The pathway from adverse early experience to adulthood for internationally adopted children is complex in identifying key influences, impacts, and outcomes. This review arose from the authors’ involvement in the British Chinese Adoption Study, a recent outcomes study that explored the links between early orphanage care, adoptive experiences, and midadulthood. It differs from previous reviews in focusing on a greater length of time since adoption. Both quantitative and qualitative studies were included to allow for examination of a fuller range of adult-related outcomes rather than mental health scores alone. The sampling, methods, and results of reviewed articles are summarised and a critical commentary is provided. Despite methodological differences and identified strengths and weaknesses, conclusions are drawn on the basis of the evidence available. Special attention is paid to the interpretation of negative outcomes. Findings identify areas that should be explored further in order to gain a fuller understanding of midlife outcomes of people who experienced a poor start in life followed by international adoption. Such studies help in refining lifespan developmental theories.
A substantial body of literature has developed which identifies the adverse impact on children’s development over time when their birth families cannot provide them with sensitive, reliable, and committed care. This is particularly stark for children who are separated from their birth families, including those who go on to be internationally adopted. Freud was hugely influential in articulating a powerful conceptual model of human development that came to influence thinking over a generation and more. He noted the long-lasting impact of adverse early experiences on the “unconscious mind”:
The scientific community has developed the research base for further understanding the significance of early experiences, and this is set out in great detail, particularly in neuroscience. But there is still a challenge in establishing a clarity of view of the influence of early experience on later development and then throughout the life course.
The authors’ interest in this topic arose from the experience of conducting the British Chinese Adoption Study, based on data collected from 72 women in their 40s and 50s who had been adopted from Hong Kong to the UK in the 1960s and 70s. The study explored the links between early institutional care, international adoption, and subsequent experiences and midlife outcomes. Access to contemporaneous data from the records offered a relatively rare opportunity for matching individual data recorded on the women’s early lives with self-reported information gathered around 45 years later. From the original group of 100 girls, 99 adult women were traced and 72 agreed to participate in the research study [
In that context, this paper aims to review the existing research literature on international adoption long-term outcomes with a particular focus on midlife. The main midlife adult studies are presented with details of samples, methods, measures, and conclusions. The discussion concentrates on the issue of contrasting outcomes and the factors that may influence diverse results. We note that complementary reviews of international adoption literature have been completed, for example, on childhood outcomes [
As well as risks, studies have produced evidence of developmental recovery across domains, sustained over periods of several years, for ex-institutional children after they have been placed for adoption. Not all children with longer exposure to very poor quality care have poorer outcomes, and the level of individual problems differs substantially within groups [
Many, although not all, cases of international adoption involve children being raised in families who do not reflect or share the variety of factors that make up a child’s heritage. Whether families can enable their transracially adopted children to develop a positive, cohesive sense of self and identity remains a closely scrutinised issue in both domestic and international adoptions [
Several adolescent/young adult studies have found that comparably raised risks for severe outcomes (e.g., suicide, suicide attempts, and psychiatric admissions) were associated with older age at adoption among other factors [
A number of methodological challenges exist in understanding the effects of early experiences on the lives of internationally adopted people. The possible influences are numerous and vary greatly across cohorts: genetic and perinatal factors (often undocumented/unknown); duration and quality of preadoption care; postadoption environmental variables [
An initial list of studies was collated based on sources we had consulted in planning the British Chinese Adoption Study. A subsequent search was carried out on the PsycINFO internet-based bibliographical database with additional hand-searching of key journals.
Although we were interested in ex-orphanage samples, studies of internationally adopted adults with mixed or unknown early experiences were included due to limited number of exclusively ex-orphanage cohorts. This allowed us to gain a broader picture of potential influences across the life course of internationally adopted adults. Cohort age ranges varied substantially, and many studies included some adults in midlife along with younger counterparts. Because of our focus on midlife, we included only those studies with a mean participant age of more than 25 years (in order to exclude studies of emerging adulthood, commonly defined as the period between 18 and 25 years). If mean age was not specified, the decision was based on whether the age range and reported findings suggested that it was likely that the sample would meet this criterion. Studies with very large age ranges where results were not disaggregated to show midlife outcomes were excluded.
