Starting Over – The Language Development in Internationally-Adopted Children [1 ed.] 9789027267290, 9789027244086

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Starting Over – The Language Development in Internationally-Adopted Children Edited by Fred Genesee and Audrey Delcenserie

JOHN BENJAMINS PUBLISHING COMPANY

Starting Over – The Language Development in Internationally-Adopted Children

Trends in Language Acquisition Research issn 1569-0644 TiLAR publishes monographs, edited volumes and text books on theoretical and methodological issues in the field of child language research. The focus of the series is on original research on all aspects of the scientific study of language behavior in children, linking different areas of research including linguistics, psychology & cognitive science. For an overview of all books published in this series, please see http://benjamins.com/catalog/tilar

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Philip S. Dale

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Volume 18 Starting Over – The Language Development in Internationally-Adopted Children Edited by Fred Genesee and Audrey Delcenserie

Starting Over – The Language Development in Internationally-Adopted Children Edited by

Fred Genesee McGill University

Audrey Delcenserie University of Montreal

John Benjamins Publishing Company Amsterdam / Philadelphia

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TM

The paper used in this publication meets the minimum requirements of the American National Standard for Information Sciences – Permanence of Paper for Printed Library Materials, ansi z39.48-1984.

doi 10.1075/tilar.18 Cataloging-in-Publication Data available from Library of Congress: lccn 2015049306 (print) / 2016004983 (e-book) isbn 978 90 272 4408 6 (Hb) isbn 978 90 272 6729 0 (e-book)

© 2016 – John Benjamins B.V. No part of this book may be reproduced in any form, by print, photoprint, microfilm, or any other means, without written permission from the publisher. John Benjamins Publishing Company · https://benjamins.com

Table of contents Acknowledgements Introduction Fred Genesee

vii 1

Part I.  General development chapter 1 Pre-adoption stress, adversity and later development in IA children Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan chapter 2 Children’s cognitive development after adoption Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

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Part II.  Language development chapter 3 Language development during the preschool years Kathleen A. Scott & Jenny A. Roberts chapter 4 Language, cognitive, and academic abilities of school-age internationally-adopted children Audrey Delcenserie

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chapter 5 Long-term language development in international adoptees Gunnar Norrman, Kenneth Hyltenstam & Emanuel Bylund

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chapter 6 Speech and language clinical issues in internationally-adopted children Sharon Glennen

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chapter 7 Language loss or retention in internationally-adopted children: Neurocognitive implications for second language learning Lara J. Pierce, Fred Genesee, & Denise Klein Index

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Acknowledgements The authors would like to express their gratitude to Janet Werker (University of British Columbia, Vancouver), Frances Aboud (McGill University), Roberta Golinkoff (University of Delaware), Leslie Rescorla (Bryn Mawr College), Erika Hoff (Florida Atlantic University), Natacha Trudeau (Université de Montréal), and David Birdsong (University of Texas at Austin) who generously accepted to review the chapters of this book. Your suggestions and insightful comments significantly contributed to the improvement of this book.

Introduction Fred Genesee

McGill University

Internationally-adopted children (IA children hereafter) are a unique population of language learners. They begin learning their first language at birth, indeed before birth, but discontinue exposure to and acquisition of that language when they are adopted by families that speak other languages. Thus, the adopted language becomes their primary and often their only language while their birth language undergoes attrition. On the one hand, IA children resemble monolingual learners insofar as they become monolingual following adoption, in most cases. However, unlike other monolinguals, they have initial exposure to another language, which is discontinued, and their initial exposure to what is sometimes referred to as their second first language (DeGeer, 1992) is delayed in comparison to that of typical monolinguals. On the other hand, they might be thought of as second language learners insofar as they begin to acquire the adopted language after initial exposure to a first language. However, they differ from typical second language learners who usually continue to learn and use their first language once second language learning begins whereas most IA children are exposed to only their second (adopted) language, like monolinguals. IA children share experiences with yet other language learning groups while differing in other important respects. Like children who are born deaf but have cochlear implants, IA children experience delayed exposure to the language, which ultimately becomes their primary language. However, IA children differ from children with cochlear implants who were born deaf because they have had exposure to language prenatally and ­following birth whereas children born deaf are typically deprived of exposure to language prior to cochlear implantation. One might ask why the study of language development in IA children is interesting and important since, after all, relative to other childhood language learners, they are a very small population. Understanding the language learning of IA children through research is worthy in its own right for practical and clinical reasons. Clinically speaking, IA children are often thought to be at-risk for language learning for a number of reasons. To begin, they may suffer from perinatal complications, including low birth weight; pre- or post-natal exposure to toxins,

doi 10.1075/tilar.18.01gen © 2016 John Benjamins Publishing Company

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Fred Genesee

drugs, or other adverse conditions; poor pre- and post-natal care; and physical hardship (Zeanah, et al., 2004). In short, the pre-adoptive care environments in which IA children are initially raised may be inadequate to meet their basic physical, medical, social, and cognitive needs. The degree of deprivation experienced by IA children can vary from mild to extreme and, thus, the consequences of their early environments can similarly vary from mild and short lived to significant and long term (Juffer et al., 2011; Zeanah et al. 2003; see also Rice et al., this volume for more details). A growing body of research on language development in non-adopted children suggests that early experiences with language shape later development of that language in significant ways (see Pierce et al. this volume) and that first language development during the early months and years of life is important for establishing the foundations for the acquisition of other languages (Kuhl, 2004, 2010). In short, attrition or truncated acquisition of the birth language might be a risk factor for IA children’s development of their adopted language (Johnson & Newport, 1989; Mayberry, 2007). The change in living conditions that IA children experience upon adoption might also be considered a risk factor since it entails a significant difference in socio-cultural, nutritional, physical, and interpersonal conditions for them. Delayed exposure to the adopted language might itself have significant negative consequences for acquisition of the adopted language (­Abrahamsson  & Hyltenstam, 2009). Most versions of the critical period hypothesis argue that early language learning, both first and second, is likely to result in “nativelike” levels of competence and that delayed acquisition of language is likely to result in incomplete competence or, at least, competence that differs from that of native speaker monolinguals (e.g., Mayberry, 1993). “Native-like” is often implied, if not explicitly stated, to correlate with monolingualism, a point I return to later. Most research on the critical period hypothesis has focused on delays that occur quite late in development, between 12 and 15 years or age, and later. There is much less evidence concerning the consequences of delayed acquisition in young children. In short, we simply do not know if delays that occur within the first two to three years of life are consequential for children’s eventual language learning outcomes and/or the processes that they deploy to acquire language if onset is delayed. Notwithstanding these possibilities, there are reasons to think that IA children have certain advantages when it comes to acquisition of the adopted language. More specifically, IA children who are adopted prior to two years of age – ­common for children from many countries, and especially China – are well within what is considered the classic critical period for language learning, although there is considerable debate about the existence and parameters of the critical period

 Introduction

(­Birdsong, 2004). In comparison to second language learners, IA children have the added advantage, as noted above, that their learning time is not divided between two languages. Moreover, many IA children are adopted by older parents who are above average with respect to education and economic status, all factors that are often associated with superior language learning outcomes (Hart & Risley, 1995; Hoff, 2006). Empirical evidence is needed in order to ascertain if, to what extent, and in what ways IA children are at risk or not. In the same way that it is important from a strictly practical point of view for parents, educators and others who care for any child to understand the typical language learning trajectory of children, it is important for those who care for IA children to know their typical language learning trajectory and the preadoption and post-adoption factors that might affect their growth. It is equally important to have realistic, empirically-based expectations of IA children’s general development, including their physical, medical, cognitive, and personal development. Some IA children will be at risk for or experience language learning and other developmental disorders that go beyond the normal challenges faced by all IA children. Clinicians who work with IA children require solid empirical evidence about typical development in order to better identify those children who are at risk or experience exceptional developmental delays so that they can provide additional support that will meet their developmental needs. The question arises how to distinguish between IA children who are experiencing exceptional language learning difficulties from those who are coping with the challenges of a new language, a new family, and a new environment that all IA children face. Normative expectations based on the development of nonadopted children can provide some useful reference points for clinicians who work with IA children. However, these may not be sufficient and, arguably, may even be inappropriate (see Glennen, this volume) for valid clinical assessment and intervention. Establishing expectations based on norms that are specific to IA children is called for. These practical and clinical concerns raise important empirical questions: What is the typical language learning trajectory of IA children after adoption – in the short, medium and long term? What factors affect the language learning of IA children: age at adoption, country of origin, quality and nature of the pre-adoption learning environment (foster versus institutional care), health status at the time of adoption, and others. Do IA children achieve parity with non-adopted children, in what domains of acquisition, and when? What is the normal range of variation in language learning outcomes among IA children? How can we distinguish IA children who are at-risk for or experience language impairment from IA children who are simply struggling learning a new l­ anguage in a new family?

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Fred Genesee

IA children also provide researchers with opportunities to study issues of broad theoretical implication that arise as a result of their learning experiences: How resilient is the language development of IA children who experience early deprivation and adversity? How resilient is their cognitive development following adoption and what are the consequences of cognitive delays for language learning? Is learning of the adopted language by adoptees affected by their greater cognitive maturity when they begin acquiring that language in comparison to monolingual children? Do IA children experience total attrition of their birth language? What about neuro-cognitively – is there evidence of underlying traces of the birth language after adoption (see Pierce et al., this volume)? In a related vein, what are the neuro-cognitive processes that underlie acquisition, processing and use of the adopted language – are they the same as those found for monolingual native speakers or like those of other early second language learners? Does attrition or discontinued acquisition of a birth language influence subsequent language acquisition and why (see Delcenserie, this volume)? Does early delay in exposure to language affect acquisition of that language, to what extent, and in what ways? Does the language development of IA children resemble that of first or second language learners? And, how do we interpret differences, if any, between IA and non-adoptive children in language competence? Until the late 1990s, there was a tendency for language acquisition researchers to focus on monolinguals and, primarily, learners of English. In contrast, research on language development in IA children is part of a general trend during the past 20 to 25 years to examine language learners with varied language learning experiences. This has included children acquiring two languages simultaneously or successively, children with an impaired capacity for learning language, learners of signed languages, children with cognitive and/or perceptual handicaps, among others. Findings from such research are broadening our empirical knowledge about language learning and enriching our theories of language acquisition. Theories built on evidence from monolinguals cannot provide a complete and generalizable theory of language acquisition in its multiple forms and, thus, risks distorting our understanding of how language learning takes place under diverse conditions. In particular, it risks depicting language learning in non-monolingual contexts as deviant or deficient, rather than simply as different. Once one begins to look closely at different kinds of child language learners, one becomes acutely aware of the diversity of experiences that learners face and of the enormous plasticity of the language learning capacity of young learners. Research on the language development of IA children can contribute to our unfolding and ever-expanding understanding of children’s capacity for language learning. It is in the differences they present in comparison to typically-developing monolingual children that IA children can help us better understand language learning in general.

 Introduction

Studying language learners in diverse learning environments is not without its methodological challenges. Considering research on IA children more specifically, a number of methodological challenges arise. IA children have very varied backgrounds that can differ with respect to age of adoption, birth language and the extent to which it is similar to or different from the adopted language, and their country of origin. They also vary among themselves with respect to the conditions in which they were growing up prior to adoption (home care, orphanage care, or foster care); their social, nutritional, and physical condition at the time of adoption; and reasons for being given up to the state for adoption or placement in foster care homes. Examining these issues systematically is complicated by the fact that it can be difficult, if not impossible, to ascertain valid and precise information about some of these factors from the home countries of IA children. Faced with inadequate information about some of these background issues, researchers may unwittingly include children with diverse backgrounds. Researchers may deliberately include children with diverse background characteristics in order to ensure adequate sample sizes but, as a result, have difficulties later on with interpretation and generalizability of their data. Moreover, there is the question of what is the most appropriate frame of reference for interpreting the results of IA children. The same issue arises in all research on language development in children who are not monolingual language learners, such as simultaneous bilinguals. To date, researchers have tended to use two comparison groups in studies of IA children– same age children who comprise the norming group for standardized tests and questionnaires (like the MacArthur Communicative Development Inventory; Fenson et al., 1993) or typically-developing non-adopted monolingual children who are matched to IA children in particular studies on measures of gender, age, and socio-economic status (see for example, Cohen, Lojkasek, Zadeh, Pugliese, & Kiefer, 2008; Gauthier & Genesee, 2011). While the former can tell us how well and to what extent IA children acquire language like monolinguals, the latter can tell us to what extent the language development of IA children resembles that of monolingual children who are raised in equally favorable learning environments. When each of these frames of reference is appropriate and in what ways is revealed in a number of the chapters in this volume (Delcenserie, Finet et al., Glennen, and Norrman et al.).

