Adjustment, Openness in Adoption, and Family Services: Findings from The Early Growth and Development Study 2 nd Annual Adoption Caseworker Forum Heart.

Adjustment, Openness in Adoption, and Family Services:

Findings from The Early Growth and Development Study

2nd Annual Adoption Caseworker Forum

Heart of Adoptions, Inc.Tampa, FL

February 26, 2009

Leslie Leve, Ph.D.Oregon Social Learning Center

Jody Ganiban, Ph.D.George Washington University

Overview of PresentationOverview of Presentation

I.I. Description of the Early Growth & Description of the Early Growth & Development Study (EGDS)Development Study (EGDS)

II.II. Early Results on Developmental Outcomes Early Results on Developmental Outcomes and the Adoption Process from EGDSand the Adoption Process from EGDS

III.III. Implications for Prevention and Services for Implications for Prevention and Services for Adoptive FamiliesAdoptive Families

I. Early Growth and Development StudyI. Early Growth and Development Study

3 NIH3 NIH grants to study adoption process and grants to study adoption process and nature-nurture interplay with nature-nurture interplay with 560560 linked linked adoptive families and birth parentsadoptive families and birth parents

Domestic adoption placementsDomestic adoption placements

Adoption occurred within 3 mo. post-Adoption occurred within 3 mo. post-partumpartum

Infant free of major medical problemsInfant free of major medical problems

3 major assessments 3 major assessments for birth parents andfor birth parents and 6 major assessments6 major assessments for adoptive families for adoptive families spanning infancy through 1st gradespanning infancy through 1st grade

Adoption Triad: Adoption Triad:

Birth mother/birth father, Birth mother/birth father, adoptive mother/father, adoptive mother/father, & adopted child& adopted child

EGDS study designEGDS study design

AdoptedChild

BirthMother

BirthFather

AdoptiveMother

AdoptiveFather

EGDS Family of StudiesEGDS Family of StudiesEGDS-Phase 1 (PI: Reiss)

Sept 2002- Aug 2007

n = 360 adoption triads

parenting, context, externalizing, internalizing,

social competence, birth parent characteristics

EGDS-Phase 2 (PI: Neiderhiser)Sept 2007 – May 2012

n = 200 NEW + 360 from EGDS-Phase 1

New: 200 cases, DNA, enhanced measurement of birthparent experiences, prenatal exposures

EGDS-School (PI: Leve)Sept 2007 – July 2012

n = 360

New: Emergent literacy, executive functioning, HPA

axis functioning

3 m

o to

6 m

o

Prenatal Period9

mo

18 m

o

27 m

o

36-

48

mo

4 ½

yr

s

6 y

rs

7 y

rs

AssessmentsAssessments

In-person assessment In-person assessment with adoptive families with adoptive families at age 9-, 18-, 27-at age 9-, 18-, 27-months, and age 4 1/2, months, and age 4 1/2, 6, 7 years6, 7 years

In-person assessment In-person assessment with birth parents 3-6 with birth parents 3-6 mo., 18 mo., and 4 mo., 18 mo., and 4 years postpartum years postpartum

Data collected from Data collected from parent questionnaires, parent questionnaires, interviews, home interviews, home observations, children, observations, children, teachersteachers

Recruitment LocationsRecruitment Locations

Three data collection sites in Phase IThree data collection sites in Phase I Pacific Northwest (Oregon Social Learning Center)Pacific Northwest (Oregon Social Learning Center) Mid-Atlantic (George Washington University)Mid-Atlantic (George Washington University) Southwest (University of California, Davis)Southwest (University of California, Davis)

Two additional regions added for Phase 2Two additional regions added for Phase 2 Midwest (University of Minnesota)Midwest (University of Minnesota) SoutheastSoutheast

Recruitment StrategyRecruitment Strategy

Agency RecruitmentAgency Recruitment Each data collection site identifies “local” Each data collection site identifies “local”

agenciesagencies Collects data on number and type of placementsCollects data on number and type of placements Identify agency liaison once agency agrees to Identify agency liaison once agency agrees to

participateparticipate 33 agencies in 10 states participated in 33 agencies in 10 states participated in

Phase 1Phase 1 20 agencies participating in EGDS-Phase 2 20 agencies participating in EGDS-Phase 2

(6 new agencies)(6 new agencies)

Demographics for BPs and APs: Demographics for BPs and APs:

BM BF AM AF

Mean age (range)

23.83 (13-51)

25.31 (15-45)

36.96 (25-54)

37.89 (26-60)

Race (%)

Caucasian 78 63 93 92 African-American 11 20 4 5

Hispanic/Latino 4 8 1 1

Multi-ethnic 5 5 2 2

Other 2 4 1 1

Mean education level Tradeschool Tradeschool College College

Annual household income (median)

$14k $21k $119k

People in home (mean) 3.6 3.5 3.7

Demographics (Con’t)Demographics (Con’t) Adoptive ParentsAdoptive Parents

1% single1% single 84% AM, 86% AF married84% AM, 86% AF married 1% divorced/separated1% divorced/separated 9% remarried9% remarried 5% AM, 4% AF cohabitating, committed rel.5% AM, 4% AF cohabitating, committed rel.

