1.1 Historical and Contemporary Trends in Adoption

Adoption involves the legal transfer of parental rights and responsibilities from biological parents to adoptive parents. Depending on the country in which a family resides, adoption is governed by national, regional, or state law. Although there is considerable diversity in how adoption is practiced from country to country, the legal basis of adoption can be traced to the earliest civilizations. Adoption is referenced in the Bible and in the codes and laws of such ancient societies as the Babylonians, Egyptians, Hebrews, Hindus, and Chinese. Unlike today, most adoptions in ancient societies involved the adoption of adults, typically males, and was a vehicle to ensure inheritance rights and the continuity of the family, to meet the requirements to hold public office, for religious purposes, or to forge an alliance between separate, but potentially rival, groups (Reference French and BornsteinFrench, 2019).

In most countries, the shift in adoption practice toward focusing on the interests of vulnerable children did not emerge until the mid-nineteenth to early twentieth centuries. In the United States, for example, the first adoption statutes were passed by the state of Massachusetts in 1851. For the first time, there was an explicit recognition in law that adoption was to promote the welfare of children needing placement outside of their biological family. Although other states soon passed similar legislation, it was not until 1929 or thereafter that other states and different countries instituted some form of judicial oversight regarding adoption. Initially, adoption involved children born in the same country as the adopters (domestic adoption). However, for reasons to be discussed below, intercountry adoptions, and in some countries, foster care adoptions, emerged as alternatives for those wishing to adopt. Together with other changes that will also be examined, such as the emergence of open adoption or adoption by gay and lesbian adults, adoption has become a complex phenomenon that affords new opportunities and concerns for children and adults as well as for those interested in the study of this form of family life, parenthood, and identity.

1.2 Characteristics of Adopted Children, Adoptive Parents, and Adoptive Families

What type of children are most often adopted and who are viewed as suitable to be adoptive parents? The answers to these questions are complex, have changed over time, and vary from one country to another. As the birth rate declined following World War I and the influenza epidemic of 1918, US public interest in adoption as a form of family building increased dramatically, a change that also occurred in other countries in connection with their own unique circumstances. Most adopting adults at the time were heterosexual infertile couples wanting to adopt newborn babies; in contrast, older children, those with special medical and mental health needs, and those who were part of a sibling group were seldom considered for adoption. Over time, the desire for adoptable babies soon exceeded the number available for adoption. This trend reflected the growing availability of contraception and abortion, which reduced the number of babies being born, as well as less social stigma associated with out-of-wedlock pregnancy and single parenthood, and increasing availability of social programs supporting the ability of parents to keep their children.

As a result of the decline in adoptable babies, some US adults began to look outside the United States as a means of building their family. For example, following World War II and especially the Korean and Vietnam Wars, large numbers of orphaned children were adopted by US citizens. Although in some places, such as the United Kingdom, domestic adoption was always preferred, many other Western countries also pursued intercountry adoption, with the number of international placements increasing rapidly from the late 1980s to 2004, when international placements peaked in most Western countries before a sharp decline. For example, in the United States, approximately 23,000 intercountry adoptions occurred in 2004, whereas by 2021 the number had dramatically declined to 1,785. A similar phenomenon has been observed in many other countries (e.g., during the same period, intercountry adoptions in a smaller country like Spain changed from 5,500 to 170). The reasons for the decline in intercountry adoptions are complex and involve, among other factors, legal and ethical concerns regarding how intercountry adoptions were being practiced in both “sending countries” (i.e., the child’s country of origin) and “receiving countries” (i.e., where prospective adoptive parents reside), greater support for domestic placements in sending countries, and fewer infants or young children being made available for adoption by sending countries (Reference Palacios, Adroher and BrodzinskyPalacios, Adroher, et al., 2019).

Another important change in adoption practice concerned children who lingered in foster care. In the United States, for instance, prior to the 1980s, adoption of foster children from state care was uncommon. Because many of these children were older and had a history of adversity including prenatal exposure to drugs or alcohol, neglect, abuse, exposure to domestic violence and parental mental health problems, and/or multiple foster placements, they often were considered “unadoptable” and, consequently, child welfare agencies made relatively little effort to recruit prospective adoptive families for these youngsters. In 1980, however, the US government passed legislation which sought to create family permanency in the lives of children lingering in foster care. This landmark legislation, as well as subsequent legislative acts passed over the next three decades, emphasized the importance of timely permanency planning for children who were unlikely to be returned to their birth family. As a result, large numbers of foster children were legally freed for adoption, not only providing them greater family stability, but improving their health and emotional well-being. Currently, adoption of foster children represents the single greatest source of children for US citizens wishing to build or expand their families through adoption. A similar trend can be seen in other Western countries, where permanence and stability have become guiding principles of child protection regulations and policies.

The child welfare field has also witnessed remarkable changes in those who are viewed as acceptable adoptive parents. In the past, adoption agencies employed quite restrictive criteria in determining which adoption applicants were suitable to adopt children. In most cases, adoptive parents were middle-class to upper-class, married, white, infertile, heterosexual couples, usually in their 20s to early 40s, and free of disabilities or significant health problems. In contrast, single and older adults, racial minority adults, sexual minority adults, fertile couples, those from lower- or working-class backgrounds, adults with disabilities, and foster parents were seldom approved for adoptive parenthood. This practice was based on uninformed and biased views of what type of family best serves the interests of children. However, as developmental and family research began to show that family structure was much less important for supporting healthy child development than family processes (Reference GolombokGolombok, 2015), adoption agencies began “screening in” applicants as opposed to “screening them out.” Today, child welfare practice focuses more on identifying prospective adoptive parents who have the motivation and ability to meet the needs of children waiting to be adopted, and who understand and accept the challenges that often accompany adopting children with early adverse life experiences. Applicants’ marital status, age, race, income level, foster parent status, and sexual orientation are no longer barriers to adopt children in an increasing number of countries, although almost all sending countries object to placing children with sexual minorities. Moreover, even in the United States, where such adoptions are legal, adoption agencies with religious affiliations sometimes have policies of not placing children with LGBT adults (Reference Brodzinsky, Brodzinsky and PertmanBrodzinsky, 2012). Despite these types of restrictions, there is clearly greater diversity today in most Western countries in terms of who is building or expanding their family through adoption.

The racial, ethnic, and cultural makeup of adoptive families has also changed over time. In the past, most adoptions involved in-racial or in-ethnic placements, usually with non-Hispanic White parents adopting White children. With the emergence of intercountry adoption and domestic foster care adoption, many adoptive families are now characterized by parents and children who do not share the same race, ethnicity, or cultural heritage.

A final change in adoption practice and in adoptive family life is the growing numbers of adoptive and birth families who have some level of contact with one another following adoption placement. For most of the twentieth century, adoptions were closed and strictly confidential, with no identifying information shared or contact between the adoptive and birth families. However, beginning in the 1970s and 1980s, some adoption professionals and adult adoptees began advocating for open adoption, resulting in adoption researchers starting to explore the impact of postadoption contact on adoptive and birth family members, including the adopted child. In contrast to the dire warning of opponents of open adoption, research indicated that in many cases contact between the families could be especially positive for adoptive parents, adopted children, and birth parents (Reference Grotevant, Wrobel and HelderGrotevant, 2020). As will be discussed later, contact between adoptive and birth families in domestic placements is becoming more common in a growing number of countries. Although such contact is less common in intercountry adoptions, some internationally adopted individuals are also seeking contact with birth relatives in their country of origin.

These changes in adoption policies and practices suggest that there is no such thing as a “typical adoptive family” or a “typical adopted person.” Adoptive families are highly diverse in their makeup, and the lived experiences of adopted individuals are also extremely diverse and constantly changing. Therefore, in considering questions related to the adjustment of adopted persons and their families, it is important to examine a wide range of biological, ecological, interpersonal, and developmental factors impacting the lives of these individuals.

1.3 Theoretical Perspectives in Adoption Research

Although there were previous isolated studies, the earliest systematic research on adoption, unguided by formal theory, began in the late 1950s and early 1960s, with a primary focus on describing the differences in adjustment between adopted and nonadopted individuals. Later research interest focused on developmental questions such as the role of genetics and the impact of early adversity on adoptees’ psychological adjustment and recovery, and the processes and factors underlying their development (Reference Palacios and BrodzinskyPalacios & Brodzinsky, 2010). The field of specialization of researchers has guided their empirical work and the theories that could best serve to address the issues of interest. Neurobiological and psychological trauma theories have guided studies focusing on the impact of early nutritional deficiencies and other cumulative adversities on physical, neurological, and psychological development of adopted individuals, and their postadoption recovery from previous life difficulties (Reference Johnson and GunnarJohnson & Gunnar, 2011; Reference Rutter, Sonuga-Barke and CastleRutter et al., 2010; Reference Wade, Parson and HumphreysWade et al., 2022); attachment theory has been used to understand the impact of preadoption hardships and relationship disruptions on later attachment security of adoptees and their adjustment (Reference Dozier, Rutter, Cassidy and ShaverDozier & Rutter, 2016); cognitive developmental theory and stress and coping theory have provided valuable insights into how children comprehend and appraise their adoption experience and cope with loss and grief (Reference Brodzinsky, Brodzinsky and SchechterBrodzinsky, 1990, Reference Brodzinsky2011b); psychodynamic theory has contributed to understanding how adoption is internalized and experienced emotionally by the adoptee (Reference Hindle and ShulmanHindle & Shulman, 2008); Erikson’s psychosocial theory and narrative theories have guided insights into adoptive identity development (Reference Grotevant, von Korff, Schwartz, Luyckx and VignolesGrotevant & Von Korff, 2011); and lifespan developmental psychology and family life cycle theories have been helpful in examining adoption as a lifelong experience (Reference Brodzinsky, Schechter and HenigBrodzinsky et al., 1992). In their scoping review and analysis of adoption research, Reference Séguin-Baril and Saint-JacquesSequin-Baril and Saint-Jacques (2023) identified twenty-seven theories that have guided empirical investigators, sixteen of which originate from psychology.