The present volume Language development does not take place in isolation of other aspects of children’s development and, thus, understanding the general background within which IA children develop is important for understanding their language development

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Fred Genesee

specifically. This is particularly true for IA children given the unique, complex, and varied nature of their pre-adoption and post-adoption experiences. Thus, the volume begins with two chapters that are intended to provide readers with the big picture so that they are better able to understand research on the language development of IA children that is reviewed in subsequent chapters. Chapter 2 by Rice, Jackson, Mahoney and Tan focuses on the pre-adoption environments of IA children from the perspective of risk, stress, adversity and resilience. As they note, the institutional care that many IA children experience can be viewed as “a series of major environmental failures that are at odds with children’s developmental needs” (p. 3). That the quality of institutional care is so important and can put adopted children at risk arises from the fact that during the infant/toddler stage of development, children undergo particularly rapid and critical changes that set the stage for later long term development. Rice et al. consider the child’s developmental needs with respect to basic physical/medical, social/personal, and neuro-cognitive issues. Importantly, they point out that not all institutional care is equally impoverished and that the long term consequences of institutional care is linked to the severity of deprivation, length of care in the institution, and age at adoption, among other factors. Thus, in studying children in the post-adoption stages of development, it is important to consider the quality of the pre-adoption care they experienced. However, this is easier said than done. Rice et al. encourage researchers to develop strategies to overcome barriers to ascertaining the level of stress and adversity experience by adopted children in order to enhance our understanding of their post-adoption development. While stress and adversity are salient and may be characteristic of the early care environments of many adopted children, resilience and adaptability are equally salient when research on their post-adoption development is considered, a point that is reinforced in subsequent chapters. Chapter 3 by Finet, Vermeer, Juffer, Bosmans and Bijttebier focuses on the cognitive development of IA children. We felt that it was important to juxtapose research findings on the language development of IA children presented in the remaining chapters against findings on their cognitive development in order to better understand to what extent language outcomes are inter-related with cognitive factors and to what extent the developmental outcomes of IA children might be domain specific. Finet and colleagues provide detailed reviews of four longitudinal natural studies of adopted children, including one on non-international or domestic adoptions. In contrast to these studies, they also review the results of the Bucharest Early Intervention Study, which entailed the random assignment of institutionalized children to foster care, thereby making it possible to examine the effects of alternative forms of pre-adoption care minimizing selection bias. Since both children in the foster care group and those in the group with continuing

 Introduction

institutionalization were assessed prior to adoption, it was also possible to examine the developmental trajectory of children in both groups before and after adoption more accurately; it is rare for studies of adopted children to have pre-adoption assessment information. A meta-analysis by Van IJzendoorn, Juffer, and Poelhuis (2005) is also discussed. The studies reviewed in this chapter provide a broad view of cognitive development, including intelligence quotient (IQ) and developmental quotient (DQ), school achievement, executive function, and others. The authors of Chapter 3 illustrate the complexities of assessing IA children’s development by detailing the alternative comparison groups that these studies used: randomized versus convenience sampling, domestic versus international adoptions, same-age peers in the adoption country versus peers in the country of origin, and children raised by adoptive parents versus children raised by biological parents. Each type of comparison reveals different and important information. At issue in these studies, as discussed by Rice and colleagues, are the developmental risks experienced by adopted children and their developmental resilience in the face of these risks and in response to the remedial environments afforded by their new adopted homes. The next three chapters focus on findings of studies that have examined language development of IA children. Scott and Roberts (Chapter 4) review research on IA children from birth to 5; that is, during the pre-school years. The primary issue for this age group is how they manage the transition from the birth language to the adopted language and, more specifically, to what extent and how quickly they demonstrate the same levels of competence as non-adopted monolingual children and what factors might affect their development, such as age at adoption. These studies are motivated, once again, by the general concern that IA children may be at-risk for acquisition of the adopted language; thus, documenting their language outcomes during this early phase of adoption is critical. Fundamentally at issue is how resilient IA children are in the face of possibly impoverished preadopted care, disruption in exposure to the birth language, and potentially traumatic transitions to a new linguistic and cultural environment. Scott and Roberts provide detailed reviews of findings according to domain of development, including pragmatic, phonological, lexical and morpho-syntactic, broken down by type of measurement – including global and discrete measures in specific domains and results from standardized language tests and parent-report measures. Comparing results across measurement types is important to determine the reliability of findings from different studies that use different measurement methods. Scott and Roberts conclude by saying that while we have learned a lot about IA children’s language during the pre-school years, there is a need for additional research with greater breadth to cover the full range of language skills, especially pragmatic and morpho-syntactic. Research with more depth in all domains is also called for

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Fred Genesee

in order to enhance our understanding of these early critical years. Studies that link development during these early years with later development would be useful as well in order to assist parents and professionals to better identify children who might need additional support before they begin school and provide a more detailed longitudinal understanding of how language develops in IA children. Chapter 5, by Delcenserie, reviews research that has examined the language development of IA children as they enter school and during the school years. A central question in this research is whether IA children continue to demonstrate the same resilience in language learning shortly following adoption as they progress through school and face increased demands on their language competencies. As Delcenserie and Scott and Roberts point out, while the majority of IA children show rapid and impressive progress in acquiring the adopted language, there is a larger than expected percentage of IA children who exhibit lags or weaknesses in their development; this is evident in their performance on standardized language tests and in comparisons to carefully matched control groups. On the one hand, one might expect that the demands of schooling to acquire new registers of language – language for academic purposes, and new modalities of language competence – reading and writing, might stimulate their language development further, thereby reducing some of the weaknesses noted in younger IA children. On the other hand, these increased demands on language in school could exacerbate weaknesses that were evident earlier on. Thus, research on school-age IA children has also sought to examine if these lags and weaknesses are resolved when children have more extended and enriched exposure to the adopted language. In this regard, Delcenserie presents some new findings from the McGill ­longitudinal study to address this issue directly. Since academic performance is an essential component of children’s overall development and is intimately linked to language ability (Scheffner-Hammer et al., 2014), the question arises whether the academic performance of IA children keeps pace with their age and grade l­evels. In a related vein, researchers have begun to examine the executive functions of IA children, including working memory, because these too have been shown to be ­correlated with language, and especially literacy development, and with overall academic achievement (Dalen, 2002; Dalen & Ryvgold, 2006; ­Delcenserie, ­Genesee, & Gauthier, 2013; Schoenbrodt, Carran, & Preis, 2008). Finally, she presents interesting and novel data on language development from three cases studies of IA children who were raised bilingually in adoptive homes where both French and English were used. Taken together, findings from these different domains of development provide a broad picture of IA children’s development during the school years, one that could expand our understanding of the underlying ­processes that underpin the acquisition of their new language.

 Introduction

In Chapter 6, Norrman, Hyltenstam and Bylund pursue the language development of IA children by examining their language abilities as adults. The authors document that many adults who were adopted internationally as children attain very high levels of proficiency in the adopted language – sufficiently high to pass as native speakers of the target language in their day-to-day lives. However, they argue, when you examine their competence in the adopted language carefully, it is possible to discern subtle differences that distinguish them from native speakers. While the lens problem of how best to study and interpret the language performance of IA children was first identified by Scott and highlighted by Glennen in her chapter, it emerges again in Norrman and colleagues’ chapter as they seek to go below the surface and identify the nature of language development in IA children. They conjecture that the differences that they and others in this volume have seen in the language performance of IA children and adults in comparison to test norms and matched non-adopted controls may in fact indicate that the language development of IA resembles that of second language learners. The focus changes in Chapter 7 by Glennen to clinical issues. As noted at the beginning, IA children are often considered at risk for language development. On the one hand, and contrary to these fears, most IA children transition to their new language quickly, especially children who are adopted at relatively young ages. More specifically, most IA children score within age-appropriate ranges on standardized tests of language and academic achievement. On the other hand, it has been found that there is a larger than expected subgroup of IA children who score below the typical range and, as well, there is a high incidence of referrals of IA children for speech and language services, discussed in greater detail by Glennen. Identifying IA children who present with language difficulties that cannot be accounted for by their delayed exposure to the adopted language or by the normal range of individual differences that is found among all language learners is a complicated matter. Chief among these is what standards of ability are appropriate and valid for identifying children who need additional support. IA children are not native speakers of the language and, thus, strictly speaking, standardized tests that use monolingual native-speakers norms are not appropriate. Even standards that might be established for bilingual or second language learning children are not appropriate because, unlike these learner groups, IA children do not retain their birth language (see Pierce et al., this volume, for more discussion of this issue). Glennen proposes an alternative strategy for identifying IA children with impaired language development – one that relies on locally-derived norms based on the performance of other IA children. She describes a norming project she has carried out for many years in the U.S. that illustrates the value of this approach. She also describes in some detail the results from that project and how

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those results can assist clinicians in identifying IA children with impairment. She then discusses specific issues that require special attention when identifying IA ­children who might be in need of additional support and how formal identification criteria can differ from region to region. This chapter ends with a consideration of intervention for both IA children who meet official criteria for speech and/or language impairment as well as children who fall outside official guidelines but might nevertheless benefit from additional support in school. Glennen points out throughout this chapter that understanding the language development of IA children, especially on the part of speech and language specialists, poses a lens ­problem – that is, through what lens do we judge their performance in order to make the most appropriate decisions. The volume ends on a neuro-cognitive note with a chapter by Pierce, Genesee, and Klein. A number of researchers report that IA children undergo rapid loss of the ability to speak or understand their birth language within months of adoption (e.g., Gindis, 1999; Nicoladis & Grabois, 2002). If true, this might reflect a possible form of neural plasticity whereby early neuro-cognitive traces of the birth language are erased or lost when they are no longer useful, thereby creating a neuro-cognitive state for learning the adopted language that is akin to that when children typically learn their first language. In the final chapter, Pierce, Genesee and Klein provide an in depth review of evidence for and against loss of the birth language. This includes a discussion of behavioral research on language loss and retention in other language learners who discontinue exposure to the birth language, studies of IA children relearning their birth language, and neuro-imaging studies of language processing in IA children. Notwithstanding reports of attrition of the birth language, Pierce and colleagues present evidence that the birth language may, in fact, be retained to some extent. In particular, they present results from their recent neuro-­cognitive studies of IA children from China who had learned French as an adopted language. They examined the neural substrate for processing both the birth language (Chinese) and the adopted language (French), neuro-cognitive processing of both the birth and adopted language in IA children. The goal was to determine if there were neural traces of the birth language some 12 years after adoption with no exposure to Chinese and if processing of the new language differed from that exhibited by monolingual learners of that language. They argue that, taken together, these results have important implications for understanding the language learning trajectory of IA children and may help explain behavioral evidence from IA children that points to some weaknesses in comparison to monolinguals. They also explore the theoretical implications of these findings for understanding the impact of early language learning experiences on later ­language development in general.

 Introduction

Summing up The chapters in this volume provide comprehensive and detailed reviews and discussions of the diverse lines of research that have been undertaken on internationally-adopted children to date. Two issues stand out that permeate much of this work; namely, developmental resilience and the importance of early experiences for later development. Most authors conclude that most IA children exhibit remarkable resilience despite both significant change and deprivation during the first year or two of their lives. Specifically, there is extensive evidence that, on average, IA children score within the typical range on standardized tests of language and cognitive ability (see Scott & Roberts, Delcenserie, Norrman et al., Glennen, this volume). This is accomplished very quickly in the case of children adopted before approximately one year of age and takes somewhat longer in children adopted at older ages. However, not all IA children are so fortunate. In their pioneering research on adoptees from Romania, Rutter and his colleagues found that even six months of exposure to extreme deprivation after birth can have long lasting and negative consequences on adoptees’ development (e.g., Croft et al., 2007; Rutter, Sonuga-Barke, & Castle, 2010). In other words, early experience matters. Indeed, there is evidence throughout these chapters that, notwithstanding remarkable resilience, the early experiences of IA children can have significant influences on their later development, even when extreme deprivation is not an issue. For example, when compared to SES- matched comparison children from family environments that are advantaged to the same extent as those of the adoptive families, IA children often score significantly lower than their non-adopted peers on a variety of language (e.g., Cohen, et al., 2008; Delcenserie & Genesee, 2014a; Eigsti, Weitzman, Schuh, & De Marchena, 2011; Gauthier & Genesee, 2011) and memory tests (e.g., Delcenserie & Genesee, 2014a; Eigsti et al., 2011), as well as on measures of executive functioning (e.g., Eigsti et al., 2011; Loman et al., 2013; see also Finet et al., this volume). Comparison with SES-matched peers might be considered inappropriate because these comparison groups are above average and, thus, represent a statistically improbable and, therefore, unrealistic bench mark. Because these comparison groups are above average, evidence of differences between IA children and these groups should not be interpreted as evidence of clinical problems. Nevertheless, such comparisons give us an indication of IA children’s ability to benefit fully from the enriched environments into which they have been adopted. In addition, detailed examination of the acquisition of specific grammatical features of the adopted language indicates typical acquisition in some respects (see, for example, research cited in Delcenserie and in Glennen, this ­volume), but lower than age expectations in others, even after many years of exposure to the new language (e.g., Delcenserie & Genesee, 2014b;