Birth ParentsBirth Parents 77% BM, 72% BF single77% BM, 72% BF single 8% BM, 22% BF married8% BM, 22% BF married 14% BM, 5% BF divorced/separated14% BM, 5% BF divorced/separated 1% BM & BF remarried1% BM & BF remarried

Developmental Research DomainsDevelopmental Research Domains• Birth parents, adoptive parents, and childrenBirth parents, adoptive parents, and children

• Temperament and personalityTemperament and personality• Social context (stress, social support, economic Social context (stress, social support, economic

circumstances, partner/marital relations)circumstances, partner/marital relations)• Externalizing, internalizing, social competenceExternalizing, internalizing, social competence• Alcohol & drug use and problemsAlcohol & drug use and problems• Executive functioning and literacyExecutive functioning and literacy• DNA and salivary cortisol samplesDNA and salivary cortisol samples

• Adoptive parents onlyAdoptive parents only• ParentingParenting

• Birth parents onlyBirth parents only• Prenatal exposure to substances, toxins, stressPrenatal exposure to substances, toxins, stress

Clean-up Task – designed to examine Clean-up Task – designed to examine parenting and child complianceparenting and child compliance

Temperament Task – designed to Temperament Task – designed to examine child’s frustration/attentionexamine child’s frustration/attention

II. EGDS Results:II. EGDS Results:

• Adoption opennessAdoption openness

• Agency selection & servicesAgency selection & services

• What was helpful, what was hardWhat was helpful, what was hard

A.A. Contributions to general developmental theoryContributions to general developmental theory

• Understanding the contributions of genes & Understanding the contributions of genes & parenting to children’s behavior and adjustmentparenting to children’s behavior and adjustment

B. Contributions to understanding the adoptionB. Contributions to understanding the adoption processprocess

Birth Parent’sBirth Parent’sExternalizingExternalizing

behaviorbehavior

Infant’s risk forInfant’s risk forExternalizingExternalizing

behaviorbehavior

BUT … BUT … The size and significance of this association The size and significance of this association depends on the adoptive mothers’ behaviors. depends on the adoptive mothers’ behaviors.

• emotion regulation skillsemotion regulation skills• tendency to structure child’s behavior tendency to structure child’s behavior

Leve et al. (in press). Infant pathways to externalizing behavior: evidence ofLeve et al. (in press). Infant pathways to externalizing behavior: evidence ofGenotype x environment interaction. Genotype x environment interaction. Child DevelopmentChild Development..

Openness:• Understanding the effects of openness on Understanding the effects of openness on

birth and adoptive parentsbirth and adoptive parents

B. Contributions to understanding the adoptionB. Contributions to understanding the adoption process.process.

Ge et al. (2008). Bridging the divide: openness in Adoption and postadoption psychosocial adjustment among birth and adoptive parents. Journal of Family Psychology, 22, 529-540.

What was the level of openness in the What was the level of openness in the adoption?adoption?

05

1015202530354045

Veryclosed

Closed QuiteOpen

Mod.Open

Open VeryOpen

SemiOpen

Openness in the adoption(1-7 rating scale, mother report when child is 9 months)

% o

f A

dop

tive

moth

ers

65% reportOpen adoptions

Ge et al. (2008)

65% reportOpen adoptions

How satisfied are adoptive How satisfied are adoptive mothers mothers with the with the information they have about the birth parents? information they have about the birth parents? (very stable; numbers here are at 27-months)(very stable; numbers here are at 27-months)

very satisfied

fairly satisfied

fairly dissatisfied

very dissatisfied

Birth Mothers

Birth Fathers

How satisfied are adoptive How satisfied are adoptive fathers fathers with the with the information they have about the birth parents? information they have about the birth parents? (very stable; numbers here are at 27-months)(very stable; numbers here are at 27-months)

very satisfied

fairly satisfied

fairly dissatisfied

very dissatisfied

Birth Mothers

Birth FathersBirth

Fathers

Degree ofOpenness

Satisfaction withadoption process

Ge et al. (2008)

How does openness relate to post-adoption adjustment for Adoptive Parents?