For the most part, psychological theories guiding adoption research have been rather narrow in focus, examining specific aspects of the adoption experience. An exception is the application of Bronfenbrenner’s bioecological model of development to the field of adoption (Reference Palacios, Wrobel and NeilPalacios, 2009). The model focuses on the development of the person, embedded within a complex nesting of contextual influences, from the direct impact of immediate influences such as family, peer group, school, and health services (microsystems), to the impact of the interactions of different microsystems (mesosystems), to the indirect effects of community influences on adoption, such as governmental agencies, social services, mass media, and neighbors (exosystems); to the broader influences of culture, social values, and laws related to adoption (macrosystems). Moreover, the chronosystem adds a temporal dimension to each of the previous levels of analysis (such as age-related changes in adoption identity in connection with parents’ and professionals’ changing attitudes about contact between adoptive and birth families, and changing laws and policies regarding the right of adopted persons to have access to origins-related information). Bronfenbrenner’s model resonates with the “specificity principle of adoption” proposed by Reference Bornstein and SuwalskyBornstein and Suwalsky (2021), who assert that the experience of adoption for individuals is best understood when considering its specific setting conditions, specific people, specific times, specific processes, and specific domains. Sections in this Element reflect research findings inspired by these perspectives, as well as the other ones noted in the preceding paragraphs.

Finally, efforts to integrate different theoretical perspectives can be seen in longitudinal studies that incorporate a transdisciplinary approach. For example, the English and Romanian Adoption Study (ERA) has examined genetic influences, neuropsychological functioning, cognitive development, mental health, and behavioral adjustment in children, adolescents, and young adult adoptees (e.g., Reference Sonuga-Barke, Kennedy and KumstaSonuga-Barke et al., 2017). Similarly, the Early Growth and Development Study (EGDS), a longitudinal investigation of adopted children, their birth parents, and their rearing parents, studied across infancy and childhood, has investigated the role of genetics, prenatal circumstances, and rearing environments on adopted children’s psychological adjustment (Reference Reiss, Ganiban and LeveReiss et al., 2023). Although it focuses on the adjustment of foster children, the Bucharest Early Intervention Project (BEIP) has also been guided by several theories, including those related to neuropsychology and attachment (e.g., Reference Wade, Parson and HumphreysWade et al., 2022). Findings from these and other longitudinal projects are reported in this Element.

2.1 Do Adopted Children Have More Problems?

Hundreds of studies have compared the adjustment of adopted and nonadopted individuals, using different age samples, methodologies, and outcome measures. To overcome the limitations of any one study, researchers have used meta-analysis to provide a synthesis and integrated view of the research findings. One of the first meta-analyses in the adoption literature involved more than 25,000 adoptees and 80,000 nonadopted children across different studies and countries (Reference Juffer and van IJzendoornJuffer & van IJzendoorn, 2005). Findings indicated that although most adoptees are well adjusted, they tend to have more externalizing and internalizing symptoms than nonadopted children, with adoptees overrepresented in clinical settings. However, except for use of mental health services, for which there was a large effect size, the magnitude of the group differences was modest, with overall results supporting Reference HaugaardHaaugard’s (1998) thesis about the greater presence of adoptees in the more problematic range of maladjustment. This interpretation is consistent with a previous study by Reference Sharma, McGue and BensonSharma et al. (1996) showing that, in the midrange distribution of scores for psychological problems, there was a 1:1 ratio for adopted and nonadopted adolescents, but the ratio was more than 3:1 at the upper range of the distribution, indicating significantly more adopted youth at the extreme level of adjustment difficulties.

Reference Behle and PinquartBehle and Pinquart (2016) published another meta-analysis based on eighty-five studies to see if adoptees were more represented in the extreme end of clinical problems. The risk of a psychiatric diagnosis was found to be approximately twice as high in adoptees as in non-adoptees, with an elevated risk for ADHD, conduct disorder, anxiety disorders, substance use, depression, personality disorder, and psychosis. The mean percentages of adoptees receiving diagnoses varied between 32 percent (conduct disorders, oppositional and defiant disorder) and 13 percent (depression). Moreover, adoptees were at 2.35 times higher risk for receiving ambulatory mental health assistance and psychiatric treatments in general, as well as 2.63 times higher risk for receiving psychiatric hospital treatment.

Another meta-analysis focused on eleven studies of internationally adopted adolescents (Reference Askeland, Hysing and La GrecaAskeland et al., 2017). Once again, more problems were identified in the adopted group, with higher scores for total behavior problems and externalizing difficulties, but not for internalizing problems. The difference was larger when relying on parents’ reports than adoptees’ self-reports, suggesting that parents could be over-estimating their children’s problems or that teenagers could be under-reporting their difficulties. Also, larger differences were observed in studies using clinical categories than when symptoms were assessed on a continuum. The use of diagnostic labels would explain why register-based studies, which tend to rely on categorical data, report larger estimates of mental health problems in adoptees.

Although adoptees’ propensity to manifest higher levels of adjustment difficulties could explain their overrepresentation among children receiving mental health services, there could also be a referral bias on the part of adoptive parents. Adoptive parents have a greater propensity to seek professional services even when their children’s problems are not especially serious, suggesting that they may be unduly sensitive to the challenges associated with their children’s difficulties (Reference WarrenWarren, 1992). However, this bias does not seem sufficient to explain the overrepresentation of adoptees in clinical settings, especially those in inpatient facilities. For example, adopted youth are disproportionately represented in residential treatment facilities (Reference Brodzinsky, Santa and SmithBrodzinsky et al., 2016). Although adoptees represent only slightly more than 2 percent of the US child population, 25–30 percent of youth enrolled in these programs were adopted. Compared to their nonadopted peers in the same facilities, adopted youth manifested more attention problems, impulsivity, oppositional behavior, attachment difficulties, trauma symptoms, identity issues, fear of rejection, and problems with empathy.

When present, adoptees’ adjustment difficulties appear more enduring than transient. This is illustrated in a longitudinal study of international adoptees placed beyond the age of 4 years and followed for 3 years (Reference Helder, Mulder and GunnoeHelder et al., 2016). For these children, externalizing problems remained as an area of difficulty, with some worsening over time in internalizing problems as well. A similar outcome for externalizing problems was reported in the longitudinal studies by Reference Paine, Fahey, Anthony and SheltonPaine et al. (2021) and Reference Nadeem, Waterman and FosterNadeem et al. (2017), in which a significant proportion of the children (20 percent or more) continued to manifest problems in the clinical or borderline-clinical range over time, particularly externalizing behaviors. In contrast, prosocial behavior was observed to improve significantly with more time in the adoptive family (Reference Paine, Fahey, Anthony and SheltonPaine et al., 2021).

Research has also examined differences in adopted and nonadopted children in other relevant areas of functioning. Executive functioning (EF) encompasses a diverse set of cognitive abilities (e.g., sustained attention, working memory, and inhibitory control) that are crucial for social interactions and school learning. There is abundant research showing the negative impact of early deprivation and its enduring consequences on EF. Research comparing EF abilities in community samples of never-institutionalized children and those with institutional experience who were later placed in foster care or in adoptive families has documented the persistence of EF difficulties in the latter groups. These difficulties have been observed shortly after adoption (Reference Hostinar, Stellern, Schaefer, Carlson and GunnarHostinar et al., 2012), as well as several years later, as in the study of children adopted in Spain from Russian institutions and examined 7 years after their adoptive placement (Reference Peñarrubia, Palacios and RománPeñarrubia et al., 2020). The persistence of EF problems following early adversity has also been observed in studies with a longer follow-up. In the BEIP, children who remained in institutional care were compared to those who started in institutions but were later placed in high-quality foster care, as well as to a group of community-based, never-institutionalized children. Although improvements were observed in some aspects of EF, the difficulties of the foster care group in EF functioning persisted during childhood and adolescence (Reference Wade, Fox, Zeanah and NelsonWade et al., 2019). Together with other difficulties, such as behavioral problems and linguistic deficiencies, persistent EF problems may explain a lower academic attainment in the comparisons with nonadopted classmates (Reference Brown, Waters and SheltonBrown et al., 2017).

In contrast to the persistence of EF problems for children placed in foster care in the BEIP longitudinal study, there was significant improvement in IQ in the first years after placement, with remarkable stability in the following years (Reference Fox, Almas, Degnan, Nelson and ZeanahFox et al., 2011). The impact on intelligence of a more stimulating environment was also shown in a Swedish study based on national register data, in which the IQs of more than 2,500 male siblings separated by adoption were studied at the age 18–20 years (Reference Kendler, Turkheimer, Ohlsson, Sundquist and SundquistKendler et al., 2015). IQs of adopted-away individuals were higher than those of their full siblings reared in their biological home environment, reflecting the more stimulating context provided by adoptive parents with higher education.

Positive changes in attachment behaviors have also been observed after placement in adoptive families. For example, a longitudinal study comparing children adopted from Russia into Spanish families and a group of children in institutional care has documented significant improvements in attachment disorders for the adoptees, but not for those in group care, whose difficulties persisted or worsened over time (Reference Román, Palacios and MinnisRomán et al., 2022). In addition, research has documented improvements in quality of attachment relationships for children with early adversity once placed in adoptive homes (Reference Helder, Mulder and GunnoeHelder et al., 2016; Reference Raby and DozierRaby & Dozier, 2019).

