Behavior Study

8/3/2019 Behavior Study

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Parental Assessment of Behavior in Chinese Adoptees During Early Childhood

Jay W. Rojewski, Ph.D.

Department of Occupational Studies

University of Georgia

Michael S. Shapiro, Ph.D.

Michael S. Shapiro and Associates, PC

Piedmont College

Athens, Georgia

Mary Shapiro, Ph.D.

Michael S. Shapiro and Associates, PC

Piedmont College

Athens, Georgia

All correspondence concerning this manuscript should be addressed to Dr. Jay W. Rojewski, Department

of Occupational Studies, University of Georgia, 210 Rivers Crossing, Athens, GA 30602 (706.542.4461;

e-mail: [email protected]).


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Abstract

The Parent Rating Scale of the Behavior Assessment Scale for Children (PRS-BASC) was used to

examine the behavior of 45 Chinese adoptees. In all but one case, results from the 9 BASC-PRS scales

ranged in the average, or normal, range. Thus, as a group, no deviations from normal behavior were

revealed. However, the variability of ratings for several scalesHyperactivity, Aggression, Conduct

Problems, and Attention Problemsindicated a greater potential for at-risk behavior. Age of adoption

from China was not a significant influence on parents perceptions of adoptees behavior. However, older

adoptees were more likely to be rated hyperactive or aggressive than younger children, while younger

adoptees were more likely to exhibit withdrawal.

KEY WORDS: Intercountry Adoption, Chinese Adoptees, Child Behavior.


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Parental Assessment of Behavior in Chinese Adoptees During Early Childhood

Today, adoption is viewed as a viable alternative for building a family. However, it has only been since

the end of World War II that the negative stigma associated with adoption has diminished.1

Ironically, as

the interest in adoption increased, the availability of healthy adoptable babies and young children in the

United States (and other industrialized Western countries) decreased due to falling birth rates and growing

social acceptance of single parenthood. As a result, many adoptive couples began to look to other

countries and cultures for adoptive children.2, 3

International adoption, also referred to as intercountry adoption (ICA), was popularized after the

Korean War when extensive efforts were initiated to bring orphaned and abandoned South Korean

children to the United States.4

Around this time, international adoption was largely motivated by the

adoptive parents desire to rescue abandoned children (p. 84).2

While many couples still cite religious and

humanitarian reasons for adopting internationally, more recent interest has increased among couples

primarily motivated by infertility. Regardless of adoptive couples motives, international adoption has

steadily increased over the past decade to where now the practice is a permanent part of American

culture.3, 5, 6

For example, in 1989, a total of 7,948 intercountry adoptions were recorded by the U.S.

Immigration and Naturalization Service.7

This figure almost doubled to 15,774 in the 1998 calendar year.

While many countries are represented in U.S. intercountry adoptions, a majority of adoptees come from

Asia, Central America, and South America.8

One country where international adoption has received increased attention over the past several years

is China. Given Chinas one childpolicy to control population growth and an historical preference for sons

to support and care for parents in old age, many female children are abandoned in hopes of giving birth to

a male child.9,10

As a result, the number of girls in state-run orphanages has swelled dramatically during

the past decade. In an effort to relieve some of the pressures associated with this extremely complex and


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difficult situation, the Chinese government allows the international adoption of abandoned girls.6

Adoption

of Chinese children by U.S. families has grown from 201 in 1992 to 4,206 in 1998.7

According to INS

immigration visa records, a total of 14,749 Chinese children have been adopted by U.S. parents from 1985

through 1998.11

Research on international adoption by U.S. families is limited, although a fair number of studies have

been carried out in Europe [Unfortunately,] most are not available in English and many are not

published (p. 747).3

Available research has tended to focus on the initial and long-term adjustment of

adopted children and their familiesKorean adoptees in the 1970s and a more diverse population including

