Adoptive parents’ worries and concerns about their adolescent adopted children

Introduction

In the UK in 2022, there were 82,170 children looked after, with only 3% of them being successfully adopted (Department for Education, 2023). The number of children waiting to be adopted is increasing, while the number of approved adopters have demonstrated a 20% decline. Most of these adoptions resulted from children entering local authority care following experiences of abuse or neglect. Many of these adopted children will invariably have had a range of negative life experiences, including maltreatment and significant disruptions in care, before being placed with stable and nurturing adoptive families.

Adverse childhood experiences, prior to the adoptive placement, have been increasingly recognised as significant predictors of individuals’ outcomes in adulthood and need to be considered to understand the impact of adoption as well as the challenges that adopted children may face. These adverse experiences interfere with the identified developmental opportunities that result from the experience of parental and family life, especially over the first thousand days. They can have a pernicious and persistent effect (Zeanah, Shauffer and Dozier, 2011). Initially, interest in the impact of the early disadvantage of high-risk populations emerged from exploring in the general population the relationship of childhood adversity with health in adulthood (Boullier and Blair, 2018; Danese and McEwen, 2012; Felitti et al., 1998). Other important repercussions have also been identified, including poor educational, economic and income outcomes in adulthood (Metzler et al., 2017), suicide (Dube et al., 2001), illicit drug use (Dube et al., 2003) and premature mortality (Brown et al., 2009).

These adverse outcomes observed in adopted children are likely to be caused by a combination of risk factors to which they can be exposed both before and after birth. Prenatal risk factors include genetic predispositions, such as biological parents’ intellectual disabilities and mental health difficulties (Smoller and Finn, 2003; Vissers, Gilissen and Veltman, 2016), as well as exposure to drugs, alcohol and opioids in utero (Bandstra et al., 2010), with adopted children exposed to prenatal substance abuse being at greater risk for neurodevelopmental, behavioural and neurological diagnoses (Landgren et al., 2010). Postnatal factors, on the other hand, can include maltreatment, neglect and instability in their placement arrangements (Newton, Litrownik and Landsverk, 2000; Rushton and Dance, 2006; Tarren-Sweeney, 2017). Within this context, older age at adoption has been identified as one the strongest developmental predictors, as it represents a proxy for length of exposure to adverse backgrounds prior to being placed with an adoptive family (Howe, 1998b; Palacios et al., 2019). When comparing adolescents placed in infancy to those placed at older ages, David Howe (1997) found that the older placed group showed the highest rates of problem behaviours in adolescence. Other studies indicate that those placed after the age of four years display the most unfavourable developmental outcomes (Nadeem et al., 2017; Vandivere and McKlindon, 2010). Indeed, frequent separations, as well as unpredictable and unstable family environments, have a damaging effect on a child’s welfare (Newton, Litrownik and Landsverk, 2000), often leading to behavioural challenges irrespective of other risk factors (Rubin et al., 2007). Older placed children are at risk of poor mental health, behavioural problems and relationship difficulties (Brown, Waters and Shelton, 2017; Dekker et al., 2017; Hodges and Tizard, 1989; Howe, 1998a; Howe and Hinings, 1987; Juffer and van IJzendoorn, 2007; Quinton et al., 1998; Tizard, 1977). Studies further demonstrate that they remain more at risk for most internalising and externalising disorders (Behle and Pinquart, 2016; Keyes et al., 2008; Miller et al., 2000; Rueter et al., 2009; Selwyn, Wijedasa and Meakings, 2014; Tieman, van der Ende and Verhulst, 2005).

Considering the intense and complex ingredients of the adolescent phase for both adoptees and their adoptive parents, it is essential to gather more accurate and comprehensive insights into what these ‘major challenges’ are. Unfortunately, there is limited research into the experiences of adoptive parents, particularly during adolescence. A few studies on their lived experience with adoption conducted by Howe in the 1990s revealed that parents of late adopted children exposed to early adversity, reported their later increased vulnerability to eating disorders, lying, expulsion and exclusion from school, running away and missing from home overnight, theft of both money and property from their adoptive homes, as well as crimes committed outside of home, and, significantly, violence towards other family members (Howe, 1997). Evidently, these early experiences also have the greatest impact on the children’s attachment and the quality of the relationships they will build throughout their lives (Bowlby, 1982). Children adopted at older ages have been shown to have an increased risk for unfavourable emotional and social development, due to feelings of insecurity, anxiety, and, in some cases, confusion and anger, caused by these early negative experiences (Howe, 1996).

