Helping adoptive families thrive

Each year, some 115,353 children are adopted in the United States, with more than half adopted from foster care or the public welfare system. In 2022, the most recent year for which statistics are available, more than 100,000 children in foster care were awaiting adoption, 58% of whom had been in foster care for 2 to 5 years, according to the National Council for Adoption, a national network of adoption professionals. The U.S. Supreme Court’s 2022 Dobbs v. Jackson Women’s Health ruling is likely to raise those numbers even higher, with some states already seeing as much as a 30% increase in infant domestic adoptions, according to the Texas-based Gladney Center for Adoption.

What is more, adopted children and their families are 2 to 5 times more likely to use outpatient mental health services than nonadoptive families, and adoptive parents are 4 to 7 times more likely to place their children in residential treatment centers than nonadoptive parents, research finds.

This is clearly a high-need area, and one well suited to many of psychologists’ skills. Yet working with adopted and foster children and their parents also requires specialized understanding and clinical tools, and most psychologists receive almost no training in this area. Addressing this training deficit is of vital importance, both because the right kind of treatment can greatly benefit families and children, and because uninformed care can do the opposite, said licensed clinical social worker Lisa Maynard, a training and implementation specialist for the Center for Adoption Support and Education (C.A.S.E.), a leading U.S.-based adoption-competence training and mental health center specializing in supporting the foster, kinship, and adoption community.

“Behavioral issues are typically what brings adoptive or foster families into mental health services,” she said. “But when providers don’t have a good understanding of the core issues that kids come in with—abuse, neglect, loss and grief, ambiguous loss, complex trauma, identity issues—they can do more harm than good.”

Added Maynard: “I can’t tell you how many times I’ve had a family come to me and say, ‘I was working with the therapist, and the therapist said, ‘I understand that this isn’t really what you expected—maybe you should just give the kid back.’ But all that does is exacerbate the child’s challenges and disrupt the possibility of having a permanent family.”

Fortunately, good training in the area is available and growing all the time. For the past two decades, C.A.S.E. has rigorously developed and implemented training for mental health providers, child welfare workers, and school counselors. In 2009, the organization developed a manualized 72-hour training called Training for Adoption Competency, the only accredited and evidence-informed training in adoption competency rated by the California Evidence-Based Clearinghouse for Child Welfare.

Now, C.A.S.E. is further expanding its reach, thanks to a 5-year, $20 million cooperative agreement from the U.S. Department of Health and Human Services through the Administration for Children and Families to launch the National Center for Adoption Competent Mental Health Services, which C.A.S.E. rolled out in October 2023.

The funds will enable C.A.S.E. to provide technical assistance and evidence-informed training to strengthen coordination and capacity among child welfare and mental health systems, with the aim of improving the quality and accessibility of mental health services for children and families experiencing child welfare, said C.A.S.E. founder and chief executive officer Debbie Riley, a licensed marriage and family therapist. This mission is facilitated via free state-of-the-art, evidence-informed, web-based training called the National Adoption Competency Mental Health Training Initiative, available through the new center.

There are many ways that trained psychologists can help facilitate healthy adoption experiences for adopted kids and their adoptive families, starting with helping parents decide if they want to adopt in the first place.

In work David Brodzinsky, PhD, professor emeritus of clinical and developmental psychology at Rutgers University, has done over the years with adoption agencies and prospective parents, he first attempts to glean parents’ motivation in wanting to adopt, to make sure they want to undertake this responsibility for reasons that are in the best interests of the adopted child. For example, if they want to fill a void due to infertility or a miscarriage, it is important they understand that adopting a child is different and more complex than having a biological child, particularly if the child has a significant history of early adversity. He also asks prospective parents if they understand the implications of those complexities for parenting and talks with them at greater length about behavioral issues that can arise and parenting strategies that can help in various circumstances.

Psychologists can also help prospective adoptive parents explore their views of adoption as a way of building a family, said Hal Grotevant, PhD, a psychologist and professor emeritus at the University of Massachusetts Amherst, who together with Ruth G. McRoy, PhD, professor emerita at the Boston School of Social Work, headed a major longitudinal study called the Minnesota/Texas Adoption Research Project, or MTARP, which played a significant role in the current trend toward open adoption. Their research showed that open adoptions—which involve the birth family in the child’s life in varying degrees and now constitute 95% of all adoptions—can foster positive relationships for all if there is open and honest communication, mutual empathy, and flexibility among birth and adoptive parents.

Unlike in the era of closed adoptions, when families viewed adoption as adding a child to their existing family, the newer model of open adoption places the child at the center of a broader network that includes both the extended adoptive family and the extended birth family, Grotevant explained. Facilitating this wider view can start to prepare families for this reality, which will often be a lifelong relationship that can strengthen their adopted child’s sense of identity as an individual and in the world.

Before adoption is finalized, psychologists can also help agencies determine whether prospective parents are well suited for adoption or not, Brodzinsky said. For example, this life choice may not be advisable for people who have serious mental health issues or who have highly unrealistic expectations about adoptive parenting.

