Adult Outcomes

Abstract

The chapter focuses exclusively on the 60 adoptees aged over 18 who completed the follow-up survey. It draws on data collected through survey responses and interviews focusing on 24 adult adoptees. It explores their outcomes across a range of dimensions that together contribute to a composite measure of adult functionality. It presents the outcomes the adoptees achieved on each of these key domains and explores how they compared both with those of the normative Australian population and a contemporaneous cohort of care leavers. The adoptees showed more evidence of poor mental health than care leavers, but often did better in terms of education and employment. The presence of a committed adoptive parent appears to have acted as a powerful protective factor, and only extreme indicators of vulnerability at entry to the adoptive home correlated with poor adult outcomes.

Introduction

Studies of childhood development have identified a range of dimensions along which children need to progress if they are to achieve ‘long-term wellbeing in adulthood’ (see Parker et al., 1991). This overall concept of adult functionality is dependent on a constellation of positive, interlocking outcomes across the spectrum of dimensions. Positive outcomes include having achieved educational qualifications and employment; being able to make positive relationships; having reasonable mental and physical health and wellbeing; and an absence of criminal or addictive behaviour patterns. Finding safe, stable and suitable accommodation is also often included because it is interrelated with positive developmental outcomes (Parker et al., 1991; Stein, 2012; McGloin & Spatz Widom, 2001; Cashmore & Paxman, 2007).

As we have seen, some adoptees made significant progress on a range of developmental dimensions after they entered their adoptive homes. Although a small group failed to reduce developmental deficits, or developed new problems, the majority managed to overcome many of the consequences of their early adversities. However, although we have been able to explore their progress, it was only after they were 18 or older that we could assess adult functioning. This chapter explores the quantitative data concerning the 60 adoptees who were aged 18 and over at the time they and/or their adoptive parents responded to the survey, supplemented with the qualitative data from the interviews with 21 adoptive parents and 20 adoptees, concerning a total of 24 adoptees. It presents the outcomes they achieved on each of these key domains and explores how they compared both with those of the normative Australian population as well as with those of the care leavers studied by Cashmore and Paxman (2007). The adult adoptees covered a wide age range, so many of them were at different stages in their developmental trajectories; this needs to be borne in mind when considering the outcomes they achieved.

Education and Training

Qualifications

We have already seen (Chap. 7) that about two-thirds of the adoptees made significant academic progress after they reached their adoptive homes. Table 8.1 shows the highest educational qualifications those who were aged 18 or over had obtained at the time of the survey. At that time, at least 35 (63%) of the adult adoptees had completed Year 12¹ or obtained a further education qualification and 19 (34%) had no qualifications. Two adoptees had ‘other’ qualifications, the level of which is unclear. One 18-year-old was still at school. The percentage of adult adoptees who had completed Year 12 is very similar to that of the Australian population, 66% of whom had reached this level of education in 2016, the year of the survey (Australian Bureau of Statistics, 2017).² It should, however, be noted that, unless otherwise indicated, the population data referred to in this chapter covers a wider age range (15–64 years) than that of the adult adoptees (18–44 years).

Table 8.1 Educational qualifications (core follow-up sample: adult adoptees N = 60)

Higher Education

About one in four (13: 23%) of the adult adoptees had their Year 12 Certificate only, one in five (11: 20%) had a trades or vocational certificate, and approximately one in five (11: 20%) had an undergraduate or postgraduate degree. The prevalence of higher education qualifications was likely to increase, as about a quarter of the group were still studying (15: 27%), including three who were apprenticed to a trade and six who were at university, four of whom were undergraduates. If they all completed their courses, 15 (27%) of the sample would have a degree. This is only marginally lower than the normative Australian population, 30% of whom had a bachelor’s degree or postgraduate qualification at the time of the survey (Australian Bureau of Statistics, 2017).

Employment

Data were available on 53 adult adoptees; data missing for 7 adoptees.

Nearly two-thirds of the adoptees (33/53: 62%) were in full-time work, full-time study or both part-time work and study at the time of the survey. This is similar to Australian population data which indicate that, at the time of the survey, 65% of Australians were fully engaged in employment or study (Australian Bureau of Statistics, 2017, Table 33.1.13), although the age range (15–64) is larger than that of the adult adoptees (18–44).

NEET Status

Most OECD countries have introduced policy initiatives to reduce the number of young people who are not engaged in any education, employment or training (NEET). Table 8.2 shows that almost three-quarters (37/53: 70%) of the adoptees were engaged in some form of education or employment at the time of the survey. There were 16 (30%) adoptees who were NEET: five indicated they were not in work or looking for employment due to a disability; two were parenting full-time and one was a full-time carer. There are no explanatory data concerning the nine others.

Table 8.2 Number of adult adoptees in education, employment or training, or not, at the time of the survey (core follow-up sample: adult adoptees N = 60)

It is difficult to compare these findings with Australian population data. An analysis of OECD data on Australian young people (Australian Institute of Health and Welfare, 2017) indicates that in 2016, 5% of 15–19-year-olds and 12% of 20–24-year-olds were NEET.³ The findings presented above relate to the adult adoptees in the Barnardos sample across the full age range (18–44 years). The number of Barnardos adoptees who fell within the population age ranges (15–19 and 20–24) are too few for meaningful analysis, and there are no data on those aged 15–17 years. The closest approximation shows that of the 15 Barnardos adoptees aged 18–24 for whom such data are available, 20% (3) were NEET in comparison with 17% of the general population.

The numbers of young adults who are not in education, employment or training are a cause for concern for any society because NEET status is known to have a negative impact on physical and mental health and to increase the likelihood of risk-taking behaviours such as substance misuse and crime (e.g. Henderson et al., 2017; Allen, 2014). By the time they are 21, young people who have been NEET for six months or more are more likely than their peers to be unemployed, to be poorly paid, to have no training, to have a criminal record and to suffer from poor health and depression (Allen, 2014). Of the 16 Barnardos adoptees who were NEET, 6 were involved in crime, 4 were involved in substancemisuse and 9 had poor mentalhealth. Six of them displayed more than one of these outcomes. Although these data indicate an association between NEET status and negative outcomes, there are too many missing data items, and the numbers are too small for meaningful analysis.

