Progress After Placement

Abstract

The chapter explores the progress made by the 93 adoptees in the core follow-up sample in terms of physical and mental health and education from the time they entered their adoptive homes until they were followed up, on average 18 years later. It draws on data collected through responses to an online survey concerning 93 adoptees (44% of the cohort) completed at follow-up, and interviews focusing on 24 adult adoptees. On entering their placements, 40% of adoptees were developmentally delayed; 13% had poor physical health; 38% were in poor mental health. Emotional and behavioural problems affected their academic progress; 76% required specialist help. After placement, 74% improved in physical health, 66% in mental health and 68% in academic performance. The challenges faced by adoptive parents provide a powerful case for careful preparation and long-term post-adoption support.

Introduction

Studies of children who have experienced acute adversity in infancy have shown strong evidence of recovery-to-normal developmental trajectories following placement with sensitive and supportive substitute parents (Masten, 2001, 2014; Rutter et al., 2007; Sonuga-Barke et al., 2017; Zeanah et al., 2011). The majority of the Barnardos adoptees found stability and security in their adoptive homes and became fully integrated into their adoptive families; most of them also felt that they had always or often experienced ‘sensitive parenting’ from their adoptive parents (Chap. 5). Factors such as these are known to strengthen resilience and facilitate a sense of psychologicalpermanence (Masten, 2006). The policy of open adoption also enabled most adoptees to have continuing contact with their birth families; although contact was not always beneficial and raised numerous complex issues (Chap. 6), nevertheless it enabled the adoptees to retain a sense of continuity with their past and an understanding of their origins. The data on stability and contact explored in the two previous chapters suggest that, after they reached their adoptive homes, most of the Barnardos children found themselves in a supportive environment. However, the fundamental question is whether the experience of adoption promoted developmental recovery and increased the children’s long-term chances of achieving ‘satisfactory wellbeing in adulthood’ (Parker et al., 1991).

This chapter explores the progress made by the 93 adoptees in the core follow-up sample in terms of their physical and mental health and their education. Chapter 8 then focuses on the 60 adoptees who were 18 or older at the time of the survey and asks how they had progressed on a range of adult outcomes including education, mental health, ability to make friends and relationships and wellbeing. Both chapters draw on quantitative data collected through the survey and qualitative data collected through interviews with 20 adoptees and 21 adoptive parents, focusing on 24 adoptees. In order to understand the outcomes achieved by the adoptees, it is useful to look at their position first, at the time they joined their adoptive families, and then when they completed the survey, on average 18 years later.

It should be noted that in the New South Wales child welfare system, the adoption order was granted, on average, four years after the adoptive placement began. The data included in this chapter relate to the children’s status at entry to the adoption placement, rather than at the time the adoption order was made. In addition, many of the placements commenced as long-term foster care placements and it was only after several years that the plan was changed to that of adoption. To avoid confusion, we refer to all these placements as ‘adoptive placements’, regardless of the original plan for the child.

Developmental Status of the Adoptees When They Joined Their Adoptive Families

Chapter 3 explored the information held on social work files and presented to the courts showing the many factors that are likely to have had an impact on the development of the adoptees before they entered the Find-a-Family Programme. We know that 69% of the full cohort had had four or more adversechildhood experiences (ACEs) while living with their birth parents, and about half had encountered further negative experiences in out-of-home care before entering their adoptive homes. As a result, 57% were classified as highly vulnerable to poor outcomes. We also know (Chap. 1) that there were no significant differences in previous experience between the full cohort and the 93 adoptees who responded to the survey; 70% of the core follow-up group had had four or more ACEs and 54% were classified as being highly vulnerable to poor outcomes. It is not surprising, therefore, that at entry to their adoptive homes, the impact of past adversities was evident in the developmental trajectories of some (though not all) of the adoptees.

Physical Health

When they entered their adoptive homes, just under half (44%) of the adoptees in the core follow-up sample had a diagnosed health condition, and just over one in four (27%) had two or more conditions. Table 7.1 shows how the adoptive parents rated their children’s physical health at this stage. In their view, about two-thirds (55/86: 65%) of the adoptees were in ‘good’ or ‘excellent’ health, and just over one in ten (11/86: 13%) were regarded as being in poor or very poor health. There is evidence that some adoptees had significant health conditions and disabilities that were the direct result of previous experiences of abuse and neglect. For instance, two children had experienced brain damage that was thought to be the consequence of physical abuse.

