Table 7.
Behavior problems
| Study | Country of origin | Severity of deprivation | Age at assessment | N | Construct measured | Outcome measure | Age at adoption: Distribution | Age at adoption: Measurement | Statistical test | Significant effect of age at adoption? | Form of the relationship? | Relationship with other variables? |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Positive Results | ||||||||||||
| Ames (1997) | Romania | Globally depriving | most 4.5y; some 5.5–9y | 46 | stereo typed behavior problems | parent interview | 8–8m; Md = 18.5m1 | continuous1 | correlation | yes | — | — |
| Romania | Globally depriving | most 4.5y; some 5.5–9y | 46 | behavior problems | CBCL (parent-report) | 8–8m; Md = 18.5m1 | continuous1 | correlation | yes, for Total, Internalizing, and Externalizing | — | — | |
| Fisher, Ames, Chisholm, & Savoie (1997) | Romania | Globally depriving | 18–76m | 46 | behavior problems | CBCL (parent-report) | 806m; M = 18.51 | continuou1 | correlation | yes for Total and Internalizing, marginal for Externalizing | — | — |
| Romania | Globally depriving | 18–76m | 46 | rate of improvement in stereo typed behavior problems | parent interview | 8–6m; M = 18.51 | continuous1 | correlation | yes | — | — | |
| Beckett, Bredenkam, Castle, Groothues, O’Connor, Rutter, & The ERA Study Team (2002) | Romania | Globally depriving | 6y | 144 | Rocking, self-injury, unusual sensory interests, problems with chewing and swallo wing | parent interview | 45 0–6m, 19 6–2m, 35 12–24m, 45 24–42m | < 6m, 6–12m, 12–24m, 24–42m | chi square trends, ANOVA | yes | linear, step function at 6m | — |
| Rutter, Sonuga-Barke, Beckett, Castle, Kreppner, Kumsta, Schlotz, Stevens, & Bell (2010) | Romania | Globally depriving | 6y, 11y, 15y | 144 | Deprivation Specific Psychological Patterns | most extreme 15% for cognitive impairment, quasiautistic patterns, inattention/over activity, and disinhibited attachment (parent & teacher-report) | 58 < 6m, 59 6–24m, 48 > 24m | < 6m (combined with UK adoptees and non-PI Romanian adoptees), > 6m | logistic regression, Fisher’s exact test | yes | past work suggests step function at 6m | subnutrition did not relate to DSP independently or through an interaction with age at adoption; DSP was related to head circumference |
| Romania | Globally depriving | 6y, 11y, 15y | 144 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent & teacher-report) | 58 < 6m, 59 6–24m, 48 > 24m | < 6m (combined with UK adoptees and non-PI Romanian adoptees), > 6m | ANOVA; path analysis | yes | past work suggests step function at 6m | no effect of gender; effect present at all ages, but interaction with age at assessment: more problems at 11 and 15 than at 6; mediated by DSP | |
| Ellis, Fisher, & Zaharie (2004) | Romania | — | 2–6y | 51 | anxiety/affective symptoms | ECI-4 (parent-report) | 1m–5.5y; M = 2.5y2 | continuous2 | multiple regression | yes | — | — |
| Elmund, Lindblad, Vinnerljung, & Hjern (2007) | Multiple | — | No info | 16,522 | out of home care due to child’s behavior | rates of out of home care in national database | 78% before age 2y, 15.5% age 2–3y, 6.5% age 4–6y | 0–1y, 2–3y, 4–6y | logistic regression | yes | — | — |
| Gunnar, van Dulmen, & the International Adoption Project Team (2007) | Multiple | — | 4–18y | 899 | behavior problems | CBCL (parent-report) | M = 29.5m, SD = 30.7m; 38% were ≥ 24m | < 12m, > 12m; < 24m, > 24m | multivariate logistic regression | yes | — | no interaction between age at adoption and PI status |