Criminal Behaviour

Although a relatively high proportion of the adult adoptees who were NEET (6/16: 38%) had committed offences, in the sample as a whole the prevalence of crime appears to have been relatively low. Only one of the five adoptees who had committed a criminal offence by the time they joined their adoptive families continued to offend after placement. Most of the adult adoptees had no record of offending behaviour after adoption (50/60: 83%).⁴ Ten adoptees, however, had some involvement with the criminal justice system after joining their adoptive families: four had committed offences for which they received custodial sentences; two had been fined; and four had been cautioned. Four other adoptees had apparently committed criminal offences, but the police had taken no further action. A caution does not constitute a conviction, and therefore these are not included in conviction rates. Altogether six adult adoptees (6/60:10%) had a criminal conviction by the time of the survey. It is difficult to ascertain how this figure compares with that for the general population. Australian data on the percentage of the population with a criminal record are not available.⁵ In England and Wales, over 11 million adults have a conviction (31% of the adult population), significantly more than the Barnardos adoptees.⁶ It should be noted, however, that the average age of the adult adoptees was 29 (sd = 7.4; range 18–44), and the British data on criminal convictions cover a lifespan, so exact comparisons are impossible.

Alcohol Consumption and Substance Misuse

Adoptees were categorised as misusing substances if they said they used non-prescription drugs and it was a problem, or if they were currently accessing rehab or detox services. If no adoptee survey data were available, then the response of the adoptive parent was used and misuse established if they indicated alcohol or drugs use was a behaviour of their adoptee that was of current concern to them. Data were available for 43 adult adoptees.

In view of their birth parents’ experiences, many of the adoptees were concerned that they would become addicted to alcohol or illicit drugs:

He went through a stage where he was going, “Mum, am I going to be a drug addict? If I take a tablet or something am I going to end up on drugs?” (Adoptive parent of young man, aged 2 when permanently placed)

My mum would be like, “Now, you know what your mum is, you know what your dad is, so, don’t you ever try drugs”. And I went, “Okay”. Not that I ever intend to, and I’m allergic to alcohol, so we’re safe on that one. (Young woman, aged 6 months when permanently placed, aged 23 when interviewed)

Self-reported findings on alcohol consumption and substance misuse are notoriously unreliable. Nevertheless, the following responses to the survey tend to complement rather than contradict what we know of the adoptees from other sources.

Most adult adoptees indicated that they did not drink alcohol (25/37⁷: 68%) or only at low levels (7:19%, 1–2 units per week). However, 16 (16/43⁸: 37%) adoptees were using non-prescription drugs at the time of the survey. This is about three times higher than the prevalence found within the normative population (12.6%) (Australian Institute of Health and Welfare, 2017).

Although a high proportion of the adoptees used non-prescription drugs, this was not always regarded as an issue of concern. There were concerns about substance misuse for seven (7/43:16%) adoptees. Only one (2%) adoptee reported ever accessing a detox programme or rehabilitation services for drug or alcohol use.

Mental Health

A well-established body of research has identified associations between risk-taking behaviours such as misuse of illicit drugs and/or alcohol and crime and/or depression and other mental health issues (e.g. Conway et al., 2006; Torrens et al., 2011; Beautrais, 2000); the high prevalence of substance misuse amongst the Barnardos adoptees may therefore be related to their continuing struggles with mental health issues. Although, for most adoptees, these were less intense than they had been at the start of the placement (see Chap. 7), they had rarely been fully overcome.

The responses to the survey indicated that in adulthood, 11 adult adoptees (11/59⁹: 19%) had a diagnosed classifiable mental disorder according to the ICD10¹⁰ criteria. These included schizophrenia (two adoptees), bipolar disorder (two), chronic depression (four), anxiety/stress-related disorders (six) and personality disorder (two). Four adoptees had been diagnosed with more than one mental health condition.

An analysis of data collected for the Australian National Survey of Mental Health and Wellbeing focuses on experiences of affective disorders; anxiety disorders and substance misuse disorder. This found that 20% of Australians had experienced at least one of the above disorders in the previous year, and 45% over a lifetime (Slade et al., 2009, para 2.1). The Barnardos cohort showed a similar recent prevalence (10/59¹¹:17%). However, the data were collected differently¹¹ and may not be strictly comparable.

We also explored mental health issues more broadly. In this analysis we interrogated the survey responses to find out whether adoptees who did not necessarily have a diagnosed psychiatric disorder indicated that they had continuing issues concerning depression, anxiety and substancemisuse.¹² Responses from the adoptive parents that showed whether they had current concerns around adoptees’ self-harming behaviours, eating disorders or obsessive-compulsive behaviours were also included as indicators of ongoing mental health issues. The data indicated that 35 (35/60: 58%) adult adoptees met these criteria. This is a high prevalence; it is markedly greater than that found in Cashmore and Paxman’s (2007) sample of care leavers (46%), where similar data are presented, and is an issue to which we will return.

The Barnardos study only has data from personal reports rather than standardised instruments, and our criteria may have been broader than those used in other research; as a result, our findings may not be fully comparable. Nevertheless, we can say with some certainty that a relatively high proportion of the Barnardos adoptees continued to have ongoing mental health issues in adulthood. This is consonant with research on the developmental trajectories of the Romanian children adopted from institutional care which found that severe adversity in early childhood ‘can have a profound and lasting psychological impact despite subsequent enrichment in well-resourced and supportive families’ (Sonuga-Barke et al., 2017 p. 1545).

However, despite a high prevalence of mental health issues, many of the adult adoptees had good educational qualifications and secure and fulfilling employment. On most criteria they appeared to be functioning exceptionally well. It is also evident from their interviews that several adoptees had developed considerable insight into the consequences of their past and had resolved many of the emotional and behavioural problems that had been so evident at placement.

As the years progressed, gradually I was healing, because I was getting exactly what I needed, emotionally, physically and psychologically. I was just gradually healing. And over time, I am where I am now.… So it took years and years and years of counselling and just routine at the home, and someone [adoptive mother] that was emotionally giving me what I needed, actually spoke to me about what was going on.