Table 7.1 General physical health of adoptees when they joined the adoptive family: adoptive parents’ ratings (core follow-up sample N = 93)

Developmental Delay

At entry to their adoptive home, 37 (40%) adoptees in the core follow-up sample had been identified as having some form of developmental disorder or delay. The prevalence is similar to that found in the full cohort (37%) and likely to be more than 2.5 times that found in the general population (see Chap. 3). Most of these children had more than one type of developmentaldelay. Table 7.2 shows the prevalence of the different types of developmental disorders and delays that were identified. Twenty (22%) adoptees had a cognitive or language delay; ten (11%) had delayed physical or motor skills, and seven (8%) had developmental disorders including autism and ADHD. Before they were adopted, the carers of 14 (38%) of these children had received extra funding in response to their high levels of need.

Table 7.2 Developmentaldelays and disorders in core follow-up sample (N = 93)

Although some children suffered from congenital impairments, the high prevalence of developmental delay in the Barnardos sample is also likely to reflect early experiences of abuse and neglect (see Chap. 3). Physical abuse had affected the development of some children; others had been affected by poor nutrition and inadequate stimulation, others by substance misuse when they were in the womb, and others by inattention to health conditions or congenital abnormalities that required early intervention. For instance, one three-year-old had a minor physical condition (tongue-tie) that had not been corrected by the time he entered his adoptive home, and that had adversely affected the development of his language and communication skills.

Mental Health and Manifestations of Distress

As Table 7.3 shows, adoptive parents rated the mental health of well over half (53/86: 62%) of the children as between ‘fair’ and ‘excellent’ when they joined the family. However, the mental health of 33 adoptees (38%) was considered to be ‘poor’ or ‘very poor’.

Table 7.3 General mental health of adoptee when they joined the adoptive family: adoptive parents’ ratings (core follow-up sample N = 93)

Eleven (12%) adoptees were perhaps showing signs of incipient psychiatric illnesses in that they went on to develop conditions such as schizophrenia, bipolar disorder, depression and anxiety disorder as they grew older. However, many adoptees whose adoptive parents regarded them as having ‘poor’ or ‘very poor’ mental health were also showing signs of acute distress, and this is likely to have been related to their earlier experiences. These adoptees were also, on average, 33 months¹ older than those with better mental health ratings when they entered their adoptive homes, indicating a relationship between poor mental health and length of exposure to adverse experiences.

The 24 adoptees who were the subjects of interviews² were all aged 18 or over at the time of the study. All except five had shown evidence of emotional or behavioural difficulties at the time they joined their adoptive families. The interview data give vivid descriptions of their behaviour at the beginning of their placements. Some adoptees showed internalising problems; they described themselves (or were described as) unhappy, depressed, fearful, anxious and insecure.

When she came to live with us, she was just so withdrawn, lacking in self-esteem. She was just like a mouse and was always cowering…. When she came to live with us, it wasn’t easy to see a lot of positives with [daughter] in the beginning. She was a lot harder to be a parent to because of this negative attention-seeking behaviour, withdrawal, sulking…. (Adoptive parent of young woman, aged 6 when permanently placed)

Other adoptees found it hard to cope with physical contact or had difficulty forming attachments. These children could be ‘hard to get through to’, wary of trusting adults and/or difficult to comfort:

No, she wasn’t easy. She developed quite quickly after she came. She learnt to speak pretty well straightaway. But I found her not easy to comfort, and she was just difficult. She wasn’t naughty. I just found her not easy to comfort, I suppose. She was different… (Adoptive parent of young woman, aged 3 when permanently placed)

Some children had learnt to develop manipulative relationships as a survival skill:

He was fun, he was wonderful, but his behaviours… this is right from when he was two, and trying to play that person off against that person, trying to play on his cuteness. He knew how to do all that, at the age of two. He knew: “If I can’t get what I want from that person, I’ll suck up to that person, in a specific way, and they’ll help me out”. He had these little survival skills at the age of two. (Adoptive parent of young man, aged 2 when permanently placed)