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Gauthier, ­Genesee, & Kasparian, 2012; Glennen & Masters, 2002). In a related vein, the results reported by Norrman and colleagues indicate long term differences in certain aspects of language acquisition and processing between adopted and non-adopted individuals. Finally, there is also evidence that the quality of IA children’s pre-adoptive care is important – specifically, IA children raised in foster care tend to exhibit better post-adoption outcomes that IA children raised in institutions (see Finet et al., this volume; Loman et al., 2013). Before proceeding, it is important to emphasize that these differences are often subtle in nature, not characteristic of all IA children, and are evident usually only when IA children are compared to high performing groups (e.g., Delcenserie & Genesee, 2014a; 2014b, and Cohen et al., 2008) and/or under demanding test conditions (see Scott & Roberts, and Norrman et al., this volume). This is not to say that some IA children do not experience clinical levels of language difficulty and, thus, require the support of professional speech and language specialists; see Glennen, this volume, for more discussion of related issues. Nor does it mean that additional non-clinical support would not benefit IA children who struggle with language below official clinical levels. To the extent that IA children live in families and neighbourhoods with advantaged backgrounds and, thus, may be educated in school environments with many high performing children, additional in–class support might help to integrate IA children who have difficulty keeping up with their non-adopted peers. In short, and perhaps not surprisingly, early experience makes a difference in the language, and cognitive, development of IA children. These differences raise important and interesting questions about early experience and language development that, to a large extent, are primarily of theoretical significance. More specifically, the question arises what might explain these differences? There are multiple possible explanations. First, they might reflect the limitations of IA children’s preadoptive and, possibly their pre-natal, environments. As has been pointed out repeatedly in these chapters, IA children are often considered at-risk for language development because of the impoverished nature of their pre-adoption environments. It has been argued that whatever pre-adoptive adversity IA children might have experienced, it is likely to have been relatively short-lived and below the level that might result in significant and long-term difficulties of a clinical nature (Gauthier & Genesee, 2011). Otherwise, how could one explain the relatively strong performance of most IA children, excluding the obvious cases of extreme adversity reported by Rutter and colleagues, for example (although see Rice et al., this volume, for a counter-argument). Definitive support for this line of argument is impossible at present since we lack sufficiently detailed and specific information about the pre-adoptive environments of most IA children. Moreover, it could be that the impoverished quality of the pre-adoptive experiences of most IA children

 Introduction 

are not of sufficient magnitude or kind to result in clinical levels of impairments, but are sufficient to result in subtle non-clinical effects as noted in the research reported in these chapters. Two additional possibilities, that are often difficult to disentangle, are attrition of the birth language and/or delayed exposure to the adopted language. While Pallier has argued that attrition of the birth language in IA children “cleans the slate” and allows for full acquisition of the adopted language (Pallier et al., 2003), results reported by Pierce et al., in this volume, argue against this hypothesis. The evidence for neuro-cognitive traces of the birth language that they report suggests that IA children may not acquire the adopted language exactly like monolingual native speakers because the neuro-cognitive systems that are typically recruited to acquire a first language are pre-tuned in the case of IA children to a language that is no longer being acquired. As a result, IA children, while recruiting some of the classical language learning areas of the brain, also recruit alternative neurocognitive systems that differ from those used by monolingual native speakers. In effect, acquisition of the adopted language does not unfold in the same way as in children who acquire language from birth because the neuro-cognitive substrate for language learning is different in the former in comparison to the latter. Norrman and colleagues, this volume, similarly argue that the language development of IA children is more akin to that of second language learners than first language learners, a point we return to later. Results reported by Delcenserie, Glennen and Finet et al., in this volume, with respect to the verbal memory abilities of IA children suggest that while the distal effect of delayed exposure to the adopted language may be differences in language outcomes in comparison to non-adopted native speakers, the proximal effect might be differences in verbal memory. More specifically, evidence of differences in verbal memory for the adopted language in IA children in comparison to native monolingual speakers of the same languages suggests that their acquisition of the adopted language may be altered by a verbal memory system that is fine tuned to a language that is no longer being acquired. Delcenserie has explicitly hypothesized that it is underlying differences in verbal memory for the adopted language that underlie differences in language development between IA and non-adopted children. Taken together, findings from this body of research raise an even broader question – what does it mean to be a native speaker? Since the dawn of research on language development in children, monolinguals have been used as the gold standard for gauging the language development of all learners. In effect, monolingual competence has become synonymous with native language competence. However, findings from the research on IA children reported in this volume have shown us that even children who begin to acquire a language less than one or two years after birth in relatively advantaged families exhibit differences in comparison to children who

 Fred Genesee

have acquired those languages exclusively since birth. The precise explanation for these differences awaits further research. In the meantime, we must begin to reconceptualise our notion of native language competence to include alternative routes to language learning, such as simultaneous bilingualism, acquisition of an additional language after a first language is acquired, and acquisition of an adopted language after birth. In other words, native language competence takes different forms in different kinds of language learners under different conditions of learning.

References Abrahamsson, N., & Hyltenstam, K. (2009). Age of onset and nativelikeness in a second language: Listener perception versus linguistic scrutiny. Language Learning, 59(2), 249–306.  doi: 10.1111/j.1467-9922.2009.00507.x/full Birdsong, D. (2004). Second language acquisition and ultimate attainment. In A. Davies & C. Elder (Eds.), The handbook of applied linguistics (pp. 82–105). Oxford: Blackwell. doi: 10.1002/9780470757000.ch3 Cohen, N. J., Lojkasek, M., Zadeh, Z. Y., Pugliese, M., & Kiefer, H. (2008). Children adopted from China: A prospective study of their growth and development. The Journal of Child Psychology and Psychiatry, 49, 458–468.  doi: 10.1111/j.1469-7610.2007.01853.x Croft, C., Beckett, C., Rutter, M., Castle, J., Colvert, E., Groothues, C., … Sonuga-Barke, E. J. (2007). Early adolescent outcomes of institutionally-deprived and non-deprived adoptees: Language as a protective factor and a vulnerable outcome. Journal of Child Psychology and Psychiatry, 48, 31–44.  doi: 10.1111/j.1469-7610.2006.01689.x Dalen, M. (2002). School performances among internationally adopted children in Norway. Adoption Quarterly, 5, 39–58.  doi: 10.1300/J145v05n0203 Dalen, M., & Rygvold, A.-L. (2006). Educational achievement in adopted children from China. Adoption Quarterly, 9, 45–58.  doi: 10.1300/J145v09n04_03 DeGeer, B. (1992). Internationally adopted children in communication: A developmental study. Unpublished doctoral dissertation, Lund University. Delcenserie, A., Genesee, F., & Gauthier, K. (2013). Language abilities of internationally-adopted (IA) children from China during the early school years: Evidence for early age effects? Applied Psycholinguistics, 34, 541–568.  doi: 10.1017/S0142716411000865 Delcenserie, A., & Genesee, F. (2014a). Language and memory abilities of internationallyadopted children from China. Journal of Child Language, 41, 1195–1223.

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Delcenserie, A., & Genesee, F. (2014b). The acquisition of accusative object clitics by IA children from China: Do they still experience difficulties during school-age? Journal of Child Language, 42, 196–209.  doi: 10.1017/S0305000913000500 Eigsti, I.-M., Weitzman, C., Schuh, J., De Marchena, A., & Casey, B. J. (2011). Language and cognitive outcomes in internationally adopted children. Development and Psychopathology, 23, 629–646.  doi: 10.1017/S0954579411000204 Fenson, L., Dale, P., Reznick, J., Bates, E., Thal, D. J., & Pethick, S. J. (1993). MacArthur communicative development inventories: User’s guide and technical manual. San Diego, CA: Singular.

 Introduction  Gauthier, K., & Genesee, F. (2011). Language development in internationally adopted children: A special case of early second language learning. Child Development, 82, 887–901. doi: 10.1111/j.1467-8624.2011.01578.x Gauthier, K., Genesee, F., & Kasparian, K. (2012). Acquisition of complement clitics and tense morphology in internationally adopted children acquiring French. Bilingualism: Language and Cognition, 15, 304–319.  doi: 10.1017/S1366728910000635 Gindis, B. (1999). Language-related issues for international adoptees and adoptive families. In T. Tepper, L. Hannnon, & D. Sandstrom (Eds.), International adoption: Challenges and opportunities (pp. 98–107). Meadow Lands, PA: PNPIC. Glennen, S., & Masters, G. (2002). Typical and atypical language development in infants and toddlers adopted from Eastern Europe. American Journal of Speech-Language Pathology, 44, 417–433.  doi: 10.1044/1058-0360(2002/045) Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young ­American children. Baltimore, MD: Paul H. Brookes. Hoff, E. (2006). How social contexts support and shape language development. Developmental Review, 26, 55–88.  doi: 10.1016/j.dr.2005.11.002 Johnson, J. S., & Newport, E. L. (1989). Critical period effects in second language learning: The influence of maturational state on the acquisition of English as a second language. Cognitive Psychology, 21(1), 60–99.  doi: 10.1016/0010-0285(89)90003-0 Juffer, F., Palacios, J., Le Mare, L., Sonuga-Barke, E., Tieman, W., Bakermans-Kranenburg, M., …Verhulst, F. C. (2011). Development of adopted children with histories of early adversity. Monographs of the Society for Research in Child Development, 76(4), 31–61.

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Kuhl, P. K. (2004). Early language acquisition: Cracking the speech code. Nature reviews. Neuroscience, 5(11), 831–84.  doi: 10.1038/nrn1533 Kuhl, P. K. (2010). Brain mechanisms in early language acquisition. Neuron, 67(5), 713–727.

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Loman, M. M., Johnson, A. E., Westerlund, A., Pollak, S. D., Nelson, C. A., & Gunnar, M. R. (2013). The effect of early deprivation on executive attention in middle childhood. Journal of Child Psychology and Psychiatry, 54, 37–45.  doi: 10.1111/j.1469-7610.2012.02602.x Mayberry, R. I. (1993). First-language acquisition after childhood differs from second-language acquisition the case of American Sign Language. Journal of Speech, Language, and Hearing Research, 36(6), 1258–1270.  doi: 10.1044/jshr.3606.1258 Mayberry, R.I. (2007). When timing is everything: Age of first-language acquisition effects on second-language learning. Applied Psycholinguistics, 28(03), 537–549.

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Nicoladis, E., & Grabois, H. (2002). Learning English and losing Chinese: A case study of a child adopted from China. International Journal of Bilingualism, 6(4), 441–454.

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Pallier, C., Dehaene, S., Poline, J.-B., LeBihan, D., Argenti, A.-M., Dupoux, E., & Mehler, J. (2003). Brain imaging of language plasticity in adopted adults: Can a second language replace the first? Cerebral Cortex, 13(2), 155–161.  doi: 10.1093/cercor/13.2.155 Rutter, M., Sonuga-Barke, E., & Castle, J. (2010). Investigating the impact of early institutional deprivation on development: Background and research strategy of the English and ­Romanian adoptees (ERA) study. Monographs of the Society for Research in Child Development, 75(1), 1–20.  doi: 10.1111/j.1540-5834.2010.00548.x

 Fred Genesee Scheffner-Hammer, C., Hoff, E., Uchikoshi, Y., Gillanders, C., Castro, D. C., & Sandilos, L. E. (2014). The language and literacy development of young dual language learners: A critical review. Early Childhood Research Quarterly, 29(4), 715–733. doi: 10.1016/j.ecresq.2014.05.008 Schoenbrodt, L. A., Carran, D. T., & Preis, J. (2008). A study to evaluate the language development of post-institutionalized children adopted from Eastern European countries. ­Language, Culture, and Curriculum, 20, 52–69.  doi: 10.2167/lcc326.0 van IJzendoorn, M., Juffer, F., & Poelhuis, C. (2005). Adoption and cognitive development: A metaanalytic comparison of adopted and non-adopted children’s IQ and school performance. Psychological Bulletin, 131, 301–316.  doi: 10.1037/0033-2909.131.2.301 Zeanah, C. H., Nelson, C. A., Fox, N. A., Smyke, A. T., Marshall, P., Parker, S. W., & Koga, S. (2003). Designing research to study the effects of institutionalization on brain and behavioral development: The Bucharest Early Intervention Project. Development and ­Psychopathology, 15, 885–907.  doi: 10.1017/S0954579403000452 Zeanah, C. H., Scheeringa, M., Boris, N. W., Heller, S. S., Smyke, A. T., & Trapani, J. (2004). Reactive attachment disorder in maltreated toddlers. Child Abuse & Neglect, 28(8), ­877–888.  doi: 10.1016/j.chiabu.2004.01.010

part i

General development

chapter 1

Pre-adoption stress, adversity and later development in IA children Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan Department of Educational and Psychological Studies, College of Education University of South Florida

In this chapter, we first review the research on internationally adopted (IA) children’s experiences with birth families. Then we focus on literature related to institutional care and its impact on young children’s development, as well as the impact of pre-adoption adversity on IA children’s post-adoption development. We aim to highlight the challenges facing adoption research in linking pre-adoption adversities with post-adoption outcomes. We emphasize that the challenges are mainly due to two methodological barriers: challenges in prospectively identifying and studying children who will be abandoned, institutionalized, and later adopted, and the lack of standardized post-adoption measures that can be used among IA children from different countries. Notwithstanding such limitations, findings point to the links between prolonged and severe pre-adoption deprivation and neurobiological impairments, post-adoption cognitive delays, attention problems, and learning disabilities. Finally, we emphasize that despite pre-adoption adversity, IA children demonstrate considerable resilience in recovery and developmental catch-up.