“In general, we look for parents who are mature enough to understand in a real sense that these children’s needs must be in the forefront of their minds, at all times,” he said.

Once a child has been adopted, one of the main skills that psychologists and other trained providers can impart is helping parents communicate effectively with their adopted children—an overarching skill that ideally starts upon adoption and continues throughout a child’s life, said psychologist Rachel Farr, PhD, a professor at the University of Kentucky and current principal investigator of MTARP and a longitudinal study of adoptive families headed by lesbian, gay, and heterosexual parents called the Contemporary Adoptive Families Study, or CAFS.

The key to success is open, honest, and respectful communication. Data from MTARP and CAFS show major benefits of this kind of communication: “When adoptive families feel more cohesive, unified, and warmly toward each other, kids do better behaviorally and feel better about their adoption,” Farr said ( Journal of Family Psychology , Vol. 33, No. 8, 2019 opens in new window).

The same principle applies to any communication specifically related to adoption, Grotevant added. “The key is to start talking about adoption early and often, even before the child fully understands what the words mean,” he said. For young children, there are many excellent books that address the topic of adoption and family diversity with sensitivity, and “looking at or reading books together makes it easier to open the door for further conversation,” he said.

As children get older and start to raise questions about their origins, Brodzinsky advises communicating with them in ways that draw the child out, validate and normalize their feelings, and help them feel safe and supported. If, for example, their birth parents regularly used substances or fought all the time, Brodzinsky recommends discussing that history in a way that is realistic but does not demonize the parents—perhaps by telling the child that illness is something that everyone experiences at some point and that some illnesses are not easy to get over. Such an approach “helps the child internalize where they came from and who their birth parents are in a way that does not unduly damage their developing sense of self,” he said.

Good communication skills are also essential in helping children, as well as birth and adoptive parents, successfully navigate open adoptions, Grotevant added. Several ingredients are involved: One is recognizing that open adoption is a process that evolves over time. When a child is young, it makes sense to start small, writing letters back and forth with biological parents or family members. As children get older, they may decide they want more contact; if so, parents can help foster larger forms of connection, including in-person visits. There are also cases where families start to have in-person contact very early on, such as when the birth mother and prospective adoptive parents meet before the child’s birth. Such situations can work out well if all parents receive support from adoption-competent providers, Grotevant said.

It is also vital that everyone involved assesses how things are evolving over time, said Brodzinsky. The goal of open adoption is to foster positive family connections and a positive sense of identity for the child, he emphasized. When that arrangement is working well, communication can flow organically and often joyfully within practical limits. But if issues arise that impinge on the child’s safety or well-being, it is imperative that adoptive parents take a stand, either by calling a time-out until the adults can renegotiate the process or, if things are truly damaging, stopping the arrangement entirely.

“The goal of the adoptive parent is always about supporting the child and keeping them safe,” he said.

If and when problems arise that parents have difficulty handling, it is a good time to see a trained provider. To help parents get comfortable using these services, Brodzinsky encourages adoption agencies to “normalize” these sessions by telling parents that raising an adopted child can be challenging and that it is a strength to seek appropriate help. “It doesn’t mean parents have to go into long-term therapy,” he said. “It means that when something arises, they can get some information that might be helpful to them.”

He also encourages parents to interview therapists in the same way they would interview medical providers if they needed surgery—thoroughly and with whatever questions they think are important to raise. Besides asking about a provider’s background and training, for example, it might mean asking them what they would do if a child exhibits a certain type of behavior.

“Just because a provider is child-oriented or has worked with adopted or foster kids doesn’t always mean they’re an expert in the area,” he said.

Also important is helping psychologists and parents understand potential underlying reasons for a child’s difficult behavior, Riley added. “We see a lot of behavioral manifestations of unresolved grief and loss in these children that often aren’t treated as such,” she said. “Instead, they’ll be diagnosed with conduct disorder or treated for anxiety and depression.” But “there are children who are grieving very deeply and intently, and they’re struggling,” she said. “They need to process the profound impact of significant losses and understand why and how these losses occurred—how they got here, why their parents could not care for them, why they were taken away.”

Fortunately, there are evidence-based practices specifically developed to address common issues faced by adoptees, including those related to attachment difficulties, grief, trauma, and fetal alcohol (or drug) spectrum disorders. An example is Attachment and Biobehavioral Catch-up (ABC), an attachment-related protocol developed by Mary Dozier, PhD, of the University of Delaware, who is also ABC’s principal investigator. The intervention—now implemented in 25 U.S. states and 10 countries—takes place over 10 weeks. It employs trained coaches who provide feedback to parents on a minute-to-minute basis to help them respond effectively to young children who have attachment issues that appear as avoidance, resistance, or fussiness. Instead of using time-outs or reprimands, parents learn to consistently behave in ways that are nurturing, responsive, and “non-teachy”—that give kids a soothing environment to develop in, Dozier said. Sessions are videotaped so parents can see their progress and changes in the child’s behavior.