Many adoptees had had numerous moves when living with their birth families and/or in out-of-home care before entering their adoptive homes. Adoptive parents reported them as being fearful of further instability:

Every time someone came to the door, he was anxious. He would scurry under the bed, because he thought he’d be removed. (Adoptive parent of young man, aged 2 when permanently placed)

or wary of making new relationships:

He’d got to that stage where he’d decided that he would no longer makefriends, because he was not going to be in one place long enough to makefriends. (Adoptive parent of young man, aged 8 when permanently placed)

I think, in terms of him as a little boy who was taking it and not putting very much into it because – I mean, we were the seventh house he’d lived in, and so he just was going through the motions… (Adoptive parent of young man, aged 6 when permanently placed)

Externalising Problems

However, many of the adoptees externalised their distress. Some were described as ‘difficult’, ‘oppositional’, ‘argumentative’ or ‘disobedient’. ‘Anger’ was the word that both they and their adoptive parents most frequently used to describe their emotional state when they joined their new families: ‘I was an angry child’, ‘I was very, very angry and I’d often have flip outs and temper tantrums’:

She was very difficult in the first few years, I think, very defiant and angry. She actually made it very difficult with [adoptive father].… She used to bite him and hit him and kick him, and just a lot of anger and violence…

I remember once, feeling really quite disturbed because she’d got these Barbies,… and she’d painted their faces purple, cut all their hair off, and then torn them limb from limb. And I remember thinking: “Oh, my God, what’s this?” I was just – and luckily, she went for a visit to the psychologist after that, and the psychologist said: “Look, she’s just got a lot of anger, and she’s taking it out, and I don’t think you need to worry. She’s going to be all right”. (Adoptive parent of young woman, aged 8 when permanently placed)

As one adoptee explained, reflecting on his younger self in adulthood:

I was such an angry person before, both with my mum and myrelationshipsand that was a direct reflection of how much anger I had for myself. (Young man, aged 2 when permanently placed, aged 25 when interviewed)

In addition, many of the adoptees were described as ‘out of control’ or ‘needing structure’, ‘boundaries’ or ‘routine’ when they first joined their adoptive families:

He was like a wild child when he first came. You had to be with him most of the time, keep an eye on him, because he really didn’t have any self-discipline at all. (Adoptive parent of young man, aged 9 when permanently placed)

In care, yeah, he lived in a dirty place with a lot of older children. He had no rules or boundaries. The carer mother was very nice and very supportive, but it was just chaos and there were no boundaries or anything. (Adoptive parent of young man, aged 2 when permanently placed)

Children whose needs had previously been ignored sometimes expressed their distress by over-eating or hoarding food:

She had all the characteristics of a child who hadn’t had much to eat. She used to hide food…. Because she was this obsessive about food – she would be this – she was really focused on McDonald’s, so, sometimes she’d have sport, or something like that, we’d take her out to McDonald’s, about three or four in the afternoon…. And once she’d go there and have this big Happy Meal and whatever – and I just assumed she wouldn’t want dinner, and at six o’clock she’d go: “Where’s my dinner? Where’s my dinner?” and I was like: “But you just ate an hour ago”. “I want my dinner”. And I can relate that as actually a security thing. She needed to know that her dinner would appear, even if she didn’t eat it. (Adoptive parent of young woman, aged 8 when permanently placed)

Others stole from their adoptive parents and their friends:

Some of the worst things were when he started stealing from ourfriends; not just us. You know, going to a familyfriends’– really goodfriends’places, and then finding out later he’d stolen their son’s watch, and the repercussions…. And that was just like really feeling pretty bad about that…. We know you steal from us. We know that. But to do that – and it wasn’t just the once. There were a couple of people that he stole from, that we know of. (Adoptive parent of young man, aged 6 when permanently placed)

Five (5%) of the adoptees for whom there were survey responses had been involved in criminal behaviour before they entered their adoptive homes, although most had been below the age of criminal responsibility at the time.