I feel like what I’ve been through has turned me into an extremely resilient adult and also teenager. My resilience is just – when I compare myself to people my age, I just seem to bounce back from shitty things so quickly. And I just kind of like shrug it off. I think it’s because anything that has happened from after my childhood is just nowhere near worse than what it was before. So that’s why I have resilience when things happen now. Because I’m like: “This will pass”. (Young woman, aged 10 when permanently placed; aged 21 when interviewed)

Some of the adoptees, such as the young woman quoted above, appeared to have overcome their antecedents by the time of the interview. The interviews show numerous indicators of personal strength and resilience. Nevertheless, almost all the interviews also reveal an underlying vulnerability. For instance, one adoptive mother described her adult son, now in his 20s and with a good job and a stable relationship:

He seems happy. He seems mostly at peace with himself. His demons have sort of gone. I think they’re at the surface sometimes. I think they’re not far. They’re waiting to come out if there’s adversity. So I think they’re still – as we all have, things to deal with in our lives. I probably over-worry for him because I don’t want this world that he’s created to crash around him… (Adoptive parent of young man, aged 6 when permanently placed)

Even those adoptees who appeared to be functioning exceptionally well as adults nevertheless often showed an underlying enduring vulnerability. For instance, one young man, who was ‘happier than he’d ever been’ with a wife and child and a reasonable job, was still aware of his unresolved, underlying anger:

I’d say I’m a strong-headed person that knows where he’s going in life now. I have a loving family. Weaknesses: I’m highly emotional. I’m angry… Nothing’s really changed. I guess maybe not – like I think I have dealt with those sort of things. But I guess I can get to points, emotionally and all that sort of stuff, that just makes me go over the top and overboard. I don’t know. I’m a very defensive person. So maybe that’s why. I just put up a massive shield or wall, and that’s how I deal with things. (Young man, aged 9 when permanently placed, aged 35 when interviewed)

The case study of Geoffrey is an example of the positive trajectories and also the underlying vulnerability displayed by some of the most successful adult adoptees.

Geoffrey

Before Entering His Adoptive Home

Geoffrey was six when he and his sister were placed with their adoptive parents. While living with their birth parents, they had witnessed domestic violence and been exposed to neglect, physical abuse and sexual abuse. Geoffrey had been placed in out-of-home care at the age of ten months but had then had four placements, some of which had been abusive, before entering his permanent home. When Geoffrey was first placed with his adoptive parents, he was very withdrawn, anxious, lacking in self-esteem and prone to negative attention-seeking behaviour.

Progress During Childhood and Adolescence

Because of his previous experiences, Geoffrey found it very difficult to trust people.

Trust for me is really difficult and I would always build up a wall… If I felt [someone] coming too close to me, I would do anything in my power to test them and to push them away.

Both he and his adoptive parents recognised that this had been a dynamic in his early relationship with them, resulting in lengthy periods when he would withdraw, testing out how they would respond to the ‘black hole of emotional need’ he displayed.

As Geoffrey settled into his adoptive home, he gradually became more relaxed.

And so we’d say 90% of the time Geoffrey was miserable. But then it was 80% of the time he was miserable. And then there was a time when he was happier more than he was unhappy. And when he was happy, he was delightful.

As a teenager and young adult, Geoffrey had to come to terms with unwanted information about the details of his childhood experiences of abuse as well as a definitive rejection by his birth mother. He went through a difficult period when he became very depressed and decided to end the relationship with his birth family. He also continued to suffer from anxiety and low self-esteem. His lack of trust and fear of abandonment impacted on his relationships with partners, who he continued to push away.

Both Geoffrey and his adoptive parents were interviewed when he was 29, By that time, Geoffrey had overcome many of his difficulties.

And to see him develop as a teenager and as a young man…, to see that transition happen with Geoffrey was fantastic…

He had very good educational qualifications, a steady job and had been living as an independent adult for several years. It was also clear from interviews with both him and his adoptive parents that he was aware of his tendency to low self-esteem and his issues with trust and that he had developed a number of coping strategies. He was now in a stable relationship with a supportive partner whom he had ‘not been able to push away’.

Relationships

Partners

As Table 8.3 shows, nearly two-thirds of adult adoptees (26/42: 62%) were in a long-term relationship at the time of the survey. Only five of them had never had a partner. As one would expect, the older adoptees were more likely¹³ to have a long-term partner than those who were still under 30: 78% (18/23) of those aged 30 or over were in a long-term relationship, and only one adoptee in this age group had never had a partner.

Table 8.3 Do you currently have a partner? (Core follow-up sample: adult adoptees N = 60)

Nevertheless, the adoptees’ underlying vulnerability sometimes appears to have had an impact on their relationships with partners. We have already seen how some adoptees tended to push people away for fear that they might be abandoned again if they got too close. One young man’s solution had been to avoid relationships altogether:

Look, I’ve been hurt a few times in my life and it taught me a lot about my… how to deal with my emotions, my feelings and what I don’t want to get myself into, and that is to the point where I’m in a depression and I want to kill myself, because someone has hurt me terribly. I’ve never been in a relationship, have gone out, yes, and they’ve broken me. (Young man, aged 9 when permanently placed, aged 39 when interviewed)

Others reacted by being over-controlling:

My relationships were always very connected and close but also there was always a very consistent theme, and a very consistent negative theme… and it took me until the most recent break up…, before I finally got it. And I think that this actually is quite relevant to your research, because I think it is tied to the unconscious memories of adoption. And I think I… always had a real inherent fear of being abandoned, a fear of people just – of them just leaving or me not being good enough. And that manifested itself in a lot of insecurities around relationships and would then manifest in behaviours that could be seen as controlling. (Young man, aged 23 months when permanently placed, aged 25 when interviewed)

And one 18-year-old who was living with his adoptive parents still found it hard to cope with physical affection, 15 years after he came to live with them:

It’s hard for him to just walk up and give you a hug, and if you go to hug him, he goes: “What are you doing?” (Adoptive parent of young man, aged 2 when permanently placed)

Domestic Abuse

Nine adoptees (26%¹⁴) had been in relationships in which their partner’s anger or aggression had been a problem—five in past relationships and four at the time of the survey. The overall rate of domestic abuse does not appear very different from that in the Australian population, where 23% of women and 7.8% of men aged 18 or over have experienced violence by an intimate partner since they were 15 years old. However, it should be noted that the prevalence of male victims (5/14: 36%) is much higher in the Barnardos sample. Although the numbers are too small for statistical comparison, it is noteworthy that the two adoptees who had Apprehended Violence Orders (AVOs)¹⁵ made against them to protect others from their aggressive behaviour were also women.