Randomized controlled trials show remarkable results: “We see these whopping effects on children’s attachment to their parents, on cortisol production, on behavior regulation, on children’s trust in their parents, on brain development, and on autonomic nervous system regulation,” said Dozier ( Current Opinion in Psychology , Vol. 15, 2017 opens in new window).

When adopted children are of a different race or culture from their adoptive parents, there are additional things to learn about and act on, other psychologists said. For one thing, it is never too early to expose kids to positive racial and ethnic role models and to share positive messages and materials about their heritage (Huff, C., Monitor on Psychology, October 2023).

Adoptive parents should also consider bringing the child’s heritage into their home and lives, said Amanda L. Baden, PhD, a New York-based counseling psychologist and a professor at Montclair State University in New Jersey who specializes in treating these families.

“I have seen adult adoptees of color who are afraid of their same ethnic group because they don’t know how to be Korean enough or Ethiopian enough,” she said. Parents can mitigate this problem by befriending families of the child’s ethnicity and inviting them over for meals, for instance, or taking the child on outings to sections of town related to their identity, for example, Chinatown, Little Ethiopia, or Koreatown.

“I tell parents that they can’t just live in a diverse area—they have to bring people into their lives,” she said.

Baden also recommends that adoptive parents practice cultural humility—staying open to learning about the child’s ethnic or cultural identity issues from the child’s perspective and not thinking they always know best.

When parents do this work, there is an immense payoff, she said: Children in such families are often able to incorporate racial and cultural factors into a healthy and secure identity ( Journal of Social Distress & the Homeless , Vol. 9, No. 4, 2000 opens in new window).

Psychologists can also remind parents that adoption per se does not explain all of the issues or behaviors that adopted children and teenagers might display. Some misbehaviors might just be typical acting out, while other problems might be intertwined with medical, environmental, social, or other factors, including issues within the adoptive family unrelated to the dynamics of adoption, such as parental illness or financial stress.

Similarly, each adoptive family is unique, Grotevant noted. For example, not all adopted children want the same amount of information about or contact with their birth parents, and adoptive parents should respect and work with that decision. (If a child is not interested at one point in time, they may be interested later, he added.) At the same time, parents should not hesitate to raise the topic if their child is remaining silent about their adoption, because talking about it can help to normalize it: Some children do not know how to talk about these feelings or are afraid of hurting their parents if they do. To help children feel comfortable expressing themselves, parents might gently suggest questions they think might be on the child’s mind or hook those questions into a relevant activity they are doing together, like watching a TV show related to adoption.

Parents and psychologists also need to be savvy about how adopted children and teenagers use social media, as it is increasingly easy for young people to discover information about their genetic makeup, biological relatives, and more, Farr added.

“I’ve heard a lot of adopted people wanting that information—they’re curious, they have legitimate reasons for wanting to know it, but it can be difficult when they find out certain things,” she said. That reality is one more reason that ongoing family communication that is open, warm, and respectful is important because it can buffer whatever new information arises, she noted.

Farr also observes that adoptees often place different weight on their adoptive identity at different times. In her sample of teenagers, “we’re seeing that the dynamics of their racial, ethnic, and gender and sexual identities are actually more interesting or central to them than their adoptive identities,” she said. While their adoptive identity is always part of their experience, “other factors might be firing more strongly at a particular time.”

Unfortunately, there are times when adoptive parents cannot handle the stress of their children’s behaviors—behaviors that are often fueled by difficult early experiences. When parents have not learned the skills to support these needs, sadly, they may think about ending the adoptive relationship. Known as adoption dissolution, it happens rarely, in only about 1% of cases, and involves returning a child to foster care. It is also very difficult and complicated to enact legally.

Other less drastic but still difficult separations may occur, as well. One is for parents to temporarily place a child into residential treatment, with the aim of returning the child to the family once the child’s issues are better under control. Another is “psychological disruptions,” where the relationship between an adoptive parent and child is fractured and distant even though the child is still living in the adoptive home. There is also a growing illegal movement known as “re-homing,” where parents take it on themselves to find a new home for the child.

With the increasing availability of adoption-competent training, Riley said she hopes all of these situations become less common or nonexistent in the future. But if parents cannot see their way forward, it is critical that both children and parents receive professional counseling to help them navigate these profound separations and their psychological impact, she said.

“Placement disruptions should not be an option,” as she put it. “If we engage parents and children with supports early on and with trained professionals,” she added, “we can mitigate these risks.”

Thankfully, most adoptions do work out. And in the many cases when they do, they represent a transformative opportunity for adoptive parents to stretch emotionally, psychologically, and experientially, and for adopted children to gain a true sense of family security, said Farr. For psychologists, adoptions in general and open adoptions specifically can bring to bear all the skills and interests in their bailiwick. Adoptions also offer a fascinating up-close look into trends that are already happening in society, including the shift toward greater numbers of blended families and a continued trend toward “chosen families.”

“With adoption, there is this dynamic of becoming intimately connected to people who are often strangers but who are very likely to become family in all senses of the word,” said Farr.

“When adoptive parents stay open to this experience and roll lovingly and with grace with the parts that feel difficult,” she added, “it will be so positive for their kids. And the parents are going to learn and grow, too.”