Even when adoptees had no obvious behavioural difficulties, they could still require high levels of support from adoptive parents. One boy, for instance, insisted on being carried everywhere by them:

I carried [adoptee] for a year, close to a year, which completely, like, threw me. I was just never expecting that I was going to be cooking dinner carrying a seven-year-old with me…. But that was sort of nice, too. He wasn’t hard – defiant – it was just hard because I wasn’t expecting it. It was practically hard when I’m trying to cook dinner, and the neediness that it showed was sort of like oh, my god, this poor little kid. (Adoptive parent of young man, aged 6 when permanently placed)

Another needed intensive developmental support:

So we had to go through all that process of going to all different organisations to teach him how to understand language, and how to play with other children, and how to play, just in general, and how to eat properly and stuff like that…. Taught him to be a little kid. He didn’t know – you’d sit him in front of blocks and he didn’t know what to do. He didn’t know how to ask for a drink. He always sat back until someone went to him. So, yeah being a little kid. (Adoptive parent of young man, aged 3 when permanently placed)

The boy whose adoptive parent is quoted above had been in out-of-home care for a year before he was placed with his adoptive family. The 93 adoptees in the core follow-up sample had been in out-of-home care for an average of just over two years before they entered their adoptive placements; more than half of them had been separated from abusive parents for over a year.³ The prevalence of developmental delays, behavioural problems and manifestations of distress, reported by adoptive parents indicates that greater attention might have been paid to helping these children address some of their difficulties during the lengthy period between separation and permanent placement.

School Performance

Inevitably, the adoptees’ poor developmental progress and their emotional and behavioural problems had an adverse impact on their school performance. Some had also been frequently absent from school or had experienced numerous changes before entering their adoptive homes and were consequently significantly behind their peers. According to their adoptive parents, three-quarters of the adult adoptees (42/55: 76%)⁴ had had problems at school. About a third of this group had experienced difficulties related to delayed or impaired cognitive development, developmental disorders or missed schooling. However, it was the adoptees’ emotional and behavioural problems that posed particular challenges in the school environment and often compounded, or were compounded by, their developmentaldelays and disorders. Examples include one boy whose adoptive parents described him as having an ‘intellectual disability and emotional instability leading to poor peer relationships’ and who had kicked the teacher in the shins on his first day at school; another who became ‘defiant, uncooperative and disruptive’ when his teacher left half way through the school year; and a girl who had ‘poor maths and English skills, poor social skills’ and who ‘got into the wrong crowd’ and began ‘leaving school at lunchtime with boys’ and ‘stealing from a local chemist’. As Table 7.4 shows, by the time they reached adulthood, the parents of 33 (60%)⁵ of the adoptees had had to attend their children’s school because of their poor behaviour, 12 of them on numerous occasions.

Table 7.4 Adoptive parents: Did you ever have to attend your child’s school because of their poor behaviour? (core follow-up sample: adult adoptees N = 60)

Stigma

Some of the adoptees also found school difficult because they were stigmatised by other students and, occasionally, by staff. When asked what the worst thing was about being adopted, interviewees frequently identified the way in which their situation was viewed by others. Being adopted meant that they were different from other children, and could be singled out for unwanted attention; as a result, many adoptees did not want others to know about their history:

He only ever did it once at prep school, and he told his very best friendat the time, who then told the other boys, so, [adoptee’s] reaction to that was: “Well, I told him, and he wasn’t meant to tell anybody, and I basically called him a liar”, and the other boys then turned against the boy he’d told, and it was never mentioned after that. He would not tell anybody, and we never mentioned it to any of the parents. (Adoptive parent of young man, aged 8 when permanently placed)

I feel if I tell anyone where I actually came from, they’re going to judge me… they’re going to be like: “Ew”. So, I don’t tend to talk about it. (Young woman, aged 6 months when permanently placed, aged 24 when interviewed)

The worst thing about being adopted I would say is going through school and telling people you’re adopted and I found that people used that against me when they wanted to, and that, to me, would be the worst thing, telling people about it and not knowing what response you might get, what their opinions are of adoption, when they might use it against you… (Young woman, aged 6 when permanently placed, aged 29 when interviewed)

