study have:

19. Variables of Study Independent Variables Risk Factors Birth weight Length of time in orphanage Age at institutionalization Birth mother's exposure to alcohol Protective Factors Family Environment Cohesion Expressiveness Conflict Dependent Variable Competence

20. Risk Factors Conditions or variables that can be associated or linked to a higher probability of a negative outcome are considered risk factors (Jessor, Van Den Bos, Vanderryn, 1995; McGrath & Sullivan, 2003; McGuinness, Ryan, & Robinson, 2005).

21. Risk Factors Birth weight Length of time in orphanage Age at institutionalization Birth mother's exposure to alcohol

22. Birthweight A lower birth weight is associated with cognitive deficits and increasing levels of morbidity for children (Breslau, 1995; Klein, 1998; Lindeke, Stanley, Else, & Mills, 2002; Lucina,, Lindeke, Georgieff, Mills, & Nelson, 1999; Saigal, Szatmari, Rosenbaum, Campbell, & King, 1991; Vhor & Msall, 1997). The degree of prematurity at birth as indicated by birth weight has been the most consistent global predictor of poor outcomes for children (McCormick, 1994; Taylor, Klein, Munich, & Hack, 2000). The magnitude of the effect of being born at a low birth weight appears to decrease over time, even though the children continue to demonstrate modest negative performances on math and reading tests when compared to normal birth weight children (Boardman et al., 2005). The degree of prematurity at birth as indicated by birth weight has been the most consistent global predictor of poor outcomes for children (McCormick, 1994; Taylor, Klein, Munich, & Hack, 2000). The magnitude of the effect of being born at a low birth weight appears to decrease over time, even though the children continue to demonstrate modest negative performances on math and reading tests when compared to normal birth weight children (Boardman et al., 2005).

23. Age at Adoption and Length of Institutionalization Children adopted from institutions generally focus on the mental and physical challenges (Nakashima, 1996; Talbot, 1998). Risk for psychopathology (Bimmel, Juffer, Ijzendoorn, & Bakermans-Kranenburg, 2003; Groza & Ryan, 2002, Rutter et al., 1999), Risks to child competence in all salient domains of development (academic, social, and conduct competence) (Wilson, 2003), Higher rates of maladaptive behavior in later adolescence (Bimmel, et al; Verhulst & Versluis-den Bieman, 1995).

24. Alcohol Exposure Children whose mothers consumed alcohol during pregnancy are largely placed at various risks for development. Studies report: A critical impact in the first few weeks of conception (Overholser, 1990); Teratogenic effects within the first 8 weeks of pregnancy (Michaelis & Michaelis, 1994); Growth and cognitive impairment effects with use later in pregnancy (Young, 1997). 47% of Time 3 cohort had exposure to alcohol Time 3 data reveals that 47% (N = 30) of the cohort had histories of documented exposure to alcohol before birth which is the highest percentage of all the time periods. Documented history of alcohol exposure at Time 1 was 44% (N = 105) and 38% (N = 45) at Time 2 Time 3 data reveals that 47% (N = 30) of the cohort had histories of documented exposure to alcohol before birth which is the highest percentage of all the time periods. Documented history of alcohol exposure at Time 1 was 44% (N = 105) and 38% (N = 45) at Time 2

25. Protective Factors Protective factors are internal and external processes, independent of risk, that exert a positive force on an outcome and contribute to competence in the face of adversity (Fraser, Kirby, & Smokowski, 2004; Luthar & Zigler, 1991; Masten, 2001; McGrath & Sullivan, 2003).

26. Protective Factors In the family environment: Cohesion Expressiveness Decreased conflict

27. Protective Factors Family environments, characterized by low interpersonal conflict and involving members who easily express their feelings (also known as the relationship dimension of the FES), are considered an important protective factor for adolescents attempting to navigate the adolescent years (Galaif, Stein, Newcomb, & Bernstein, 2001; Johnson et al., 1998; R. H. Moos, 2003). According to Sameroff (2006), “The family figures predominately among determinants of children’s academic, social, and conduct competence. Families clearly matter in promoting youth development, but understanding how requires a comprehensive analysis of the etiology of problems in child development” (p. 54). Greater levels of cohesion and expressiveness, as part of the relationship dimension of the family environment, have been implicated as a predictor of higher social competence and a decreased level of psychological distress (Varni, Katz, Colegrove, & Dolgin, 1996). According to Sameroff (2006), “The family figures predominately among determinants of children’s academic, social, and conduct competence. Families clearly matter in promoting youth development, but understanding how requires a comprehensive analysis of the etiology of problems in child development” (p. 54). Greater levels of cohesion and expressiveness, as part of the relationship dimension of the family environment, have been implicated as a predictor of higher social competence and a decreased level of psychological distress (Varni, Katz, Colegrove, & Dolgin, 1996).