Introduction From 2003 to 2013, nearly 360,000  children from about 100 sending countries were adopted by families in 27 receiving countries (Selman, 2015). About 70–80% of Internationally-Adopted (IA) children are 0–4 years of age at the time of adoption and about 85% of IA children are adopted by families in Canada, France, Italy, Spain and the United States (Selman, 2015). The U.S. is the largest adopting country, receiving about half of the 360,000 children. Over the past two decades, about

doi 10.1075/tilar.18.02ric © 2016 John Benjamins Publishing Company

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan

90% of IA children in the U.S. are from China, Guatemala, Russia, and South Korea (U.S. Department of State, 2015). Compared to biological parents with same-age children, adoptive parents are usually older and have higher education levels and incomes (Hellerstedt et  al., 2008; Lindbald, Weitoft, & Hjern, 2010). While the sending countries differ in social-cultural practices, economic conditions and political climate, a common practice is the utilization of institutions to care for children who are relinquished by their family. Relinquished children’s journey to international adoption can be briefly represented with the following figure. Birth

Birth

Living with parent(s)

Placement in foster care

Entering institution

Placement in adoptive home

Figure 1.  Brief illustration of children’s paths to adoption Note. The bi-direction dashed line between entering institution and placement in foster care is used to indicate that children placed in foster care sometimes return to live in the institution. The dashed line between entering institutions and placement in the adoptive home is used to show that only some ­institutionalized children get adopted. Similarly, the dashed line between placement in foster care and placement in the adoptive home is used to show that only some foster care children get adopted

As shown in Figure 1, IA children might have lived with birth families before placement in institutions, or they might have lived in the institutions since birth. As such, it is possible for IA children to have experienced stress and adversity in both families and institutions or only in institutions. In addition, while under institutional care, some children are placed with local families for foster care. Compared to institutional care, foster care is generally considered more favorable for young children’s development (McLaughlin, Zeanah, Fox, & Nelson, 2012; Nelson et al., 2007). Because there are substantial variations in IA children’s pre-adoption experiences, there are considerable challenges in accurately ascertaining the extent of their pre-adoption stress and adversity. Furthermore, pre-adoption stress and deprivation might not apply uniformly to institutionalized children from different countries or even children from the same institution. These variations might be partly responsible for the heterogeneity in IA children’s conditions at the time of adoption and in their outcomes later on. Nonetheless, child relinquishment and institutional care constitute a series of failures in meeting young children’s basic needs. For example, institutional care limits young children’s access to some or all of the experience-expectant features in a typical environment, such as responsive caregiving, adequate nutrition, sensory and cognitive stimulation, and linguistic input (Bos, Fox, Zeanah, & N ­ elson,



Chapter 1.  Pre-adoption stress, adversity and later development in IA children 

2009). In this chapter, we first describe typical stress and adversity within the pre-adoptive environment that IA children reside in before and after entering the institution. We then describe literature on the links between pre-adoption stress, adversity and IA children’s short- and long-term outcomes. Finally, we briefly describe research on IA children’s resilience and recovery from pre-adoption stress and adversity.

Stress and adversity before entering institution Rarely has research been conducted to determine the experiences of institutionalized (and IA) children prior to relinquishment. Based on sparse research, however, it appears that family poverty is a major risk for child relinquishment. This is particularly true in Romania, Guatemala and China. For instance, in Romania, during the Ceausescu era, families were mandated to have at least five children; poor families who were unable to care for their children were often forced to hand their children over to the state (Moskoff, 1980). As one of the poorest countries in Latin America, Guatemala was ranked second in the world for number of children with chronic malnutrition in 2003 (McCreery Bunkers, Groza, & Lauer, 2009). In 1990, Guatemala was open to international adoption but closed this option in 2008. In the two years before it closed for international adoption, Guatemala adopted out about 1% of its infants, more than any other nation per capita (Gibbons, Wilson, & Schnell, 2009). According to Graff (2008), at the time of adoption, most Guatemalan children were infants born to poor families. In China, poverty, coupled with the One-Child-Per-Family Policy, is also a main factor in pushing some rural Chinese families to relinquish their daughters (Johnson, Huang, & Wang, 1998). In recent decades, child relinquishment in South Korea does not seem to be related to poverty but instead is mainly a result of stigma associated with having children outside of marriage. For instance, in 2012, over 90% of Korean children who were sent overseas for adoption were born to unmarried mothers. Deeply rooted in Confucianism, South Koreans ascribe shame to women who have children before marriage. Unmarried mothers sometimes relinquish their babies to avoid facing the collective shame that can fall on themselves and their families and subject their children to discrimination (Tan, Major, Marn, Na, & Jackson, 2015). Finally, maternal alcohol abuse seems to be a key factor in child relinquishment in Central America, Russia, and other Eastern European countries. As an example, one study shows that nearly 60% of Russian children in one orphanage have physical features that are indicative of prenatal alcohol exposure (Miller et al., 2006) and about half of the Russian children who are relinquished by their mothers are underweight at birth (Miller et  al., 2007). Taken together, poverty in the birth ­family,

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan

inadequate prenatal and perinatal medical care, and maternal separation are some of the main sources of stress that many institutionalized children might have experienced prior to entering the institutions (Juffer & Van IJzendoorn, 2005).

Stress and adversity during institutionalization Developmentally, institutionalized children often enter care at infancy or toddlerhood, a stage of rapid physical, social-emotional, cognitive and ­neurological growth. This stage has been considered a window of vulnerability (Johnson, Browne, & Hamilton-Giachritsis, 2006). The causal relationship between institutional care and poor developmental outcomes has also been established in studies that utilize randomized design (e.g., Smyke, Zeanah, Fox, Nelson, & Guthrie, 2010). Existing research on institutions in China, Central America, Latin America, Romania, Russia, and Ukraine has demonstrated that, structurally and psychologically, institutional care is at odds with young children’s developmental needs (Crockenberg et  al., 2008; Dozier, Zeanah, Wallin, & Shauffer, 2012; Johnson, 1996; Johnson & Gunnar, 2011; Zeanah, Smyke, & Settles, 2006). Some of the typical institutional child caring practices that are detrimental to young children’s development include failure to meet children’s individual socio-emotional needs, cognitive and learning needs, and their nutritional, medical and health care needs (Kroupina et al., 2012; Ruggiero & Johnson, 2009).

Lack of individualized care It is common for institutions to have high child-to-caregiver ratios, to employ under-qualified and poorly paid caregivers working in rotating shifts, to use regimented and non-individualized care and feeding schedules, and to hold poorly informed beliefs about childrearing (Huynh, 2014; Johnson, 1996; McCall et al., 2010; Tottenham, 2012). For instance, due to fiscal constraints, institutions in Central America have limited facilities, furniture and toys but the child-to-caregiver ratio ranges from 8-to-1 to 12-to-1 (Groark, McCall, Fish, & the Whole Child International Evaluation Team, 2011). Similarly, caregivers employed at institutions often lack the training necessary to work with infants and children (e.g., McCall, 2013; Merz & McCall, 2010). Even in institutions with properly trained caregivers, there is often a lack of consistent presence of the same caregiver (Groark & McCall, 2011). As such, institutions often fail to provide individualized and meaningful caregiving, with caregivers mechanically interacting with infants and children (St.  Petersburg–USA Orphanage Research Team, 2005). Furthermore,



Chapter 1.  Pre-adoption stress, adversity and later development in IA children 

long shifts and low pay can result in frequent vacations and caregiver turnover. For instance, on average, institutionalized Russian children have 60–100 caregivers before they are two years old (McCall, 2013; Merz & McCall, 2010; St. ­Petersburg– USA Orphanage Research Team, 2005). Such instability is often coupled with regular coming-and-going of medical professionals, prospective adoptive parents, and short-term volunteers (Van IJzendoorn, Bakermans-Kranenburg, & Ebstein, 2011). Inconsistent care like this often leads to indiscriminate friendliness, extreme withdrawal, aggression, and impulsivity in institutionalized children (Groark, McCall, McCarthy, Eichner, & Gee, 2013).

Limited access to learning opportunities Institutions are often ill equipped to care for relinquished children (e.g., Brown, 2009). Institutionalized children often have little access to learning materials and are rarely prompted to partake in conversations with caregivers (BakermansKranenburg et  al., 2011; Johnson, Browne, & Hamilton-Giachritsis, 2006). Low stimulation and limited social and language opportunities are some of the common challenges facing children in institutions (e.g., Ruggiero & Johnson, 2009). As such, cognitive delays and neurological problems are common among these children (e.g., Linville & Prouty Lyness, 2007). While the quality of institutional care does vary, the adversity faced by institutionalized children is typically substantial (St. Petersburg-USA Orphanage Research Team, 2005).

Lack of adequate medical care Research has shown that, even with the best of intentions, institutions frequently fail to meet the basic needs of many children under their care, especially those who were born prematurely and those with medical needs (Dozier et al., 2012; Johnson, 2000; Johnson & Gunnar, 2011). For infants and children who have already experienced separation from birth parents and/or who have medical conditions such as tuberculosis, hepatitis B, and intestinal parasites, institutional care might inadvertently aggravate these vulnerabilities (Cardona, Manes, Escobar, López, & Ibáñez, 2012; Dozier et al., 2012). Inevitably, institutional care often exposes children to chronic stress, which has been shown to lead to deregulations in the hypothalamic-pituitary-adrenal (HPA) systems, subsequently impacting stress and emotional regulation (McCall, 2013; Nelson, Bos, Gunnar, & Sonuga-Barke, 2011). It is thus not surprising that institutionalized children are three to four times more likely to be diagnosed with attachment, affective, anxiety, and/or quasi-autistic disorders (Miller, Chan, Comfort, & Tirella, 2005). In sum, as a form of childrearing, institutional care is a drastic departure from family care. Children reared in institutions typically score below their f­ amily-reared

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan

age-peers in weight, height, head circumference, and motor development, as well as social and cognitive development (Ellis, Fisher, & Zaharie, 2004; McLaughlin et al., 2012; Nelson, Bos, Gunnar, & Sonuga-Barke, 2011; Van IJzendoorn et al., 2011; Zeanah, 2009).

IA children’s pre-adoption adversity and post-adoption development The link between pre-adoption adversity and post-adoption outcomes is complex. For medical disorders, the link is relatively easy to establish. For instance, problems such as fetal alcohol syndrome (FAS), epilepsy and cerebral palsy typically persist after adoption (Landgren, Svensson, Strömland, & Grönlund, 2010; Pomerleau et al., 2005). Unlike medical disorders, however, the link between pre-adoption psychosocial adversity and post-adoption outcomes is more challenging to establish. This is not to say that such a link does not exist, rather there are two methodological barriers in ascertaining IA children’s pre-adoption psychosocial adversity. The first barrier is that it is logistically very difficult to carry out prospective and longitudinal studies that follow children from birth, through institutionalization and into international adoption and thereafter because it is hard to identify in advance children who might be relinquished by their parents and even harder to determine which institutionalized children will subsequently be adopted. We know of no study that has overcome this barrier. Meanwhile, general knowledge of the population of institutionalized children cannot be reliably applied to predict IA children’s post-adoption development since IA children are not simply a randomly selected subgroup of the institutionalized population. Because the number of institutionalized children usually surpasses the number of children sent for international adoptions, it has been speculated that IA children represent a select group of institutionalized children who are younger and possibly have a more favorable status in physical, social and cognitive development (Crockenberg et al., 2008; Tan & Marfo, 2006). The second and related barrier is a lack of standardized post-adoption measures that can be used to gather data to reflect IA children’s experiences prior to their adoption, partly because IA children from different sending countries often differ significantly in age at adoption and in prenatal and pre-adoption experiences. Researchers who are interested in examining the associations between IA children’s pre-adoption experiences and their post-adoption outcomes employ different conceptualizations to address this issue. Frequently, IA children’s age, developmental and psychosocial status at/around the time of adoption are conceptualized to reflect duration and severity of pre-adoption deprivation. In practice, different approaches (e.g., parental report of likelihood of pre-adoption abuse,