| Hawk & McCall (2011) | mostly Russia | Socially-emotionally depriving | 6–18y | 316 | behavior problems | CBCL (parent-report) | 3.3–57.7m; M = 16.0m, SD = 11.4 | < 18m, > 18m; < 6m, 6–11m, 12–17m, 18–23m, 24m+ | ANOVA, MANOVA | yes | step function at 18m | effects only present at older age at assessment (12–18y) |
| Merz & McCall (2010) | mostly Russia | Socially-emotionally depriving | 6–18y | 342 | behavior problems | CBCL (parent-report) | M = 16.4, SD = 11.75 | < 9m, 9–17m, ≥ 18m | chi square; hierarchical multiple regression | yes | step function at 18m | effects only present at older age at assessment (12–18y) |
| Verhulst, Althaus, & Versluis-Den Bieman (1990) | Multiple | — | 10–15y | 2148 | behavior problems | CBCL (parent-report) | 513 0–6m, 221 7–12m, 329 13–24m, 311 25–36m, 278 37–48m, 198 49–60m, 156 61–72m, 142 73–125m | < 6m, 7–12m, 13–24m, 25–36m, 37–48m, 49–60m, 61–72m, 73–125m | chi square; ANCOVAs | yes, for extreme scores (total sample), internalizing, and externalizing | sharp increase in problems after 24m | interaction with age at assessment for internalizing but not externalizing |
| Verhulst, Althaus, & Versluis-Den Bieman (1992) | Multiple | — | 9–17y | 3519 | behavior problems | CBCL (parent-report) | 0–10y; majority < 4y | < 6m, 7–12m, 13–24m, 25–36m, 37–48m, 49–60m, 61–72m, 73–125m | log-linear analyses | yes | — | effect is over and above that of age at assessment and gender; effect is better accounted for by abuse, neglect, and number of placements |
| Mixed Results | ||||||||||||
| Cederblad, Höök, Irhammer, & Merke (1999) | Multiple | — | 13–27y | 147 | behavior problems | CBCL (parent-report) | 54% < 7m; 30% > 1y | < 1y, > 1y at adoption | ANOVA | yes, for 1 subscale | — | — |
| Multiple | — | 13–27y | 147 | behavior problems | CBCL (parent-report) | 54% < 7m; 30% > 1y | < 6m or > 6m in institution or foster care | ANOVA | yes, for total score and 4 subscales | — | — | |
| Habersaat, Tessier, & Pierrehumbert (2011) | Multiple | — | 12–18y | 350 | behavior problems | CBCL (parent-report) | 83 < 6m, 52 6–12m, 43 12–24m, 172 > 24m | < 6m, 6–12m, 12–24m, > 24m | — | yes, for < 6m and > 24m; no for < 12m and > 12m | — | moderated by maternal solicitations style; not moderated by attachment |
| Kreppner, Rutter, Beckett, Castle, Colvert, Groothues, Hawkins, O’Connor, Stevens, & Sonuga-Barke (2007) | Romania | Globally depriving | 6y, 11y | 144 | impairments | most extreme 15% for cognitive impairment, quasiautistic patterns, inattention/over activity, disinhibited attachment, conduct problems, emotional problems, peerrelationship problems (parent & teacher-report) | 0–42m | continuous; < 6m, 6–24m, > 24m | chi square; binary logistic regression | yes, but only < 6m, > 6m comparison | step function at 6m | no interaction with weight at adoption (subnutrition) |
| Rutter, Kreppner, & O’Connor (2001) | Romania | Globally depriving | 6y | 165 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent & teacher-report) | 58 < 6m, 59 6–24m, 48 > 24m | < 6m, 6–24m, 24–42m | chi square trends | no | — | — |
| Romania | Globally depriving | 6y | 165 | dysfunction | problems in attachment, attention, emotional, autism, cognition, peer or conduct domains (parent & teacher-report) | 58 < 6m, 59 6–24m, 48 > 24m | < 6m, 6–24m, 24–42m | — | yes | — | — | |
| Nielsen, Coleman, Guinn, & Robb (2004) | Ug and a | Various levels of deprivation | 1–3y | 33 | temperament | care giver interview | 3m–3y; M = 1.5y, SD = .67y2 | < 1y, 1–2y, 2–3y2 | MANCOVA | no | — | — |
| Ug and a | Various levels of deprivation | 1–3y | 33 | aggressiveness toward other children, objects, and adults | observation of free play | 3m–3y; M = 1.5y, SD = .67y2 | < 1y, 1–2y, 2–3y2 | MANCOVA | yes: only for interaction | — | interaction between duration of institutionalization and contact with relatives; longer institutionalization and contact with relatives was associated with aggressiveness toward adults | |