For the PsycINFO database search, the following search terms were entered: [adopt
These searches returned a combined total of 420 abstracts. Abstracts were then viewed individually and screened using the following criteria.
Inclusion criteria are the following: Investigated outcome or experiences of internationally adopted adults. Mean age of sample over 25 years. Published in peer-reviewed journal.
Exclusion criteria are the following: Full text not published in English. Nonempirical studies.
After initial screening, 66 papers were identified that potentially or clearly fitted our criteria. Full text articles were accessed and assessed for eligibility. Main reasons for rejection were as follows: (a) age of sample not fitting criteria, (b) nonrelevancy to topic (e.g., “adoption” referred to adoption of a new policy or intervention, not to adoption of children), (c) full text not published in English, or (d) nonempirical papers. A total of 19 papers, which reported findings from 11 studies, were identified for inclusion.
A core concern is the extent to which evidence has so far accumulated on whether risks associated with early preadoption experiences and subsequent recovery continue into midlife for internationally adopted adults. In addition, we explore potential modifying influences that emerge over time, such as identity and adjustment processes related to being internationally adopted. Each of the papers included for this review contributes to these aims.
To aid interpretation of results, studies that test across-group differences for outcomes are presented separately from single-cohort studies. Table
Studies with across-group comparisons.
Author(s) and year of publication | Sample size and characteristics | Preadoption circumstances | Age of participants1 | Methods incl. main measures/interview topics | Comparison group | Main findings |
---|---|---|---|---|---|---|
Irhammar and Bengtsson, 2004 [ |
|
88% born in Asia (mostly India, Thailand, and Sri Lanka), and the remainder mostly in Latin America. All except one had spent some time in orphanage care prior to adoption. | Mean age: 28 years; range: 25–34 years. | Measures included Adult Attachment Interview (AAI, semistructured), mainly about relationships with adoptive parents during childhood. Transcripts coded to adult attachment classifications: autonomous, dismissive, or preoccupied. | Compared to AAI results of a “norm group” of nonclinical mothers from a meta-analysis. | Adopted group’s AAI scores were not found to differ significantly from nonclinical comparison group. |
|
||||||
von Borczykowski et al., 2006 [ |
|
No specific information on this cohort, general discussion of possible preadoption adversity. | Range: 29–39 years. | Suicide attempt and suicide death data taken from national hospital discharge and cause of death registers. | ( |
IC adopted group had higher suicide attempt (RR 4.5) and suicide death (RR 3.6) rates than gen. pop. and sibling samples. IC adopted women’s risk compared to other female groups was elevated to a greater extent than men’s. |
|
||||||
Tieman et al., |
(a) |
Approx. 47% experienced neglect and 12% preadoption abuse. Rates based on data reported by adopters, using predefined scales of level of adversity; only information that parents reported as being “certain” of was included. | Range: 22–32 years at most recent time of data collection. | (a) Composite International Diagnostic Interview (standardised psychiatric interview that generates DSM-IV diagnoses). Some items from National Institute of Mental Health Diagnostic I/v Schedule. |
(a) 695 age-matched general population sample. |
(a) Adopted group at higher risk than control group to meet criteria for anxiety disorder (1.52 times), substance abuse or dependence (2.05 times), and, for men only, mood disorder (3.76 times). |
|
||||||
van den Berg et al., 2008 [ |
|