Friends

The adoptees’ underlying vulnerability appears also to have had an impact on their ability to make friends. Six (16%) of the adult adoptees who responded to the survey claimed that they had no friends,¹⁶ and only just over half this group (20/37: 54%) said they had four or more. The interviews revealed how some adoptees struggled to make and retain friendships:

I mean, he did make friends, but he hasn’t got long-term friends, even today… He’s quite happy being by himself. He gets on well with people, and he can sit down and have a conversation with anyone, but he hasn’t got that closeness… I think the damage that was done back in those early years, affected him, to some degree, because he just – the making of friends was not easy, and he hasn’t kept friends. (Adoptive parent of young man, aged 8 when permanently placed)

My ability to keep – make, keep and hold closeness with people. I don’t have that. It’s very hard, because you want it, but you just don’t know how to achieve it. (Young man, aged 10 when permanently placed, aged 39 when interviewed)

But he’s still not terribly fabulous at engaging with people. So that’s an ongoing thing – superficially, but, you know… He just doesn’t put himself out very much for anyone. (Adoptive parent of young man, aged 6 when permanently placed)

Isolation

While many adoptees displayed some degree of vulnerability, and this had an impact on their relationships with peers and partners, a small number appeared to struggle with relationships more extensively. Six of the adoptees who had experienced (or were experiencing) domestic abuse had no friends or just one friend. Two of these adoptees were estranged from their adoptive families, and one was also estranged from his children. This group appeared to be very isolated and only three of them had achieved sufficiently positive outcomes on other dimensions to meet the criteria for ‘successful adult functioning’ (see below).

Outcomes for the Barnardos Adoptees, Australian Care Leavers and the Wider Australian Population

Comparison with the Australian Population

The first three columns of Table 8.4 (pp. 238–240) summarise the data discussed so far concerning the adult outcomes for the Barnardos adoptees and how they compare with those for the general population in Australia. It should be noted that these are not exact comparisons—the adoptees were aged 18–44 years, while the adult population data covers a much wider range—from 15 (or sometimes 20) to 64 years. There were also only 60 adult adoptees, and the percentages shown for each outcome often relate to very small subsets, reducing the likelihood of accurate comparisons with the much larger population database. Notwithstanding these caveats, the data indicate that on the following variables the Barnardos’ adoptees had similar positive outcomes to the rest of the Australianpopulation¹⁷:

• education (year 12 or more): 63% vs 66%

• completed bachelor’s degree (or expected completion): 27% vs 30%

• in full-time education, employment or training: 62% vs 65%.

Table 8.4 Adult outcomes: Barnardos adoptees compared with normative Australian population and with care leavers

The adoptees also had similar adverse outcomes to the wider population on the following variables:

• substance misuse: 13% vs 16%

• mental health diagnosis: 17% vs 20% one year prevalence

• domestic abuse (women): 19% vs 23%

However, on the following variables the Barnardos adoptees had markedly more negative outcomes than the Australian national population:

• NEET: 20–30% vs 5–12%

• substance use: 37% vs 13%

• victim of domestic abuse (men): 36% vs 8%.

Comparison with Care Leavers

Setting the Barnardos’ data alongside the Australian national statistics provides a context for exploring how the adoptees fared when compared with the rest of the population. The fourth and fifth columns of the table show how the outcomes for the Barnardos adoptees compared with those of other young people who had had similar antecedents: the cohort of care leavers whose trajectories were followed for five years by Cashmore and Paxman (1996, 2007). Once again, the comparisons are not exact. Although very similar questions were asked, they were not always phrased identically. The care leavers cohort was smaller than the Barnardos adult adoptees sample and the age range was much shorter (20–23 years vs 18–44 years). Moreover, the care leavers were all interviewed four to five years after they aged out of the system, while the adult adoptees in the Barnardos sample were followed up between 10 and 37 years after they were placed with their adoptive parents. Not only was there a much wider timeframe for the Barnardos’ follow-up, but the average time after leaving their adoptive home was much greater (10 years; sd = 7.42). This is important as there is some evidence to show that outcomes for care leavers, particularly concerning education, improve as they grow older, because a number return to further and higher education as mature students (Jackson et al., 2011); outcomes for the care leavers in the Cashmore and Paxman study might therefore have been more positive had they been followed up when they were older. On the other hand, the findings from the Cashmore and Paxman study might insufficiently reflect the difficulties that care leavers encounter, because those who participated had more stable care careers than those who could not be accessed (Cashmore & Paxman, 1996, p.22).

Keeping these caveats in mind, the data nevertheless indicate that the Barnardos adoptees had significantly more positive outcomes than the Cashmore and Paxman care leavers on the following variables:

• educational qualification (Year 12 or more): 63% vs 42%¹⁸ (p = 0.04)

• expected or completed bachelor’s degree or higher: 27% vs 10%¹⁹ (p = 0.037)

• in full-time education, employment or training: 62% vs 34%²⁰ (p = 0.007)

The care leavers were too young to have completed their degrees when they were interviewed. However, only three were at university, and a fourth was about to go the following year, with her fees paid by her employer (Cashmore & Paxman, 2007, p. 33). Although some others might eventually enter university as mature students, at the time of the study it seemed likely that four (10%) care leavers would become graduates, substantially fewer than the adoptees. There were also significantly more adoptees in full-time work and/or education or training. However, although there were fewer adoptees who were NEET (30% vs 44%),²¹ the difference was not sufficient to reach statistical significance.

The Barnardos adoptees did markedly better than the care leavers on positive outcomes such as employment and education, and on many of these variables they were similar to the general population. However, although the only one to reach statistical significance was the use of non–prescription drugs, their outcomes were markedly worse than those of the care leavers on the following variables, all of which are indicative of negative outcomes:

• substance use: 37% vs 17%²² (p = 0.039)

• substance misuse (i.e. problematic substance use): 16% vs 10%²³ (not significant, p = 0.376)

• mental health issues: 58% vs 46%²⁴ (not significant, p = 0.235)

The Barnardos adoptees had similar outcomes to the care leavers on the following variables:

• victim of domestic abuse: 26% adoptees vs 29% care leavers

• mental health diagnosis: 19% adoptees vs 17% care leavers

Overall, therefore, the adoptees appear to have done much better than the care leavers in terms of education and employment, but worse, or equally unsatisfactorily, in terms of mental health issues and related adverse outcomes such as substance misuse and domestic violence.