Chapter 1.  Pre-adoption stress, adversity and later development in IA children 

neglect and multiple placements; parental report of medical assessment results) are used to indirectly measure IA children’s pre-adoption developmental and psychosocial experience (Hawk et al., 2012; Tan, Marfo, & Dedrick, 2010; Verhulst, Althaus, & Versluis-den Bieman, 1992). In pediatric clinical practice, attempts are also made to utilize medical records and videos that adoption agencies provide to adoptive parents to help identify a possible link between IA children’s ­pre-adoption developmental status and post-adoption medical assessment results, with limited success (e.g., Boone, Hostetter, & Weitzman, 2003; Jenista, 2000; Miller, 2000). Results often show that, using IA children’s pre-adoption medical files or video clips, it is only possible to gain crude information on their developmental status before adoption, but it is not possible to detect moderate to severe delays. Notwithstanding these methodological barriers, several key findings have emerged from a large body of literature. First, pre-adoption adversity is associated with medical problems, developmental delays and sensory processing problems in newly adopted children (Cermak & Daunhauer, 1997; Fuglestad et al., 2013; Miller et al., 2005; Pollak et al., 2010). Fetal alcohol syndrome (FAS) is common among children adopted from Guatemala, Russia, and other Eastern European countries (Hawk & McCall, 2010; Landgren et al., 2010; Miller et al., 2005; Pomerleau et al., 2005). For instance, in a study of 103 Guatemalan adoptees by Miller et al. (2005), 30% had anemia, 28% had features indicative of prenatal alcohol exposure, 14% had unspecified medical conditions (e.g., congenital anomalies), and 14% had global delays. Landgren et al. (2010) similarly show that in a cohort study of 71 IA children from Eastern Europe, 52% have FAS, partial FAS, and alcohol-related neurodevelopmental disorders. Also, pre-adoption adversity increases the risk for sensory processing problems such as touch, movement, vision, and audition and developmental and motor delays (Cermak & Daunhauer, 1997; Tan, Marfo, & Dedrick, 2010; Wilbarger, Gunnar, Schneider, & Pollak, 2010). Second, prolonged and severe pre-adoption deprivation can lead to neurobiological impairment related to emotional regulation (e.g., Chugani et al., 2001; Rutter et al., 2007; Wismer Fries, Shirtcliff, & Pollak, 2008), attachment disorders (Julian, 2013; Van den Dries, Juffer, Van IJzendoorn, & Bakermans-Kranenburg, 2009; Van Londen, Juffer, & Van IJzendoorn, 2007), behavior problems (e.g., anxiety, depression, withdrawal, aggression), as well as increased need for mental health services (Cohen, Lojkasek, Zadeh, Pugliese, & Kiefer, 2008; Gunnar, Van  Dulmen, & the International Adoption Project Team, 2007; Juffer & Van IJzendoorn, 2005; Tan, Marfo, & Dedrick, 2010; Tan & Marn, 2013; Vorria et al., 2006). For instance, Romanian adoptees with severe pre-­adoption deprivation in infancy continue to experience the negative impact from such deprivation in early adolescence (Beckett et al., 2006; Rutter, Sonuga-Barke, & Castle, 2010). Recent analysis of the 2007 U.S. National Survey of Adoptive P ­ arents shows that older

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan

age at adoption is associated with a stronger likelihood of receiving mental health services in IA children (Tan & Marn, 2013). Third, pre-adoption adversity is also related to risk for post-adoption cognitive delays, attention problems, learning disabilities and poor school performance (Dalen & Rygvold, 2006; Harwood, Feng, & Yu, 2013; Kreppner et  al., 2001; Lindbald, Weitoft, & Hjern, 2010; O’Connor et al., 2000; Tan, 2006, 2009; Van IJzendoorn, Juffer, & Klein Poelhuis, 2005; Van IJzendoorn, Luijk, & Juffer, 2008; Vinnerljung, Lindblad, Hjern, Rasmussen, & Dalen, 2010). IA children, particularly those who have experienced serious pre-adoption deprivation, or who are adopted at an older age, are at an increased risk for problems with executive functioning, which has long-term implications for academic achievement and social competence (e.g., Johnson, 2000; Johnson & Gunnar, 2011; Merz, McCall, & Groza, 2013; Rutter & the ERA Study Team, 1998) and language delays (­Rajagopal et al., 2013). In their meta-analysis of 62 studies, Van IJzendoorn, Juffer and Klein Poelhuis (2005) report that while adopted children’s IQ is not different from their non-adopted peers, their school performance and language abilities lag behind, and more adopted children have learning problems. Older age at adoption is associated with poorer school performance. Research has also shown that Attention Deficit Hyperactivity Disorder (ADHD) is prevalent in IA children, especially among boys and those from Eastern European countries where FAS is common (Abrines et  al., 2012; Hoksbergen, ter Laak, Van Dijkum, Rijk, & Stoutjesdijk, 2003; Landgren et al., 2010; Wiik et al., 2011).

Resilience in IA children with a history of early deprivation Despite a history of pre-adoption deprivation, the vast majority of IA children experience massive developmental catch-up in physical, socio-emotional and cognitive development soon after adoption (e.g., Bakermans-Kranenburg et  al., 2011; Johnson, 2000; Van IJzendoorn & Juffer, 2006; Van IJzendoorn, Juffer, & Klein Poelhuis, 2005). Longitudinal studies and national studies also show that the majority of IA children function well within normal range (Juffer et al., 2011). In some cases, IA children even outperform non-adopted children in academic performance and social competence (e.g., Dalen & Rygvold, 2006; Stams, Juffer, Rispens, & Hoksbergen, 2000). These findings are a powerful illustration of the resilience that the IA children demonstrate. Resilience is defined as the capacity to be “bent without breaking” and “once bent, to spring back” (Vaillant, 1993, p. 484). It is also characterized by “patterns of positive adaptation in the context of significant adversity or risk” (Masten & Reed, 2002, p. 75). Resilience theories suggest that better outcomes can be achieved via



Chapter 1.  Pre-adoption stress, adversity and later development in IA children 

the availability of resources (i.e., protective factors) to counteract the adversity (i.e., risks) and/or the reduction or removal of the adversity (Ungar, Ghazinour, & Richter, 2013; Rutter, 1988). Undoubtedly, adoption itself is the most beneficial factor in facilitating institutionalized children’s recovery, as it entails the removal of most, if not all, risk factors from the institutional environment in their development. International adoption, as a form of intervention, changes children’s developmental context dramatically. The adoptive environment plays a powerful role in facilitating IA children’s developmental catch-up during the early periods of adoption, as well as promoting their recovery from pre-adoption deprivation. Specific protective factors within the adoptive environment that are particularly conducive to developmental catch-up and recovery can include: individualized care, improved nutrition, enriched learning resources, proper socialization opportunities and access to medical and therapeutic services, such as early intervention (Johnson & Dole, 1999; Tan, 2014). As an example, sensitive adoptive parenting promotes IA children’s attachment formation (Juffer, Bakermans-Kranenburg, & Van IJzendoorn, 2005). Nonetheless, heterogeneity in IA children’s post-adoption outcomes is also widely reported (see also Scott & Roberts, Delcenserie, and Norrman et al., this volume). From the perspective of resilience, some research suggests that at the child level, the absence of prenatal drug/alcohol exposure, being a girl, displaying easier temperament, and having good health can be helpful in coping with deprivation both while in institutions as well as when adjusting to adoption (­Rutter & the ERA team, 1998; Van IJzendoorn, Bakermans-Kranenburg, & Ebstein, 2011). These attributes are also likely to evoke tending behaviors from adults. Over the last several years, the study of resilience in IA children has extended to examine the role of genes in moderating the impact of pre-adoption stress and adversity on later outcomes. Of particular interest is the serotonin transporter gene (5-HTT), indicated to regulate serotonin levels in the brain, and monoamine oxidase A (MAOA) gene, responsible for metabolizing or deactivating neurotransmitters like serotonin and dopamine (Caspi et al., 2002). Within adoptees, 5-HTT and MAOA genes are shown to moderate the relationship between pre-adoption adversity and post-adoption adjustment (Kumsta et  al., 2010; Li, Tan, Camras, Chen, & Moyzis, 2014; Van der Vegt et al., 2009). For instance, in a study of 125 IA children adopted from Romania into the U.K. (Kumsta et al., 2010), severe preadoption adversity is associated with more emotional problems among adoptees who carry the S/S (short/short) and S/L (short/long) 5-HTT variants than their peers who carry the L/L (long/long) variant. Regarding links between MAOA and behavioral problems in post-institutionalized children, “high activity” MAOA (i.e., the 4R variant) is associated with greater externalizing problems in IA boys than is the 3R variant (Van der Vegt et al., 2009) while a greater number of “high

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan

activity” MAOA confers a protective effect against internalizing problems in IA Chinese girls (Li et al., 2014). More investigations on the roles of the serotonin system and the dopamine system in facilitating resilience in institutionalized and IA children could potentially help better understand the risk and resilience of young children under severe and chronic stress. Institutional deprivation might also lead to epigenetic modification in young children (Van IJzendoorn, Bakermans-Kranenburg & Ebstein, 2011). Epigenetics involves the structural modification of chromosomal regions that create altered activity states that can ultimately impact brain functioning (Dudley, Li, Kobor, Kippin, & Bredy, 2011). In the case of institutionalized children, for example, early deprivation may silence particular genes through epigenetic mechanisms, like methylation, resulting in permanent alterations in gene expression (Van IJzendoorn, Bakermans-Kranenburg, & Ebstein, 2011). Further research in these areas might be particularly informative in determining whether a favorable post-­ adoption environment also leads to positive epigenetic modification in IA children.

Conclusion and future directions In this chapter, we first described research on child relinquishment, institutional care and how such experiences are related to children’s outcomes after adoption. Our main goal was to emphasize that while there is converging evidence that institutionalized children, as a group, demonstrate specific developmental and behavioral risks associated with institutionalization, nuances in individual children’s pre-adoption experiences and post-adoption developmental patterns should also be recognized, much like individual differences in the population of children in general. We also highlighted barriers to ascertaining the extent of IA children’s preadoption stress and adversity and methods devised by researchers to gauge IA children’s pre-adoption adversity from post-adoption evaluations. We emphasize that relying on IA children’s developmental status around the time of adoption to infer their pre-adoption adversity usually only captures the cumulative effect of pre-adoption adversity. However, this approach cannot determine the children’s developmental state at the time of entering the institution, the children’s specific patterns of coping with the challenges that are inherent to institutional living, or the specific types and severity of psychosocial adversity that the children experienced. To put it simply, age at adoption and post-adoption evaluation results cannot determine if pre-adoption adversity is exclusively a result of the deprivations to which children were exposed while in institutional care or a combination of constitutional factors (e.g., genetic disorders), prenatal stress and institutional



Chapter 1.  Pre-adoption stress, adversity and later development in IA children 

deprivation. Thus, it is important for the research community to continue developing and validating proximal measures that not only capture the effect of institutionalization in general (e.g., delays in adopted children) but also pinpoint specific types of deprivation. Finally, we should also point out that there appear to be two bodies of seemingly contradictory literature on IA children’s post-adoption development. On the one hand, much of the literature that we presented suggests that stress and adversity prior to adoption often manifest physically, cognitively, and socio-emotionally in IA children’s post-adoption short-and long-term development. On the other hand, literature also shows that the majority of IA children experience complete or near complete developmental catch up after adoption. We strongly recommend that more research be conducted to determine if the effect of pre-adoption adversity may depend on how long IA children have already been living in the adoptive families such that the effects of adversity might be more evident in those who have been recently adopted whereas IA children who have been residing in the adoptive homes for several years may be less likely to show the effects of adversity. In sum, the unique pre-and post-adoptive experiences of internationally adopted children present a rare and invaluable natural experimental opportunity to study the short-and-long term effects of adverse childhood experiences.

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Pollak, S. D., Nelson, C. A., Schlaak, M. F., Roeber, B. J., Wewerka, S. S., Wiik, K. L., … Gunnar, M. R. (2010). Neurodevelopmental effects of early deprivation in post-institutionalized children. Child Development, 81(1), 224–236.  doi: 10.1111/j.1467-8624.2009.01391.x Pomerleau, A., Malcuit, G., Chicoine, J., Séguin, R., Belhumeur, C., Germain, P., … Jéliu, G. (2005). Health status, cognitive and motor development of young children adopted from China, East Asia, and Russia across the first 6 months after adoption. International Journal of Behavioral Development, 29(5), 445–457.  doi: 10.1177/01650250500206257 Rajagopal, A., Holland, S. K., Walz, N. C., Staat, M. A., Altaye, M., & Wade, S. (2013). A functional magnetic resonance imaging study of language function in international adoptees. The Journal of Pediatrics, 163(5), 1458–1464.  doi: 10.1016/j.jpeds.2013.06.026