As above. | As above. | Adopted adults’ self-reported ratings of internalising and externalising problems on standardised scales. Parented-reported Young Adult Behaviour Checklist. | Within-group only: compared biologically related siblings, nonrelated siblings, and singles. | Only study to explore genetic and environmental influences on adult outcomes. Both data sources (self- and parent-report) indicated that genetic influences were greater for internalising problems and environmental influences were greater for externalising problems. This reversed findings from the same sample during adolescence. |
|
||||||
van der Vegt et al., |
(a) |
As above. | (a) Mean age: 26.3 years; range: 22–32 years; SD: 1.4. |
(a) Measures included interviews generating information on DSM-IV codes of mental disorders. Recorded these diagnoses individually plus created an “any disorder” variable. Plus parent reports on early abuse, neglect, and multiple preadoption placements. |
Within-group only. | (a) Multiple early adversities associated with increased risk of adulthood anxiety (OR = 2.22; 95% CI 1.11–4.45); mood disorders (OR = 2.20; 95% CI 1.00–4.86); or substance abuse or dependence (OR = 3.81; 95% CI 1.62–8.98). After controlling for childhood onset of mental health problems, differences remained. Level of de novo onset suggests that consequences of early adversity can appear many years later. |
|
||||||
McGinnis et al., |
|
Majority of time prior to adoption spent in orphanages (35%), foster families (39%), birth family (13%), unknown (11%), or other (2%). | Mean age: 31 years. All over 18 years. | Online questionnaire, incl. Family of Origin Scale, Multigroup Ethnic Identity Measure, Rosenberg Self-Esteem, and Satisfaction with Life. Also questions about (1) changes in self-identification and (2) support services. | 156 white American-born adopted adults, from same total sample as Korean-born group. Mean age: 44 years (13 years older than Korean-born group). | Adoption is an increasingly significant aspect of identity across lifespan for both groups; “race”/ethnicity is increasingly important for Korean group, peaking in adulthood. |
|
||||||
Storsbergen et al., 2010 [ |
|
Authors characterise this as a group who did not suffer severe deprivation: relatively limited number of caregivers in relatively limited number of caregivers in orphanage and attempts at consistency in care. | Mean age: 29 years; range: 25–36 years. | General questionnaire about adult life circumstances and adoption, plus mental health (Symptom Check-List 90), well-being (Satisfaction with Life scale), and self-esteem (Rosenberg). | Normative data on Dutch-born young adults, taken from different sources for each measure. | Only significant difference from comparisons on mental health, well-being, and self-esteem was higher rate of depression for adopted men in comparison to nonadopted men. Within-group: those who searched for birth parents reported more difficulties in mental health, well-being, and self-esteem. Further analysis identified that negative appraisal of adoption was a stronger predictor than search status for mental health outcomes and well-being. |
|
||||||
Rushton et al., |
|
Relatively well-run orphanages with adequate physical care and nutrition but overcrowding and lack of opportunity for selective attachment to adult carers. | Mean age: 48 years; range: 42–53 years; SD: 2.4. | Orphanage/adoption records. Questionnaires covering mental health (General Health Questionnaire and Malaise Inventory), self-esteem (Rosenberg), life satisfaction, personality profiles, community connectedness, partnerships, and adoptive family relationships. Interviews on life history and current circumstances (usually 2-3 hours). | (a) Within-group only. |
(a) Ethnic and social identification not found to predict psychological adjustment. |
Single-cohort studies.