In summary, research on the adjustment of adopted children supports two main conclusions. First, adopted children are within the normal range of adjustment in most domains of functioning, including those children with relatively low levels of preadoption adversity (Reference Hornfeck, Bovenschen and HeeneHornfeck et al., 2019), as well as those with more significant early life challenges (Reference Nadeem, Waterman and FosterNadeem et al., 2017). This finding runs counter to the stigma often associated with adoption, suggesting that most adoptees are maladjusted. It also supports the belief that adoption is an effective societal intervention for children who cannot be reared by their biological parents, and who otherwise might continue to live in adverse circumstances (Reference Palacios, Adroher and BrodzinskyPalacios, Adroher, et al., 2019; Reference van IJzendoorn and Juffervan IJzendoorn & Juffer, 2006). The second conclusion, however, qualifies the first one. Although most adoptees are well adjusted, as a group, they do manifest significantly more problems than their nonadopted agemates, with a higher percentage of problems in the clinical or borderline range of adjustment, especially for externalizing behavior (ranging from 20 percent to 30 percent) (Reference Paine, Fahey, Anthony and SheltonPaine et al., 2021). The percentage of internalizing problems for adoptees compared to non-adoptees is smaller, but still above the clinical threshold, with proportions varying for different domains of functioning (8 percent for somatic problems, 15 percent for anxiety/depression) (Reference Nadeem, Waterman and FosterNadeem et al., 2017). Finally, although the percentage of adopted children with clinically relevant symptoms is concerning, and requires the attention of adoptive parents and professionals, it is important to keep in mind that the problems of these children are substantially less than those youngsters who remain in maltreating homes. For example, Reference Éthier, Lemelin and LacharitéÈthier et al. (2004) found that children exposed to continued chronic maltreatment manifested behavior problems above the clinical threshold, ranging from 69 percent in their initial assessment to 75 percent 6 years later.

2.2 The Influence of Preadoption Adversities

As previously noted, many adopted children experience early adversity and trauma prior to adoption placement. Understanding the relation between these early adverse experiences and later developmental outcomes has been of considerable research interest.

Meta-analytical evidence based on intercountry adoption studies has documented that depriving preadoption experiences put adopted children at increased risk for behavioral maladjustment (e.g., Reference Juffer and van IJzendoornJuffer & van IJzendoorn, 2005). Most of these studies, however, use age at adoption placement as a global proxy for preadoption adversity because there is usually little information about children’s preadoption experiences (Reference Rutter, Sonuga-Barke and CastleRutter et al., 2010). Even when studies can add more information about preadoption adversity, such as type of care prior to adoption (e.g., institution vs foster care) as well as limited information provided by adoptive parents, the percentage of variance explained by the known preadoption adversities is small (Reference Finet, Vermeer, Juffer and BosmansFinet et al., 2018).

Fortunately, domestic adoption research generally has access to detailed information about the child’s preadoption circumstances. This is illustrated by a Welsh prospective longitudinal study of children placed for adoption (Reference Paine, Fahey, Anthony and SheltonPaine et al., 2021). Besides the child’s age at placement, available information included the number of days spent with birth parents and in foster care before adoption, the number of moves prior to the adoptive placement, and ten categories of adverse childhood events (ACEs), including childhood abuse and household dysfunction. Results indicated strong correlations between different preadoption adversities (ACEs, time with birth parents, number of moves, time in care) and persistent negative impacts on adopted children’s internalizing and externalizing scores over time. The number of preadoption adverse events per se and in interaction with number of moves while in care were significantly related to children’s problems. However, after about a year and a half in caring families, the long-term effects of ACEs on externalizing problems were no longer significant, which the researchers suggest reflects the positive experience of living with loving and stimulating families for children with more preplacement adversity.

Reference Murray, Williams, Tunno, Shanahan and SullivanMurray et al. (2022) also had access to detailed information about children’s preadoption adversities in their study of suicidal ideation and suicidal behaviors. Before being adopted, nearly all adolescents in their sample had experienced at least one type of potentially traumatic event (93.5 percent), most had experienced more than one type (73 percent), and many experienced all four types of maltreatment considered (physical abuse, sexual abuse, psychological maltreatment, or neglect) (17 percent). Compared to nonadopted peers, adolescents who were adopted had increased likelihood of endorsing both suicidal ideation and suicidal behavior, but when polytrauma and traumatic stress symptoms were added into the predictive models, adoption status was no longer a significant predictor for either indicator, while polytrauma by itself was significantly related to both. Once again, the more detailed information about preadoption adversities, frequently absent in adoption research, is essential to provide the context for a thorough understanding of adoptees’ problems.

An important implication of this discussion is that, more than any single predictor, the accumulation of preadoption adversities helps to explain postadoption adjustment difficulties. This conclusion is well illustrated in the German study by Reference Hornfeck, Bovenschen and HeeneHornfeck et al. (2019) assessing multiple preadoption risk factors, including prenatal risk (e.g., maternal psychopathology and substance abuse during pregnancy), experiences of emotional, physical, and sexual abuse and neglect, and number of placement changes before adoption (with relatives, in foster or institutional care). As the number of risk factors increased, the likelihood of showing serious emotional and behavioral problems increased from 0 percent (no risk factors present) to 50 percent (four risk factors present).

2.3 The Role of Age at Adoptive Placement

Does age at adoption matter? Is there a specific adoption placement age after which children can be considered at risk for developmental difficulties? This last question is tied to a classic issue in developmental science, namely the existence of critical/sensitive periods (Reference BornsteinBornstein, 1989): Is there a critical period for positive and negative experiences to leave a permanent imprint on a child’s developmental trajectory? Is there an age threshold after which recovery is compromised? The study of children exposed to significant adversities during known periods of time and to more positive caregiving experiences afterwards sheds light on this key developmental issue. This problem is addressed before responding to the more general question about the importance of age at adoption.

For the critical/sensitive period question, two longitudinal studies following the early adversity-later enrichment paradigm are particularly relevant. One is the ERA study involving children removed from very depriving Romanian institutions between a few weeks to 42 months and placed with advantaged adoptive parents in the United Kingdom (Reference Sonuga-Barke, Kennedy and KumstaSonuga-Barke et al., 2017). The second study is the BEIP, in which children between 6 and 31 months were recruited from institutions in Bucharest and then randomized to either continue in institutional care or to be placed in a high-quality foster care program (Reference Nelson, Zeanah and FoxNelson et al., 2019). Both the ERA and the BEIP studies have followed their participants from early childhood to young adulthood, using comparison samples.

The ERA results are more in accordance with the classic critical period concept. Because problems such as cognitive impairment, inattention-overactivity, disinhibited attachment, and autistic-like social behaviors were consistently present in virtually all those adopted after the age of 6 months, but not before this age, the suggestion is that introducing enriched family conditions before the 6-month threshold facilitates normal development (Reference Sonuga-Barke, Kennedy and KumstaSonuga-Barke et al., 2017). The BEIP conclusions are more complex and nuanced (Reference Nelson, Zeanah and FoxNelson et al., 2019). The main difference in this study was between those exposed to enriched circumstances before or after 24 months. But, more importantly, both the deprivation effects and the subsequent recovery varied by domain. Some domains were apparently unaffected by exposure to adversity (e.g., face and emotion processing), other domains showed evidence of improved caregiving effects but not evidence of critical period effects (e.g., social competence, psychiatric disorders), and other domains had little improvement after placement in a family environment (e.g., some executive functions, and ADHD). The idea of a developmental critical period is also undermined by the fact that, within broad constructs such as IQ, language, and attachment, there seems to be different critical periods for different underlying processes (Reference Nelson, Zeanah and FoxNelson et al., 2019), as discussed in the next section.

In summary, the existence of one critical or sensitive period that determines when recovery after initial adversity is unlikely has little empirical support (Reference Brodzinsky, Gunnar and PalaciosBrodzinsky et al., 2022). Across and within domains, there are cascades of different sensitive periods under the influence of multiple experiential and biological factors. Later acquisitions can compensate for skills not well established previously, although in other cases poor initial acquisitions impair the development of more advanced skills (Reference Nelson and Gabard-DurnamNelson & Gabard-Durnam, 2020). With enriched stimulation, the possibility of functional modifications extends into adolescence, as illustrated with three examples. The stress system response is recalibrated in adolescence in the presence of significant improvements in the supportiveness of the environment (Reference Gunnar, Reid, Gelman and WaxmanGunnar et al., 2019). High-quality caregiving in adolescence is associated with improvements in EF and behavioral adjustment, with stronger associations during adolescence than in the preceding years (Reference Colich, Sheridan and HumphreysColich et al., 2021). When adoptive mothers have a secure state of mind, the association with positive changes in the adoptees’ attachment representations is more evident in adolescence than in the preceding years (Reference Pace, Di Folco, Guerriero and MuziPace et al., 2019).

Does this discussion imply that age at adoption is irrelevant for understanding later adjustment? Evidence from individual studies is inconsistent, with some reporting a lack of association between age at adoption and behavioral adjustment (e.g., Reference Finet, Vermeer, Juffer and BosmansFinet et al., 2018), and others supporting the view that older age at placement results in detrimental outcomes for children (e.g., Reference Helder, Mulder and GunnoeHelder et al., 2016). Meta-analytical evidence is also contradictory, with studies looking at behavioral adjustment indicating a lack of evidence for a decisive influence of age at placement (Reference Juffer and van IJzendoornJuffer & van IJzendoorn, 2005), and studies looking at psychiatric disorders and treatment in mental health services reporting a significant association between older age at adoption and greater prevalence of disorders (Reference Behle and PinquartBehle & Pinquart, 2016). In terms of the previous discussion of Reference HaugaardHaaugard’s (1998) proposition of adoption-related risk, it may be that age at adoption is more critical when the extreme end of clinical problems is considered.

A good example of the importance and limitations of age at placement can be found in research on adoption instability and breakdown. An older age at adoption is related to increased risk of serious placement difficulties (Reference Palacios, Rolock, Selwyn and Barbosa-DucharnePalacios, Rolock, et al., 2019). However, such difficulties are not the consequence of one isolated factor, but of an accumulation of risk factors in the child (including a longer exposure to previous adversities, with more separations, relational distrust, and insecurity, and with more emotional and behavioral dysregulation), in the adoptive parents, and in postadoption professional support (Reference Palacios, Rolock, Selwyn and Barbosa-DucharnePalacios, Rolock, et al., 2019). Although age at placement is a significant predictor of adoption breakdown, most late adoptions are stable (e.g., Reference Rushton and DanceRushton & Dance, 2006). The conclusion is that age at adoption provides insufficient information for understanding the role of specific adversities and does not address how child, parent, or family characteristics might influence the impact of such adversity on children’s development and adjustment. In subsequent sections, these influences are studied in more detail.