Others experienced overt stigmatisation, with other children bullying them because they did not look like their adoptive parents, because their adoptive parents were not their ‘real’ parents, or because of their birth parents’ problems:

So, basically, the comment which came from both [bullies] but not exactly the same words were: “If your own dad can’t love you, then why would anyone else?” So, the other, in primary school, it was just slightly different words. I think it was ‘parents’, but it was still a comment that I definitely haven’t let go of. (Young woman, aged 6 when permanently placed, aged 29 when interviewed)

Any indication of their status, such as a contact visit during school time, could emphasise their difference:

I didn’t care about him missing school per se. But it was another thing that made him different to other kids, and the reasons… was more ammunition for kids to give him a hard time. (Adoptive parent of young man, aged 6 when permanently placed)

While most of the bullying came from peers, one young woman described in some detail how staff at her school had been prejudiced against her because of her antecedents:

There was a lot of judgement and prejudice and I felt like I was always on trial and everyone: “Be careful of her. She’s come from this bad family.” And these tutors would tell other girls not to befriendswith me, because I was a bad influence… I was the devil child. I was made out of sin. I remember leaving and the principal was like: “By the time you’re 25, you will”, what did she say? “You will have had a baby and you will be in jail.” I’m 24. I’ve never had a criminal record. Don’t have a baby…. And she was like: “You know, I just know it. People like you never turn out well”. (Young woman, aged 6 months when permanently placed, aged 24 when interviewed)

Issues Facing Adoptive Parents

Not all the adoptees had to deal with the difficulties described above, and some of them only encountered problems when they reached adolescence. However, 57 (61%) were described by their adoptive parents as showing signs of poor mental or physical health or developmental delay when they entered their adoptive homes, and 14 more encountered problems at school, with the result that at least three out of four (71/93: 76%) faced specific challenges which required specialist help from adoptive parents and other professionals if they were to be adequately supported.

Given the range of difficulties faced by the adoptees, it is not surprising that the adoptive parents of almost half the children found the first year of the placement to be ‘stressful’ or ‘very stressful’. Less than a third of the children had adoptive parents who rated the first year as ‘always good’ or ‘OK’ (see Table 7.5). Parents who had adopted more than one child gave different responses for 17 of them.

Table 7.5 Adoptive parents: How did you find the first year of your child’s placement? (Core follow-up sample N = 93)

Parents’ perceptions of stress in the first year of the placement were not significantly associated with their motivation for adopting, the total number of children in the household or the number of children they had adopted. However, adoptees who had been ‘only’ children were significantly⁶ more likely to perceive themselves as always having received ‘sensitive parenting’ than those who had grown up with other children in the household.

It is important to note that many of the adoptees’ difficulties were closely related to their experiences before joining their new families. Adoptees whom we had classified as being highly or extremely vulnerable to poor outcomes on entering their adoptive homes were significantly more likely than others to be considered by their adoptive parents as having poor or very poor mental health at this time.⁷ Moreover, adoptive parents who had made this assessment were significantly more likely to have rated the first year as ‘stressful’ or ‘very stressful’.⁸ They were also significantly more likely to rate the first year as stressful if the child had had face-to-face contact with their birthfather⁹ (but not their birth mother) during the placement. It is not clear why this should have been the case; contact with birth fatherswas not, for instance, related to perceptions of the child’s mental health.

Some (23/53: 43%) families received respite care and/or continuing post-adoption support from the agency after the adoption order had been made. Almost all of them would also have been eligible for a post-adoption allowance (see Chap. 1). Nevertheless, some adoptive parents faced additional stress because of the financial impact of the adoption. The 93 adoptees in the core follow-up group were placed with 60 adoptive families. At least 24 (40%) of the primary carers had given up work to look after their adoptees. Only 4 had returned to work after a year, and 13 within five years. Six of the others had never returned to work, or never returned fully, sometimes explicitly because the children appeared to need them at home. This had caused financial difficulties for almost half of these families (11/24: 46%), and two families claimed that these had been significant. Most of those (8/11) for whom the placement had caused some financial strain had also found the first year stressful.

