What really helps adopted children thrive?

Adopted children can face many challenges, such as the impact of early trauma. What can parents do to support them? Author and adoptive dad Ben Fergusson investigates.

In 2018, my husband and I were one of the first married same-sex couples to adopt in Germany. Before we were approved, we had to complete a long process of interviews, financial and medical checks, as well as extensive preparation classes. In these classes, we were often confronted with the myriad challenges that many adoptive children face. Some of them are to do with a fundamental sense of separation and loss: what the Scottish writer and adoptee Jackie Kay, in her memoir, Red Dust Road, describes as the "windy place right at the core of my heart". Others are rooted in traumatic experiences that occurred before the adoption, which can include neglect and abuse, prenatal alcohol exposure, or spending early childhood in institutional care.

While individual experiences of adoption can vary hugely, these underlying traumas can pose long-term risks for the child. According to an analysis of 85 studies on the mental health of adoptees and non-adoptees, the risk of adoptees experiencing psychiatric disorders, having contact with mental health services, or treatment in a psychiatric hospital was approximately double that of non-adoptees. Similarly, a Swedish study on international adoptees found a higher risk of severe mental health problems and suicide in adolescence and young adulthood among children who had been adopted.

However, although being adopted is associated with these risks, a successful adoption placement can help vulnerable children overcome the early adversity they faced. Adoption has been shown to help close the developmental gap between children who have been in care and their peers, having a measurably positive impact on, for instance, their cognitive development.

For children who have faced abuse or neglect in their birth families, adoption and foster care can bring a range of long-term benefits that continue to have an effect well into adulthood – the most important arguably being an enduring sense of safety. But this journey can vary greatly depending on individual circumstances, notably the child's age at adoption. One study has shown that children adopted at a very young age were as securely attached to their permanent families as non-adopted children, while children adopted later tended to struggle more with attachment.

The question then, for an adoptive parent like me, is how best to help your child address these challenges. This seems basic enough. Something that science must have long since come up with some solid answers for. But when I talk to researchers about what has surprised them most about their work on parenting adopted children, their response is unanimous.

"Oh! How few studies there are," says Kathryn Murray, a psychologist and consulting associate at Duke University, North Carolina. She does not miss a beat. The sentiment is echoed by every researcher I speak to. There are plenty of studies on the developmental risks and challenges that young adopted children face, but far fewer on the nuances of their experiences, the best parenting strategies, or the children's development over the course of their lives.

"We have almost no research on adoption post childhood," says JaeRan Kim, an associate professor in the School of Social Work and Criminal Justice at the University of Washington at Tacoma, whose research focuses on the wellbeing and experiences of adoptees. "But if you're adopted, you don't stop having to deal with issues related to your adoption once you grow up," she says. "How do adopted people parent? What kind of adoptive parents do they make? How do they deal with the loss of their biological parents? And their adoptive parents? We need to better understand these questions so that we can offer them the right kind of support."

Because adoption is often framed as the final stop in a neglected or parentless child's journey to safety and stability, even the most basic information about the issues that children face after their adoption is frequently missing. This can include further trauma and disruption, such as abuse or abandonment by adoptive parents. It may even involve a return to foster care if the adoptive family lacks support and cannot cope with the consequences of early trauma, such as violent behaviour. "We know that not all adoptive parents raise their adopted children to adulthood," says Kim. "We call this adoption breakdown. But, here in the States, the figure could be anywhere between 5 and 25%. We just don't know for sure because the stats aren't there."

So with huge holes in the research literature, how can we, as adoptive parents, use science to become better at addressing our children's unique needs?

"Well, what we do have is lots of great research on the kinds of things that children who were adopted are more likely to have experienced," says Murray. "We know, for instance, that risk of suicide attempts is around four times higher for children who were adopted. That sounds really scary for someone thinking about adopting."

But when Murray and her team took a large sample and controlled for trauma, they discovered that trauma accounted for much of that heightened risk.

"That suggests that adoption in and of itself does not raise your suicide risk; but being adopted means that you are much more likely to have experienced trauma in the first few years of your life. And the good news is that we have lots of really great interventions for trauma." She gives the example of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), an evidence-backed treatment that has been shown to be effective at reducing post-traumatic stress symptoms, and other difficulties with mood and behaviour related to traumatic life events.