3.1 Differential Plasticity

The term “plasticity” refers to the capacity of the organism to adjust to changing circumstances and demands of the environment, but “differential plasticity” indicates that such capacity is not homogeneous across different developmental domains (Reference Palacios, Román, Moreno, León and PeñarrubiaPalacios et al., 2014). As Reference Nelson, Zeanah and FoxNelson et al. (2019) noted, prolonged positive stimulation in a family context may overwrite the effects of early deprivation, but not in all domains. In their examination of changes in growth and in several important psychological dimensions, adoption researchers have documented these differences.

3.2 Resilience and Genes

If some developmental domains change more rapidly and more completely than others, another relevant question is whether, adopted after early adversity, some children are more susceptible to change than others. To address this issue, the concept of resilience and the analysis of genetic influences are of interest. The latter refers to a classic question in developmental science, namely, the relative influence of nature and nurture, and the debate on gene-environment (G×E) interactions. In typical circumstances, the effects of genes and environment are confounded, as both are provided by the same parents (the so-called passive G×E correlation). To disentangle their effects, behavior genetic researchers have utilized the “adoption design,” whereby the genes come from the birth parents and the environment is configured by the adoptive parents. Not all the studies utilizing an adoption design are interested in adoption per se, so our analysis is limited to genetically informed adoption research, with the resilience paradigm as a framework.

According to Reference Plomin, Gidziela, Malanchini and Von StummPlomin et al. (2022), three stages can be identified in the history of G×E research. In the first stage, genes were not directly assessed, but the genetic risk of adopted children was estimated based on birth parents’ psychopathological conditions assumed to have a genetic component. Once the tools to analyze DNA became available, a new generation of studies started, although initially the time and expense to genotype DNA variants limited the analysis to a few genes, typically those coding for neurotransmitters presumed to be related to psychopathology. However, according to Reference Plomin, Gidziela, Malanchini and Von StummPlomin et al. (2022), the heritability of complex traits and common disorders is caused by thousands of inherited DNA differences, each with miniscule effects. A new technology now allows researchers to aggregate all these genome-wide variants in a single genetic index or polygenic score, opening new ways for the third stage of genetically informed research.

4.1 Adoptive Parent Factors

Various aspects of adoptive parents’ mental health have been linked to children’s postadoption recovery and adjustment. For example, depressive symptoms in one or both adoptive parents have been associated with their children’s depressive symptoms (Reference Liskola, Raaska, Lapinleimu and ElovainioLiskola et al., 2018) and internalizing behavior problems (Reference Goldberg and SmithGoldberg & Smith, 2013; Reference Hails, Shaw and LeveHails et al., 2018). In addition, Reference Hails, Shaw and LeveHails et al. (2018) found that adoptive fathers’ depressive symptoms moderated associations between adoptive mothers’ depression and children’s externalizing behavior. Postadoption depression in parents is not uncommon – with rates comparable to postpartum depression in biological parents – and is usually linked to unfulfilled and unrealistic expectations related to their children or themselves, as well as unmet support needs (Reference Foli, South and LimFoli et al., 2012).

Parental stress is another factor linked to children’s postadoption recovery and adjustment. In a sample of 7-year-old internationally adopted children placed during infancy, Reference Gagnon-Oosterwaal, Cossette and SmollaGagnon-Oosterwaal et al. (2012) reported that children’s preadoption adversity (assessed as health and developmental problems at placement) was positively associated with current internalizing and externalizing problems, and that these relations were mediated by adoptive mother’s current level of stress. Reference Santos-Nunes, Narciso, Vieira-Santos and RobertoSantos-Nunes et al. (2018) also found a link between adoptive parents’ stress, often related to violated expectations, and their children’s adjustment difficulties. This circumstance (violated expectations) is often present in adoptions that become unstable or break down (Reference Palacios, Rolock, Selwyn and Barbosa-DucharnePalacios, Rolock, et al., 2019).

Different aspects of parenting style have been explored in relation to children’s adjustment. Reference Audet and Le MareAudet and Le Mare (2011), for example, reported that authoritarian parenting was negatively associated with inattention and overactivity problems for youngsters who experienced significant preadoption deprivation. Negative power assertive parenting strategies have also been linked to placement instability (Reference Rushton, Dance and QuintonRushton et al., 2000). High-quality structure and limit setting by adoptive parents resulted in fewer regulation problems for postinstitutionalized children (Reference Lawler, Koss and GunnarLawler et al., 2017). In addition, parental warmth moderated the link between children’s early adversities and their subsequent internalizing behavior three years after placement (Reference Anthony, Paine and SheltonAnthony et al., 2019).

Adopted children’s adjustment is also impacted by parental sensitivity (i.e., understanding children’s signals and providing appropriate and prompt responses to them) and parental mind-mindedness or reflective functioning (i.e., representing and holding in mind children’s presumed thoughts, feelings, and desires). In a study by Reference van der Voort, Linting and Juffervan der Voort et al. (2014) of adolescents internationally adopted in infancy, maternal sensitivity in infancy and middle childhood predicted less inhibited behavior in adolescence, which in turn predicted lower levels of internalizing problems. Reference Priel, Melamed-Haas, Besser and KantorPriel et al. (2000) also reported an association between higher maternal self-reflectiveness and decreased levels of externalizing problems in adopted children.

Parent’s cognitions and attitudes about adoption play a role in children’s adjustment. Some adoptive parents readily acknowledge the inherent differences between adoptive and nonadoptive families, whereas others deny or minimize such differences. Reference Lo and GrotevantLo and Grotevant (2020) found that adoptive parents characterized by an acknowledgment-of-differences perspective during middle childhood had youth who experienced stronger feelings of attachment to their parents during adolescence.

Finally, adoptive parents’ internal working models of attachment have been linked to adoptees’ attachment security. For example, in a sample of Italian families, Reference LionettiLionetti (2014) reported that secure attachment in adopted infants is facilitated when mothers have secure attachment states of mind. In addition, Reference Pace, Di Folco, Guerriero and MuziPace et al. (2019) reported that late-placed adopted adolescents showed both an increase in attachment security and a decrease in disorganized attachment from childhood to adolescence and that adoptive mothers’ secure states of mind were significantly associated with their children’ increase in attachment security in adolescence.

4.2 Adoption Communicative Openness

Among the many responsibilities of adoptive parents are sharing adoption information with their children, supporting their curiosity about their origins, helping them cope with adoption-related loss, promoting a positive view of their heritage, and supporting a positive sense of self and adoption identity. Success in achieving these tasks is linked to creating a family atmosphere that supports open communication about adoption, that involves sharing adoption information with children and sharing adoption-related feelings and becoming emotionally attuned to the children’s adoption experiences (Reference Brodzinsky, Brodzinsky and PalaciosBrodzinsky, 2005).

Higher levels of communicative openness generally are associated with better psychological adjustment, including fewer behavior problems (Reference Aramburu, Perez-Testor and MercadalAramburu et al., 2020; Reference BrodzinskyBrodzinsky, 2006), more positive self-esteem (Reference BrodzinskyBrodzinsky, 2006; Reference Hawkins, Beckett and RutterHawkins et al., 2007), and more positive adoptive identity (Reference Le Mare and AudetLe Mare & Audet, 2011). In addition, communicative openness is related to more trust of adoptive parents by youth, fewer feelings of alienation from them, and better family functioning, as well as a greater effort to seek new information about their background as they enter young adulthood (Reference Kohler, Grotevant and McRoyKohler et al., 2002). However, Reference Grotevant, Rueter, Von Korff and GonzalezGrotevant et al. (2011) failed to find a relation between communicative openness and adolescents’ psychological adjustment.

Not surprisingly, open adoptions that involve contact between adoptive and birth families are also associated with greater adoption communication between parents and children (Reference BrodzinskyBrodzinsky, 2006; Reference Grotevant, Rueter, Von Korff and GonzalezGrotevant et al., 2011). Such contact leads to children asking more questions about birth family and the reasons for their adoption, thereby facilitating communication transactions between parents and children over time.

In short, when the adoptive family environment promotes an open and accepting atmosphere regarding conversations about adoption, and when adopted children and adolescents feel comfortable expressing their thoughts, feelings, and questions about adoption, they are much more likely to internalize their adoption experience in a positive manner and display positive psychological adjustment. This is especially true when parents foster what Reference Reuter and KoernerReuter and Koerner (2008) describe as a conversation orientation that respects children’s unique feelings and experiences about adoption and provides them with appropriate structure and guidance regarding important adoption issues such as helping to interpret background information, correcting misunderstandings about adoption, and supporting their search interests. This style of communication contrasts with what the researchers referred to as a conformity orientation, in which parents engage in discussions about adoption with their children, but with an emphasis on promoting their own view of adoption experiences rather than respecting the unique experiences, perspectives, and interests of their adopted children. The distinction between conversation orientation and conformity orientation highlights the importance of recognizing that talking with children about adoption is not inherently the same as adoption communicative openness (Reference Pinderhughes, Brodzinsky and BornsteinPinderhughes & Brodzinsky, 2019), an emotional and relational attitude that expresses parents’ empathy and respect toward their children’s needs and experiences (Reference Brodzinsky, Brodzinsky and PalaciosBrodzinsky, 2005).

4.3 Ethnic, Racial, and Cultural Socialization

As noted previously, over the past few decades, a growing percentage of adoptions involves transethnic, transracial, and/or transcultural placements, especially international adoptions, and those from domestic foster care. Among the many adoption-related responsibilities of parents in these types of adoption are supporting children’s identity, self-esteem, pride, and adjustment in relation to their ethnicity, race, and cultural heritage through ethnic, racial, and cultural socialization (e.g., Reference Ferrari, Rosnati, Fatigante, Zucchermaglio and AlbyFerrari & Rosnati, 2022; Reference Pinderhughes, Brodzinsky and BornsteinPinderhughes & Brodzinsky, 2019). This aspect of parenting involves providing information, perspectives, experiences, and skills related to the child’s ethnic, racial, and cultural origins. An important part of this socialization process is preparation-for-bias that is associated with ethnic, racial, and cultural minority status, including being part of a transracial, transethnic, and/or transcultural adoptive family. Because transracially adopted children and their families are often exposed to microaggression and microinsults (Reference Zhang, Zhang and PinderhughesZhang et al., 2019) as well as more overt forms of discrimination and bias, it is important for parents to help their children learn to navigate these experiences.