How does openness relate to post-adoptionadjustment for Birth Mothers & Fathers?

Degree ofOpenness

Satisfaction withadoption process

Adjustment tothe process

PositiveImpression

Ge et al. (2008)

Changes in Openness and SatisfactionChanges in Openness and Satisfactionacross Toddlerhoodacross Toddlerhood

Openness & satisfaction with opennessOpenness & satisfaction with openness

• Most families report a moderate levels of openness Most families report a moderate levels of openness and satisfaction with the adoption process and satisfaction with the adoption process throughout throughout toddlerhood:toddlerhood:

• e.g., maintain periodic phone contact, visits, or mail e.g., maintain periodic phone contact, visits, or mail exchangesexchanges

• BUT .. openness and satisfaction with the adoption BUT .. openness and satisfaction with the adoption process process decreaseddecreased somewhat over time according to somewhat over time according to adoptive mothers, adoptive father, birth mothers, and adoptive mothers, adoptive father, birth mothers, and birth fathers.birth fathers.

How would adoptive How would adoptive mothersmothers change openness? change openness?

More closedSameMore open

9-months

18-months

27-months

How would adoptive How would adoptive fathersfathers change openness? change openness?

More closedSameMore open

9-months

18-months

27-months

Openness:• Understanding the effects of openness on Understanding the effects of openness on

birth and adoptive parentsbirth and adoptive parents

B. Contributions to understanding the adoptionB. Contributions to understanding the adoption process.process.

Agency Selection:• How do parents select an agency to work with?How do parents select an agency to work with?

Why did the adoptive family select their agency?Why did the adoptive family select their agency?

• On average, adoptive families looked at 3-4 agencies On average, adoptive families looked at 3-4 agencies before selecting the one they used. The primary before selecting the one they used. The primary deciding factors were:deciding factors were:

• The agency’s philosophy about adoption, including The agency’s philosophy about adoption, including openness, and the agency mission statement (83%)openness, and the agency mission statement (83%)

• The information received about the adoption agency The information received about the adoption agency from a packet, website, or meeting (69%)from a packet, website, or meeting (69%)

• Other people’s recommendation, word of mouth, or Other people’s recommendation, word of mouth, or agency reputation (68%)agency reputation (68%)

• Geographic location of the agency (53%)Geographic location of the agency (53%)

• Agency staff (50%)Agency staff (50%)

Why did the birth mother select their agency?Why did the birth mother select their agency?

• On average, birth mothers looked at about 2 agencies On average, birth mothers looked at about 2 agencies before selecting the one they used. The primary before selecting the one they used. The primary deciding factors were:deciding factors were:

• The agency’s philosophy about adoption, including The agency’s philosophy about adoption, including openness, and the agency mission statement (68%)openness, and the agency mission statement (68%)

• The information received about the adoption agency The information received about the adoption agency from a packet, website, or meeting (64%)from a packet, website, or meeting (64%)

• Services offered, such as counseling, meeting other Services offered, such as counseling, meeting other birth parents, or support group (50%)birth parents, or support group (50%)

• Other people’s recommendation, word of mouth, or Other people’s recommendation, word of mouth, or agency reputation (47%)agency reputation (47%)

• Agency staff (45%)Agency staff (45%)

Adoptive Parents’ Satisfaction (‘very’ or Adoptive Parents’ Satisfaction (‘very’ or ‘somewhat’) with services‘somewhat’) with services

• The information agency provided about adoption process (96%)The information agency provided about adoption process (96%)

• Education and support services (90%)Education and support services (90%)

• Ability to make recommendations for outside services like Ability to make recommendations for outside services like counseling (89%)counseling (89%)

• Staff responsiveness to requests (88%)Staff responsiveness to requests (88%)

• Skill of the staff (92%)Skill of the staff (92%)

• Policy about openness (98%)Policy about openness (98%)

• Home study process, including the length of time it took to Home study process, including the length of time it took to complete it (95%)complete it (95%)

• Matching process (95%)Matching process (95%)

• Placement process (94%)Placement process (94%)

• Post placement services (91%)Post placement services (91%)

Services sought outside of the agencyServices sought outside of the agency

• Legal services (19%)Legal services (19%)

• Home study from a different agency (7%)Home study from a different agency (7%)

• Infant care/parenting classes (4%)Infant care/parenting classes (4%)

• Support group (4%)Support group (4%)

• Counseling (3%)Counseling (3%)

Openness:• Understanding the effects of openness on birth and Understanding the effects of openness on birth and adoptive parentsadoptive parents

B. Contributions to understanding the adoptionB. Contributions to understanding the adoption process.process.

Agency Selection:• How do parents select an agency to work with?How do parents select an agency to work with?