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan Ruggiero, J. A., & Johnson, K. (2009). Implications of recent research on Eastern European adoptees for social work practice. Child & Adolescent Social Work Journal, 26(6), 485–504.  doi: 10.1007/s10560-009-0181-1 Rutter, M. (1988). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57(3), 316–331.  doi: 10.1111/j.1939-0025.1987.tb03541.x Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. (1998). Developmental catch-up, and deficit, following adoption after severe global early deprivation. Journal of Child Psychology and Psychiatry, 39(4), 465–476.  doi: 10.1111/1469-7610.00343 Rutter, M., Beckett, C., Castle, J., Colvert, E., Kreppner, J., Mehta, M., … Sonuga-Barke, E. (2007). Effects of profound early institutional deprivation: An overview of findings from a UK longitudinal study of Romanian adoptees. European Journal of Developmental Psychology, 4(3), 332–350.  doi: 10.1080/17405620701401846 Rutter, M., Sonuga-Barke, E., & Castle, J. (2010). Investigating the impact of early institutional deprivation on development: Background and research strategy of the English and Romanian adoptees (ERA) study. Monographs of the Society for Research in Child Development, 75(1), 1–20.  doi: 10.1111/j.1540-5834.2010.00548.x Selman, P. (2015). Key Tables for Intercountry Adoption: Receiving States 2003–2013; States of Origin 2003–2012. Retrieved from 〈http://www.hcch.net/upload/selmanstats33.pdf 〉 Smyke, A. T., Zeanah, C. H., Fox, N. A., Nelson, C. A., & Guthrie, D. (2010). Placement in foster care enhances quality of attachment among young institutionalized children. Child Development, 81(1), 212–223.  doi: 10.1111/j.1467-8624.2009.01390.x St. Petersburg–USA Orphanage Research Team. (2005). Characteristics of children, caregivers, and orphanages for young children in St. Petersburg, Russian Federation. Journal of Applied Developmental Psychology, 26(5), 477–506.  doi: 10.1016/j.appdev.2005.06.002 Stams, G. M., Juffer, F., Rispens, J., & Hoksbergen, R. C. (2000). The development and adjustment of 7-year-old children adopted in infancy. Journal of Child Psychology and Psychiatry, 41(8), 1025–1037.  doi: 10.1111/1469-7610.00690 Tan, T. X. (2006). History of early neglect and middle childhood social competence: An adoption study. Adoption Quarterly, 9(4), 59–72.  doi: 10.1300/J145v09n04_04 Tan, T. X. (2009). School-age adopted Chinese girls’ behavioral adjustment, academic performance, and social skills: Longitudinal results. American Journal of Orthopsychiatry, 79(2), 244–251.  doi: 10.1037/a0015682 Tan, T. X. (2014). Developmental delays at arrival, early intervention enrolment and adopted Chinese girls’ academic performance and internalizing problems in adolescence. Journal of Genetic Psychology, 175(4), 318–331.  doi: 10.1080/00221325.2014.913547 Tan, T. X., Major, D., Marn, T., Na, E., & Jackson, A. L. (2015). Adopted children’s country of origin and post-adoption parent-child relationship quality: Findings from the United States National Survey of Adoption Parents (NSAP). Children and Youth Services Review, 48, 117–125.  doi: 10.1016/j.childyouth.2014.12.001 Tan, T. X., & Marfo, K. (2006). Parental ratings of behavioral adjustment in two samples of adopted Chinese girls: Age-related versus socio-emotional correlates and predictors. ­Journal of Applied Developmental Psychology, 27(1), 14–30. doi: 10.1016/j.appdev.2005.12.004 Tan, T. X., Marfo, K., & Dedrick, R. F. (2010). Early developmental and psychosocial risks and longitudinal behavioral adjustment outcomes for preschool-age girls adopted from China. Journal of Applied Developmental Psychology, 31(4), 306–314.

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Chapter 1.  Pre-adoption stress, adversity and later development in IA children 

Tan, T. X., & Marn, T. (2013). Mental health service utilization in children adopted from US foster care, US private agencies and foreign countries: Data from the 2007. National Survey of Adoption Parents (NSAP). Children and Youth Services Review, 35, 1050–1054.

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Tottenham, N. (2012). Risk and developmental heterogeneity in previously institutionalized children. Journal of Adolescent Health, 51(2), S29-S33.  doi: 10.1016/j.jadohealth.2012.04.004 U.S. Department of State (2015, March 31). Annual report on intercountry adoption in Fiscal Year 2014. Retrieved from: 〈http://adoption.state.gov/about_us/statistics.php 〉 Ungar, M., Ghazinour, M., & Richter, J. (2013). Annual research review: What is resilience within the social ecology of human development? Journal of Child Psychology and Psychiatry, 54(4), 348–366.  doi: 10.1111/jcpp.12025 Vaillant, G. E. (1993). Disadvantage, resilience, and mature defenses. In the Wisdom of the Ego (pp. 284–325). Cambridge, MA: Harvard University Press. Van den Dries, L., Juffer, F., Van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2009). Fostering security? A meta-analysis of attachment in adopted children. Children and Youth Services Review, 31(3), 410–421.  doi: 10.1016/j.childyouth.2008.09.008 Van der Vegt, E. J., Oostra, B. A., Arias-Vásquez, A., Van der Ende, J., Verhulst, F. C., & ­Tiemeier, H. (2009). High activity of monoamine oxidase A is associated with externalizing behaviour in maltreated and nonmaltreated adoptees. Psychiatric Genetics, 19(4), 209–211.

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Van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Ebstein, R. P. (2011). Methylation matters in child development: Toward developmental behavioral epigenetics. Child Development Perspectives, 5(4), 305–310.  doi: 10.1111/j.1750-8606.2011.00202.x Van IJzendoorn, M. H., & Juffer, F. (2006). The Emanuel Miller memorial lecture 2006. Adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development. Journal of Child Psychology and Psychiatry, 47(12), 1228–1245.  doi: 10.1111/j.1469-7610.2006.01675.x Van IJzendoorn, M. H., Juffer, F., & Klein Poelhuis, C. W. (2005). Adoption and cognitive development: A meta-analytic comparison of adopted and nonadopted children’s IQ and school performance. Psychological Bulletin, 131(2), 301–316.  doi: 10.1037/0033-2909.131.2.301 Van IJzendoorn, M. H., Luijk, M. P. C. M., & Juffer, F. (2008). IQ of children growing up in Children’s homes: A meta-analysis on IQ delays in orphanages. Merrill-Palmer Quarterly, 53(3), 341–366.  doi: 10.1353/mpq.0.0002 Van IJzendoorn, M. H., Palacios, J., Sonuga-Barke, E., Gunnar, M. R., Vorria, P., McCall, R. B., & Juffer, F. (2011). Children in institutional care: Delayed development and resilience. Monographs of the Society for Research in Child Development, 76(4), 8–30.

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Van Londen, W. M., Juffer, F., & Van IJzendoorn, M. H. (2007). Attachment, cognitive, and motor development in adopted children: Short-term outcomes after international adoption. Journal of Pediatric Psychology, 32(10), 1249–1258.  doi: 10.1093/jpepsy/jsm062 Verhulst, F. C., Althaus, M., &Versluis-den Bieman, H. J. (1992). Damaging backgrounds: Later adjustment of international adoptees. Journal of the American Academy of Child & Adolescent Psychiatry, 31(3), 518–524.  doi: 10.1097/00004583-199205000-00020 Vinnerljung, B., Lindblad, F., Hjern, A., Rasmussen, F., & Dalen, M. (2010). School performance at age 16 among international adoptees: A Swedish national cohort study. International Social Work, 53(4), 510–527.  doi: 10.1177/0020872809360037

 Jessica Rice, Andrea Jackson, E. Emily Mahoney, & Tony Xing Tan Vorria, P., Papaligoura, Z., Sarafidou, J., Kopakaki, M., Dunn, J., van Ijzendoorn, M. H., & ­Kontopoulou, A. (2006). The development of adopted children after institutional care: A follow-up study. Journal of Child Psychology and Psychiatry, 47(12), 1246–1253.

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Wiik, K. L., Loman, M. M., Van Ryzin, M. J., Armstrong, J. M., Essex, M. J., Pollak, S. D., & ­Gunnar, M. R. (2011). Behavioral and emotional symptoms of post-institutionalized children in middle childhood. Journal of Child Psychology and Psychiatry, 52(1), 56–63.

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Wilbarger, J., Gunner, M., Schneider, M., & Pollak, S. D. (2010). Sensory processing in internationally adopted, post-institutionalized children. Journal of Child Psychology and Psychiatry, 51(10), 1105–1114.  doi: 10.1111/j.1469-7610.2010.02255.x Wismer Fries, A. B., Shirtcliff, E. A., & Pollak, S. D. (2008). Neuroendocrine dysregulation ­following early social deprivation in children. Developmental Psychobiology, 50(6), 588–599.

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Zeanah, C. H. (2009). The importance of early experiences: Clinical, research, and policy perspectives. Journal of Loss & Trauma, 14(4), 266–279.  doi: 10.1080/15325020903004426 Zeanah, C. H., Smyke, A. T., & Settles, L. D. (2006). Orphanages as a developmental context for early childhood. In K. McCartney & D. Phillips (Eds.), Blackwell handbook of early childhood development (pp. 424–454). Malden, MA: Blackwell.  doi: 10.1002/9780470757703.ch21

chapter 2

Children’s cognitive development after adoption Chloë Finet1, 2, Harriet J. Vermeer1, Femmie Juffer1, Guy Bosmans2, & Patricia Bijttebier3 1 Centre

for Child and Family Studies, Leiden University, Leiden, the Netherlands / and Special Education Research Unit, University of Leuven, Leuven, Belgium / 3 School Psychology and Child and Adolescent Development, University of Leuven, Leuven, Belgium 2 Parenting

This chapter provides an overview of research on the cognitive development of adopted children, focusing on IQ scores, school achievement and executive functioning. Because of the deprivation many adoptees experience prior to adoption, it might be expected that their cognitive development is at higher risk compared to non-adopted children. However, the question arises whether children who experience a more nurturing and more stimulating environment after early deprivation show a catch-up in development. In this chapter, research on three different types of ‘atypical’ rearing conditions is discussed, that is institutional care, foster care and adoptive families. We first present the results of longitudinal studies, or ‘natural’ experiments, in which the development of internationally adopted children is studied over several years. Second, we discuss outcomes of an experimental study (the Bucharest Early Intervention Project), that studied the effects of placement in foster care on children’s development. Finally, a series of meta-analyses (comparing adoptees with their environmental peers and with peers who were left behind) is presented in which the effects of adoption on cognitive development are examined. In sum, the studies reported in this chapter provide support for the notion that adoption is a positive intervention fostering the cognitive development of adoptees.

Introduction There are many reasons why children are placed for adoption, such as poverty in the birth family, unwed motherhood, death of the biological parents, or abandonment (Grotevant & McDermott, 2014). After separation from their birthparents,

doi 10.1075/tilar.18.03fin © 2016 John Benjamins Publishing Company

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

children can differ in pre-adoptive experiences: some children live in an institution prior to adoption, whereas other children stay in a temporary foster family in their country of origin. These different types of pre-adoption rearing conditions vary in quality of care and may therefore result in differential developmental outcomes after adoption. In this chapter, we focus on the cognitive development of internationally-adopted (IA) children, taking into account their backgrounds of foster care or institutional care before adoption. Foster care provides children with a more normal family life and a more stimulating environment than institutional care (see Rice et al., this volume, for a more detailed discussion of this issue). Although there is a lack of systematic research on the quality of institutions, many institutions (e.g., in Romania and India) are typified by “structural neglect” (Van IJzendoorn et al., 2011, p. 12). Consequently, children in institutions are deprived of experiences necessary for normal brain and behavioral development (Nelson, Bos, Gunnar, & Sonuga-Barke, 2011). In other words, institutionalized children often do not have the experiences that are expected to take place to foster optimal development. As such, institutional care can be seen as a risk factor for child development, and different developmental domains (such as physical, emotional, and cognitive development) may be differentially affected (Zeanah et al., 2003). Likewise, these developmental domains may have a different potential for recovery after transition to family care. The catch-up after placement in a family can be conceptualized as an intervention effect resulting from the drastic change to more optimal caregiving conditions (Van IJzendoorn & Juffer, 2006; Zeanah et al., 2003). Adoption is, thus, characterized by both risk factors (including prenatal and pre-adoption experiences) and protective factors (associated with usually better environmental conditions in the adoptive ­family) for development. The focus of this chapter is on adopted children’s cognitive development and cognitive processes. Research on cognitive competence (intelligence or developmental quotient), cognitive achievement (school performance) and executive functioning is presented. In the pertinent studies, adoptees are compared with non-adopted children raised in their birth families (current peers) or with children who remained in institutions (past peers). This corresponds with two important research trends in the adoption literature, examining (1) developmental differences between adopted children and children raised by their biological parents, and (2) the possibilities for developmental recovery and catch-up after adoptive placement (Palacios & Brodzinsky, 2010). These comparisons allow us to draw conclusions about both the risk (adoptees versus non-adoptees) and protective factors (adoptees versus institutionalized children) associated with adoption. We start with an overview of outcomes on cognitive functioning (cognitive development and school achievement). First, several longitudinal studies of



Chapter 2.  Children’s cognitive development after adoption 

adopted children are discussed. Next, we present the results from a randomized controlled experiment (the Bucharest Early Intervention Project, BEIP; Zeanah et al., 2003) in which the effects of family foster care were investigated. Finally, we provide the main findings from a meta-analysis on adopted children’s cognitive functioning (Van IJzendoorn, Juffer, & Klein Poelhuis, 2005). In the second section, we focus on a more recent line of research on cognitive development, that is, executive functioning. Finally, we draw conclusions about the consequences of institutional care and the remediating effects of adoption on cognitive development.

Natural experiments of adoption In this section we describe four longitudinal studies in which the development of IA children is examined: the English and Romanian Adoptee study, the Greek Metera study, the Leiden Longitudinal Adoption Study, and our study on Chinese Adoptees in the Netherlands. These longitudinal studies can be conceptualized as ‘natural experiments’ (Bronfenbrenner, 1979; Rutter, 2007; Van IJzendoorn & Juffer, 2006) in which the effects of adoption on development after early (institutional) deprivation can be examined.