For adoptive parents to be successful in supporting children’s ethnic, racial, and cultural identity and self-esteem, as well as their psychological adjustment, they must first acknowledge the importance of ethnicity, race, and culture in the family’s life (especially the child’s) as well as the reality of prejudice, bias, and stigma that is associated with ethnic/racial/cultural minority status in society. When parents readily acknowledge ethnic, racial, and cultural differences in the family, can see these differences from both their own and the child’s perspectives, are aware of their own implicit biases and stereotypes related to these issues, recognize the importance of providing exposure to the child’s ethnic, racial, and cultural origins, and value the importance of preparing children for stigma, they are more likely to provide ethnic, racial, and cultural socialization, including preparation-for-bias (Reference Lee, Grotevant, Hellerstedt and GunnarLee et al., 2006; Reference Pinderhughes, Zhang and AgerbakPinderhughes et al., 2015).

Successful socialization in these areas involves connecting children to their origins and redefining the family as one that is multiethnic, multiracial, or multicultural. As parents share information about the child’s origins, they can also take the opportunity to talk about their own unique heritage, which is often different for parents, even those who are the same race (e.g., parents may come from different religious backgrounds or different cultural heritages). Such conversations reinforce the reality that children are not the only ones who are different in the family; that is, each member has a unique heritage that enriches the entire family.

Adoptive parents are highly variable in the extent to which they engage in these types of socialization practices as well as in the strategies they use. Some of the common strategies used by parents include: talking with children about their ethnic, racial, and cultural heritage; reading books with children that incorporate information about their heritage; attending activities or events that are related to children’s heritage; developing friendships with families of color and other transracial adoptive families; finding an ethnic, racial, or cultural mentor for children; developing relationships with the child’s birth relatives (when possible); and visiting the child’s birth country (Reference Pinderhughes, Brodzinsky and BornsteinPinderhughes & Brodzinsky, 2019).

Parents’ success in engaging in heritage socialization depends, in part, on where they live. When families live in urban areas and multicultural countries, parents are often able to find appropriate resources to support ethnic, racial, and cultural socialization efforts. But when families live in small towns and rural areas, or in more ethnically/racially/culturally homogeneous countries, such resources are often limited, reducing opportunities for such socialization, and resulting in children and their families sometimes feeling marginalized in their communities. In addition, parents who more often have previous experiences interacting with minority group members, and who less often adopt a “color-blind” attitude, are more likely to expose their children to their ethnic, racial, and cultural heritage and prepare them for possible discrimination (Reference Hrapczynski and LeslieHrapczynski & Leslie, 2018). However, the tendency of adoptive parents to prepare their children for bias may vary depending on their children’s ethnic, racial, or cultural heritage. For example, Reference Killian and KhanaKillian and Khana (2019) reported that “color-conscious” parents of Black adopted children were more likely to prepare them for discrimination and bias than “color-conscious” parents of Asian and Latino adopted children.

Research has also focused on the impact of ethnic, racial, and cultural socialization on children’s adjustment. Reference Johnston, Swim, Saltsman, Deater-Deckard and PetrillJohnston et al. (2007), for example, reported that White mothers of Asian adopted children who engaged in more cultural socialization had children with fewer externalizing problems, but not internalizing problems. Racial and cultural socialization are also associated with decreased feelings of marginalization and increased self-esteem (Reference Mohanty and NewellMohanty & Newhill, 2011) as well as with adoptees’ ethnic identity and pride (Reference Hu, Anderson and LeeHu et al., 2015). Moreover, Reference Rosnati and FerrariRosnati and Ferrari (2014) noted that, whereas the perception of social discrimination undermined the ethnic identity of adolescent and young adult Italian adoptees, adoptive parents’ cultural socialization strategies played a vital role in supporting their ethnic identity

Finally, there has also been a focus on bicultural socialization efforts by adoptive parents and its impact on transracial and transcultural adoptees. This aspect of socialization supports adoptees’ connection to their birth culture and to their adoptive country. Reference Manzi, Ferrari, Rosnati and Benet-MartinezManzi et al. (2014) noted that youth who receive cultural socialization in relation to their birth heritage are also more likely to feel connected to their adoptive parents’ national identity. When adoptees are successful in integrating both aspects of their identities, they generally experience more positive well-being (Reference Ferrari, Rosnati, Manzi and Benet-MartinezFerrari et al., 2015; Reference Manzi, Ferrari, Rosnati and Benet-MartinezManzi et al., 2014). However, when they have difficulty integrating both their ethnic and national identities, they often feel “caught in the middle” and display greater adjustment difficulties (Reference Manzi, Ferrari, Rosnati and Benet-MartinezManzi et al., 2014).

5.1 Adoption-Related Loss and Identity Development

Common to all adopted individuals is the experience of loss and grief. Understanding the losses associated with adoption, learning to cope with them, processing adoption-related grief, and finding ways of integrating those experiences into their identity are critical development achievements for adoptees.

Loss in adoption is universal and pervasive (Reference BrodzinskyBrodzinsky, 2011b). Not only are adoptees separated from their birth parents, but also others in the birth family, including grandparents, uncles and aunts, cousins, and sometimes even siblings. For children placed very early in life, these family disruptions are seldom traumatic, primarily because attachments were never formed with these individuals. As children get older and begin to reflect on these individuals, however, it is common for them to experience a deep sense of loss related to relationships that were never allowed to form. For children removed from their birth family at older ages, separation from parents, siblings, and extended family is likely to be more disruptive and even traumatic because these individuals most often played significant roles in their lives, with some being important attachment figures, even when abuse and neglect were present. Older placed children also experience the loss of nonbiological support figures from the past, such as friends, teachers, and therapists. In addition, children adopted from foster care and those who experienced institutional life often form strong and meaningful relationships with caregivers and other children they lived with. The loss of these individuals can be quite disruptive for adoptees.

As children grow up, it is common for them to ask questions about their early years. “What was I like as a baby?” “Was I easy to care for or difficult?” When children continue to live with the people who reared them from infancy, these questions are easily answered. For adoptees who have been separated from their early caregivers (e.g., birth parents, foster parents, or institutional staff), these questions too often are unanswerable. The loss of a “meaning maker” (i.e., the person or people who can describe and explain the child’s early years) leaves not only a long-lasting informational gap in the child’s life narrative, but also an emotional void for the person’s emerging identity.

At some point, children begin to recognize that most people view adoptive family status as “second-best” compared to growing up in the family of birth. Reference FrenchFrench (2013) coined the term “birth privilege” to describe the inherent societal bias against which adopted individuals are often judged by others and themselves. This experience sometimes leads adopted children to feel “lesser than” their nonadopted peers, potentially underlying their self-esteem, identity, and adjustment. Because adopted individuals and their adoptive family members do not share a genetic link, it is also quite common that they look physically different or have different personality traits or abilities. For some children and adolescents, these differences can result in feelings of not “fitting in” or “belonging” to the family, yet another loss that can complicate identity and adjustment. This is especially true for adoptees who are placed across ethnic, racial, and/or cultural lines. Integrating adoption, ethnicity, race, culture, and other aspects of identity can be particularly challenging for these individuals when they live with families and/or in communities that do not offer them appropriate models, information, and experiences that help them understand what it means to be adopted and what it means to be a member of a particular ethnic, racial, or cultural group (Reference Pinderhughes, Brodzinsky and BornsteinPinderhughes & Brodzinsky, 2019).

Coping with adoption-related loss and grief and integrating one’s experiences into a healthy, secure, and cohesive adoptive identity can be challenging for several reasons. Because adoption is statistically uncommon in most societies (e.g., approximately 2 percent of children in the United States are adopted), adopted youth often feel that there are few people who truly understand what they are experiencing, which can accentuate feelings of being different and compromise self-esteem and identity. In addition, adoption loss is not necessarily permanent in some respects. Birth family members and other significant figures from the past are usually alive. Even when they are unknown and there is no contact with these individuals, they continue to live in the thoughts and emotional life of the adopted person (Reference Brodzinsky, Scabini and RossiBrodzinsky, 2014), keeping fantasies of reunion a possibility. For some, these feelings are more intense than for others. The child’s understanding of the reasons for adoptive placement can also make it difficult to integrate being adopted into a secure sense of self. When children understand that they were voluntarily placed for adoption by their birth parents, it can raise questions about whether they were unwanted because of characteristics or behaviors that the birth parents found unacceptable (e.g., “I cried too much”; “they didn’t want a boy”). When children understand that they were removed from their birth parents by child welfare authorities, it can raise questions about whether they come from people who are damaged and whether they too will have similar problems as their birth parents. In either case, children can potentially internalize negative beliefs about themselves and their origins, undermining self-esteem and identity. Finally, adoption loss is often unrecognized by others, who tend to focus more on what the child has gained because of their adoptive placement. Such circumstances often result in adoptees feeling ignored, misunderstood, and unsupported, leading to what Reference Doka and DokaDoka (1989) referred to as “disenfranchised grief,” which is much more difficult to resolve than when a person’s grief is both acknowledged and supported.

In short, adoption loss and grief are universal for adoptees. Yet how these life experiences are understood by adopted children and the impact they have on self-esteem and identity depend on many factors, including the person’s developmental level, the adoption information available to them, the parents’ communication style, the support received from others, their propensity to explore adoption issues, and the salience of adoption in their emerging identity.