Vietnamese and Colombian adoptees in the 1980s. Although much of the early research reports generally

positive outcomes, empirical findings on the adjustment of international adoptees is still inconclusive and, at

times, contradictory.4

Some studies have shown that functioning levels of intercountry adoptees do not significantly differ

from nonadopted or domestically adopted children. A nationwide study by Kim12

examined the long-term

adjustment of Korean adoptees in the U.S. focusing on identity and socialization patterns. Korean

adoptees were found to progress well in all areas of life, report a positive self-concept, and did not

experience any serious mental health problems. Bagley8

reported that Korean adoptees exhibit very good

patterns of adjustment and high academic achievement. Recently, Levy-Shiff, Zoran, and Shulman13

found

no significant differences in the school adjustment, psychological adjustment at home (e.g., anxiety,

depression, hyperactivity, and self-concept), or ability to cope with adoption issues between international

and domestic adoptees in a sample of 100 Israeli families. Tizard3

provided an extensive summary of

additional studies that have reported positive findings about the behavioral-emotional characteristics of

international adopteeschildren adopted from South Korea, Latin America, Thailand, Vietnam, India, and

other Asian countries (e.g., Hoksbergen,14

Kuhl15

).


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Other studies have reported less positive findings. Kim et al.1

reported that common behavioral

problems of young Korean adoptees included temper tantrums and excessive or frequent crying, especially

in children adopted before the age of 3 years. In children adopted after the age of 3, learning difficulties

and shyness-withdrawing behavior were the most common problems. Jenista and Chapman16

compared

adopted and nonadopted children referred for mental health counseling and found that behavioral and

emotional problems increased for adoptees as the childs age of placement increased. Even then, however,

reported problems usually fell within the normal ranges of all children clinically referred.

Verhulst, Althaus, and Versluis-Den Bieman17

compared the prevalence of behavioral-emotional

problems and competencies of internationally adopted children living in the Netherlands with nonadopted

Dutch children and found that adopted boys, ages 12-15 years, exhibited higher rates of externalized

behavior problemshyperactivity and delinquency. In a follow-up study, Verhulst and Versluis-Den

Bieman18

continued to see a significant increase in maladaptive behaviorsparticularly withdrawn and

delinquent behaviorand a decrease in competencies of ICA adolescents. The authors were not able to

attribute these problem behaviors to the age or medical condition of the child at placement, early abuse or

neglect, or racial antagonism. Hoksbergen19 also reported increased behavior problems in his study of

international adopteeshigher rates of internalized behavior problems for girls and externalized behavior

problems for boys. In general, problem behaviors were most likely to be found in adolescents rather than

younger children.3

It is important to remember that for a majority of international adoptees outcomes are positive; they

have close and mutually satisfying relationships with their parents and are as successful as other adoptive

families.5

When difficulties do occur they are often attributable to children who were adopted at a

relatively late age or as a consequence of early traumatic experiences.3

Despite the increasing numbers of ICA adoptions, including those of Chinese children, by U.S.

families, relatively little is known about the scientific, psychological, or social issues surrounding these


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children and the adoption process. Therefore, our purpose in this study was to profile select behavioral

characteristics of young Chinese adoptees. The information provided may contribute to an emerging

understanding of the demographic, psychological, and social characteristics of Chinese adoptees. In

addition, knowledge can be used to address the general lack of awareness and understanding about (1) the

theoretical relevance, (2) potential applied and policy issues, and (3) developmental trajectories of social

relations and attachment patterns currently associated with intercountry adoption.2

Given the contradictory

nature of the literature, it was difficult to establish a priori hypotheses, although the trend toward finding

increased behavioral-emotional problems during adolescence influenced our belief that relatively fewer

behavioral problems would be encountered with young Chinese adoptees.

Method

Participants

A total of 61 research packets were mailed to adoptive families who had adopted children from China

within the past 5 years and completed their adoptions through a state-licensed, church-sponsored agency

located in the Southeast. Only parents with adopted children 2 years of age or older were included in the

original data pool. A total of 44 families returned completed research materials representing a 71.1%

return rate. Responding families resided throughout the United States. All parents were Caucasian and

between the ages of 35-50 years. Most families were in middle or upper socioeconomic levels.

Responses for 45 children (1 family had two children adopted from China) were included in the final

data pool including 39 females and 6 males. Thirty-eight children were under the age of 6 years (female, n

= 33; male, n = 5), while 7 children (female, n = 6; male, n = 1) were 6 years of age or older. The mean

current age of adoptees was slightly under 4 years of age (M= 46.9 months, SD = 19.1,Mdn = 43.0) with

ages ranging from 22 months to 116 months (9 years, 8 months) of age. The mean age at adoption was

found to be 21.7 months (SD = 17.9), although the median of 15.0 months may provide a more accurate

description of the sample as 86.7% of children were adopted on or before their 3rd birthday. Ages at


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adoption ranged from 1 month to 84 months (7 years). The average length of time adoptees had spent in

their adoptive homes was 25.5 months (SD = 15.6) ranging from a low of 3 months to a high of 62 months

(4 years, 2 months.). Interestingly, the mode of 38 months (3 years, 2 months) was reported by 20% of the

sample (n = 9).