Adoption Process:• What was helpful?What was helpful?• What was difficult?What was difficult?• How has adoption affected your life?How has adoption affected your life?

Agency services that were most helpfulAgency services that were most helpful

• The matching/placement processThe matching/placement process

• Educational classesEducational classes

• Orientation workshopOrientation workshop

• Specific social worker/staff memberSpecific social worker/staff member

• Availability and support of agency staffAvailability and support of agency staff

• CounselingCounseling

• Mediation with birth motherMediation with birth mother

Nicest or most important thing someone did Nicest or most important thing someone did during the adoption processduring the adoption process

• Support from friends and familySupport from friends and family

• Baby showerBaby shower

• The birth parents choosing us to raise their childThe birth parents choosing us to raise their child

• Friends and family providing mealsFriends and family providing meals

• Friends and family babysittingFriends and family babysitting

• Friends and family sharing their experiences with Friends and family sharing their experiences with adoptionadoption

The most difficult part of the adoption processThe most difficult part of the adoption process

• Waiting for a childWaiting for a child

• Coming to the decision to adoptComing to the decision to adopt

• The adoption processThe adoption process

• General adjustment to new child (lack of sleep, General adjustment to new child (lack of sleep, siblings)siblings)

• Coming to terms with infertility issuesComing to terms with infertility issues

• Adoption paperworkAdoption paperwork

• CostCost

• Dealing with a failed adoption(s)Dealing with a failed adoption(s)

How has your child affected your life? (How has your child affected your life? (mothers @ mothers @ 27 months27 months))

Improved lot

Improved slightly

No change

Slightly worse

Lot worse

Marital Relationship

Other Children

Satisfaction With Life

How has your child affected your life? (How has your child affected your life? (fathers @ fathers @ 27 months27 months))

Improved lot

Improved slightly

No change

Slightly worse

Lot worse

Marital Relationship

Other Children

Satisfaction With Life

III. Implications for Prevention and III. Implications for Prevention and ServicesServices

• Most challenging parenting issues

• Desired services

• Format of services

What months have been the most What months have been the most challenging to parent?challenging to parent?

0

20

40

60

0 2 4 6 8 10 12 14 16 1820222426

Moms

What months have been the most What months have been the most challenging to parent?challenging to parent?

0

20

40

60

0 2 4 6 8 10 1214 161820222426

MomsDads

What do adoptive parents think are the “most What do adoptive parents think are the “most challenging issues” as parents (1challenging issues” as parents (1stst year of life) year of life)

0

10

20

30

40

50

60

# R

epor

ting Mothers-

1st year

Fathers -1st year

What do adoptive parents think are the “most What do adoptive parents think are the “most challenging issues” as parents (2nd year of life)challenging issues” as parents (2nd year of life)

0

10

20

30

40

50

60

# R

epor

ting

Mothers-1st year

Fathers -1st year

Mothers -2nd yearFathers -2nd year

What do adoptive parents think are the “most What do adoptive parents think are the “most challenging issues” as parents (2nd year of life)challenging issues” as parents (2nd year of life)

0

10

20

30

40

50

60

# R

epor

ting Mothers -

2nd year

Fathers -2nd year

Desired Adoption-Specific Parenting ServicesDesired Adoption-Specific Parenting Services

Talking to child about adoption (how/when)

Contact with birth parents (how much/how to manage)

Transracial and cultural issues (how to educate)

Blended families (how to discuss with your children)

Stigma/responding to others’ questions

Agency services families wished the agency had Agency services families wished the agency had providedprovided

• More/better education about the adoption process

• More/better support groups

• More parenting education

• More staff accessibility

• Support groups pre-placement

• More support for birth mothers

How often wanted some advice about parenting?How often wanted some advice about parenting?

05

1015

20253035

4045

50

never rarely sometimes often almost/ alltime

never rarely sometimes often almost/ all time

Mothers

Fathers

05

101520

253035

4045

Top 3 areas where parenting information would be Top 3 areas where parenting information would be helpful (helpful (mothers @ 27 monthsmothers @ 27 months))

Not at all helpfulA littleSomewhatHelpfulVery helpful

Disciplining

Managing Toddler Emotions

Temper Tantrums

Top 3 areas where parenting information would be Top 3 areas where parenting information would be helpful (helpful (fathers @ 27 monthsfathers @ 27 months))