5.2 Developmental Perspectives on Adoptive Identity

Adoptive identity begins when children are first informed of their adoptive family status – typically through a simple and naïve story told to them in the preschool to early school years – and seek to understand its meaning. Although most children at this age can label themselves as “being adopted” and have developed a rudimentary adoption language (i.e., they can often recite a brief version of their adoption story shared by parents), they have little understanding of what adoption means (Reference BrodzinskyBrodzinsky, 2011b; Reference Brodzinsky, Singer and BraffBrodzinsky et al., 1984). It is not until middle childhood that adoptees possess the cognitive maturity and experience beyond the family to begin to appreciate the differences between adoption and birth as pathways to family membership. Adoption-related thoughts and feelings often emerge during this period and, unless there is a family atmosphere of open communication about adoption, the adoptive parents remain unaware of how their children are experiencing being adopted and sometimes believe that it is of little interest to or has minimal impact on their children. In addition, during adolescence and young adulthood, individuals develop a deeper cognitive and social understanding of adoption, including its legal status, differing social views and values about adoption, and the motivations and life circumstances underlying the reasons why people adopt children and why birth parents place their children for adoption or have their children removed from their care by child welfare authorities.

Although adoptive identity begins to develop when children first learn about their unique family status, it is, in fact, a lifelong journey involving the cyclical interweaving of multiple processes, including exploration, assessment, reconsideration, consolidation, and integration of information related to the self and one’s relationship to others (Reference Grotevant, von Korff, Schwartz, Luyckx and VignolesGrotevant & von Korff, 2011). Even though there is a developmental course to building an adoption identity, it is not a linear process in which new phases supersede the previous ones. Thoughts and feelings about the unknown or the past may emerge later in life – for instance, during life transitions such as getting married, becoming a parent, or losing an adoptive parent. The desire to know more about the past or to initiate some contact with the birth family may be more salient in certain periods than in others. The outcome of these processes and life experiences is an emerging self-narrative or identity regarding being adopted that is constructed and reconstructed over time as individuals actively explore what they know about their history, how they feel about being adopted, what feedback they have received from others about adoption and the circumstances of their placement, what contact, if any, they have had with birth family members, the impact that contact has had on them, and what information they still desire but do not yet have about themselves.

There is considerable variability among adoptees in terms of their inclination to explore adoption-related issues, the centrality of adoption for their sense of self, and their feelings about self and being adopted (Reference ColanerColaner, 2014; Reference Dunbar, Grotevant, Pratt and FieseDunbar & Grotevant, 2004). Reference ColanerColaner (2014) has described two orthogonal dimensions that are part of the adoption identity process. Reflective exploration involves the degree to which adoptees think about their adoption and its meaning in their lives and preoccupation refers to the salience given to adoption as a component of the person’s identity. High levels of preoccupation indicate that adoption is viewed not just as an important aspect of one’s identity, but as one of the primary organizing perspectives through which the person explores and understands their self, and their relationships with others and the world (Reference Grotevant, Dunbar, Kohler and EsauGrotevant et al., 2000).

The intersection of these two dimensions results in four distinct patterns of adoption identity, defined slightly differently by different researchers (Reference ColanerColaner, 2014; Reference Dunbar, Grotevant, Pratt and FieseDunbar & Grotevant, 2004; Reference Grotevant, Lo, Fiorenzo and DunbarGrotevant et al., 2017). Individuals who display higher levels of reflective exploration, but relatively low to moderate levels of preoccupation are thought to have engaged in the most adoptive identity work and to have integrated adoption into their sense of self in a reasonably healthy and cohesive manner. Reference Dunbar, Grotevant, Pratt and FieseDunbar and Grotevant (2004) refer to these individuals as the integrated group. Others manifest high levels of reflective exploration, but also high levels of preoccupation, their identity work being considered still unresolved – these individuals are identified as the unsettled group by Reference Dunbar, Grotevant, Pratt and FieseDunbar and Grotevant (2004). Many of these individuals are actively searching for information about their adoption, including their original birth certificate (OBC) or access to their adoption files, but find themselves confronting obstacles in their adoption search process, resulting in great frustration (Reference Rizzo WellerRizzo Weller, 2022). The third group of adoptees display low levels of reflective exploration, but moderate to high levels of preoccupation in relation to adoption – described as having a limited adoptive identity by Reference Dunbar, Grotevant, Pratt and FieseDunbar and Grotevant (2004). Although adoption is salient for these individuals, they tend not to reflect on the reasons for its salience and the way in which it relates to other aspects of their identity. Sometimes the meaning of adoption they have internalized reflects others’ views of adoption (e.g., their adoptive parents) rather than their own self-assessment of this identity issue. Finally, those adolescents described by Reference Dunbar, Grotevant, Pratt and FieseDunbar and Grotevant (2004) as being in the unexamined group present with both low adoption exploration and low preoccupation, suggesting little curiosity or effort to address the meaning of adoption in their lives and a sense of self that is relatively independent of their adoptive status. High levels of preoccupation in relation to adoption are often linked to low self-esteem (Reference Horstmann, Colaner and RittenourHorstmann et al., 2016), negative thoughts and feelings about adoption and birth parents (Reference Colaner and SolizColaner & Soliz, 2015), more adjustment issues (Reference Grotevant, Lo, Fiorenzo and DunbarGrotevant et al., 2017), and more emotional distance from and lack of trust of adoptive parents (Reference Kohler, Grotevant and McRoyKohler et al., 2002). High reflective exploration and low to moderate preoccupation is associated with higher levels of identification with both the adoptive and birth families (Reference Colaner, Horstman and RittenourColaner et al., 2018).

5.3 Family Influences on Adoptive Identity Development

Among the most important tasks for adoptive parents are sharing adoption information with their children and engaging them in adoption-related conversations (Reference Pinderhughes, Brodzinsky and BornsteinPinderhughes & Brodzinsky, 2019). Parental attitudes and emotional tone associated with these tasks, as well as parents’ willingness to initiate conversations and respond to children’s curiosity and questions about adoption, are critical for creating a caregiving environment conducive to supporting adoptive identity exploration. To promote such exploration, adoptive parents must first acknowledge the unique aspects associated with adoptive family status that children inevitably confront as they develop, such as their inherent connection to two or more families, confusion about their origins and the reasons for their adoption, loss and grief related to separation from their birth family, and coping with differences between themselves and family members (e.g., in transracial placements). Unfortunately, some adoptive parents identify adoption communication only with discussions about known information, so that if there is little known about the child’s past, there is little effort to engage children regarding their adoption experience. More importantly, not all parents find it easy to acknowledge the inherent differences associated with adoptive status, choosing instead to minimize or reject the differences and rearing their children as if they were born to them. Reference KirkKirk (1964) suggested that this “rejection-of-difference” coping style created difficulties for adopted children because there was no emotional space in the family to address the differences they felt and the unanswered questions about adoption they had (Reference Lo, Cashen, Wrobel, Helder and MarrLo & Cashen, 2020).

The adopted person’s need to explore their origins and the meaning of adoption in their life is both normal and inevitable (Reference Müller and PerryMüller & Perry, 2001), although as noted in Section 5.2, there is variability in the extent and emotional intensity to which such exploration is undertaken. There is a natural progression for most adoption searches. For children, the search begins with basic questions about where they come from, who their birth parents are, and why they were adopted. As they get older, there often is a desire to understand the origin of their physical characteristics, traits, and talents. A more direct link between searching and identity development is found in adolescence and emerging adulthood, when individuals actively seek new information about their origins, sometimes trying to repair emotional vulnerabilities associated with adoption-related loss and grief, as well as feelings of envy and jealousy that are connected to feelings of difference. For those who have never felt security in adoptive family relationships, the search can also reflect a longing for human connection and attachment. This sometimes leads to efforts to contact birth family members. For most adopted people, though, searching is also fundamentally a reflection of innate curiosity and a desire to resolve unanswered questions that are at the core of their adoption experience. As noted in Section 5.2, satisfaction with the search process is tied to a family environment that gives the adopted person permission and support to explore adoption-related issues. This is most likely to occur when parents create an open communicative atmosphere related to adoption (Reference Brodzinsky, Brodzinsky and PalaciosBrodzinsky, 2005; Reference Wrobel, Kohler, Grotevant and McRoyWrobel et al., 2003).

For transracial and intercountry adoptees, there are more complex issues in identity development, as they seek to navigate the intersection of adoption, ethnicity, race, culture, and other factors influencing their emerging sense of self. Reference LeeLee (2003) coined the term “transracial paradox” to describe the complications that transracial adoptees face. He noted that transracial adoptees benefit from privileges usually conferred to their parents as members of their country’s racially dominant group (e.g., in the United States, non-Hispanic White parents of European origin), but are disadvantaged by the stigmas associated with being adopted (Reference BadenBaden, 2016; Reference Ferrari, Caravita, Ranieri, Canzi and RosnatiFerrari et al., 2022), as well as being an ethnic or racial minority member (Reference Sue, Bucceri, Lin, Nadal and TorinoSue et al., 2007) and/or an immigrant (Reference LeeLee, 2003). Integrating all these factors into a healthy, cohesive, and balanced identity is influenced by parents’ success in addressing these issues in family conversations, a process referred to as ethnic/racial/ cultural socialization (see previous discussion of this process in Section 4).

5.4 Societal and Social Influences on Adoptive Identity Development

Societal attitudes and values related to adoption play an important role in the lived experiences of adoptees. Although anthropological scholars have reported very positive views about adoption and less focus on biological parenting in some non-Western cultures (Reference BowieBowie, 2004), most Western societies generally privilege family membership through birth over adoptive family membership (Reference FrenchFrench, 2013), which can lead to feelings of stigma, difference, and not belonging among adoptees, potentially undermining a healthy and secure identity. Societal laws and practices related to adoption also play an important role in the ability of the person to integrate adoption into their emerging sense of self. In some countries, the person’s OBC and other adoption documents are sealed by the court at the time of adoption and a new birth certificate is issued with only the adoptive parents listed on the form. Although this practice was begun with the idea that it protected the best interests of all parties, many adopted individuals, as well as adoption professionals, believe that access to these documents is important for resolving adoption issues and fostering a cohesive and integrated identity for adoptees (Reference Rizzo WellerRizzo Weller, 2022). In other countries, the OBC is not changed after adoption and the key for obtaining information about the birth family and the circumstances leading to adoption is access to the files kept in the archives of child protective services.