Adoptive parents experienced financial stress not only because the adoptees’ needs made it difficult for primary carers to return to work, but also because accessing appropriate services for them could be expensive. During the time that the child was fostered, Barnardos covered these costs. However, as part of the normalisation process, this ceased when the child was adopted:

I think before adopting, people need to realise that some of these children have ongoing problems which need ongoing therapies etc. which after adoption can put a huge financial strain on the family budget. I know I get a post-adoptionallowance but with three kids all with additional needs the financial impact is huge, especially with all the therapies, doctors’ visits, psychology visits… and when fostered Barnardos covered those costs so impact wasn’t felt as much. Plus a lot of the psychological issues not having occurred till the kids got older. I wouldn’t swap any of this but I think people do need to realise this. (Adoptive parent of young woman, aged 18 months when permanently placed).

These findings have profound implications both for the recruitment and training of prospective adoptive parents and for policies concerning the provision of post-adoption support; we discuss them in the final chapter of this book.

Progress

There is considerable evidence to show that children who have suffered extreme deprivation and adversity in infancy can show dramatic improvement in developmental progress when placed in well-functioning families. For instance, Rutter and colleagues’ study of infants who suffered gross deprivation in Romanian orphanages found that, following removal and placement with adoptive families in the UK, their developmental catch-up was ‘spectacular’ (Rutter et al., 2007; Sonuga-Barke et al., 2017). The Barnardos adoptees had not suffered the extreme institutional neglect that had been the experience of the Romanian adoptees, but they had experienced significant adversity before entering their adoptive homes (see Chap. 3) and, as we have seen, they showed considerable evidence of poor physical and mental health, developmental delay and poor academic achievement. The responses to the survey showed how far their developmental trajectories changed after they entered their adoptive homes. Although there would inevitably have been changes as the adoptees grew older, as we shall see, there were also other factors at play.

Changes in Physical Health

According to their adoptive parents (Table 7.6), three-quarters (63/85: 74%) of the adoptees saw an improvement in their physical health after they entered their new families. These included 10 of the 11 adoptees whose health had been rated as poor or very poor on entry; data are not available for the other adoptee. Those whose health showed little change had all been previously assessed as having good, very good or excellent health. The health of only two adoptees, both of whom had significant developmental problems, appeared to have deteriorated.

Table 7.6 Adoptive parents: Did your child’s general physical health change after they came to live with you? (core follow-up sample N = 93)

Some adoptees experienced significant changes to both their physical health and their developmental progress. Corinne’s case study may be an extreme example, but other adoptees had similar, though less dramatic, experiences.

Corinne

Before Entering Her Adoptive Home

Corinne’s mother would strap her in her cot and leave her on her own all day while she went out to beg. Corinne was not changed and was often apparently left covered in faeces. She was given no opportunity to move around or play like other children and had no one to communicate with. She was 19 months old when the police found her and removed her. At that time her development had been grossly delayed, and she was assessed as having the mental and physical abilities of a two-month-old baby. She ‘did not react if you put a hand in front of her face’. She was thought to be probably brain damaged. She also had hip flexion contractures, possibly caused by staying in the same position for long periods of time. She was placed with her adoptive parents just before she was two, and they rated both her physical and mental health as ‘very poor’. According to the case papers, she had ‘developmental delay, speech delay, and gross and fine motor skills impairments’.

Progress During Childhood and Adolescence

Corinne’s speech had been significantly delayed because she had not had anyone to communicate with for the first 19 months of her life. She was five when people could eventually understand what she was trying to say. As a child she also had very bad physical coordination, because her motor skills had not adequately developed:

I was always the last kid picked on a sports team, that kind of stuff, which was very – it was at the time, the type of thing that really sucks when you’re a kid, because those sorts of things mean a lot to you, because I’d want to be as good as the other kids at sport. And I just couldn’t catch the ball.

She finally began to catch up at puberty. When interviewed at the age of 25, she said:

And now I don’t feel it affects me at all, physically. I feel – I train a lot, I’m physically strong, I eat well and I don’t feel any need – I feel I’ve well and truly caught up. Who knows? Perhaps I’d be even better if I didn’t have that, but I don’t feel like I’m in anyways below par in my physical abilities now.