Author(s) and year of publication | Sample size and characteristics | Preadoption circumstances | Age of participants1 | Topics/questions covered | Mode of analysis | Main findings |
---|---|---|---|---|---|---|
Mohanty et al., |
|
67% in orphanage care, 22% foster care, 5% multiple placements, and 5% other settings. | Mean age: 29 years, range: 18–44 years, and SD: 5.96. | Web-based survey including self-esteem measure (Rosenberg) and ethnic identity and cultural socialisation scales developed by the research team. | Statistical analysis, using path analysis models. | Most reported little cultural socialization and not growing up in areas “with neighbours who reflect my race.” |
|
||||||
Docan-Morgan, |
|
No information given about preadoption experiences, except in passing in vignettes from interview reports. | Mean age: 26 years, range: 18–40 years, and SD: 6.6. | Qualitative interviews/online survey: questions about intrusive interactions from strangers (e.g., excessive personal questions and being stared at when with adoptive family members) and dealing with race-based mistreatment. | Thematic analysis of interview data then survey data. Member-checking by sending initial research paper to participants. | Participants reported frustration and defensiveness as a result of obvious intrusions, such as strangers’ stares or comments about not being a “real” family, but also with excessive compliments (“Asian babies are so cute!”). Racist experiences included name-calling, appearance mocking, stereotyping, and physical attacks. |
|
||||||
Tigervall and Hübinette, 2010 [ |
|
No information given. | Range: 21–48 years (mean age and SD not given). | Semistructured interviews about experiences of race-based mistreatment, including discrimination and exclusion. | Thematic analysis based on “social-constructivist” concepts (i.e., emphasis on concepts such as “race” as relational and identities as fluid and negotiable). | Day-to-day experiences of discrimination described, such as being followed in shops or facing heavy scrutiny at border/customs controls in comparison to white Swedish peers. Also regularly facing questions about their family and origins. Participants’ views varied; some saw questions as “mere curiosity”; others felt regularly harassed. |
|
||||||
Lindblad and Signell, |
|
Age at adoption ranged from a few months to 4 years; most ( |
Range: 18–35 years; half the group were aged over 30 years. | Interviews focused on “experiences of degrading attitudes with probable relation to Asian appearance”; the perpetrators; subjective reactions and strategies for coping with such attitudes; communication about them. | Open coding based on grounded theory. |
Degrading attitudes were reported in relation to both Asian appearance and adoption, including comments about their perceived sexual availability/libido or general hostility expressed towards immigrants. Perpetrators came from all age groups, and events were reported as repeated experiences, not one-off events. These experiences provoked a wide range of feelings, from anger to sadness. |
|
||||||
Song and Lee, |
|
Mean age at adoption 22 months (range: 0–195 months; SD: 29.46). 60% had one and 28% had two preadoption placements (proportion of orphanage versus other placements not specified). | Mean age: 27 years, range: 18–49 years, and SD: 6.6. | Survey included Multigroup Ethnic Identity Measure [ |
Thematic analysis of qualitative responses. Resulting categories were then compared with MEIM scores to identify correlation between cultural socialisation and ethnic identity. | Factors that correlated positively with ethnic identity were living in multicultural community, racial awareness (developing an awareness of being part of racial minority group and an adopted person), and visiting Korea/searching for birth/foster family. Significant positive correlation between cultural activities during ages 18–21 years and ethnic identity. Increasing interest over time in “lived experience,” for example, visiting Korea and socialising with Korean people. |
Results related to the same cohort are grouped together: seven papers for a large Dutch cross-sectional study [
The review is structured in three main sections. First, adult outcomes are reported for psychological adjustment and social functioning/relationships. Second, predictor variables from early life are explored. Third, findings on social location, including specific experiences arising from being internationally adopted adults, are examined.
Only four studies included across-group comparisons based on standardised mental health measures or indicators. Previous studies with younger adult cohorts (up to mean age of 25 years), particularly those based on epidemiological data from Swedish national datasets, indicated raised risks for serious mental health problems among internationally adopted adults [
von Borczyskowski et al. [
In a large Dutch study, Tieman et al. [
Storsbergen et al.’s [
The British Chinese Adoption Study also found that psychological adjustment was comparable for women adopted internationally from Hong Kong and their UK-born peers. Using standardised measures (General Health Questionnaire (GHQ12, [
The relatively limited numbers of studies of psychological adjustment in midlife preclude strong statements on the long-term relationship between orphanage care, international adoption, and psychological adjustment at this stage. In individual studies, results are heterogeneous. As with younger cohorts, enduring effects were found in some cohorts, although the extent, domains, and proportion affected varied. We note, however, that two studies found no evidence of raised risks for poor psychological adjustment in samples that experienced international adoption following orphanage care that was not severely depriving, suggesting the potential for recovery over the long term. Nevertheless, evidence from large-scale studies that found somewhat raised risks for severe mental health problems cannot be dismissed.