As noted previously, the practice of open adoption varies from country to country. Where it is practiced and supported, contact with birth family increases the person’s knowledge about their origin, the circumstances surrounding their adoption, and access to people who can serve as models for a more complete sense of self (Reference Grotevant, Wrobel and HelderGrotevant, 2020). Open adoption also promotes more adoption-related communication among adoptive family members, which, in turn, facilitates adoptive identity development (Reference Von Korff and GrotevantVon Korff & Grotevant, 2011).

Another social context in which adopted children and adolescents receive feedback about adoption and which can impact adoptive identity is their peer group and people in the community. Although most adopted individuals report positive adoption experiences with their friends and others, they also acknowledge experiencing a variety of adoption microaggressions while growing up. Building on minority stress theory (Reference MeyerMeyer, 2003) and research on social microaggressions related to marginalized groups (Reference SueSue, 2010), adoption researchers have identified a variety of microaggressions experienced by adopted individuals and adoptive parents (Reference BadenBaden, 2016; Reference Garber and GrotevantGarber & Grotevant, 2015). Many adoptees and adoptive parents report overly intrusive questions related to themselves and their family. This is especially true in transracial placements in which the physical dissimilarities between family members are obvious – for example, “Is that your real mother?”; “Is your husband Chinese?.” These types of interactions with others can be awkward or embarrassing and undermine family members’ sense of privacy regarding their adoption experience. In some cases, adoptees experience microassaults, which are more conscious and explicit efforts by someone to inflict emotional pain through adoption-related insults – for example, “Your real mother didn’t want you … she just got rid of you”; “You’re a bastard.” Whatever the nature of the microaggressions, the intended or unintended outcome for adopted individuals is a recognition that others view them as different or disadvantaged, which can complicate and ultimately compromise a secure identity and positive sense of self.

Finally, although we have highlighted the considerable variability in adoptive identity exploration and the different developmental and contextual factors that support or undermine a healthy, well-integrated, and balanced sense of self, it is important to point out that the challenges experienced by adoptees in this aspect of development do not appear to compromise at least one aspect of identity – namely, self-esteem. Meta-analysis of eighty-eight studies found no differences in self-esteem between adopted children and adolescents compared to their nonadopted agemates (Reference Juffer and van IJzendoornJuffer & van IJzendoorn, 2007). Moreover, this outcome was found for both same-race and different-race adoptive families. This finding adds to the earlier research reviewed suggesting that most adoptees are well within the normal range of development, despite encountering more than average adversity and challenges than their nonadopted counterparts.

6.1 Open Adoption

As discussed in Section 1, adoption has a long history, with different priorities and practices during different time periods. Prior to the rise of the modern child welfare system in the early part of the twentieth century, when adoption was more informal and not yet institutionalized, it was common for birth parents to place their children with known families and to have some level of contact with them following placement (Reference Baran, Pannor, Brodzinsky and SchechterBaran & Pannor, 1990). This practice began to change with the emergence of public and (where they existed) private adoption agencies, which had government authority for placing in adoptive homes abandoned and vulnerable children, as well as children whose parents chose not to rear them. Independent and informal child placements were criticized by adoption agencies as not being in the best interests of adoptive kinship members. To protect the well-being of these individuals, agencies argued successfully that adoption placements needed to be closed, with no sharing of information or contact between the parties, either before or after adoption placement. In those cases when babies were abandoned and entered institutional care before being adopted, no efforts were made to register the circumstances and people involved, and therefore no identifying information could be shared. For nearly 50 years, the practice of closed or confidential adoptions went unchallenged.

In the 1970s and 1980s, however, perspectives on adoption practice began to change. In the United States, adult adoptees and birth parents, who had longed for information about one another, began to voice their concerns about the practices of closed adoptions, including sealing of the child’s OBC and barriers to postplacement contact. Soon, a small group of adoption professionals suggested that some problems identified in adopted persons were a function of the inherent secrecy and stigmatization that are part of the closed adoption experience (Reference Sorosky, Baran and PannorSorosky et al., 1975) and that open adoption should be standard practice (Reference Baran and PannorBaran & Pannor, 1993). Proponents of open adoption argued that eliminating secrecy in adoption was morally justified and would facilitate healthier adjustment in all adoptive kinship members. The arguments of these professionals, however, were met with resistance from many in the adoption community who believed that the philosophy and practice of open adoption would undermine the well-being of all members of the adoptive kinship system, especially the adopted child (Reference Kraft, Palumbo, Woods, Schmidt and TuckerKraft et al., 1985). Although the path leading to open adoption was different in other countries, concerns about its negative impact were similar and confidential adoption was the norm.

In response to this debate, a substantial body of research has emerged over the past four decades, most of which has focused on domestic infant adoptions, although a smaller literature also exists on openness in foster care adoptions and international adoptions. To date, the findings have largely supported the benefits of open adoption compared to its potential drawbacks (Reference Grotevant, Wrobel and HelderGrotevant, 2020), although researchers and child welfare professionals have noted difficulties in some postadoption contact arrangements from foster care. Because of the benefits associated with open adoption, it is now being practiced in an increasing number of countries.

6.2 Adoption by Sexual Minority Adults

More and more sexual minority adults are becoming parents through adoption. Like in other areas of sexual minority parenting (Reference Bos, Gartrell, Goldberg and AllenBos & Gartrell, 2020; Reference Tasker, Lavender-Stott, Goldberg and AllenTasker & Lavender-Stott, 2020), this development has been met with questions as to whether adopted children are disadvantaged when reared by lesbian or gay parents and whether these parents manifest different characteristics or parenting qualities than their heterosexual counterparts. In this section, we address these questions, as well as trends and practices in adoption by lesbians and gay men.

7.1 Types of Postadoption Services and Support

There are many types of services and support available to adoptive parents and their children (Reference Merritt, Ludeke, Wrobel, Helder and MarrMerritt & Ludeke, 2020; Reference PennerPenner, 2023), with types and availability differing by country or even by state or region within countries. Some services focus primarily on providing emotional support to family members (e.g., parent and child support groups, individual and family counseling); others are more informational or skill building in nature (e.g., online adoptive parent courses, parent education classes, referral hotlines and information networks, academic tutoring for children); some focus on advocacy training for parents with service providers, schools, and other professionals who do not adequately understand the child’s or family’s needs; still others focus on stabilizing families during a crisis (e.g., crisis counseling, parent respite care). Finally, depending on the type of adoption and where it takes place, other support provides families with access to adoption subsidies offered by child welfare agencies that pay for medical and mental health care for children, out-of-pocket childcare expenses, and/or home modifications and vehicle equipment to support special needs children.

Postadoption services and support are invaluable for meeting the needs of adopted children and their parents. Use of postadoption services is associated with decreased emotional and behavioral problems in children and more effective and satisfactory parenting as well as decreased likelihood of adoption instability or breakdown (Reference Palacios, Rolock, Selwyn and Barbosa-DucharnePalacios, Rolock, et al., 2019; Reference Smith and HowardSmith & Howard, 1999). Although efforts to assess the effectiveness of postadoption services have been hampered by a lack of rigorous methodology and the heterogeneity of services offered to adoptive families (Reference PennerPenner, 2023), overall there is general agreement that adoptive families benefit from them.

Where they exist, adoption subsidies, as one key form of postadoption support, have had a profound effect on adoptive families, especially those adopting children from foster care. In the past, foster children too often lingered in care, without the benefit of a permanent family, undermining their emotional well-being compared to those who were adopted (Reference Hjern, Vinnerljung and BrännströmHjern et al., 2019). To meet the needs of these vulnerable children, the US Congress in 1980 passed a law that, for the first time, created a program of financial and medical assistance that helped promote adoption from foster care, reduced the financial burden of adoption, and allowed parents to meet the needs of children adopted from state care. The success of the adoption subsidy program can be seen in the large number of US children adopted from foster care since the passage of this legislation. Since 2010, over 50,000 children have been adopted from foster care each year.Footnote ² Moreover, higher adoption subsidies have been associated with more stable adoption placements (Reference Barth and BerryBarth & Berry, 1990).

One aspect of postadoption support that has not received sufficient attention is parent self-care. Rearing adopted children can be extremely challenging, especially for those individuals whose children are older at the time of placement and/or have significant medical, psychological, or educational special needs. High levels of stress and feelings of isolation are common among these parents (Reference Atkinson and GonetAtkinson & Gonet, 2007), especially when they do not have access to postadoption support (Reference Santos-Nunes, Narciso, Vieira-Santos and RobertoSantos-Nunes et al., 2018). Child welfare and mental health professionals clearly need to focus more on providing adoptive and foster families with strategies for stress reduction and health promotion, especially for those who are rearing special needs children.

Despite the many types of postadoption support and services available, adoptive parents often have difficulty accessing them or simply do not use them. In many cases, parents do not know what services are available to them or which ones they are eligible for (Reference Dhami, Mandel and SothmannDhami et al., 2007). Furthermore, those living in small towns or in rural areas may find that the services are not provided locally. In other cases, parents cannot afford the services, especially those provided by private agencies or mental health professionals. In other cases, parents may be reluctant to utilize postadoption services, believing that doing so reflects some level of failure on their part. A key factor in postadoption service use by adoptive parents is effective preadoption preparation (Reference BrodzinskyBrodzinsky, 2008; Reference Wind, Brooks and BarthWind et al., 2007). Those preparing and counseling adoptive parents must ensure that the message to their clients is that help-seeking, when it is needed, is a sign of strength and not an indication of parenting failure.

In short, there is a wide range of postadoption services available for adoptive families and clear evidence that the availability and utilization of these services benefit all family members, foster greater family cohesion, and support adoption stability (Reference PennerPenner, 2023). Despite this fact, too many families do not have access to these services or in some cases are reluctant to utilize them. Adoption professionals must make greater efforts to address these issues to support these vulnerable families, preventing adoption instability and breakdown (Reference Palacios, Rolock, Selwyn and Barbosa-DucharnePalacios, Rolock, et al., 2019).