Instrumentation

The Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC)20

was used

to collect data regarding parental perceptions of adoptees behavior. The BASC provides a multimethod,

multidimensional assessment of emotional disorders, personality constructs, and behavioral problems of

children. The BASC contains five separate components that can be used individually or in any combination

including a childs self-report scale (for older children), parent rating scale, teacher rating scale, structured

developmental history, and a system for recording directly observed behavior.21

The PRS contains 131

items that measure parents perceptions of their childs adaptive and problem (clinical) behaviors in

community and home settings. Three forms are available for different age groupspreschool, child and

adolescent. The PRS uses a four-choice response format ranging from neverto almost always and takes

approximately 15-20 minutes to complete.

The following 9 clinical scales were used: Aggression, Anxiety, Attention Problems, Atypicality

(psychoticism), Conduct Problems, Depression, Hyperactivity, Somatization, and Withdrawl. The

Hyperactivity, Aggression, and Conduct Problems scales can be combined to reflect an Externalizing

Problems composite score. Hyperactivity refers to the tendency to be overly active, rush through activities,

and act impulsively. Aggression is defined as verbal or physical behavior that is hostile or threatening to

others. Conduct Problems consist of antisocial or rule -breaking behaviors including the destruction of

property (scores are available only for children 6 years of age or older). Internalizing Problems are

reflected in results of Anxiety, Depression, and Somatization scales. Anxiety is a tendency to be nervous,

fearful, or worried about real or imagined problems. Depression includes feelings of unhappiness, sadness,


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or stress that bring about an inability to carry out daily activities or bring on thoughts of suicide.

Somatization describes being overly sensitive to relatively minor physical problems or discomforts. Three

additional scalesAttention Problems, Atypicality, and Withdrawlwere also included for analysis.

Attention Problems denote a tendency to be easily distracted and unable to concentrate for extended

periods. Atypicality refers to immature behavior considered odd or associated with psychosis. Withdrawl is

the tendency to avoid social contact.21

The BASC has generally received high marks as a reliable instrument. Past studies on the reliability of

the PRS, in particular, have found internal consistency coefficients ranging from the low .60s to the high

.80s with median correlations near .80. Merenda22

indicated that in general, the coefficients of internal

consistency [for the BASC] are quite impressive . . . at least half of them are in the range .80-.89 (p.

231). Test-retest estimates are less impressive, although most studies have reported correlations ranging

from around .70 to .90. Sandoval and Echandia23

urged users to exercise caution when using the BASC

with preschool children as instrument reliability scores tended to be lower. Reasonable evidence of

instrument validity has been established in several studies showing moderate correlations with similar types

of scales, e.g., Conners Rating Scales, and the Revised Behavior Problem Checklist.24

Reynolds and

Kamphaus20

reported the results of both exploratory and confirmatory factor analyses for the PRS that

provide additional evidence of the underlying structure (i.e., validity) of BASC results.

The BASC provides two major types of norms for the PRS, general and clinical. The general norms

were used in this study and are considered representative of the general U.S. population. PRS norms are

based on maternal ratings only; relatively small differences exist between mothers and fathers scores.24

Norms are subdivided by age and gender to reflect actual differences reported between males and

females. Specifically, females tend to score higher on the Depression scale, while males tend to obtain

higher scores on Aggression, Conduct Problems, Hyperactivity, and Attention Problems. Reynolds and


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Kamphaus20, 21

recommended using the general (combined) norms for most situations to allow these

gender differences to be reflected in normative scores

Prior to the interpretation of an individuals results, the raw scores on the BASC-PRS are

standardized by calculating raw scores for each behavior scale into linear T-scores (M= 50, SD = 10).