Irhammar and Bengtsson [
Results for the internationally adopted adults in this Swedish study were classified as follows: secure (47.5%), preoccupied (25%), dismissing (27.5%), and unresolved (17.5%). In comparison to a female nonclinical group of mothers, although the proportions of adopted adults with dismissive or preoccupied classification were higher, differences were not statistically significant. Within-group analysis identified that factors including later age at adoption and a desire to know more about one’s origins were significant predictors of insecure attachment styles in adulthood [
Tieman et al. [
In the British Chinese Adoption Study, the internationally adopted women (
In their smaller-scale qualitative studies, Docan-Morgan [
In summary, the evidence on social functioning and relationships is mixed, although studies so far do not suggest widespread difficulties at a group level. With limited studies to draw from, all using different measures or approaches, clear conclusions on social functioning and relationships among internationally adopted adults are not yet possible.
Few studies of internationally adopted adults address the issue of preadoption experiences in depth, although, as noted earlier, childhood studies have identified poor quality of care and duration of orphanage care as potential predictors of later difficulties.
Only one adult longitudinal study [
In within-group analysis from the same study, the researchers examined the associations between parent-reported data on early experiences and cortisol levels among a subsample (
Two studies had access to information about the specific orphanages that their samples had lived in prior to adoption [
In the British Chinese Adoption Study, reports from Childcare Officers who visited the orphanages in Hong Kong were available to help categorise the early experiences of the women [
In the distinction between “globally depriving” and “psychosocially depriving” quality of care, both of these samples’ early experiences would fit the latter category. Consistent, personalised attention from familiar caregivers was in short supply but physical care, adequate nutrition, and other basic needs appear to have been met. Other studies reported more briefly on the preadoption circumstances of their cohorts (see Tables
Evidence on whether later age at placement, as found in some studies of younger cohorts [
In childhood studies, differences in adoptive family environments beyond broad characteristics usually remain unspecified, partly due to lack of variation on factors such as socioeconomic status or the use of measures too broad to pick up subtle yet potentially important differences [
In the studies reviewed here, data on adoptive family environments were also restricted, but some relevant findings did emerge. Tieman et al. [
In the British Chinese Adoption Study, two statistically significant associations were found between adoption-related experiences and adult outcomes. Those women who reported poor care, lacking in warmth, understanding, and/or acceptance [
Overall, we are limited in the conclusions that can be drawn on early predictors. Although van der Vegt et al.’s [
A notable finding from the
Two other studies specifically measured “adoption appraisal,” meaning whether adopted adults view their adoption experiences positively or negatively (in a global sense rather than in relation to specific experiences such as racial derogation). Storsbergen et al. [
The British Chinese Adoption Study included questions asking the women whether they felt happy about being adopted, loved in their family, and a sense of belonging [
In McGinnis et al. [
Song and Lee [
Another US-based survey of 78 internationally adopted adults (mean age, 29 years) explored self-esteem, ethnic identity, and cultural socialisation [
In the British Chinese Adoption Study, three indices were developed to assess the extent of connectedness to Chinese communities and culture, connectedness to UK society, and self-regard in relation to Chinese appearance [
Findings from three qualitative, interview-based studies were reported in the four papers listed in Table
In a separate paper, Docan-Morgan [
Lindblad and Signell [
In another study from Sweden that focused on “everyday racism and ethnic identity,” 20 internationally adopted adults described day-to-day experiences of discrimination, for example, being followed in shops or facing heavy scrutiny at border and customs controls in comparison to their white Swedish peers [
In the British Chinese Adoption Study, most of the women had been on the receiving end of racism or prejudice in some form. This ranged from being called names (as adults, not just in childhood) and discrimination at work to, at the extreme end, being physically attacked. Not all the perpetrators were white nor did all experiences take place in the UK [
This review gathers together the adult midlife studies following international adoption that fitted our previously stated inclusion criteria. It explores the merits of these studies to identify what progress has been made in answering questions about long-term outcomes.