"Ambiguous loss"

When thinking about how one can deal with the traumas experienced by adoptive children, Kim points to the work of psychologist Pauline Boss who, in the 1970s, worked with the families of soldiers who had gone missing in action. Boss was trying to come up with a way to address the specific issue of grieving someone when you didn't know if they were dead or not, and she came up with the concept of "ambiguous loss". A loss that doesn't allow for any kind of complete emotional closure, such as the complex grief one might feel for a relative with dementia or for a child that was never conceived.

The focus of Boss's work was getting people grieving these complex losses to accept that what they were dealing with could be "both/and". Someone could be both here and not here. And it was possible to learn to live with that duality and still lead a satisfying life.

This approach is of course highly relevant to people who were adopted who often have missing or incomplete information about their birth families as well as countless intersecting dualities in their lives: birth parents, adoptive parents, sometimes foster parents too. If they've been adopted from another country, they may also have multiple cultural identities, neither of which they may feel they can fully inhabit. Boss's approach makes it clear that these children should not be made to feel that their differences don't matter. Indeed, adoptees have suggested that they would have benefited from questions and ambiguities being openly discussed and embraced in adoptive families.

For adoptive parents, it can also be important to acknowledge their own feelings of grief or loss. Murray cites the feelings that, in particular, straight couples who may originally have tried to conceive a biological child can have if their adopted child turns out to have a disability. "Some parents have already grieved a child they weren't able to conceive. And some parents we have spoken to describe experiencing a double grief when their adoptive child turns out, for example, to have special needs that they weren't aware of when they adopted." But, Murray says, when grief is taboo or shameful for parents and it stops them seeking help, that isn't good for them or their child.

This is just one example of the numerous ways in which research on what makes a good adoptive parent is often hampered by good intentions and cultural taboos, according to the experts I interviewed. People like to think about adoptive parents as moral people who are doing a good thing and who should not be told they could be doing it better. And they like to believe that parental love is salve enough to solve all problems. So they don't want to hear that, despite being loved unconditionally, an adoptive child can still struggle.

And yet, accepting these complex emotions and experiences around adoption can help adoptive parents let go of their old expectations of what having a child was going to be like, and embrace a different way of parenting.

One key approach for adoptive parents is what Pedro Alexandre Costa, a clinical psychologist and researcher from the University Institute of Psychological, Social and Life Sciences (Ispa) in Lisbon, Portugal, calls "responsiveness". This requires adoptive parents to engage with their children in a more receptive way, and focus on warmth, bonding and closeness rather than rules and discipline. "Adoptive parents do just have to make an extra effort," Costa says. "They need to be responsive to their child when they might want to be strict. For instance, if their child is having a tantrum. For an adoptive child, you need to understand that they are trying to communicate something that they cannot express."

This responsiveness and openness also needs to be applied to issues of attachment and security. "Adoptive parents need to be much more explicit with their child, for instance, that they are going to be around for the long haul," Costa adds.

For this to be a success, it often involves parents having to rethink their approach to parenting, and engage more deeply in how they are responding to their child. But this can also be a source of pride, and result in a closer parent–child relationship. And there is no question that this relationship is central to dealing positively with the issues faced by kids who have gone through the care system. When I ask Costa what has most surprised him about his research into adoption, he points to the positive statistics on adoption improving a wide range of developmental outcomes, saying that he had not expected that "despite the difficulties, most children and parents are doing really well".

For me, the key phrase here is "despite the difficulties…" Despite the difficulties of adoption, my life with my husband and my son is still defined by the everyday travails and very deep joys of family life. Sharing a cheeky doughnut on the way back from nursery, holding hands as we watch a red squirrel traverse the willow by the supermarket, trying not to laugh as our son pulls faces at the dinner table. These moments transcend the necessary legal convolutions of adoption that marked our first years as parents.

The adoptive parents and grown-up adoptees I know have experienced a very broad range of challenges, many of which are unique to adoption. But the truth is that, despite the difficulties, they have each, in their own way, created families as complex and full of joy as anyone else's. Not without setbacks. Never without loss. But joyful, nonetheless.

Ben Fergusson is a writer and translator. He is the author of three novels and the non-fiction book Tales from the Fatherland, an exploration of adoption and same-sex parenthood. He lives in Berlin with his husband and son.

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