Not at all helpful

A little

Somewhat

Helpful

Very helpful

Disciplining

Managing Toddler Emotions

Sleep Issues

Other areas where help information and services Other areas where help information and services would be helpful (at least 1/3 of mothers said would be helpful (at least 1/3 of mothers said information would be ‘helpful’ or ‘very helpful’)information would be ‘helpful’ or ‘very helpful’)

• Enhancing child’s strengths (46%)

• General child development (43%)

• Adoption issues (42%)

• Child compliance (40%)

• Child hitting, biting (39%)

• Child whining (38%)

• Child temperament (37%)

• How to play with child (34%)

How would you like to receive parenting How would you like to receive parenting resource information?resource information? mail

doctor/ped

website

home visit

group meeting

check-in phone

hotline

Mo

the

rsF

ath

ers

How often would you like services?How often would you like services?

weekly

monthly

every other month

yearly

as needed

never

Mo

the

rsF

ath

ers

SummarySummary

• Most adoptive parents, and especially mothers, would like more information about parenting

• Areas where information and services are most desired are: discipline and child behavior, general child development, strength building, and adoption

• Adoptive families would prefer these services be delivered as an as-needed or monthly basis

• Mailed information, information from a doctor or pediatrician, or parenting website are the most desirable formats

• 0-2 months, 10-12 months, 18 months, and 24-months are times when parents report the most challenges

So where do we go from here? So where do we go from here? What kinds of services and What kinds of services and

programs might be beneficial?programs might be beneficial?

Key components of ‘evidence-based’ programs Key components of ‘evidence-based’ programs for infants, toddlers, and preschoolersfor infants, toddlers, and preschoolers

• Teach warm and sensitive (but firm and consistent) parenting

• Strength-building

• Prevention-based

• Work within the multiple contexts that families and children interact in (home, school, community)

• Include both a child and caregiver components

• Include parenting groups for social support

• Weekly service delivery

• Video-based feedback

What about adoptive families?What about adoptive families?

• No evidence-based programs have been evaluated specifically for adoptive families, although there are evidence-based programs for foster parents

• Unique needs of adoptive families may include:

• generally well-educated and invested in parenting

• uncertainties about child’s genetic background

• transracial and cultural issues

• blended families

• interface with birth parents

• talking to child about adoption/their background

• attachment

Additional Future Research DirectionsAdditional Future Research Directions

Birth parents who are rearing their own childrenBirth parents who are rearing their own children Applying for a grant to study the children of the birth Applying for a grant to study the children of the birth

parents in EGDSparents in EGDS

Translate interviews Translate interviews Allow recruitment of a Spanish-speaking populationAllow recruitment of a Spanish-speaking population

Health, eating habits, and obesityHealth, eating habits, and obesity Applying for a grant to study how families, prenatal Applying for a grant to study how families, prenatal

influences, and genetic factors affect children’s healthinfluences, and genetic factors affect children’s health

Continue to assess EGDS families in adolescenceContinue to assess EGDS families in adolescence

The EGDS TeamThe EGDS Team

Jenae Neiderhiser (PSU) Jenae Neiderhiser (PSU) Leslie Leve (OSLC)Leslie Leve (OSLC) David Reiss (GWU, Yale)David Reiss (GWU, Yale) Xiaojia Ge (UMN)Xiaojia Ge (UMN) John Reid (OSLC)John Reid (OSLC) Danny Shaw (U Pitt)Danny Shaw (U Pitt) Laura Scaramella (UNO)Laura Scaramella (UNO) Linda Mayes (Yale)Linda Mayes (Yale) Jody Ganiban (GWU)Jody Ganiban (GWU) Phil Fisher (OSLC)Phil Fisher (OSLC) Rand Conger (UC Davis)Rand Conger (UC Davis)

Consultants:Consultants: Joel Gelernter (Yale)Joel Gelernter (Yale) Joan Kaufman (Yale)Joan Kaufman (Yale) Steve Petrill (OSU)Steve Petrill (OSU) Steve Suomi (NICHD intramural)Steve Suomi (NICHD intramural)

Over 30 participating adoption Over 30 participating adoption agencies across the USagencies across the US

EGDS-Phase I & EGDS-school: EGDS-Phase I & EGDS-school: R01 HD042608 (co-funding by R01 HD042608 (co-funding by NIDA & OD)NIDA & OD)

EGDS-Phase II: R01 DA020585 EGDS-Phase II: R01 DA020585 (co-funding by NIMH & OD)(co-funding by NIMH & OD)

Too many recruiters & interviewers Too many recruiters & interviewers to nameto name

Amy WhiteselAmy Whitesel Danielle GuererroDanielle Guererro Cristin McArdleCristin McArdle David MartinDavid Martin