The English and Romanian adoptee study The English and Romanian Adoptee study (ERA; Rutter & the ERA study team, 1998) is a longitudinal investigation of Romanian children who were adopted into UK families between 1990 and 1992. The ERA study compared the development of Romanian adoptees (n = 165) who experienced profound institutional deprivation prior to adoption (ranging from a few weeks to 42 months) with the development of within-UK adoptees (n = 52) who did not experience institutional deprivation and who were adopted before 6 months of age. Within-UK adoptees were ­chosen as a comparison group because this allowed the researchers to determine the effects of early deprivation while controlling for possible effects of adoption per se (Rutter, Sonuga-Barke, & Castle, 2010). To examine the effects of prolonged deprivation, the Romanian sample was divided into three age categories: placed from the institution in an adoptive family before 6 months of age (n = 58), between 6 and 24 months (n = 59), and between 24 and 42 months of age (n = 48). The developmental assessments of the Romanian and the within-UK samples were undertaken at 4, 6, 11, and 15 years of age. During the follow-up assessments, different domains of development were investigated. Here, we discuss the main findings on the Romanian adoptees’ cognitive development and school achievement.

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

Cognitive development To examine the effects of prolonged deprivation, the cognitive development of the two groups of early-placed adoptees (children adopted before 6 months or between 6 and 24 months of age) was compared with the development of the lateplaced adoptees (children adopted between 24 and 42 months of age). In addition, the ERA study investigated whether the early- and late-placed adoptees displayed catch-up after adoptive placement and to what extent this catch-up was maintained in the long run. Retrospective parent reports, using the Denver Developmental Scales (Frankenburg, van Doornick, Liddell, & Dick, 1986), were used for measuring general cognitive functioning of the children at entry into the UK and at age 4 years. Intellectual functioning at ages 6, 11, and 15 years was assessed with standardized tests of intelligence. It should be noted that the Romanian children who were adopted between 24 and 42 months had not yet participated in the age 4 years assessment because at that time they had just joined the adoptive family (Rutter & the ERA study team, 1998). Effects of short versus prolonged deprivation.  The retrospective Denver scores as reported by the parents – at age 4 for the children who were adopted before their second birthday and at age 6 for the children who were adopted after their second birthday – indicated that the Romanian adoptees displayed severely delayed development when they entered the UK. The average developmental quotient (DQ) of the Romanian children who were adopted before their second birthday was 62.89 (SD = 41.24; Rutter & the ERA study team, 1998), whereas the Romanian children who were adopted after their second birthday had an average DQ of 45.7 (SD = 25.4; O’Connor et al., 2000). These DQs, which can be seen as a rough index of level of functioning (Rutter & the ERA study team, 1998), suggest that the majority of the Romanian adoptees were developmentally delayed relative to UK standards when they arrived in the UK. The cognitive development of the within-UK adoptees and the early- and late-placed Romanian adoptees were compared at the follow-up assessments. Results pointed to the importance of duration of deprivation for later development. More specifically, the assessments at 4 and 6 years suggested that there was a dose-response relation between duration of deprivation and cognitive development (O’Connor et al., 2000; Rutter & the ERA study team, 1998). While the cognitive development of the Romanian children adopted before 6 months of age was comparable to the cognitive development of the within-UK adoptees, both groups outperformed the Romanian children adopted between 6 and 24 months of age who in turn outperformed the Romanian children placed after their second birthday. However, the follow-up studies at 11 and 15 years did not provide ­support for the dose-response relation found at ages 4 and 6 years. In contrast, results re-



Chapter 2.  Children’s cognitive development after adoption 

vealed a 6-month threshold effect (Beckett et al., 2006; Beckett, Castle, Rutter, & Sonuga-Barke, 2010), indicating that less than 6 months of institutionalization did not negatively affect cognitive abilities, whereas institutionalization for more than 6 months was associated with persisting cognitive delays, irrespective of the exact duration of institutionalization (6 to 42 months). Catch-up over time.  Despite these cognitive impairments, the adoptees showed improvement in their cognitive functioning after adoptive placement. More specifically, the children already showed remarkable catch-up between adoptive placement and their fourth birthday (Rutter & the ERA study team, 1998). Further catch-up was found between the fourth and sixth birthday (O’Connor et al., 2000) and between the sixth and eleventh birthday (Beckett et al., 2006). However, catch-up between ages 6 and 11 years was only found for the Romanian children who were adopted after their second birthday (Beckett et  al., 2006). Finally, at 15 years of age, further catch-up was found, but only for the Romanian children who were adopted after 6 months of age (Beckett et al., 2010). Catch-up over time was not associated with age at adoption, but with the degree of impairment at the prior assessment wave (Beckett et al., 2006, 2010; O’Connor et al., 2000). For example, the larger the cognitive impairment at 4 years, the larger the cognitive improvement between 4 and 6 years (O’Connor et al., 2000). The same positive association between cognitive impairment and cognitive improvement was found at 6 years (Beckett et al., 2006) and during the assessment at age 11 (Beckett et al., 2010). Taken together these findings suggest that institutional care characterized by severe deprivation and lasting for 6 months or more has long-lasting negative consequences for children’s cognitive functioning and that these detrimental effects are largely found in a subgroup of late-adoptees who experience severe cognitive impairments (Beckett et al., 2006). At the same time, improvement in the caregiving environment after adoption led to remarkable catch-up, and moderate gains in cognitive development were still possible even after many years since the children left the institution (Beckett et al., 2010). School achievement School achievement was studied when the children were 11 and 15 years old. Converging with findings with respect to cognitive development, a 6-month threshold effect was found for school achievement (Beckett et al., 2007, 2010). Romanian children who were institutionalized for less than 6 months performed as well at school as the within-UK adoptees, and both groups significantly outperformed the Romanian adoptees who were adopted at older ages. These differences in school achievement at age 11 years were primarily mediated by the intelligence

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

quotient (IQ) scores of the children at the same age and to a smaller degree by symptoms of inattention /overactivity, the term used by the authors (Beckett et al., 2007). ­Psychopathology symptoms, such as emotional disturbance and conduct problems, had no additional effect on school achievement after the influence of IQ scores and inattention/overactivity was taken into account. Thus, the negative effects of institutional deprivation on school achievement could be explained largely by the detrimental effects of institutionalization on IQ (Beckett et al., 2007). In line with this, Beckett et al. (2010) found that the differences in school achievement at 15 years were mainly a function of IQ at age 6. This indicates that, within this sample, general cognitive development is a good predictor of school achievement. Although the ERA study found that school achievement was mainly influenced by cognitive competence, it has been hypothesized that school achievement can be hampered by the effect of early adverse experiences on socio-emotional development (Van IJzendoorn et al., 2005).

The Greek Metera study Another longitudinal study on the development of post-institutionalized adopted children was conducted at the Metera Baby Centre (Vorria et al., 2003). Metera is a large institution in Athens (Greece) where about 100 children were reared prior to placement with an adoptive family, a foster family or were reunited with the birth family (Vorria et al., 2003). Caregivers at the center were encouraged to form an attachment relationship with one of the children (Vorria et al., 2003), and the infant-caregiver ratio (4:1 to 6:1) was more favorable than in Romanian institutions (30:1; Croft et al., 2007). Most of the children were admitted shortly after birth (approximately 5 days after birth) and the main reasons for placement were socioeconomic and health problems of the parents (Vorria et al., 2003). The study followed a sample of institutionalized children who were adopted after staying for almost two years in Metera (Vorria et al., 2006). The development of these children was studied at three different time points. The children (n = 86) first participated in the study around their first birthday (mean age = 13 months). At that time, they were still living in Metera. Next, after adoptive placement, a follow-up study was performed when the children (n = 61) were approximately 4 years old (Vorria et al., 2006) and again when the children (n = 52) were 13 years old (Vorria, Ntouma, & Rutter, 2015). Children who were placed in a foster family or who were reunited with their birth families were excluded from the follow-up assessments (Vorria et al., 2006). In addition, a comparison group of 41 Greek children (21 boys, mean age at first assessment = 13.6 months, and 20 girls, mean age at first assessment = 14.1 months) who were raised by their biological families and attended full-time day care in infancy participated



Chapter 2.  Children’s cognitive development after adoption 

(Vorria et al., 2003). The fact that the development of the children was investigated during their stay in Metera is an important strength of this study insofar as it provided a baseline for the follow-up assessments. Moreover, because the infants were admitted to Metera shortly after birth, there was less risk of a confounding effect of poor family circumstances prior to placement (Vorria et al., 2003). Furthermore, the development of the institutionalized children and their subsequent catch-up after adoptive placement could be assessed and compared with the development of the family-reared children receiving day care. Thus, this study is noteworthy because the design makes it possible to investigate the remediating effects of adoption after institutionalization and reduces the risk of a confounding effect of less than optimal rearing conditions in the biological family. Here we discuss the outcomes of the Metera Study regarding cognitive functioning and school achievement. Cognitive development The cognitive development of the institutionalized children was compared with the cognitive development of the family-reared children prior to adoption and after adoptive placement. Standardized intelligence tests were used to assess ­cognitive functioning of the children in infancy and at ages 4 and 13 years. Vorria et al. (2003) found that the cognitive development of the one-yearold (M = 13 months) institutionalized children lagged behind the cognitive development of the family-reared comparison group. Prior to adoption (M = 20 months at adoptive placement), the one-year-old institutionalized children had a mean IQ score of 92.8 (SD = 10.3), whereas the comparison group had an average score of 102.1 (SD = 8.5). Although there was a between-group difference of 10 points, the cognitive functioning of the institutionalized children was in the normal range. A follow-up study revealed that the comparison group of family-reared children (mean IQ score = 110.9, SD = 11.9) still outperformed the adopted children (mean IQ score = 100.1, SD = 13.0) at age 4 (Vorria et al., 2006). At this assessment, the adopted children had been living in an adoptive family for 2 years and 4 months, on average. It is possible that some extra time in a stimulating adoptive family is needed to facilitate complete cognitive catchup. In early adolescence, the between-group differences in cognitive functioning were still present. The comparison children had a higher IQ (M = 112.44, SD = 9.98) compared to the adoptees (M = 105.62, SD = 14.17; Vorria et al., 2015). However, according to the authors, this between-group difference should be interpreted cautiously because the comparison families were quite highly educated which may explain the comparison children’s above average intellectual functioning (Vorria et al., 2015).

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

In sum, the cognitive functioning of the Greek adoptees was in the normal range. In addition, the slight decrease in the difference with the comparison group that was found over time (from almost 10 points in infancy to 7 points at age 13 years) provides additional evidence for cognitive recovery of institutionalized children after placement in an adoptive family. School achievement When the children were 13 years old, school achievement (school grades) was investigated (Vorria et al., 2015). The adopted children exhibited somewhat lower school performance than the family-reared children. In addition, the adoptees’ school achievement was positively associated with their IQ scores and with their social class (Vorria et al., 2015).

Leiden Longitudinal Adoption Study The Leiden Longitudinal Adoption Study (LLAS; Juffer, 1993; Rosenboom, 1994) started in 1986 to investigate the development of early-adopted children. The initial sample consisted of 160 children who were adopted before 6 months of age from Sri Lanka (n = 86), South Korea (n = 49), and Colombia (n = 25) into the Netherlands. The children from South Korea and Colombia received institutional care prior to their adoption, and the children from Sri Lanka were reared by their birth mothers before they were adopted (Stams, Juffer, Rispens, & Hoksbergen, 2000). The early placement of the children (M = 10.28 weeks at adoptive placement) who probably experienced minimal serious pre-adoption adversity is an important feature of this study. It makes it possible to examine the effects of adoption per se (Juffer & Van IJzendoorn, 2009) while controlling for the effects of impoverished pre-adoptive experiences. Thus, whereas the ERA study was mainly interested in studying the effects of duration of deprivation (Rutter & the ERA study team, 1998), the LLAS aimed to examine the effects of adoptive parenting from infancy into young adulthood (Schoenmaker et al., 2015). There was minimal drop-out during the study, and analyses confirmed that there was no selective attrition (Schoenmaker et al., 2015). We present results from the LLAS concerning cognitive development and school achievement. Cognitive development Cognitive functioning was examined at the ages of 7, 14, and 23 years (Schoenmaker et al., 2015; Stams et al., 2000) using standardized measures. Results revealed that the adopted children’s mean intelligence score at 7 years (M = 107, SD = 14) was above the general population average of 100 (Stams et al., 2000). It was also found that country of origin and sex of the children had significant effects on



Chapter 2.  Children’s cognitive development after adoption 

cognitive functioning. Boys scored higher than girls and the Korean children had higher IQ scores than the children from Sri Lanka (Stams et al., 2000). The cognitive adjustment of the children over time was influenced by the early parent-child relationship. More specifically, observed sensitivity of adoptive mothers in infancy was significantly related to cognitive development at age 7 (Stams, Juffer, & Van IJzendoorn, 2002). The follow-up assessments at ages 14 and 23 years indicated that IQ was quite stable between adolescence and young adulthood (Schoenmaker et al., 2015). School achievement At age 7 years, teachers were asked to report on the academic performance and adaptive functioning of the children at school. The adopted children performed as well at school as children from the general, normative population, and they obtained similar scores for adaptive functioning. However, a larger percentage of the adopted children had repeated grades compared to the g­ eneral p ­ opulation – 20% versus 5–10%, respectively (Stams et al., 2000). At age 23 years, socioeconomic success was assessed based on employment (or years of education for students) of the young adults. Analyses showed that intellectual functioning predicted socioeconomic success. More specifically, IQ at ages 7 and 14 years was an indirect predictor of socioeconomic success at age 23, and IQ at 23 years showed a direct, concurrent association with socioeconomic success (Schoenmaker et al., 2015).