This procedure is advisable because many of the constructs being measured are . . . not normally

distributed, and this metric preserves underlying dimensions (p. 422).23

The T-score range, 41-59 T, is

considered average. Conversely, T-scores of 60-69 Tare considered within the at-riskrange, while scores

greater than 70 Tare deemed clinically significant. Percentile equivalent scores are also provided for all

standardized scores.20,24

Procedure

A copy of the computer-scored BASC-PRS (1 page front and back) was included in a packet of

information sent by the adoption agency to all parents who had adopted children from China in the past 5

years and whose child was 2 years of age or older at the time of the investigation. The packet contained

information about a planned China families reunion weekend sponsored by the agency and scheduled for

later in the year. A cover letter informed participants about the behavior scale and that information

obtained from the BASC was being used in preparation for several workshops scheduled as a part of the

reunion weekend. Confidentiality of response was assured to all participants. A period of four-weeks was

established for receiving responses, at which time data collection ceased. Reminders to respond to the

instrument were included in several agency mailings that offered additional information about the summer

reunion.

Data Analysis

Several analyses were chosen to address our research questions. First, the entire sample was used to

calculate descriptive statistics for parent responses to the 9 BASC scales. In addition to an overall

description, we examined scores by gender as differences in behavior between male and female children


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have been reported.20,21,24

Next, we removed male adoptees scores from the remainder of our analysis as

males represented a small proportion of our sample (n = 6). The small number of male adoptees in our

sample reflects the current situation regarding adoption from China, i.e., the vast majority of children

adopted from China are female.9,10,6

While the removal of male adoptees scores did reduce our overall

sample size, the remaining pool of female scores can be interpreted without the potentially confounding

influence of gender and also reflects the fact that most Chines adoptees are female.

The final analysis included three sets of comparisons designed to examine parent ratings of adoptees

behavior on the 9 BASC scales (dependent variables) based on three independent variables: age of child at

adoption (2 groupschildren adopted before 18 months of age or after 18 months of age); current age of

adoptees (2 groupschildren 3 years of age or younger and those over 3 years of age); and, the length of

time since placement with adoptive family (2 groupschildren in adoptive homes less than 2 years or

those longer than 2 years). Only 2 groups were constructed for each set of statistical comparisons

primarily because of the small sample size. The alpha level for significance tests was set at .05, even

though this raised the possibility of Type I error because of probability pyramiding. The decision was made

because of the exploratory nature of this research and our desire to identify differences if they existed.

Effect size (ES) coefficients (Cohens d, standardized difference) were calculated for statistically

significant comparisons to examine the magnitude, or practical importance, of observed differences.

Knowledge of effect size can help clarify the implications that statistically significant results have for

theory and practice.25

Results

Description of Adoptees Behaviors

Descriptive data was generated for the entire sample, as well as by gender. However, since only a

small number of males were represented, these findings must be interpreted with caution. Even so, we felt

it was important to include data about male adoptees because of a lack of available literature describing


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adopted children from China. Using Reynolds and Kamphaus20

guidelines for interpretation, all but one of

the BASC-PRS scales ranged in the average, or normal, range. Thus, as a group, no deviations from

normal behavior were revealed (see Table 1). However, when looking at the variability of scores (using

1 SD to account for roughly 68% of the sample), ratings for several scalesHyperactivity, Aggression,

Conduct problems, and Attention problemsindicate greater potential for at-risk behavior (see Fig. 1).

Table 1

Parental Ratings (T-Scores) of Childrens Behavior on 9 BASC Scales

BASC scales Female Male Total

M SD %-tile M SD %-tile M SD %-tile

Hyperactivity 46.92 11.87 43rd

54.33 13.92 69th

47.91 12.26 46th

Aggression 47.97 10.28 47th

50.00 11.98 55th

48.24 10.40 47th

Conduct problemsa

52.00

15.40 67th

60.00

86th

53.14 14.38 70th

Anxiety 44.92 7.45 32nd

44.17 6.79 32nd

44.82 7.29 32nd

Depression 45.54 8.34 35th

45.00 9.47 35th

45.47 8.38 35th

Somatization 46.03 9.85 36th

39.50 4.46 17th

45.16 9.54 36th

Atypicality 47.97 8.75 50th

47.00 9.82 50th

47.84 8.79 50th

Withdrawl 49.85 10.31 52nd 39.33 9.18 12th 48.31 10.82 47th

Attention problems 45.79 10.57 33rd

54.83 11.57 54th

47.00 11.01 37th

Note. Some percentile scores have been rounded or estimated to accommodate use ofT-scores rather

than raw scores.aScores for Conduct Problems were available only for children 6 years of age or older (n

= 6 for females, n = 1 for males).