Successful Adult Functioning

So far, we have looked at each outcome area separately. It is, however, possible to produce a composite measure that combines positive and negative outcomes and balances them out to provide an overall indication of adult functioning, which ‘operationalises the concept of resilience’ (Cashmore & Paxman, 2006). Cashmore and Paxman (2007) developed an overall measure of success to show how well the young people in their sample had fared, four to five years after leaving care, basing this on previous work undertaken by McGloin and Spatz Widom (2001). They calculated how the care leavers had fared over seven outcomes domains: those who showed positive outcomes on at least five domains were regarded as functioning successfully as adults. Table 8.5 shows the outcomes domains and the criteria for success.

Table 8.5 Adult functioning: Outcomes domains and criteria for success

The same methodology was used to assess how the Barnardos adoptees functioned as adults. Although just over a third (22/60: 37%) had to be excluded from the analysis because of missing data on too many domains, there were no significant differences between those who were included and those who were not. Those who could not be included were the same age (77 months) when they entered their adoptive homes and of similar age when they completed the survey (27.5 vs 30); there was also a similar gender split between the two groups (41% male vs 47% male); they also showed similar levels of vulnerability (64% of those who were excluded vs 66% of those included were classified as at high risk of adverse life trajectories). Although they did not have data on enough outcomes variables to be included, the data that were available indicated that the excluded group had a higher proportion of positive versus negative outcomes (70% vs 30%) than those who were included (62% vs 38%), suggesting that, had there been sufficient data, the overall results might have been more positive.

Key Factors Contributing to Success

According to our composite measure, over half (20/38: 53%) of the adult adoptees for whom there were sufficient data available met the criteria for functioning successfully in adulthood. Although higher percentages of young women and adoptees aged under 30 met these criteria, neither gender²⁵ nor age (under or over 30) was significantly associated with successful adult functioning.²⁶ In Chap. 3 we explored the extent to which the adoptees had encountered one or more of the following risk factors, all of which are known to be associated with adverse outcomes in adulthood and/or disrupted adoption placements (Farmer et al., 2011; Felitti et al., 1998; Finkelhor et al., 2011; Nalavany et al., 2008: Osborn & Delfabbro, 2006; Rousseau et al., 2015; Selwyn et al., 2014; White, 2016):

• four or more adverse childhood experiences

• sexual abuse

• polyvictimisation

• more than 15 months between notification of abuse and separation

• aged two or older when separated from birth parents following abuse

• two or more years between separation and permanence

• two or more failed reunifications

• three or more placements in care

• behavioural problems at entry to permanent placement

• aged four or older before entering permanent placement

• more than 12 months between permanent placement and adoptionorder

As Tables 8.6 and 8.7 show, the data indicate trends, but very few statistically significant relationships, between each of these factors and the adoptees’ successful (or unsuccessful) adult functioning. In comparison with those who were successful, adoptees who had not achieved successful adult functioning tended to have waited on average 9.5 months more between notification and separation, and 2.4 months more between separation and permanence. Consequently, they were on average 12 months older at separation, and 15 months older when they entered their adoptive homes. In comparison with the group who achieved successful adult functioning, this group had, on average, spent ten months less in their adoptive homes before the adoption order was made, but a lengthy post-placement period is unlikely to be such a powerful risk factor in the Australian context, where children were often fostered for several years before there was an adoption plan, and some adoptions were delayed to take account of birth parents’ situations (see Chap. 6). The group who did not achieve successful adult functioning had also experienced slightly more placements in care, and more of them had had a failed attempt at reunification. They had also, on average, encountered one more adverse childhood experience (ACEs), more of them had been sexually abused and more of them had behavioural difficulties when they entered their adoptive homes.

Table 8.6 Key vulnerability factors (1): differences between successful and unsuccessful adult functioning in adult adoptees (means, standard deviations and t-tests)

Table 8.7 Key vulnerability factors (2): differences between successful and unsuccessful functioning in adult adoptees (frequencies, percentages and X² tests)

The only one of these risk factors that was significantly related to adult functioning was polyvictimisation: adoptees who had experienced all four types of maltreatment (physical abuse, sexual abuse, neglect and emotional abuse), were significantly less likely to be functioning successfully in adulthood than those who had experienced three or less. While more of the adoptees who had been placed in our high vulnerability group²⁷ failed to achieve successful adult functioning, and more of those in our medium vulnerability group were successful, the differences are small and do not reach statistical significance. Adoptees in the subgroups at the extreme ends of the vulnerability spectrum did show significant differences: all five adoptees who had been classified as extremely vulnerable²⁸ to adverse outcomes were unsuccessful, and the one adoptee for whom there were sufficient data who was classified as at low risk met the criteria for success; however, the numbers are too small for further analysis. Nevertheless, it seems possible that the adoption acted as a powerful protective factor, albeit not sufficient to counteract the most damaging previous experiences. One other factor that we found to be significantly associated with adult functioning lends weight to this hypothesis: adoptees who thought their adoptive parents had always parented them sensitively were significantly more likely to have achieved successful adult functioning than those who thought this had never, or only sometimes been the case; however, there are considerable missing data on this variable.

Contact with Birth Parents and Adult Functioning

It is also noteworthy that we found very little statistical association between face-to-face contact with birth parents and either adoptees’ ongoing mental health issues or their functioning in adulthood. The only finding that reached statistical significance was that those adoptees who appeared to have mental health issues at the time of the survey were more likely to have had face-to-face contact with their birth fathers post adoption.²⁹ So few adoptees had had no post-adoptive contact with birthmothers that the numbers are too small for comparative analysis. Although again the numbers are too small for statistical analysis, it is noteworthy that six of the nine adoptees whose interviews indicated that contact had enabled them to come to terms with their past had achieved successful functioning in adulthood, while four of the six whose interviews indicated that they still had unresolved issues with their birth family and they were ‘far from closure’ were not functioning successfully (and there were insufficient data on the other two).