Changes in Mental Health

In addition to completing the survey, parents of adoptees aged under 18 were asked to complete the Child Behaviour Checklist (CBCL) (Achenbach & Rescorla, 2000; Achenbach & Rescorla, 2001), a standardised measure designed to assess socio-emotional development in pre-school and school-aged children and young people. Twenty (20/33: 60%) responded. The results show that while the socio-emotional development of 13 of the adoptees who were still of school age fell within the normative range, 4 were borderline and 3 were in the clinical range. At the time of the survey, one of the adoptees in the clinical group had returned to live with their birth parents, and another was living with another member of the adoptive family, but not their adoptive parents. Some CBCL scores did not match adoptive parents’ assessments of adoptees’ mental health status: the mental health of one adoptee whose score was in the clinical range was assessed by his adoptive parents as ‘very good’ and that of another in the borderline range was assessed by adoptive parents as ‘fair’.

Four of the adoptees whose CBCL scores were in the clinical or the borderline range had been assessed as in ‘poor’ or ‘very poor’ mental health when they entered their adoptive homes, although three of them were thought to have improved by the time of the survey. The reports from adoptive parents (Table 7.7) indicated that the mental health of two-thirds (57/86: 66%) of the adoptees improved after placement. These included 26 of the 33 (79%) adoptees whose mental health had been rated as ‘poor’ or ‘very poor’, and 15 (75%) of those who were aged nine or over at entry. Almost all (35/39: 90%) of those whose mental health had been rated as between fair and excellent at entry were considered to have improved or stayed the same. The six adoptees whose mental health had deteriorated had originally been rated as ‘good’ (2), ‘fair’ (2) or ‘poor’ (2).

Table 7.7 Adoptive parents: Did your child’s general mental health/psychological state change after they came to live with you? (core follow-up sample N = 93)

Altogether there were 11 adoptees whose mental health either had deteriorated (6) or had not changed following an initial rating of ‘poor’ or ‘very poor’ (5). At entry to their adoptive homes, these adoptees were, on average, 17 months older than those whose mental health improved, and five of them were over 9 years old. Seven of these adoptees had disabilities resulting in significant impairment or had developed mental illnesses such as schizophrenia or bipolar disorder. One had died; others were likely to be dependent on services for most of their lives:

[Adoptee] has a global developmentaldelay, so hard to know how she feels sometimes. Our worry is now [she] is approaching 18 getting the right services for her so she can live independently. (Adoptive parent of young woman, aged 2 when permanently placed).

Other adoptees whose mental health was thought to have deteriorated had seen an increase in the distress they had shown on entry to their adoptive homes. These included one young woman who had become heavily involved in drugs and prostitution; a young man whose anger and aggression had increased to the point at which he was subject to a restraining order; and another who had become addicted to drugs. These three young people all had unresolved issues concerning their relationship with their birth families.

Those adoptees whose mental health had improved had not necessarily overcome all their difficulties or even overcome them sufficiently to achieve fulfilment in adulthood. For instance, one young man whose mental health was thought to have improved was living alone as an adult at the time of the survey and struggling with ‘a gambling addiction; depression, anxiety and a borderline personality disorder’. The following chapter explores in greater detail the mental health of those adoptees who were aged 18 or over at the time of the survey and considers the implications for those who continued to experience difficulties into adulthood.

Academic Progress After Joining the Adoptive Family

As the adoptees became more settled and their mental health improved, so did their schoolperformance. As Table 7.8 shows, survey responses from their parents indicated that the academic progress of two-thirds (57/84: 68%) of the adoptees improved after they joined their new families; better school performance was significantly associated with better mental health.¹⁰

Table 7.8 Adoptive parents: Did your child’s performance at school change significantly after they came to live with you? (core follow-up sample N = 93)

The trend for performance to improve is supported by the evidence that only six adoptees (10%) were reported as having repeated a grade during their school career. All but one of these adoptees repeated a school year because of learning disabilities or developmentaldelay. Altogether 20 (20/55: 36%) of the adult adoptees had been diagnosed with learning disabilities by the time they left school. Almost all of these (17/20: 85%) had experienced a significant improvement in their academic performance, and this may have been due to the additional support that such a diagnosis brought them (see Chap. 8). It is noteworthy that only 14 of the 22 adult adoptees who had been identified as experiencing developmentaldelay when they entered their adoptive homes had subsequently been diagnosed as having learning disabilities, suggesting that improvements in both physical and mental health may have helped other adoptees, such as Corinne above, to catch up lost ground.