Scales indicating slightly elevated risk of behavior problems. While none of the mean ratings fell into

at-risk or clinically significant categories, four scales had enough score variability to indicate the presence

of an elevated risk of behavior problems. Hyperactivity T-scores ranged from 23 to 76 T. The mean score

for boys was approximately three-fourths a standard deviation higher than for girls. Additionally, when


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score variability was considered, boys were at a higher risk of being identified as hyperactive. Eight

adoptees scores were rated at or above the at-riskthreshold, T 60 (female, n = 6; male, n = 2).

BASC-PRS scales

Figure 1. Mean T-scores and standard deviations on BASC-PRS clinical scales for children from China.

As a group, parent ratings of aggressive behavior were within normal limits. Scores ranged from 33 to

73 Tand were similar for boys and girls. Five children (female, n = 4; male, n = 1) had scores above the

range reflecting normal behavior. It seems that when parents indicated aggressive behavior in their child,

they were likely to rate it as a serious concern. Four of these 5 children had Aggression scores that placed

them in the clinically significant range (T 70). As a group, boys were at slightly greater risk of being

identified as aggressive than girls.

Parents ratings on conduct-related behavior was obtained only for the 7 adoptees who were 6 years

of age or older; this may have been a contributing factor to the larger variability of scores observed for

girls. Only one boy was included in this group which did not allow for any meaningful comparison of mean

Conductproblems

(6+yearsofage)

Attentionproblems

10

20

30

40

50

60

70

80

90

100

Hyperactivity

Aggression

Anxiety

Depression

Somatizatio

Atypicality

Withdraw

At-risk range

Clinically significant

risk

T-scores

Female mean T-scores

and standard deviations

Male mean T-scores and

standard deviations


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scores based on gender. Two adoptees (female, n = 1; male, n = 1) had behavioral ratings that placed

them in the at-risk range for conduct problems.

Scores on the Attention problems scale ranged from 25 to 71 Twith the overall mean at the 37th

percentile. Boys had a considerably higher mean score on the Attention problems scale (+.82 SD) than

their female peers. Scores of 2 boys (out of 6) and 3 girls were situated in the at-risk range.

Scales within normal ranges of behavior. With only one exception, results on the remaining 5 BASC-

PRS scales are interesting for their similarities rather than differences. Mean scores on the Anxiety,

Depression, and Atypicality scales were almost identical for girls and boys, as was the variability of these

scores expressed in standard deviation units. Scores on the Anxiety scale ranged from 29 to 59 T. None

of the individual Anxiety ratings were at or above the at-risk threshold of 60 T. Depression scores ranged

from 30 to 71 T; although, the behavior of only one girl was rated high enough to be identified as at-risk.

Parent ratings on the Atypicality scale ranged from 29 to 79 Twith 2 scores in the at-risk range.

Ratings obtained for Somatization and Withdrawl scales were higher for boys than girls; the only two

with this response pattern. Scores on the Somatization scale ranged from 16 to 71 T. And, while the mean

Somatization score for girls was .69 SD greater than for boys, both ratings were within acceptable

behavior ranges. Only 3 scores, all girls, were above the specified range for normal behavior.

Scores for adopted girls on the Withdrawl scale were almost a full standard deviation higher than for

boys. This large difference can probably be attributed to several issuesa very low mean score for boys

located at the 12th percentile, and although not reflective in the overall distribution of scores (see Figure 1),

Scores for five girls were in the at-risk range and one was in the clinically significant risk range. Parent

perceptions on this behavior scale ranged from 25-71 T.


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Influence of Age on the Perceived Behavior of Girls Adopted form China

A series oft-tests were used to examine the possible influences of three variablesage of child at

time of adoption, current age of adoptees, and the length of time children had lived with their adoptive

familyon the behavior ratings of adoptees using to the 9 BASC scales as dependent variables.

Age at adoption. Two age groups were constructedchildren adopted before 18 months (n = 25) and

children adopted after 18 months of age (n = 13). None of the t-tests comparing these two groups on the 9

BASC-PRS scales were statistically significant at the .05 level. This seems to indicate that age of adoption

from China was not a significant influence on parents perceptions of adoptees behavior. The behaviors

of children were similar regardless of their age at the time of adoption.

Current age of adoptees. A second series of analyses examined perceived behaviors of adoptees

according to current age: 3 years of age or younger (n = 17) and over 3 years of age (n = 22). Results of

the t-tests revealed statistically significant differences on Hyperactivity, Aggression, and Withdrawl scales.