As Chap. 6 has shown, the qualitative data indicate that post-adoption contact was generally thought to be beneficial and that it brought considerable advantages. However, poor management of contact and the issues some birth parents brought to contact sessions may have negated these benefits for some adoptees.

Differences Between Care Leavers and Adoptees’ Experiences: Understanding Disparate Outcomes

Table 8.8 shows how the 38 Barnardos adoptees who had sufficient data to be included in the composite measure of adult functioning compared with the care leavers in Cashmore and Paxman’s (2007) study. According to this measure, over half of the adult adoptees (53%) were able to function successfully as adults, in comparison with 41% of the care leavers. Of particular interest is the finding that half (50%) of the male adoptees were functioning successfully. This is a markedly higher proportion than that found in the care leavers study (31%) and, indeed, in numerous other studies which have tended to show that young men are significantly less resilient than young women (McGloin & Spatz Widom, 2001; Stein, 2004). However, neither of these disparities between the adoptees’ and the care leavers’ samples are statistically significant.

Table 8.8 Successful adult functioning: Barnardos adult adoptees (N = 38) compared with care leavers (N = 41)

So far, we have seen that the adoptees tended to be more vulnerable than care leavers in terms of their mental health and substance use, but nevertheless they often did better in terms of education and employment. They also appeared to be more likely than care leavers to function successfully as adults.

It is important to be aware that the datasets are not strictly comparable and that there are substantial missing data. Both these factors could have distorted the analysis. However, as noted in Chap. 1, there are no indications of bias in the Barnardos dataset,³⁰ and there is also ample evidence from the interviews to support the quantitative data from the survey. A more likely explanation of the disparities in outcome between adoptees and care leavers is to do with the different experiences that adoption provides, particularly over the period when young people are making the transition from adolescence to adulthood. There is substantial evidence to show that the period of emerging adulthood can be a difficult time for vulnerable young people who still need parental support as they move towards independence (Mann-Feder & Goyette, 2019). We have already seen (Chap. 5) that, as emerging adults, the adoptees were more likely to have experienced greater stability and to have received more long-term emotional and practical support from their adoptive parents than is generally available to care leavers from previous foster parents. They were also more likely to have received both personal and professional support to help them overcome the consequences of their early childhood experiences.

Living Arrangements

Table 8.9 shows the adult adoptees’ living arrangements at the time of the survey. As we have already seen (Chap. 5), 18 (31%) were still living with their adoptive parents after their 18th birthdays. Two other adult adoptees were living with an older sibling (one a birth sibling and one an adopted sibling) who was providing quasi-parental support.

Table 8.9 Livingarrangements (core follow-up sample: adult adoptees N = 60)

There is evidence from the interviews that several of the 19 adult adoptees who had run away or prematurely left their adoptive parents’ home had briefly gone back to their birth families; these attempted returns had often ended acrimoniously. Only one adult adoptee was living with a birth family member at the time of the survey; this was a young man with mild learning disabilities who had formed a relationship with an elder birth brother who was supporting him.

The majority of adoptees who were not living with members of their adoptive family or birth relatives (23/38: 61%) were living with long-term partners. Most of these (17/22: 77%)³¹ were buying their own homes or living in long-term rented accommodation. Six adoptees were living with friends, and only four were living alone. However, five others had ‘other’ living arrangements, and we know that at least one of these was in prison and another in supported accommodation for adults with mentalhealth problems. Both these young people were still receiving extensive support from their adoptive parents.

Four (4/21: 19%) adoptees³² had couch surfed or slept rough for more than seven nights since leaving their adoptive homes. This was a similar level of homelessness to that experienced by the care leavers in Cashmore and Paxman’s (2007) study (9/41: 22%). However, in other respects the adoptees’ experiences of being able to make the transition toadulthood were significantly different from that of care leavers. Only 5 of the 19 adult adoptees (26%) who were aged between 18 and 25 had left their adoptive parents’ home in comparison with 90% (37/41)³³ of care leavers who were no longer living with foster carers or members of their family by their early 20s (Cashmore & Paxman, 2007, p.17). Of the 11 adoptees in this age group for whom there were sufficient data available, 8 (73%) met the criteria for successful adultfunctioning, all but one of whom were living with their adoptive parents (or a member of their family) at the time of the survey. This is further evidence, to add to that discussed in Chap. 5, of the adoptive home providing the ‘safe and secure home base’ that a wealth of research has shown to be conducive to successful adult outcomes (e.g. Schofield, 2002; Stein, 2004).

Support with Education and Employment

Education

Adoptive parents did not only provide a secure home base from which adoptees could launch themselves into adult life, they also took steps to ensure that they acquired the skills and confidence they needed to support themselves. It is evident from the interviews that many adoptive parents had gone to considerable lengths to rectify the deficits in their adoptees’ education.

We had special needs teaching at both primary and high school. Plus, remedial teaching after school, speech pathology, occupational pathology, remedial eyesight… every form of intervention imaginable. (Adoptive parent of young man, aged 9 when permanently placed)

I hadn’t been to school properly from zero to eight… School was hard in primary school, because I started late and I didn’t have a lot of the basics, and Mum had to get a lot of tutoring for me. I had English tutoring, I had maths tutoring, I had French tutoring, I had everything. (Young woman, aged 8 when permanently placed)

I think we really, really tried hard to tackle the learning difficulty issues. She got into uni, which I think is amazing. So I think we have given her opportunities. (Adoptive parent of young woman, aged 6 months when permanently placed)

I used to read all her essays and correct them. I never wrote them for her. I used to read them, correct them, explain what she’d done wrong and make her rewrite. Sometimes, she would write two or three drafts. (Adoptive parent of young woman, aged 8 when permanently placed)

This level of support could be intrusive, and it was not always appreciated. Nevertheless, it is likely to have been a major factor in the adoptees’ educational success. It was also very different from the common experience of care leavers, which is often one of missed opportunities, ignorance of available compensatory support and the absence of an adult prepared to go out of their way to help them succeed (Jackson, 2001; Cashmore & Paxman, 2007; Skuse & Ward, 2003). Those care leavers in the Cashmore and Paxman study who had achieved educational success tended to have been in long-term stable placements with supportive foster carers whose level of commitment to them was similar to that of adoptive parents (Cashmore & Paxman, 2007, pp. 39–40).