28. Demographic Questionnaire A demographic questionnaire was developed in 1998 for the Time 1 study of the international adoptees from the former USSR. Collected demographic, background, and risk factor information.

29. Tools Family Environment Scale A combined picture of the social and psychological perspectives of the family, the trend of personal growth within members of the family, and the nature of the interpersonal relationship among family members is assessed by the FES Moos & Moos, 1994. Range of FES scales: 20-80; higher scores indicate greater expressiveness & cohesion. Lower scores on conflict subscale indicates less conflict. Family Environment Scale (FES) The FES, a conceptually and empirically derived self-report instrument, was utilized to assess family environment (R. H. Moos & B. S. Moos, 1994, 2002). A combined picture of the social and psychological perspectives of the family, the trend of personal growth within members of the family, and the nature of the interpersonal relationship among family members is assessed by the FES (Rousey, Wild, & Blacher, 2002). A stable family environment has been reported to be important for school adjustment (Ketsetzis, B. A. Ryan, & Adams, 1998) and the general positive adaptation of children and youth (Harvey & Byrd, 1998). Family Environment Scale (FES) The FES, a conceptually and empirically derived self-report instrument, was utilized to assess family environment (R. H. Moos & B. S. Moos, 1994, 2002). A combined picture of the social and psychological perspectives of the family, the trend of personal growth within members of the family, and the nature of the interpersonal relationship among family members is assessed by the FES (Rousey, Wild, & Blacher, 2002). A stable family environment has been reported to be important for school adjustment (Ketsetzis, B. A. Ryan, & Adams, 1998) and the general positive adaptation of children and youth (Harvey & Byrd, 1998).

30. The Family Environment Scale (FES) (Moos & Moos, 2002) gathers information on the stability of system and to identify strengths and weaknesses that might facilitate optimal functioning. A stable family environment has been reported to be important for school adjustment (Ketsetzis, B. A. Ryan, & Adams, 1998) and the general positive adaptation of children and youth (Harvey & Byrd, 1998).

31. Competence “Adaptational success in the developmental tasks expected of individuals of a given age in a particular cultural and historical context” (Masten & Curtis, 2000, p. 533). Competence, effective adaptation in the environment, can either be broadly defined in terms of global achievement of major development tasks, or more specifically be related to achievement domains (Masten & Coatsworth, 1998).

32. Competence as assessed by Child Behavior Checklist Competence defined: Effective patterns of behavior at with respect to conduct, socially, and at school Total Competence (conduct, social, school) score Time I assessments (n=105): 45.75 (SD=10.55) (Non-adopted US = 40-80) Time II assessments (n=51): 43.40 (SD=9.77) Time III (n=30): 45.37 (SD=10.86)

33. Question What were the relationships between protective factors (environment of the adopted family to include cohesion, conflict and expressiveness) as measured by the Family Environment Scale (FES) and competence of a group of adolescents internationally adopted from the former USSR?

34. Descriptive Statistics for Protective Factors

35. Pearson’s Correlations Coefficients- Protective Factors and Competence Small sample – hard to sign. Results Pearson only looks at Bivariate relationships. Sometimes relationships are more complex. Determining the relationships between the protective factors (environment of the adopted family) and competence was the premise of research question three. None of the protective factors (cohesion, conflict and expressiveness) was statistically significantly correlated with total competence at Time 3. When the competence subscales (academic, social, and conduct) were examined separately, cohesion in the family was moderately, statistically significantly correlated with social competence (r = .369, p = .045) and statistically significantly correlated in the strong range with conduct competence (r = -.518, p = .003) at Time 3. Increased conflict in the family was noted to be statistically significant and moderately correlated with an increase in conduct problems at Time 3 (r = -.363, p = .049). Small sample – hard to sign. Results Pearson only looks at Bivariate relationships. Sometimes relationships are more complex. Determining the relationships between the protective factors (environment of the adopted family) and competence was the premise of research question three. None of the protective factors (cohesion, conflict and expressiveness) was statistically significantly correlated with total competence at Time 3. When the competence subscales (academic, social, and conduct) were examined separately, cohesion in the family was moderately, statistically significantly correlated with social competence (r = .369, p = .045) and statistically significantly correlated in the strong range with conduct competence (r = -.518, p = .003) at Time 3. Increased conflict in the family was noted to be statistically significant and moderately correlated with an increase in conduct problems at Time 3 (r = -.363, p = .049).