The studies we have reviewed suffer some shortcomings that are impossible to overcome in understanding correlations between early experiences and adulthood, for example, lack of information on the birth parents of abandoned children or lack of preadoption information in many cases. Other deficits are endemic to adoption research, for example, isolating the contribution of adoption
As documented, a number of limitations restrict definite conclusions. Disadvantages exist in studies that use such different approaches to measurement within a limited body of empirical research. But while this creates difficulties in drawing out strong consistent messages, it also highlights the complexity involved in conceptualising and measuring adult lives with atypical histories [
In addition to differences in research design and loss to follow-up, the samples themselves differ in important ways. Cohort effects may be important in influencing outcome, given that the children in the studies were born and placed at different points in time, and therefore many factors such as adoption procedures and medical and social support services, as well as social attitudes, are likely to have varied. Some studies involved only ex-orphanage samples, while others included some children whose early experiences were in foster care or were unknown. Children from some regions of origin, such as Eastern Europe, may be at greater risks for poorer outcomes, but the sampling strategies did not always lend themselves to testing for differences on this basis. Homogenous samples, or samples that are clearly disaggregated, lead to more easily interpretable and confident conclusions. Similarly, the availability and selection of appropriate comparison groups are vital to ensure that any differences in outcome neither are overlooked nor are due to other differences between samples.
Nevertheless, some tentative directions of travel within the body of research are detectable. Psychological functioning was problematic for a subsample in all those studies where this was measured, and in two studies this was significantly worse than comparison groups. While the evidence of elevated risks of severe mental health problems is limited to a minority of the internationally adopted groups in all of the studies discussed here, it cannot be dismissed. As with younger cohorts, therefore, enduring effects were found in some cases, although the extent, domains, and proportion affected vary across studies.
In studies that have found significant raised risks for infrequent behaviours such as suicide or very poor mental health (in both adulthood and younger life phases), closer examination of the data serves as a reminder that, overall, the proportion of internationally adopted people with such severe outcomes is a small minority. Even a small increase in group-level risk signifies a greater number of individuals and families who have likely experienced enormous distress and pain. However, caution must be exercised in extrapolating findings. While acknowledging the seriousness of such results, it is important to ensure that they are not interpreted in a way that suggests that a majority of internationally adopted people experience such pronounced difficulties. Article titles and abstracts, which cover only brief “headlines,” can obscure some of the complexities of how increased risks operate across the sample. Effect sizes and amount of variance may be more important than
Conversely, those studies that focus on the extreme end of mental health outcomes may miss more subtle or internal psychological challenges, such as those relating to origins, identities, and how people locate themselves socially. Research based on smaller interview or self-report questionnaire data collected on these issues has started to put flesh on the bones and has shown a notable replication of patterns across samples in different countries. Studies focused on the prevalence of poor mental health and the related risk and protective factors must take account of these findings.
As mentioned earlier, this review was conducted in the context of the authors’ involvement in the British Chinese Adoption Study; it identified midlife outcomes that were better than predicted. Despite early years in orphanage care, followed by international adoption, this did not appear to raise the risk of poor outcome. These of course were by no means extremely depriving institutions, and the adoptive homes were largely, although not always, supportive, consistent, and loving. As a group, the women’s lives at nearly 50 were reported as mainly positive: they had mostly led settled lives, with good educational and career achievements. Many had enjoyed becoming parents themselves. Well-being and life satisfaction scores were commensurate with those of a large, sex- and age-matched, UK comparison group. However, a retrospectively reported poorer quality adoptive home was associated with poorer outcome. The knowledge of an atypical start to life and the experience of feeling different in appearance and being treated differently were a lifelong preoccupation for some (to a greater or lesser extent for individuals) but, as a group, this did not appear to have compromised their current psychological and social status [
In addition to the strengths and limitations of each study, this review also had its own benefits and restrictions. By focusing on midlife, we excluded several studies from early adulthood that may contain important messages for research with older cohorts. However, by including quantitative, qualitative, and mixed methods studies, a broader range of potential influences that should be considered in future research designs were revealed.
In searching the relevant literature, this review has been less able to address certain questions. With a lack of specific, reliable, and contemporaneous information on early experiences, it was often hard to trace links with possible long-standing difficulties. Furthermore, the investigative methods employed in most studies have yet to capture the internal conflicts and preoccupations of adopted people, which may be as revealing an aspect of outcome as mental health scores. Finally, data on the environments and experiences that may have contributed to recovery following adversity are less available, in particular on how changes in life stresses in adult life may interact with possible underlying vulnerabilities.