7.2 Factors Associated with Postadoption Needs and Service Use

Postadoption service and support needs are associated with many factors. Reference Lee, Battalen, Brodzinsky and GoldbergLee et al. (2020) highlighted characteristics associated with adoption type, as well as child and parent characteristics, that are linked to the adoptive family’s postadoption needs and service use.

The child’s pathway to adoption results in different types of postadoption needs. For example, in countries where domestic private agencies exist, like in the United States, children placed from foster care and from other countries are more likely to experience early adversities and traumas, as well as be older at the time of placement, than children placed from such agencies (Reference Howard, Smith and RyanHoward et al., 2004). These types of circumstances increase the risks for mental health and behavioral problems as well as difficulties adjusting to an adoptive placement. Helping parents understand the impact of preadoption adversity on their children, as well as the best strategies to support their children’s recovery from traumatic experiences, is an important part of adoptive parent preparation and postadoption interventions to support placement stability and the well-being of all family members.

As discussed in Section 6.1, open adoptions involving some level of postplacement contact between adoptive and birth families are increasingly common in many countries. Adoptive parents are often unsure about the benefits and risks associated with open adoptions, especially when their children have experienced adversities at the hands of birth family members, and, consequently, sometimes find it useful to consult with adoption professionals regarding strategies for navigating the additional challenges associated with open adoption arrangements.

A variety of characteristics associated with children have also been linked to postadoption service needs. Children who experienced significant preplacement deprivation, abuse, and other traumas often enter their adoptive families with medical problems, such as growth deficiencies, neurological complications, precocious puberty, and developmental delays (Reference Mason, Johnson and ProckMason et al., 2014). These health difficulties can be daunting for adoptive parents and require the support of medical professionals, especially those well versed in the complications associated with preadoption life adversities. Many of these children also have learning challenges, requiring special education services, as well as psychological and behavioral problems that benefit from skilled mental health clinicians, especially those who are adoption clinically competent (Reference Atkinson, Wrobel, Helder and MarrAtkinson, 2020). Because children who are older at the time of placement typically have experienced more preadoption adversity, parents considering adopting these youngsters must be prepared for the probability of greater postplacement support needs. Children’s current age is also a factor in postadoption service needs and use. As children get older, their developmental needs often become more complicated. The average child age at which parents first seek help is 12 years, suggesting that the transition to adolescence is a period of increased challenge for parents (Reference Waid and AlewineWaid & Alewine, 2018), as research on adoption breakdown also shows (Reference Palacios, Rolock, Selwyn and Barbosa-DucharnePalacios, Rolock, et al., 2019). In Western countries, many domestic and intercountry adoptions involve children placed across ethnic, racial, and cultural lines. These types of adoptions can present parents and their children with many challenges. As previously discussed, parents often need counseling and guidance for understanding different ethnic, racial, and cultural socialization strategies for their children as a means for supporting positive self-esteem and identity, as well as helping children cope with ethnic, racial, and cultural discrimination (Reference Pinderhughes, Brodzinsky and BornsteinPinderhughes & Brodzinsky, 2019).

Parent demographics have also been linked to postadoption service needs and use. Higher levels of family income and parent education are associated with greater help-seeking (Reference Zima, Bussing, Yang and BelinZima et al., 2000), whereas lower education is linked to greater unmet service needs (Reference Zwaanswijk, Verhaak, van der Ende, Bensing and VerhulstZwaanswijk et al., 2006). Finally, sexual minority parents who adopt children also benefit from postadoption supports related to helping their children understand and adjust to having same-sex parents and developing coping strategies to deal with homophobic comments and behavior by others (Reference Battalen, Dow-Fleisner, Brodzinsky and McRoyBattalen et al., 2019).

7.3 Parenting Interventions Addressing Postadoption Problems

Given that a sizable percentage of adoptions today involve children with adverse histories that result in difficulties in adjusting to their adoptive family, including trauma symptoms and complications in forming secure parent-child attachments, there has been significant efforts by professionals to develop clinical interventions to help adoptive and foster parents become more sensitive and competent caregivers and to facilitate more secure parent-child attachments and healthier child outcomes (Reference Rushton and MonckRushton & Monck, 2009; Reference Waterman, Langley, Miranda and RileyWaterman et al., 2018). A meta-analytic review of parenting interventions in adoption and foster care was reported by Reference Schoemaker and WentholtSchoemaker et al. (2020). A wide range of intervention programs and methodologies was represented in these studies. Eight meta-analyses were performed to assess the effectiveness of parenting interventions on four parent outcomes (i.e., sensitive parenting; dysfunctional discipline; parents’ knowledge and attitudes about their child; parenting stress), one placement outcome (stability versus disruption), and three child outcomes (i.e., attachment security; behavior problems; diurnal cortisol levels). Effectiveness of parenting interventions varied for different outcome measures.

Parenting interventions were effective for all four parent outcome measures, significantly improving sensitive parenting and parents’ knowledge and attitudes about their child, and reducing dysfunctional discipline strategies and parenting stress, compared to the control group. Only interventions targeting sensitive parenting, however, yielded a large effect size. Improvements in sensitive parenting were greater for individuals rearing children with challenging behavior problems compared to those whose children manifested fewer difficulties. In addition, group interventions resulted in greater improvement in sensitive parenting than individual interventions, suggesting that parents benefit more from going through such interventions with other adoptive and/or foster parents than from receiving them alone. This finding is consistent with other research indicating that group support from other adoptive parents is a valuable postadoption experience, fostering more effective parenting strategies, reduced stress (Reference Viana and WelshViana & Welsh, 2010), and diminished likelihood of adoption dissolution (Reference Hartinger-Saunders, Trouteaud and JohnsonHartinger-Saunders et al., 2015).

Parenting interventions did not impact placement disruption rates, although the influence of interventions on this outcome may not be a direct one. According to the authors, these interventions likely have an indirect effect on placement stability through their influence on parenting and child outcomes. As parenting quality improves and children’s behavior becomes less challenging, placement disruption is likely to be reduced. Because it takes time for parent and child outcomes to improve through interventions, the impact on placement stability can be expected to be delayed beyond the intervention time frames used in the studies.

Meta-analyses of parenting interventions on child outcome data found a positive effect for reducing children’s behavior problems, but not for improving their attachment security or impacting their diurnal cortisol levels. According to Reference Schoemaker and WentholtShoemaker et al. (2020), the impact of parenting interventions on child outcomes is also likely indirect and results from changes in parenting behaviors, knowledge and attitudes, and stress level that interact with children’s behavior. Because most of the parenting interventions in the studies reviewed occurred over relatively short time periods (four months, on average), changes in parenting outcomes may not have had a chance to impact child outcomes over this period.

Reference Schoemaker and WentholtShoemaker et al. (2020) also suggested that the heterogeneity of the intervention strategies represented across the studies may have obscured specific types of interventions that are effective in changing specific child outcomes. Their conclusion is supported by research that was specifically designed to address children’s attachment problems. For example, Reference Zeegers, Colonnes, Noom, Polderman and StamsZeegers et al. (2020) examined the impact of enhancing adoptive parents’ sensitivity and mind-mindedness on children’s attachment security, behavior problems, and parenting stress, characteristics that in past research were shown to be significantly associated with variations in children’s attachment security, socio-emotional development, and/or behavior problems (Reference Colonnesi, Zeegers, Majdandzic, van Steensel and BögelsColonnesi et al., 2019; Reference Zeegers, de Vente and NikolicZeegers et al., 2018). In the study, the Basic Trust video feedback intervention model (see Reference Colonnesi, Wissink and NoomColonnesi et al., 2013) was employed with fifty-three Dutch adoptive families with internationally adopted children, ages 2–12 years. Pretest, posttest, and 6-month follow-up assessments were conducted. The intervention was associated with significant improvement in fathers’ and mothers’ mind-mindedness, from pretest to posttest, and their sensitivity, from pretest to the 6-month follow-up. Improvement in mind-mindedness preceded improvement in sensitivity, suggesting that the intervention first changed parents’ cognitions and perceptions of the child, after which changes in their behavior took place (i.e., sensitive responding). In addition, the intervention was associated with a positive impact on children’s outcome measures, resulting in fewer child behavior problems and insecure and disorganized attachment at both the posttest and follow-up assessments.

The point noted above by Reference Schoemaker and WentholtShoemaker et al. (2020) is also supported by video-feedback research aimed at fostering parental sensitive responding to children using the Positive Parenting and Sensitive Discipline (VIPP-SD) intervention (Reference Juffer, Bakermans-Kranenburg and van IJzendoornJuffer et al., 2008). A recent meta-analysis of twenty-five randomized controlled trials (RCTs) using VIPP-SD interventions, involving more than 2,000 parents and caregivers from a wide range of families, including two studies focusing on adoptive families and two on foster families, showed significant promotion of sensitive parenting behavior and attitudes, as well as increased security in child–parent attachment, but no reduction of children’s externalizing behavior (Reference Van IJzendoorn, Schuengel, Wang and Bakermans-Kranenburgvan IJzendoorn et al., 2023). According to the authors, the failure of VIPP-SD to impact children’s externalizing behavior is likely the result of their greater distal relationship compared to the more proximal relationship between the intervention and parenting behavior. In short, it simply takes more time for the VIPP-SD intervention to impact children’s behavior.

It is clear that postadoption parenting interventions are a valuable resource for adoptive families, improving their parenting sensitivity, knowledge, and skills that facilitate better adjustment for children and more stable adoption placements. When professionals are not only skilled clinicians, experienced in working with traumatized and attachment impaired children, but also knowledgeable about the vicissitudes of adoption, they are able to support parents in helping their children recover from preadoption adversity and support them in managing the normative challenges of adoptive family life, such as talking with children about adoption, supporting their curiosity about their origins, and, for some, supporting contact with the birth family. Clinicians with these skills are considered to be adoption clinically competent (Reference Atkinson, Wrobel, Helder and MarrAtkinson, 2020; Reference Riley, Singer, Wrobel, Helder and MarrRiley & Singer, 2020).