Although differences were noted, mean scores for both groups were still well within normal ranges for

behavior. Even so, the behavior of older adoptees was rated more hyperactive (M= 51.68) than that of

their younger peers (M= 40.76), t(37) = -3.17,p = .003. The magnitude of this difference was

substantial. AnES coefficient of 1.02 indicated that approximately 84% of younger children scored at or

below the mean score established for the older adoptees group. Similarly, older adoptees were rated higher

on the Aggression scale (M= 51.91) than younger adoptees (M= 42.88), t(37) = -2.99,p = .005,ES =

1.00. Conversely, younger children were rated significantly higher in withdrawl behavior (M= 53.82) than

their older peers (M= 46.77), t(37) = 2.23,p = .03,ES = .71.

Length of time with adoptive family. A final series oft-tests examined the potential differences

between children placed with their adoptive family for less than 2 years (n = 22) and those placed for

more than 2 years (n = 16). Statistically significant differences were found on the Hyperactivity,


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Aggression, and Somatization scales. Consistent with earlier findings, the mean scores of both groups

were within normal behavior ranges. Children placed over 2 years ago were rated higher on the

Hyperactivity scale (M= 51.63) than adoptees in their homes less than 2 years (M= 43.32), t(36) = -2.21,

p = .03,ES = .73. Likewise, children with longer residence had higher aggression scores (M= 52.19) than

children in their adoptive homes for shorter lengths of time (M= 45.23), t(36) = -2.14,p = .04,ES = .66.

Children placed with their adoptive family more than 2 years ago were also rated higher (M= 49.75) on

the Somatization scaleoverly sensitive to minor physical problemsthan children in adoptive homes for

2 years or less (M= 43.09), t(36) = -2.13,p = .04,ES = .77.

Discussion

This study sought to describe the behavior of young children, primarily preschoolers, adopted by U.S.

parents from China and to examine the potential influence of age and placement on behavior. The

importance of analyses like this one is the improved understanding they can bring to the practice of

intercountry adoption in general and to children adopted from China in particular. Even so, several

delimitations should be kept in mind as these results are interpreted. First, we measured and examined

parent perceptions of their adopted childs behavior. While parents perceptions are critical in determining

the appropriateness of behavior, other sources of information were not used. Future studies may

incorporate additional information sources such as childcare providers or social workers. Regardless of

how data was collected, the positive results described in this study cannot be used as a predictor of future

behavior. In fact, some researchers3,5

have indicated that most behavior problems in adopted children

occur during adolescence. Third, our results were obtained with a relatively small sample and may not be

reflective of the population of U.S. adopted children from China. However, many past ICA studies have

also relied on small sample sizes given the difficulty in locating and following up with adoptive

families.1,12,26

Finally, many issues of particular interest and importance in determining long-term behavior

of intercountry adopteescultural identity formation, self-concept, attachment and bonding, or experiences


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of racism and discriminationwere not addressed. Additional study is needed to provide information on

these issues.

Despite these potential constraints, we feel our results do contribute to a better understanding of the

behavior patterns of Chinese adoptees in early childhood. Data can be added to the existing literature on

ICAs to form a preliminary baseline of behavior and behavioral expectations for children from China; not

only for current adoptees but for future adoptees, as well.

Past literature1, 3, 5, 6, 8, 12

describes the vulnerability of intercountry adoptees to a variety of problems

including developmental delays, social difficulty, and behavioral/emotional problems as a result of maternal

deprivation and abandonment, lack of an attachment figure in country of origin, visible differences between

adoptive family and adoptee, racism-discrimination-prejudice, and concern or confusion with cultural

identify formation. Although these are important concerns and could contribute to behavior-related

problems, our results show that, in general, adoptees, regardless of their gender, did not deviate from

normally expected behaviors to a significant degree. These findings support the past work of researchers

like Kim12

who reported no significant behavioral or mental health problems with a sample of South

Korean adoptees. Other studies8,13,14,15

have found concurring results for children adopted from a variety

of countries including Latin America, Thailand, India, and Vietnam. Our findingsthat some adoptees

were at slightly greater risk of hyperactivity, aggression, and conduct or attention problemsextends the

results of these previous studies.