| Ug and a | Various levels of deprivation | 1–3y | 33 | negative affect, crying | observation of free play | 3m–3y; M = 1.5y, SD = .67y2 | < 1y, 1–2y, 2–3y2 | MANCOVA | yes: only for interaction | — | interaction between duration of institutionalization and contact with relatives; only multivariate effect reached significance | |
| Ug and a | Various levels of deprivation | 1–3y | 33 | positive affect | observation of free play | 3m–3y; M = 1.5y, SD = .67y2 | < 1y, 1–2y, 2–3y2 | MANCOVA | no | — | — | |
| Marcovitch, Cesaroni, Roberts, & Swanson (1995) | Romania | Globally depriving | 7m–11y | 130 | Behavior problems | questionnaire designed for current study (parent-report) | 100 < 2y, 30 > 2y | < 2y, > 2y | — | yes, for some domains (but no statistical test) | — | — |
| Tan, Marfo, & Dedrick (2007) | China3 | Socially-emotionally depriving | 1.5y–5y | SN = 63 Non-SN = 689 | behavior problems | CBCL 1.5–5y (parent-report) | SN: M = 25.85, SD = 10.82; non-SN: M = 12.71, SD = 4.87 | continuous | multiple regression | no | — | — |
| China3 | Socially-emotionally depriving | 6y–15.7y | SN = 61 Non-SN = 280 | behavior problems | CBCL (parent-report) | SN: M = 46.98, SD = 37.45; non-SN: M = 15.61, SD = 15.80 | continuous | multiple regression | yes, for Total problems (but small correlation) | — | — | |
| Tan, Marfo, & Dedrick (2010) | China3 | Socially-emotionally depriving | 1.5y–5y | 452 | behavior problems | CBCL (parent-report) | 3–50m; M = 13.1m, SD = 5.1m | continuous, natural log transformed | correlation, regression | yes for correlations at Time 2; only for Total (not internalizing, externalizing) at Time 1; for regression, only T2 Externalizing ant Total were significant (small magnitude) | — | — |
| Null Results | ||||||||||||
| Barcons-Castel, Fornieles-Deu, & Costas-Moragas (2011) | Multiple | — | 6–11y | 52 | behavior problems | various BASC subscales (parent & self-report) | 8–84m; M = 28.75m, SD = 21.42m | < 12m, 13–36m, > 37m | unifactorial ANOVA | no | — | — |
| Colvert, Rutter, Beckett, Castle, Groothues, Hawkins, Kreppner, O’Connor, Stevens, & Sonuga-Barke (2008a) | Romania | Globally depriving4 | 6y, 11y | 144 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent & teacher-report) | < 43m | continuous; < 6m, > 6m | t-test, chi square | no | — | — |
| Kreppner, O’Connor, Rutter, & The ERA Study Team (2001) | Romania | Globally depriving | 4y, 6y | 137 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent & teacher-report) | 0–42m | continuous; < 6m, 6–24m, > 24m | correlation | no | — | — |
| Cohen & Farnia (2011) | China3 | — | 1.5–4y | 70 | behavior problems | CBCL (parent-report) | 8–21m; M = 13m | continuous | regression | no: ns for internalizing, marginal for externalizing | — | — |
| Dalen & Rygold (2006) | China3 | — | 7–13y | 77 | problem behavior | Rutter scales (teacher-report) | 2–52m; M = 6.88m, SD = 9.28m | — | step-wise multiple regression | no | — | — |
| Elliott & McMahon (2011) | China3 | — | 3–8y | 59 | anxiety | PAS, SCAS-P (parent-report) | 6–54m; M = 14.71m, SD = 7.66m | continuous | correlation | no | — | — |
| Goldney, Donald, Sawyer, Kosky, & Priest (1996) | Indonesia | — | M = 15.2y, SD = 2.1y | 34 | behavior problems | CBCL (parent-report) | 1m–7.5y; M = 17m, SD = 1.7y | continuous | correlation | no | — | — |
| Indonesia | — | M = 15.2y, SD = 2.1y | 34 | behavior problems | YSR (self-report) | 1m–7.5y; M = 17m, SD = 1.7y | continuous | correlation | no | — | — | |