Significantly, it is in adolescence that these behaviours and preoccupations with relationships often become more pronounced (Howe, 1996). Adolescents’ heightened emotionality and limited capacity for emotion regulation can be explained by neurobiological processes (Luciana, 2013) and social influences (Ge, Conger and Elder, 2001). They find themselves facing increased demands for maturity, higher expectations for academic achievement and transitions to schools, as well as more intense peer interactions (Eccles et al., 1993). In high-risk populations, adolescence is a period where the impact of adverse experiences and genetic predispositions are often intensified and further predispose individuals to the development of psychological disorders (American Psychiatric Association, 2013; Colvert et al., 2008; Tregeagle et al., 2019; Vandepoel et al., 2014). Moreover, adoptive adolescence itself is shown to be concomitant with increased risks, such as more psychiatric diagnoses, attachment difficulties and affective dysregulation (Pace, Di Folco and Guerriero, 2018). Such risks and manifestations undoubtedly present adoptive parents with significant challenges as they help navigate their child’s developmental challenges and transition through and beyond adolescence (Trentacosta et al., 2008).

Most studies have tended to focus on developmental outcomes and have placed far less emphasis on the impact on adoptive parents (Palacios and Brodzinsky, 2010). The adolescent adopted child clearly evokes concerns and worries for the parents which are intensified by the potential negative influence of peer groups and their involvement in risky behaviours (Bogenschneider and Olson, 1998). Most parents of adolescents struggle to adapt to their new roles during this transitional stage, which is only likely to be compounded by these young people’s early experiences. The self-determination theory, which examined the essential requisites for adolescents’ psychosocial adjustment during this period, emphasised their need for autonomy, competences and relatedness (Deci and Ryan 2000; Ryan and Deci, 2017). Adoptive parents will have already been more likely exposed to higher levels of behavioural and emotional difficulties, which have often been related to children’s disturbances in their early attachments and are now having to facilitate their more vulnerable child. In the survey conducted by Selwyn, Wijedasa and Meakings (2014), a third of parents reported experiencing ‘highs and lows’, a quarter acknowledged encountering ‘major challenges’ and a further 9% reported the adoption to have been disrupted. Furthermore, it was evident from this research that even in the most precarious and disrupted placements adoptive parents’ deep concerns and distress about their children were only reinforcing their commitment to continue supporting them. The challenges of adolescence are also evidenced in how some of the most complex and difficult cases in post-adoption work are with parents and their adopted teenage children (Howe, 1996).

As stated earlier, few studies on adoptive parents’ lived experience have revealed that parents of late-placed adopted children, exposed to early adversity had to face the young person’s increased vulnerability to a vast range of these negative outcomes (Howe, 1997). This has resulted in some adoptive parents admitting feelings of desperation at different stages during adolescence, and some revealing not wanting to go through the adoptive placement ever again (Howe, 1996).

To better support adoptive parents and facilitate adoptive placements, further studies are required to explore adoptive parents’ perception of these challenges and their anxieties and concerns regarding their now adolescent child, in relation to both their current experience and their anticipated worries as they transition from adolescence into autonomous adulthood. It is hoped that this would lead to a clearer image of outcomes in adolescence, which might help us reflect upon how adoptive parents might be supported during this process.

The Current Study

This study draws upon a major longitudinal research project collaboration between the Anna Freud Centre, Coram and Great Ormond Street Hospital, which set out to explore outcomes and experiences of adopted children and their parents from middle childhood through to adolescence, and compared early adopted with late adopted young people.

Within this qualitative paper, however, parental interview data from only the late adopted group are examined to explore those perceptions, insights and anxieties of parents from the most ‘at-risk’ cohort of children. A thematic analysis was conducted on the Parent Development Interview (PDI) (Slade et al., 2004), a schedule used with adoptive parents in the adolescent follow-up phase. Although these interviews were used with some of the adoptive fathers too, for this study, only adoptive mothers of late adopted children were included.

Method

This study reports on adoptive families of a maltreated, late-adopted sample (LA) which formed part of the Adoption and Attachment Study (Coram/Anna Freud Centre) and was funded by the Glasshouse and Tedworth Trusts of the Sainsbury Family Trusts (Principal Investigators Dr Miriam Steele, Dr Jill Hodges and Ms Jeanne Kaniuk). Ethical approval was obtained from the Institute of Child Health Ethics Committee and the Joint Ethical Committee of University College London.

