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In 1960, child psychiatrist Marshall D. Schechter reported a hundredfold increase of adopted patients in his practice compared with what would be expected in the general population. This claim (based on a small group of children seen by one psychiatrist), though reportedly based on a misinterpretation of the published adoption literature, received widespread publicity, reinforcing the notion that adoptees frequently have mental and psychiatric disturbances.

Adoptees are over represented among mental health care recipients: about 8% - 10% of children receiving in-patient or out-patient psychiatric services are adopted. However, the reasons for this are complex.

Adoptive families may be more likely to seek help for problems because of their relative maturity, socioeconomic status, and familiarity with social service availability. Indeed, adoptees are underrepresented in juvenile court populations, possibly because adoptive parents seek psychiatric care if their child demonstrates delinquent or undesirable behaviors. Similarly, adoptees may be underrepresented among adult mental health populations, perhaps because psychological issues are addressed during the teenage years.

Nonetheless, professionals and parents may wonder if adopted children, especially those adopted internationally, are at increased risk for behavioral and mental disorders. Genetic factors, separation from birth parents, environmental exposures (both pre- and postnatal), some facets of adoption itself, and the adoptive home environment all potentially increase the likelihood of these disorders.

This chapter is divided into four sections. The first reviews the links between genetics and mental health disorders (schizophrenia, affective disorder, and antisocial personality disorder). In the second, the relationship between adoption and behavior problems, as well as the difficulties interpreting research in this area, are discussed. The third section explores the risks of mental health disorders in international adoption and the relationship between behaviors observed in the orphanage and after adoption. Finally, the fourth section examines the long-term mental health outcome of adoptees.


From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.


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