36. Question What were the changes in risk and protective factors as they relate to competence through time [international adoptees studied at 6-9 years of age (Time 1), at 9-12 years of age (Time 2), and at 13-17 years old (Time 3)]? Research questions four and five could not be answered utilizing simple statistical techniques. The sample size was not adequate to develop a model to answer the research questions. Pooling the data from Time 1, Time 2, and Time 3 allowed the sample size to increase from 30 data points to 90 data points. This technique allowed for the testing of the data across the three time periods, specifically as to whether the protective factors have any impact on risk factors, and if so, does the relationship change over time?Research questions four and five could not be answered utilizing simple statistical techniques. The sample size was not adequate to develop a model to answer the research questions. Pooling the data from Time 1, Time 2, and Time 3 allowed the sample size to increase from 30 data points to 90 data points. This technique allowed for the testing of the data across the three time periods, specifically as to whether the protective factors have any impact on risk factors, and if so, does the relationship change over time?

37. Participants at Time 1

38. Participants at Time 2

39. Participants at Time 3

40. Total Competence did not change significantly over time Describe changes across time – total competence at Time 1, Time 2, Time 3 Risk factors do not change across timeDescribe changes across time – total competence at Time 1, Time 2, Time 3 Risk factors do not change across time

41. ANOVA – Protective Factors No statistically from time 1, time 2, and Time 3 across time – no changes in Protective Factors across time Questions 4 and 5 = deal with relatiohshipsNo statistically from time 1, time 2, and Time 3 across time – no changes in Protective Factors across time Questions 4 and 5 = deal with relatiohships

42. Correlations of Risk Factors with Total Competence

43. Correlations – Risk Factors and Competence Across Time Total Competence – no risk factors significant at Time 3. Birth weight was significant at Time 1 and Time 2 Academic Competence – birth weight significant at Time 1, Time 2, Time 3 Social Competence – no risk factors significant at Time 3. Birth weight was significant at Time 1 and Time 2 Conduct Competence – Age at Institutionalization significant at Time 3 only. Birth weight was significant at Time 1

45. Correlations of Protective Factors with Total Competence

46. Correlations – Protective Factors and Competence Across Time Total Competence – No protective factor significant at Time 3. Cohesion was significant at Time 1 and Time 2. Academic Competence – No protective factor significant at Time 3. Conflict was significant at Time 1 only. Social Competence – Cohesion was significant at Time 1, Time 2, and Time 3. Conduct Competence – Cohesion and Conflict was significant at Time 1, Time 2, and Time 3

47. Adoptive Families Matter Enriched environments provide corrective stimulation allowing substantial adaptive change to occur Significant emotional development is possible when children’s environments change Changes set the stage for the development of competence in other domains

48. Conclusion The families continue to face challenges, but findings are consistent with other studies demonstrating that children who are adopted after early adversities generally fare well developmentally after their environments have improved

49. “Interesting but unsurprising findings:” –Sir Michael Rutter, SRCD Prolonged deprivation leads to psychological defects. Good quality rearing in an adoptive family environment results in significant catch-up. The longer the institutional deprivation, the more limited the psychological recovery. Prolonged deprivation has a lasting effects on the neuroendocrine system.

50. Five interesting but unsurprising findings” -Sir Michael Rutter, SRCD, Relatively strong persistence of deficits up to age 11, at least 8 years after a radical change in rearing environment, implies some form of biological programming or neural damage. Nevertheless, heterogeneity in outcomes is present and cannot be fully explained.

51. Society for Research in Child Development meeting Quotes from Rutter: “ What should adoptive families do to foster normal development?” There is no intervention that offers “a magic bullet” but that does not mean that nothing useful can be done. What can be expected in adulthood? “ We don’t yet know.”

52. Take home messages The risks experienced by internationally adopted children are very similar to children who reside in our foster care system. It is important to examine resilience as well as vulnerability. Families make a difference.

53. How should mechanisms of resilience be studied? Pay attention to individual differences Note and encourage the beneficial impact of adoptive families Some do okay despite gross deprivation

54. Vera & Nadya Twins adopted from Russia as toddlers, now live in California. Christmas card from parents: “The twins are 17 now and are wonderful human beings. Everyone loves them. Both have learning disabilities. Nadya uses pure determination to overcome. Vera charms her way out of almost anything. Nadya accepts responsibility appropriately; Vera denies all responsibility. Two very different kids. All grown up but always our little ones.”

55. “Out of calamity and loss, children recover to become functionally and emotionally competent adults….Modest difficulties experienced by children who are adopted far outweigh the significant benefits they receive from having a permanent family.” Johnson, D. E. (2002). Adoption and the effect on children's development. Early Human Development, 68(1), 39-54.

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