Another factor that contributed to the adoptees’ educational success was that it provided them with tangible evidence of the distance they had travelled. Open adoption meant that adoptive parents could use this as a means of encouraging their children to succeed:

But, one thing he did, when he graduated from Year 12 he goes: “I wonder what [birth grandmother] and [birthmother] would think now?”…. So, I took a picture, exact of him, just so I’ll show her when we do see her, yeah, that he did graduate. So, that was a big thing. He had to prove a point that he was going to be better than them. (Adoptive parent of young man, aged 2 when permanently placed)

It could also help to reconcile birth parents to the adoption:

She actually walked up to me in the supermarket one day and she said: “I want to thank you”. And I said: “Oh, what for?” She said, “It’s really good to sit back and see my boys successful and well educated, and it’s because of you. Thanks for doing that.” She said, “Now I’ve got two kidsI can be really proud of”. (Adoptive parent of young man, aged 2 when permanently placed)

Employment

Most adoptive parents also continued to offer encouragement and support through the early years of employment. They went to considerable efforts to help their young people find employment, offering them work in their own businesses, or asking friends or colleagues to give them work experience, or helping them make enquiries about vacancies:

So we had to find work for [adoptee] and of course he had this real, real desire to be a deckhand. So I typed up a CV… and physically he and I walked… [to] all of the marinas around here… there are dozens of marinas.’ (Adoptive parent of young man, aged 9 when permanently placed)

They also supported them through crises until they were settled. It was not unusual for these young people to be sacked from their jobs, but they had parents who were willing to help them overcome the difficulties that had led to this setback and find further work.

We give him constant support around his financial situation, support, and or advice… [Adoptee] has this explosion every 18 months, two years where things build up and something goes horribly wrong and he quits his job and he’s without a job for weeks or a month and he continues to pay rent and he might – because he’s under pressure he goes gambling and he might drink and he does other things.

So, we’re there. We try – we’re very connected with him… So, I guess what I’m trying to say there is that we’re happy to help, but on our terms, and we’re not prepared to just give him money to bail him out. (Adoptive parent of young man, aged 5 when permanently placed)

Mental Health

The young person whose adoptive parent was quoted above was in his mid-20s at the time of the survey. Like many of the other adoptees he had received both continuing informal, personal support from his adoptive parents and professional support to help him with the periods of depression and anxiety that continued to affect him. Forty-two (42/59: 71%)³⁴ of the adult adoptees had had access to mental health support services at some point in their lives³⁵ and eight of them had been admitted to hospital. Twenty-eight (28/34: 82%)³⁶ of those adoptees who had continuing mental health issues had received professional help in dealing with them. At least nine adult adoptees were still receiving professional support at the time of the survey. Considerably more adoptees than care leavers who had mental health issues received professional mental health support (82% vs 68%) (Cashmore & Paxman, 2007, p. 93), although the disparity did not reach statistical significance.

Risk Factors and Protective Factors in the Relationship Between Adoptive Parents and Children

Adoption, therefore, provided some protection against the consequences of the adoptees’ adverse antecedents. Most adoptive parents were able to provide a secure base, and both informal and professional support to help their children overcome their earlier problems and develop the skills and confidence to make a successful transition to adulthood. The body of international research on out-of-home care indicates that these are likely to be the most significant ways in which the adoptees’ experiences differed from those of most care leavers (Cashmore & Paxman, 2007; Mann-Feder & Goyette, 2019).

There were also two other factors that appear to have contributed to adoptees’ functioning in adulthood. First, those adoptees whose parents had rated the first year of the placement as ‘stressful’ or ‘very stressful’ were significantly less likely to achieve successful functioning in adulthood than those whose parents had not.³⁷ Second, those adult adoptees who regarded themselves as having ‘always’ experienced sensitive parenting from their adoptive parents were also significantly more likely to be functioning successfully.³⁸ The significance of these two factors—adoptees’ perceptions of parental sensitivity and adoptive parents’ perceptions of the first year of the placement—indicate the importance of the relationship in promoting adoptees’ resilience. They also provide useful pointers to both training needs and support needs of adoptive parents, issues that are discussed in the final chapter.

Commitment

A final protective factor was the adoptive parents’ commitment to the children. This is not possible to quantify, but it was clearly at the basis of the adoptees’ strong sense of security that was likely to have contributed to positive outcomes.

The change in legal status underpinned the adoptive parents’ and adoptees’ commitment to the relationship; it was identified by one of the interviewees as ‘the difference between marriage and cohabitation’. The security that the adoption order brought was of great, and sometimes unexpected, significance:

I was very surprised (nobody warned me about this) that there was this huge emotional release when the judge signed the adoption order. I didn’t think that would happen. A huge sense of security for both of us. (Adoptive parent of young man, aged 2 when permanently placed)

After adoption my son said: we are a real family now, can we get the stick figures for the car? We thought at the time we were a real family, adoption gave him more security that he wasn’t going to be moved anywhere. (Adoptive parent of young man, aged 3 when permanently placed)

The change in legal status was identified by numerous adoptees as the identifying factor that distinguished adoption from their previous experiences. Both the survey responses and the interviews include numerous statements in the same vein as the following:

There was no negative side to being adopted. I mean, one of the other good things about it, it did formalise my position. (Young man, aged 2 when permanently placed, aged 40 when interviewed)

I think having that sense of comfort, that, okay they’re my family now, I don’t have to worry about anything else, that I don’t have to do this soul searching, or searching for biological relatives. I just go: “Oh, you’re mine, actually”. (Young man, aged 9 when permanently placed, aged 39 when interviewed)

Nevertheless, as Table 8.10 shows, many of the adoptive parents found that adoption had not been easy. While they described 40% (34/85) of the adoptions as very positive, more than 1 in 5 (21%: 18/85) had been mainly negative, including 16 (19%: 16/85) which had been ‘difficult and challenging’.