Contact with Birth Parents and Progress

Finally, quantitative data collected through combined responses to the survey questions from adoptive parents and adoptees shed a little light on the question of whether face-to-face post-adoption contact with birth parents had an impact on the adoptees’ developmental progress. There was no statistically significant association between improvements in the adoptees’ mental health and face-to-face post-adoption contact with either birthmothers or birth fathers, although higher percentages of those children who had no contact saw positive changes.¹¹ However, the 28 adoptees who still had face-to-face contact with either birth mothers or birthfathers at the time of the survey were significantly less likely to have experienced improvements in their school performance.¹² Given that the qualitative data presented in Chap. 6 also showed that many adoptees found face-to-face contact extremely stressful, these findings could, perhaps, be interpreted as further indications that the nature and the timing of contact needs to be carefully managed and tailored to the needs of each individual child.

Conclusion

The data explored in this chapter raise a number of important issues. First, it is evident that a high proportion of the adoptees were displaying significant developmental deficits and problematic behaviour when they entered their adoptive homes; these added to the challenges facing the adoptive parents, half of whom found the first year to be stressful or very stressful. Face-to-face contact with birth parents, particularly birth fathers, may have added to the stress. There are implications here for the recruitment and preparation of adoptive parents and also for the provision of post-adoption support. These will be discussed further in the final chapter of this book.

Second, a high proportion of the adoptees made progress in terms of their physical and mental health and their academic performance after they had entered their adoptive homes. Greater stability (Chap. 5) is likely to have been a contributing factor. The contribution made by better access to professional services, the personal efforts of adoptive parents and both adults’ and children’s understanding of the change of status brought by adoption will be discussed in the following chapter.

Key Points

• At entry to their adoptive placements, 37 (40%) adoptees showed signs of developmental delay; most of them displayed more than one type of delay. Twenty (22%) of these children had a cognitive or language delay, ten (11%) had delayed physical or motor skills, and seven (8%) had developmental disorders including autism and ADHD.

• Eleven (13%) adoptees were rated by their adoptive parents as being in poor, or very poor, physical health when they entered the placement.

• The mental health of 33 adoptees (38%) was considered to be ‘poor’ or ‘very poor’ when they joined the adoptive families: 11 (12%) were perhaps showing signs of incipient psychiatric illnesses in that they went on to develop conditions such as schizophrenia and bipolar disorder.

• Many adoptees whose mental health was considered ‘poor’ at the time of placement were showing signs of acute distress, and this is likely to have been related to their earlier experiences.

• Although adoptees showed both internalising and externalisingemotional and behavioural problems, ‘anger’was the word that both they and their adoptive parents most frequently used to describe their emotional state.

• Three-quarters (42/55: 76%) of the adult adoptees had had problems at school; the parents of 33 (60%) adult adoptees had had to attend school because of their child’s poor behaviour.

• At least three out of four adoptees faced specific challenges which required specialist help from adoptive parents and professionals to support their progress.

• The adoptive parents of almost half the children found the first year of the placement to be ‘stressful’ or ‘very stressful’; parents of less than one-third found it ‘always good’ or ‘OK’.

• At least 24 (40%) of the primary carers had given up work to look after their adoptees. Only just over half (13: 54%) had returned to work within five years. This had caused financial difficulties for almost half of these families (11/24: 46%).

• After entering their adoptive placements, about three-quarters (74%) of the adoptees saw improvements in their physical health and two-thirds (66%) in their mental health. About two-thirds (68%) also saw improvements in their school performance. Better school performance was significantly associated with better mental health.

• Improvements in both physical and mental health may have helped about a third of the adoptees who had been experiencing developmentaldelay to catch up lost ground.

• The challenges faced by adoptive parents provide a powerful case for careful preparation and extensive, long-term post-adoption support.