Adoptive families were recruited through five voluntary adoption agencies and two social services departments in the UK. Following initial agreement from the families to participate, they were provided with consent forms alongside written information about the study.

Results

This study extracted five superordinate themes that related to adoptive parents’ concerns and worries about their adolescent children. These five themes were: Vulnerability; Violence; Derailing opportunities; Autonomy; and Anxieties about the birth family. Each contained their own subordinate themes. Illustrations are provided using pseudonyms, including both the age and gender of the adopted child who was being spoken about.

Although these individual themes had their own discrete ingredients and meanings, they were expected to interplay. Overall, parents struggled to sustain feelings of hope amid the challenges, and many spoke with ambivalence:

I don’t know, I think it could go either way, I really do. I think she could, you know, get a job, get a flat, find a boyfriend, be reasonably okay or she could end up in prison. (Tia, daughter, 13)

Discussion

Within this study, we examined the concerns and anxieties that adoptive mothers described about their adolescent child. We chose to only explore those who had adopted late placed children, who are known for suffering far more negative pre-adoption experiences, including significant discontinuity of care and maltreatment. The rationale for focusing on this population was guided by the expectation that this particular group of adopted children would be more challenging and complex to parent given their pre-placement histories. These early risk factors have been increasingly recognised as impacting outcomes in adolescence and adulthood (Boullier and Blair, 2018; Danese and McEwen, 2012; Felitti et al., 1998). Such unfavourable outcomes are apparent already in early adolescence (Nadeem et al., 2017; Vandivere and McKlindon, 2010), as clearly illustrated by an increased display of behavioural problems (e.g. Rubin et al., 2007).

The five overarching themes generated from this study were Vulnerability, Violence, Derailing opportunities, Autonomy and Anxieties about the birth family.

The first superordinate theme, Vulnerability, was consistently reflected in the parents’ accounts of their current and future concerns. Although this was a discrete theme about their fragility and associated risks to their safety, the essence of it ran throughout most of the other themes. Parents spoke emotively about their children’s low-esteem, susceptibility to peer pressure and risks of being taken advantage of. Further concerns related to their child’s decision-making within and outside relationships, among them unhealthy and destructive relationships, including sexual and romantic ones, which further triggered worries regarding unplanned pregnancies. History of childhood maltreatment has been often linked to affiliation with deviant peers who engage in antisocial activities in adolescence (Grotevant et al., 2006). Furthermore, those adopted also have been found to be at increased risk for substance abuse (Westermeyer et al., 2010). This emphasises late placed adopted individuals’ increased vulnerability to detrimental adolescent outcomes, as well as involvement with antisocial peer groups.

Some of the vulnerability was also seen within their child’s often complex neurodivergent and mental health needs which only compounded their capacity to navigate the different social contexts they were exposed to (Hodges and Tizard, 1989; Howe, 1998b; Howe and Hinings, 1987; Quinton et al., 1998; Tizard, 1977).

The second superordinate theme, Violence, described their child’s aggressive and violent tendencies which, for some families, had already manifested in different situations, though there was far more emphasis on their fears of how their child’s aggressive impulses might look in future. Again, these anxieties were very much in line with what has been previously documented on adopted individuals’ negative behavioural outcomes (Hodges and Tizard, 1989; Howe, 1998a; Howe and Hinings, 1987; Quinton et al., 1998; Tizard, 1977). In many cases, these anxieties were about their child being capable of hurting and injuring other people; in other cases, the fears were much more about their child’s anger turning inwards and leading to self-harm and suicide. Previous research has highlighted that young people in such populations were more at risk for suicide (Dube et al., 2001) and these worries appeared tangible for many adoptive parents.

The third superordinate theme, Derailing opportunities, accounted for how their child’s life path and future could be destabilised leading to missed and lost opportunities, predominantly regarding their education and vocation, but also in other areas of their life. Invariably, parents spoke about their worries through the lens of the educational system where they often observed their child faltering at school and negatively engaging within their peer groups. In similar populations to the one examined, negative consequences mostly concerned poor educational, economic and income outcomes in adulthood (Metzler et al., 2017) and, within this study, even at such early stages in these young people’s development, parents were anticipating complicated corollaries. In our sample, young people were in early adolescence and exposed to the academic demands of school and within their peer groups, which parents felt was as much a risk factor in its pressures and negative diversions, as it was protective and facilitative when engaged with positively. Outside the more pragmatic parameters associated with sustainable futures, other negative outcomes have been revealed including drug use (Dube et al., 2003) and premature mortality (Brown et al., 2009). Indeed, concerns about these antisocial ramifications and catastrophic outcomes were shared by parents in our sample.