Table 8.10 Adoptive parents’ ratings of the adoption (core follow-up sample N = 93)

Adoption had also taken a toll on some adult relationships: one in six (16%) adoptive parents thought that the adoption had had a negative impact on their relationship with their partner. It had also sometimes had a negative impact on adoptive parents’ relationships with their birth children:

And I think [adoptee] came with a lot of baggage that we found really difficult, which has impacted on the whole family… and now they’re getting penalised because this child I’ve taken in, who is my daughter but is really putting me through hell and back, and now the others are saying: “But we’re not going to visit”. (Adoptive parent of young woman, aged 3 when permanently placed)

Some adoptive parents who had found the experience ‘difficult and challenging’ regretted their decision to adopt a child:

I feel angry and bitter. I feel abandoned by my child, and never a word of thanks from him. He exercised his options and preferred to return to his birth family… and I hope he has found happiness. I think he currently lives with one of his older femalesiblings. However, I don’t know. He doesn’t keep in touch. In fact, I don’t know if he is alive or dead. When we put our toe in the ‘adoption water’ and spent the many, many months with Barnardos in their excellent trainingprogramme, I remember my goals… ‘a completion of my family… enrichment of my family… and to give two abused kids a “better second chance in life”. Significant elements have gone wrong… Promise I’ll never do it again. And will never recommend it to anyone else. (Adoptive parent of young man, aged 10 when permanently placed)

However such comments were rare. Other parents who had found the adoption difficult and challenging nevertheless had few regrets:

Challenging but have no regrets. Am a much better person for having had the children. (Adoptive parent of young woman, aged 4 when permanently placed)

The early and later teenage years were very destructive to us as a family but you will never know how much of that you can put down to adoption. Thankfully now many years later our communication has improved and our relationship is much more positive and happy. (Adoptive parent of young man, aged 8 months when permanently placed)

We are glad we did it, but it was quite challenging. I think the child got something that they could not have gotten otherwise. (Adoptive parent of young woman, aged 11 when permanently placed)

Perhaps the most important finding to come from the study is that, however unsatisfactory the adult adoptees’ lifestyles, and however difficult the relationship, adoptive parents very rarely rejected them. They had come to consider themselves as the adoptees’ parents and consequently they were there for the duration. Adoptive parents continued to support adoptees who had become heavily involved in prostitution; who had become addicted to drugs; who had developed long-term mental health problems. Darren’s case study provides a typical example.

Darren

Before Entering His Adoptive Home

Darren was diagnosed with autism and epilepsy at an early age. He also had learning disabilities. He experienced physical and sexual abuse before being placed in foster care. His foster parents decided to keep his siblings but asked for him to be removed. He was placed with his adoptive parents when he was eight years old and was described as aggressive but not assertive.

Progress

Darren was described as ‘a difficult kid to manage, a difficult teenager, difficult young man’. He left his adoptive parents to return to his birth parents, but then returned to his adoptive parents when that broke down.

As an Adult

It became apparent that Darren would not be able to live independently. He could not manage his financial affairs; he could not keep his home clean or look after himself properly. When he was in his 20s, his adoptive parents moved him into supported accommodation. However, they continued to visit him and to support him in numerous ways. In their view:

What would it be like for Darren if he did not have anyone that he could rely on? He truly would be one of those homeless bag people because he does not have the inner resources.

Adoptive parents also welcomed back adoptees who had comprehensively rejected them. The following quotation comes from an adoptive mother whose son left them and had no contact for three years before he returned:

He said when he got in touch with us: “A lot of people, whether it was their natural parents or not… they would not have taken me back. They may not have wanted to talk to me”, and he said, “And I know people, after having met people over that time… I know people whose parents have not wanted to know them, after what’s happened”. And he said: “But you…”

I can’t understand why a parent would not want – even if it is years on, if a child finally realised that they needed to speak to the parent, wanted to come back to the family, no matter what happened… I find it hard to understand why a parent wouldn’t want to, then, take that opportunity to reconnect and try and work something out. Home was always here, if he ever needed to come back. (Adoptive parent of young man, aged 8 when permanently placed)

We do not know enough about the process by which adoptive parents come to regard themselves as the parents of a child to whom they did not give birth. Greater understanding of this issue would better inform the recruitment and training of adoptive parents and indicate how placements might be better supported.

Conclusion

Adult outcomes for the Barnardos adoptees were relatively positive. They did well educationally, and most of them were in employment. Although many of them had continuing mental health issues, nevertheless they were more likely to function successfully as adults than young people who age out of out-of-home care. Our composite measure of outcomes showed that 55% of the adult adoptees appeared to be functioning successfully as adults. Ten were highly successful, showing positive outcomes on six or seven indicators. Only one adoptee showed negative outcomes on all seven indicators, and two more had negative outcomes on five. However, adoption was not an easy task; many of the adoptive parents had found it challenging and stressful, both for themselves and partners and sometimes for their birth children. Their long-term commitment despite the challenges, their sensitivity and their determination to help the adoptees succeed are likely to be key factors associated with successful outcomes.

Key Points

• Educational outcomes of adult adoptees tended to be similar to those of the general population and markedly better than those of a comparable sample of care leavers.

• Adoptees were also more likely to be in work and less likely to be NEET (not in education, employment or training) than care leavers.

• There were indications that continuing mental health issues and reports of substance misuse were more common amongst the adoptees than care leavers.

• Nevertheless, more adoptees than care leavers achieved ‘successful functioning in adulthood’.

• Adult adoptees who had good qualifications, a steady, satisfying job and were in an established partnership still showed signs of underlying vulnerability.

• The presence of a committed and supportive adoptive parent helped adoptees both access the services they needed and function satisfactorily in adulthood despite ongoing consequences of earlier abuse. This was the major difference between the experiences of adoptees and care leavers.

• Adoption appears to have acted as a powerful protective factor. Only extreme indicators of vulnerability at entry to the adoptive home correlated with poor adult outcomes.

• Adoptees who felt that they had received sensitive parenting were significantly more likely to function satisfactorily in adulthood.

• Those whose adoptive parents had found the first year of the placement challenging were significantly less likely to achieve success.

• Almost all adoptive parents considered the adoptees to be their own children and continued to support them into adulthood, regardless of what were sometimes severe behavioural problems and challenging mental health issues. Better understanding of how this parental bond is formed would enhance recruitment, training and support programmes.