Chinese adoptees in the Netherlands (CAN) A more recent longitudinal adoption study, the CAN study, started in 2005 and aimed to study the development of Chinese adoptees from institutional or foster care (Van den Dries, Juffer, Van IJzendoorn, & Bakermans-Kranenburg, 2010; Van den Dries, Juffer, Van IJzendoorn, Bakermans-Kranenburg, & Alink, 2012). China has been the main country of origin for adoption to the Netherlands since 1998, and also worldwide China has dominated international adoption for many years (Selman, 2009). Despite the large number of children adopted from China, only a few studies on the general development of Chinese adoptees have been performed (Van den Dries et al., 2010). The initial CAN sample consisted of 92 Chinese girls who were adopted between 11 and 16 months of age by Dutch parents (Van den Dries et al., 2010, 2012). Chinese boys were excluded from the study because the majority of Chinese children who were placed for adoption at that time were girls  – due to the “one son/two child” policy (Selman, 2009). About half of the children (n = 50) resided in an institution in China prior to adoption and the other children (n = 42) received temporary family foster care (Van den Dries et al., 2010,

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

2012). A major aim of this study was to investigate the effects of these two types of pre-adoptive rearing conditions. The post-institutionalized children were compared with the post-foster children on different developmental domains. It was expected that the post-foster children would exhibit somewhat more favorable adjustment compared to the post-institutionalized children because they probably experienced more optimal rearing conditions prior to adoption (Van den Dries et al., 2010; see also Rice et al., this volume). Unfortunately, aside from information on type of pre-adoptive condition, no systematic, detailed information about the quality of the rearing environment was available (Van den Dries et al., 2012). To date, the development of these Chinese girls has been investigated at 2 and 6 months after adoption. Results of their cognitive development are presented here. Cognitive development The post-foster children and the post-institutionalized children had below average cognitive development 2 and 6 months after adoptive placement (Van den Dries et al., 2010). As expected, repeated measures analysis of variance showed that the post-foster children significantly outperformed the post-institutionalized children at the 2-month post-adoption assessment (post-foster: M = 84.40, SD = 17.62, post-institutionalized: M = 74.04, SD = 18.41) and at the 6-month post-adoption assessment (post-foster: M = 92.96, SD = 17.83, post-institutionalized: M = 84.38, SD = 20.1). In addition, both groups showed similar catch-up in their cognitive development between the first and second post-adoption assessments. However, the catch-up in cognitive development left room for improvement insofar as their cognitive development was still slightly below average at the second assessment (Van den Dries et al., 2010). The outcomes of this study suggest that type of preadoption care has differential effects on cognitive development, with pre-adoption foster care being less detrimental for later development than pre-adoption institutional care.

Conclusions of the natural experiments The radical changes in environment that take place when institutionalized children are placed in adoptive families provide interesting natural experiments. The longitudinal studies discussed in the previous sections made use of such ‘natural experiments’ to investigate the effects of institutional deprivation on developmental catch-up after adoptive placement. On the one hand, these studies indicate that institutional deprivation exerted enduring negative effects on cognitive development – the institutionalized children exhibited delayed cognitive development during their stay in institutional care (Vorria et al., 2003) and when they had just joined their adoptive families (O’Connor et al., 2000; Rutter & the



Chapter 2.  Children’s cognitive development after adoption 

ERA study team, 1998; Van den Dries et al., 2010). On the other hand, the postinstitutionalized children showed remarkable catch-up in their cognitive functioning after placement in an adoptive family (O’Connor et al., 2000; Rutter & the ERA study team, 1998; Stams et al., 2000; Van den Dries et al., 2010; Vorria et al., 2006), and this was maintained over the long run (Beckett et al., 2006, 2010; Schoenmaker et al., 2015; Vorria et al., 2014). Age at adoption was found to be important and, more specifically, children adopted at younger ages in general displayed more favorable cognitive development compared with children adopted at older ages. These studies, thus, provide support for the protective influence of adoption on the cognitive functioning of post-institutionalized children, especially if placement in an adoptive family occurs early in development (Juffer & Van IJzendoorn, 2009). The validity of these conclusions is strengthened by the fact that these findings are found in different longitudinal studies that have unique strengths. More specifically, whereas the ERA study design was especially suited for studying the effects of prolonged deprivation while controlling for the effects of adoption (­Rutter & the ERA study team, 1989), the LLAS study was able to examine the effects of early adoptive placement (Stams et al., 2000). In the Metera Study, the results of a baseline pre-adoption assessment were available against which cognitive development after adoptive placement could be compared (Vorria et al., 2003). Finally, the CAN study made it possible to compare the development of post-institutionalized children with that of post-foster children (Van den Dries et al., 2010). It is important to note that the results of these studies also point to the differential effects of severe versus moderate or minimal deprivation (see also Gunnar, 2001, and Rice et al., this volume). The Romanian post-institutionalized children, who experienced severe early institutional deprivation, exhibited more cognitive delays than postinstitutionalized children who experienced (probably) less severe early deprivation (e.g., the Greek Metera study) or who were adopted at very young age (e.g., the LLAS study). Although the quality of the rearing environment in these natural experiments was not examined in detail, it is important to note that the Romanian institutions were profoundly depriving. Children had hardly any opportunities to interact with caregivers due to strict daily schedules and were cared for by many different caregivers (up to 17 caregivers a week) (Zeanah et al., 2003). The conditions in the Romanian institutions were probably more severely depriving than conditions in other institutions (Dalen, 2012) and, thus, are not representative of the institutional care offered by orphanages in other countries, for example, Greece (e.g., Vorria et al., 2003) and Ukraine (e.g., Dobrova-Krol, Van IJzendoorn, Bakermans-Kranenburg, & Juffer, 2010). In the latter cases, institutions provide adequate health and nutrition support, but fail to meet stimulation and relationship needs (Gunnar, 2001).

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

Taken together, these studies confirm the positive influence of adoption on children’s cognitive functioning. It should be noted, however, that natural experiments may suffer from the risk of selection bias (Zeanah et al., 2003). The (institutionalized) children were not randomly assigned to adoptive care and we cannot exclude the possibility that some children, for example the most competent ones, were selected for adoption. To address such a possible selection bias, a randomized controlled study of family care for institutionalized children, the Bucharest Early Intervention Project (BEIP; Zeanah et al., 2003), may add important information.

The Bucharest Early Intervention Study The BEIP is the first randomized controlled study to examine the effects of an alternative form of care, in this case family foster care, for institutionalized children (Zeanah et  al., 2003). The study started in 2002 in Bucharest (Romania) where only limited alternative options for institutional care were available. Participants were 136 institutionalized children, between 5 and 31 months of age at the time of recruitment, who were randomly assigned to foster care (n = 67) or continued institutional care (n = 69). Prior to randomization, a baseline assessment was conducted to ascertain that the two groups of children were comparable. In addition, a control group of 72 never-institutionalized Romanian children was included. The aim of the BEIP was to investigate the impact of institutional care on the development of children and to examine to what degree recovery is possible after a transition to foster care controlling for other factors. The use of a randomized design, preventing selection bias, and a baseline assessment are two major strengths of the BEIP study. These strengths make it possible to attribute observed differences between the institutionalized and foster children to their different rearing environments. As such, the true effect of the foster care intervention after early deprivation can be determined (Zeanah et al., 2003). It is important to note that the BEIP study followed an intent-to-treat approach, which means that the BEIP did not interfere with the placement of children in alternative caregiving settings (for example government-sponsored foster care) when these became available (Zeanah et  al., 2003). In the intent-to-treat analyses, however, the original group assignments (foster care versus continued institutional care) are maintained.

Cognitive development Nelson et  al. (2007) examined the cognitive development of the children at 42 months and at 54 months of age. Comparison of the cognitive development of the foster care and the institutionalized groups showed that the foster children



Chapter 2.  Children’s cognitive development after adoption 

significantly outperformed the institutionalized children, both at 42 months and at 54 months of age. At 42 months, the mean developmental quotient (DQ) of the institutionalized children was 77.1 (SD = 13.3), whereas the foster children had a mean DQ of 85.7 (SD = 14.2). At 54 months of age, the institutionalized children and foster children had an average IQ of 73.3 (SD = 13.1) and 81.0 (SD = 18.5), respectively. The group of never-institutionalized Romanian children had the most favorable cognitive development, both at 42 months (M = 103.4, SD = 11.8) and at 54 months (M = 109.3, SD = 21.2). Timing of foster care placement As well, the assessment at 54 months showed that children who were placed in foster care before 24 months of age had higher IQs than children placed in foster care at an older age. Each additional month of institutionalization appeared to be associated with a loss of 0.85 DQ points at 42 months of age and with a loss of 0.59 IQ points at 54 months. In sum, age of entry into foster care was critical for the cognitive development of the children. The younger an institutionalized child was when entering foster care, the better their cognitive outcomes (Nelson et al., 2007). Follow-up Although the BEIP intervention study formally ended at 54 months of age, a ­follow-up study was conducted when the children were 8 years of age (Fox, Almas, Degnan, Nelson, & Zeanah, 2011). The goal of the follow-up was to reveal whether the foster care intervention continued to exert positive influence on the children’s cognitive abilities. Comparisons between the foster children and the institutionalized children revealed that the foster children had marginally significantly higher full-scale IQ scores (M = 81.46, SD = 15.32) than the institutionalized children (M = 76.16, SD = 14.11). The foster care intervention, thus, had continued to exert a positive influence on cognitive development. In contrast, however, the foster care children (M = 81.46, SD = 15.32) had not yet caught up completely to their noninstitutionalized peers (M = 107.00, SD = 16.54). Consistent with the findings of Nelson et al. (2007), age at placement into foster care was found to be important for the long-term cognitive development of the children (Fox et al., 2011). A change in IQ score was computed which served as an indication of the degree of change between the assessments at 54 months and 8 years of age. The institutionalized children showed greater increases in their full-scale IQ scores (M = 4.77, SD = 9.64) between 54 months and 8 years than the foster children (M = .04, SD = 14.45). It should be noted, however, that this difference was only marginally statistically significant. The lower the baseline IQ scores of the institutionalized children, the greater the gains in their IQ scores (Fox et al., 2011). In conclusion, the results of this 8-year follow-up were largely in line with the findings of Nelson et  al. (2007) at 42 and 54 months. However, at 8 years,

 Chloë Finet, Harriet J. Vermeer, Femmie Juffer, Guy Bosmans, & Patricia Bijttebier

the difference in cognitive abilities between the foster care and institutional care groups (Fox et al., 2011) were smaller than the group differences found at 42 and 54 months (Nelson et al., 2007). This may be explained by greater IQ gains over time for the institutionalized children (Fox et  al., 2011) who had scored lower initially. The greater increase in IQ scores of the institutionalized group might also be due to the fact that many of the institutionalized children were no longer living in an institution at 8 years because they were placed in government foster care. Nevertheless, it is noteworthy that despite the conservative intent-to-treat approach, the foster care children displayed higher full-scale IQ scores than the institutionalized children (Fox et al., 2011). These findings point to the importance of early placement into family care in order to improve the cognitive outcomes of previously institutionalized children.

Meta-analysis The natural experiments of adoption along with the BEIP randomized controlled study of foster care discussed above indicate that institutional deprivation is a risk factor for cognitive development but that remarkable recovery in cognitive functioning is possible after family placement. The question arises: Are these results representative of the many studies on adoption and cognitive development, or are they exceptional? To address this issue, Van IJzendoorn et al. (2005) performed a series of meta-analyses of cross-sectional studies on the cognitive development of adopted children. In these meta-analyses, the results of all available studies on the cognitive development of adoptees were combined and systematically analyzed. The meta-analyses included 62 studies in which the cognitive development of 17,767 adoptees was assessed. Four different indicators of cognitive development were examined: IQ scores, school achievement, language abilities, and learning problems. For each indicator, a separate meta-analysis was conducted. The goal of the meta-analyses was two-fold. First, the meta-analyses aimed to examine whether adoptees exhibit better cognitive development than their past peers who were not adopted and continued to live in institutions. Second, they aimed to investigate whether adoptees lag behind or catch up with their current peers who are living with their biological families. Addressing these questions is crucial because it sheds light on the possibilities and limits of children’s ability to recover from early adversity (Van IJzendoorn, & Juffer, 2006). Results of the meta-analyses are reported here in terms of Cohen’s d. This is the standardized difference between the mean of the adopted group and the comparison group. A negative Cohen’s d can be interpreted as more advanced cognitive development on the part of the adopted children compared with their past peers. A positive Cohen’s d ­indicates



Chapter 2.  Children’s cognitive development after adoption 

less favorable cognitive development by the adoptees compared with their nonadopted, current peers (Van IJzendoorn et al., 2005). The meta-analysis of IQ results indicated that the adopted children not only had significantly higher IQ scores compared to their past peers (large effect size of d = -1.17, p