The fourth overarching theme, Autonomy, was strongly evident in adoptive parents as they voiced their anxieties about their child’s struggles for independence and autonomy. Many of the examples of parents’ worries in relation to this theme focused much more on their own sense of agency and on the impact that their anxieties regarding their child’s readiness or unreadiness for autonomy was having on them. In normative samples, parents of adolescents often battle to adapt to their child’s transition towards autonomy. Consequently, it is possible that in this population, which has experienced so much discontinuity, maltreatment and trauma, the more attachment-orientated elements associated with transitions are tested even more. Parents spoke strongly about their own loss of agency, as they did not feel they possessed the role that they had when their children were younger and felt that it was only diminishing. This is not surprising: adolescence generally represents a stage at which individuals seek more independence and autonomy from their parents. Thus, the parental role moves from mostly focusing on meeting their child’s attachment needs, to supporting and helping the adolescent as they learn to meet these needs autonomously (Kobak and Duemmler, 1994).

The final superordinate theme, Anxieties about the birth family, represented a stand-alone theme that concerned parents’ worries about the presence and role of the birth family in the child’s life and how this might affect them as their child approached adulthood. Their anxieties were very much tied up in how the birth family’s ‘ghosts in the nursery’ might re-emerge and risk destabilising the child and loosen their role. Some of the concerns were about the risk of repetition of experiences and characteristics. Previous research has explored adoptive parents’ discomforts and anxieties about the role of the birth family and how potential contact could complicate their own role and the child’s overall sense of belonging and security in the home (MacDonald and McSherry, 2011). Although not shared by all parents in our sample, a number did express these fears and remained ambivalent in their opinions on the relative value associated with the reappearance of the birth family in their lives over the potential uncertainty and discomfort that might ensue. This is quite common within adoptive families; a qualitative study conducted by MacDonald and McSherry (2011) revealed that most adoptive parents were not convinced of the benefits of birth family contact and deemed any form of contact to be challenging. Birth family contact can indeed hinder adoptive parents’ efforts to form healthy attachment relationships with their adopted children and re-activate insecure attachment behaviours (Boyle, 2017). This is often the case when birth parents are either rejecting or abusive and controlling during contact. It is, however, important to recognise that, despite adoptive parents’ worries, birth family contact can sometimes be beneficial in aiding adopted children to resolve their feelings around loss (Boyle, 2017) and facilitate their identity development (Grotevant et al., 2013). Thus, addressing adoptive parents’ concerns surrounding their children’s biological parents might alleviate their worries and create a more harmonious environment for birth family contact.

These themes are all ones that were observed by David Howe in his interviews with parents of late placed adopted individuals, who relayed parents’ experiences of increased vulnerability at this stage to their children’s significant internalising and externalising psychopathology, as well as antisocial behaviour, including violence and crimes (Howe, 1997). Although adopted children have often been identified to be at greater risk for developmental outcomes throughout all stages of their lives, studies have rarely investigated adoptive parents and their experiences. Insight into adoptive parents’ worries for their children can provide a more holistic understanding of the adoptive experience and the areas in which adoptive families might benefit from support. Emotionality itself was not identified as a theme, but it appears as a meta-theme across these five superordinate themes, given that it explains how the adolescent child’s heightened emotionality and reduced capacity to regulate themselves was now being additionally challenged by social influences, which they were having to both make sense of and navigate.

Conclusions

Studies have drawn upon the more qualitative experiences of adoptive parents, but few have done so with a focus on adolescence, a period where developmental challenges and difficulties are often intensified, so precipitating additional concerns and worries for the adoptive parents.

Overall, this study adds further evidence to the very limited field on adoptive parents’ experiences and perceptions of their now adolescent adopted child. Importantly, the emerging themes are indicative of significant anxieties and worries about their child’s skills, resources and capacity to navigate the transition from adolescence to adulthood. What has emerged from this study is that adoptive parents were deeply concerned about their young adolescent’s current and future wellbeing. The five themes included those that suggest the adopted individuals were vulnerable to external pressures which could result in destructive consequences. The language used was often catastrophic in relation to the child’s impulses towards themselves and others, the pernicious influences around them, the potential intrusion of the birth family, and the loss of a more normal trajectory with positive life changes.