The normalcy of BASC-PRS ratings might be the result of several factors, either alone or in

combination. Typically, families able to adopt internationally have the economic resources that allow

access to needed services, institutions, and support.2, 27

Conceivably, parents would have greater access to

medical care and psychological counseling should behavior problems be identified The nature of parenting

may also be reflected in these findings. Most parents adopting from China, or any other international

locale, tend to be older (at least 35 years of age for China) and have made conscious decisions about


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bringing an adopted child into their family. This situation probably results in highly motivated, interested,

and actively involved parenting that may reduce, distinguish, or overlook minor behavior problems. Third,

while speculative, it is possible that adoptive families share similar values and beliefs (e.g., middle/upper-

class values) that are reflected in daily interactions between adoptive parents and child, e.g., discipline and

nurturing.

Another possible explanation for these positive findings may be the preponderance of girls in our

sample. Kim28

claimed that the positive results from behavioral studies on intercountry adoptees,

particularly children from South Korea, was probably due to the overrepresentation of adopted girls. He

observed that, regardless of adoptive status, most epidemiological studies have shown a lower risk of

emotional and behavioral problems for girls than boys. Future study may focus on the characteristics of

boys adopted from China to determine if they are at greater risk of emotional or behavioral problems.

Several other possible explanations exist, such as the one advanced by Jenista,29

Bazzoli30

and others

who noted that a majority of infants being adopted from China have been in excellent physical and mental

condition. Kim28

attributes the good health of Chinese adoptees to a reflection of Confucian beliefs held by

orphanage workers that place high value on children. These views result in good pre-adoption care.

Further, since most children are young when adopted, the long-term, maladaptive effects of

institutionalization, if any, are less apparent. Even for children that many have suffered from

institutionalization, Tizard3

reported that most intercountry adoptees make rapid progress within the first

year of their arrival, especially younger children.

The influence of adoptee age on parents behavior ratings was somewhat mixed. The childs age at

time of adoption did not make a difference in assessment of behavior. Girls adopted earlier or later in life

exhibited similar types of behavior patterns. When current age was examined, older adoptees were found

to have higher ratings for hyperactivity and aggression, while younger adoptees rated higher in withdrawl

behavior. When length of placement in adoptive home was examined, adoptees placed for longer periods


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of time had higher hyperactivity, aggression, and somatization scores than their more recently placed

peers. As these differences are considered, it is important to note that group mean scores were all within

normal behavior ranges.

Several possible explanations for these findings might be advanced. For example, the lack of at-risk

behavior in our sample of adoptees might reflect Tizards3

belief that the earlier adoptions occurred, the

smaller chance of educational or behavioral problems. It is also possible that our participants were simply

too young (most under 5 years of age) for us to be able to detect behavior problems or differences. Many

studies assert that behavior problems become more evident as adoptees grow older. Jenista and

Chapman16

found that while adoptees behavior problems increased with age, they were within normally

acceptable limits. For our group, it is possible that the short time span between younger and older adoptees

was not sufficient to reveal many differences. Deacon5

noted that significant increase in counseling of

intercountry adoptees for psychological and behavior problems between ages 11 to 15 years. Follow-up

study is important to determine the long-range implications of age and placement issues like those studied.

Differences we found generally support and extend the conclusions of past researchers. Adoptees

who were older or had been placed in their adoptive home longer generally had higher scores, although

behavior ratings were still within normal ranges. Kim12

found that age at placement and length of

placement did not significantly relate to formation of adoptees self-concept. Similarly, Verhulst and

Versluis-Den Bieman18

reported that the age or time of placement could not explain increases in

maladaptive behaviors of adopted adolescents. It is possible that the behavior differences we observed are

precursors to the increased chances of behavior problems many intercountry adoptees experience as

adolescents. However, as Serbin2

noted, the developmental trajectories of such patterns are currently

unknown (p. 89). This, again, points to the need for long-term research and follow-up of adoptees.

Another possible explanation is that behaviors (hyperactivity and aggression in particular) may be initiated


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by adoptees as preliminary efforts to differentiate self from family members but are misinterpreted by

parents as inappropriate behavior5.