| Juffer & van Ijzen doorn (2005) | Multiple | — | all ages | 29 studies, 14,581 participants | behavior problems | various | 45% of studies 0–12m; 21% of studies 12–24m; 24% of studies > 24m; 10% of studies not reported | < 12m, > 12m; < 24m, > 24m | meta-analysis | no for Total, Internalizing, and Externalizing | — | — |
| Miller, Chan, Tirella, & Perrin (2009) | Eastern Europe | Globally depriving | 8–10y | 50 | behavior problems | BASC (parent & teacher-report) | 4–55m; 50% < 18m | continuous | correlation | no | — | — |
| Tan, Camras, Deng, Zhang, & Lu (2012) | China3 | Socially-emotionally depriving4 | 2–6y | 133 | behavior problems | CBCL (parent-report) | 8–31m; M = 12.8m | continuous | correlation | no for Total, Internalizing, and Externalizing | — | — |
| Tan & Marfo (2006) | China3 | Socially-emotionally depriving | 1.5y–11y | 695 | behavior problems | CBCL (parent-report) | preschool: M = 14.2m, SD = 8.3m; school-age: M = 18.5m, SD = 23.7m | continuous, log transformed | correlation, hierarchical regression | no for Total, Internalizing, and Externalizing | — | — |
| Tizard & Hodges (1978) | UK | Adequate | 8y | 25 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent-report) | most between 2y and 4y; 5 between 4.5y and 7.5y | — | point biserial correlation | no | — | — |
| Tizard & Rees (1975) | UK | Adequate | 4.5y | 24 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent-report) | Mean = 3.11y, SD = .69y | — | — | no | — | — |
| Age at admission: Distribution | Age at admission: Measurement | Significant effect of age at admission? | ||||||||||
| Lee, Seol, Sung, Miller, & the Minnesota International Adoption Project Team (2010) | South Korea | Adequate | 4–8y | 382 | behavior problems | CBCL (care giver-report) | M and SD for children with relinquishing parent, living parent, and deceased/unknown parent were 0.96y (0.64), 4.69y (1.50), 4.47y (1.46) | < 2y, > 2y | ANCOVA | yes | — | — |
| Wolkind (1974) | UK | — | 5y–12y | 92 | antisocial disorder, stealing, lying, destructiveness, fighting, disinhibition | caregiver interview | 49 < 2y, 43 > 2y | < 2y, > 2y | chi square, Fisher exact test | yes, only for disinhibition | — | effect for disinhibition only significant in older at assessment group (> 8y) |
| Vorria, Rutter, Pickles, Wolkind, & Hobsbaum (1998b) | Greece | Socially-emotionally depriving | 9–11y | 41 | emotional (internalizing) and conduct (externalizing) problems | Rutter Scales (parent & teacher-report) | nearly half admitted around 5–6y; 16 admitted before 3.5y | < 3y6m, 3y6m–5y6m, > 5y6m | — | no | — | — |
Note. Age at adoption findings are listed above age at admission findings. Within each portion of table, top section includes positive results, middle section includes mixed results, bottom section includes null results.
CBCL = Child Behavior Checklist, ECI-4 = Early Childhood Inventory-4, PAS = Preschool Anxiety Scale, SCAS-P = Spence Children’s Anxiety Scale-Parent Report, YSR = Youth Self Report, BASC = Behavioral Assessment System for Children, SN = special needs, DSP = Deprivation-specific psychological patterns
m = months, y = years, M = mean, Md = median, SD = standard deviation
1
This study used time in the orphanage instead of age at adoption; these two variables were correlated at r = .97
2
These studies assessed children who were still institutionalized, so duration of institutionalization was assessed rather than age at adoption
3
The vast majority of children adopted from China are female
4
These articles did not provide information about the conditions of these institutions, but other studies from the same authors on the same sample did describe the severity of the deprivation.