Although comparisons across standard measures are essential to understanding any lingering risks or continued recovery from early events, we need to know more about the life experiences of these populations and changes over time. As Rushton [
We are still some way from identifying, of all the myriad possible influences, why in most cohort studies a subsample does substantially worse. Research from younger groups suggests that age at placement and quality of care, or some combination of the two, can influence outcomes in middle and late childhood or even early adulthood. This is less clear in later adult outcome studies, because either such data are missing or age at placement has not been found to predict outcomes consistently. In the two studies of groups from psychosocially depriving, rather than globally depriving, orphanage care, little or no evidence was found for increased risks for poor psychological adjustment in adulthood.
Part of the challenge lies in the number of areas that make up a life in midadulthood. As age increases beyond the early twenties, so does the number of participants likely to have experiences such as parenthood, one or more partnerships, changes in other relationships, dealing with bereavement of major figures (parents, friends, or even partners/children), fluctuations in health, or triumphs and stresses related to work or education. Thus examining of adult lives involves a potentially greater number of “life experience” domain influences than research with younger cohorts. The British Chinese Adoption Study research is continuing in order to evaluate the relative contribution that emerging adulthood and midlife events and experiences make to outcomes.
Clearly, all methods bring some benefits at the expense of losing other possibilities; this is not unique to the topic of international adoption. But in an area with relatively limited literature, it is important that all studies, regardless of their own methodological approach, build on research from across the field. We have paid attention to the findings from both large-scale quantitative research and smaller interview-based studies because we believe that learning across the methodological spectrum is the best way forward in developing a strong evidence base. For example, data from smaller interview-based studies may suggest previously unidentified but potentially important influences on outcomes, which can then be tested for replication across larger cohorts.
Further research needs to be conducted to see whether findings from individual studies are replicated across different groups. In those studies indicating elevated risks, the key factors and likely pathways leading to this outcome need to be revealed. Furthermore, studies that enable testing of whether such differences diminish over time are required. The publication of results from subsequent follow-ups of existing adoption cohorts, as well as new prospective longitudinal studies using more comprehensive data, may be able to answer some of these questions (see [
Most adulthood studies of international adoption conducted to date have used self-reported data from participants or data from national records. Some potentially illuminating approaches have yet to be employed, for example, gaining the views of people close to adopted adults, such as a partner or close friend, to compare them with self-reported or other data. Missing completely from the current picture are studies that compare the experiences and outcomes of those who stayed in orphanage care versus those who were internationally adopted or cross-national comparisons of internationally adopted adults raised in different countries. In addition, some important areas such as adult attachment, or research designs that enable exploration of mechanisms underlying associations between early experiences and adult outcomes, have yet to be tackled more than once. Over time, it is to be hoped that opportunities for studies with a greater variety of complementary research designs will increase.
Overall, there is a somewhat narrow focus on individual psychology in studies to date. But national, societal, and cultural context matters. While it may be obvious that individuals who grow up in the UK, for example, are likely to have different experiences from those brought up in the US or Scandinavia, even within one country contexts can vary greatly: compare, for example, New York City and rural Texas. Differences may relate to policy and practice, attitudes towards international adoption and “families of difference,” local histories of race relations, and levels and types of race-based mistreatment. Events as diverse as a change in government, a celebrity adopting a child from overseas, or a high-profile child protection case can all affect public perceptions and have a knock-on effect on the experiences of internationally adopted people and their families.
Our general conclusion is that longer-term follow-ups of internationally adopted people have much to offer in refining models in developmental psychology. In particular they may help to fill out the picture between early care and midlife with greater recognition of the potentially restorative influence of a stable substitute family environment and the contribution made via their adult lives and experiences.
The authors declare that they have no competing interests.
The British Chinese Adoption Study was funded by the Nuffield Foundation. Julia Feast is a co-contributor to the study.