International adoption from China, or any other country, is a complex and oftentimes controversial

practice.6,13

Difficulties are compounded by limited and inconclusive data about the effects of international

adoption on childrens adjustment and well being. While discrepancies exist, evidence from this study

suggests that Chinese adoptees exhibit generally normal behavior patterns similar to international adoptees

from other countries examined in prior studies. Although older children had higher hyperactive and

aggressive behavior patterns than their younger peers, these behaviors were still well within normal

behavioral expectation for preschoolers. The results are positive in that, at least at this relatively early

stage of life, adoptees did not experience significant behavioral problems as a result of their experience.

Continued study and follow-along will be important to document developmental obstacles, beneficial

supports, or behavior changes that occur as adoptive preschoolers enter elementary school, become

adolescents, and enter adulthood.

Summary

The purpose of our study was to profile select behavioral characteristics of children adopted from

China. The Parent Rating Scale of the Behavior Assessment Scale for Children (PRS-BASC) was

completed and returned by 44 of 61 families (71.1%) with children adopted from China. Results indicated

that, as a group, no deviations from normal behavior were found. When the variability of scores was

examined, several scalesHyperactivity, Aggression, Conduct problems, and Attention problems

revealed the presence of an elevated risk for behavior problems. The age at which children were adopted

was not a significant factor on parents perceptions of behavior. Older children were more likely to be

rated hyperactive or aggressive than younger children, while younger children were more likely to exhibit

withdrawl. Even so, the majority of respondents scores placed adoptees behavior well within normal,

acceptable ranges. While discepancies exist, our evidence is positive, suggesting that Chinese adoptees


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exhibit generally normal behavior patterns similar to international adoptees from other countries. Continued

study and follow-along will be important to document the changes that may occur in behavior, self-identity

and adjustment in future years.

References

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study. Child Welfare 63: 419-428, 1979.

2. Serbin LA: Research on international adoption: implications for developmental theory and social

policy.Int J Behav Dev 20: 83-92, 1997.

3. Tizard B: Intercountry adoption: a review of the evidence.J Child Psych Psychiatry Allied Discp 32:

743-756, 1991.

4. Wilkinson HS: Psycholegal process and issues in international adoption. Am J Family Therapy 23:

173-183, 1995.

5. Deacon SA: Intercountry adoption and the family life cycle.Am J Family Therapy 25: 245-260, 1997.

6. Riley NE: American adoptions of Chinese girls: the sociopolitical matrices of individual decisions.

Womens Studies Intl Forum 20: 87-102, 1997.

7. Immigration and Naturalization Service:International adoptions1989-1998 [WWW document].

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Hong Kong Psych Soc 28/29: 95-115, 1992.

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Bloomington, IL: StarNet Digital Publishing, 1997.

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11. FCCChina Adoption Statistics: Statistical information on adoptions from China [WWW

document]. URL: http://fwcc.org/statistics.html, 1999.


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12. Kim DS: Issues in transracial and transcultural adoption. Soc Casework59: 477-486, 1978.

13. Levy-Shiff R, Zoran N, Shulman S: International and domestic adoption: child, parents, and family

adjustment.Intl J Behav Dev 20: 109-129, 1997.

14. Hoksbergen RAC: Intercountry adoption coming of age in The Netherlands: basic issues, trends, and

development. In:Intercountry Adoption: A Seven Country Perspective, eds. Alstein H, Simon RJ.

New York: Praeger Publishing, 1990.

15. Kuhl W: When Adopted Children of Foreign Origins Grow Up. Osnabruck: Terre des Hommes,

1985.

16. Jenista JA, Chapman D: Medical problems of foreign-born adopted children.Am J Diseases Child

141: 293-302, 1987.

17. Verhulst FC, Althaus M, Versluis-Den Bieman HJM: Problem behavior in international adoptees: I. an

epidemiological study.J Am Acad Child Adolesc Psychiatry 29(1): 94-103, 1990.

18. Verhulst FC, Versluis-Den Bieman HJM: Developmental course of problem behaviors in adolescent

adoptees.J Am Acad Child Adolesc Psychiatry 29: 51-159, 1995.

19. Hoksbergen RAC: Turmoil for adoptees during adolescence?Intl J Behav Dev 20: 33-46, 1997.

20. Reynolds CR, Kamphaus RW:Manual for the BASC: Behavior Assessment System for Children.

Circle Pines, MN: American Guidance Service, 1992.

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24. Kline RB: New objective rating scales for child assessment, I. parent- and teacher-informant

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Teacher Report Form.J Psychoeduc Assess 12: 289-306, 1994.

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Researcher26(5): 29-32, 1997.

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