A Moderator for Risk for Borderline Features in TeensA Comparison Study Reasons for StudyGeneral Previous adoption studies have focused on generalized studies comparing adoptees to their nonadoptee counterparts only across developmental domains school achievement physical health social d ID: 581992
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Slide1
The Relationship of Adoption and Attachment in Adolescence
A Moderator for Risk for Borderline Features in Teens-A Comparison StudySlide2
Reasons for Study-General
Previous adoption studies have focused on :
generalized studies comparing adoptees to their non-adoptee counterparts only across developmental domains: school achievement, physical health, social development capacity
current identity studies in adoption have included the adoption triad (birth parents, adoptive parents and adoptees) within a context of a family system, openness and access to information; not the individual adoptee
cross-cultural studies looking at impact of international adoptions
Use of attachment as a theoretical framework has been primarily in high risk, maltreated samples in late placement adoptions i.e. foster care system Slide3
Reasons for Study-Personal
Clinical Experience
Intakes for adopted children & teens seemed to cluster into 2 groups:
Developmental disabilities -typically seen in very young children who were internationally adopted (possibly due to maltreatment in orphanages or neurodevelopmental etiology)
Teens referred for multi-problematic behaviors, adolescent DBT or anxiety/disruptive behavioral disorders in school-age children
Self-Disclosure
Exploration of adoption literature over time revealed numerous difficulties for many adult adoptees: unresolved issues of identity, search-reunion. Social policy around privacy and symptomatic complaints of axis-I disorders (mood/anxiety)
NSSR adult adoption study on levels of anxiety in adult adoptees yielded very high levels of anxiety, preoccupation and unresolved conceptualization of adoption and the self, even in secures
survey monkey link on facebook numerous adoption groupsSlide4
Toward a Hypothesis
my early perceptions of the effects of adoption continue to be demonstrated in both non-clinical and clinical samples
Empirical research that does exist does not typically examine the more normative adoption population found in our culture from an attachment framework
D. Brodzinsky-Identity development + Dev. Stages
(Donaldson Institute; Rutgers University)
H. Grotevant (UMass; Univ. of MN)- Adoption Triad
M. Dozier (Univ. Delaware)-Attachment + Maltreatment in Foster Care
M. & H. Steele (NSSR)-Attachment + Maltreatment in late placement adoption (using attachment for placement as a means to bolstering developmental catch-up)Slide5
Examine whether or not adoption serves as a moderating risk factor for borderline features in adolescentsChose adolescents for:
Their reflective capacity on their own experience
Presenting problems have shown some relative stability over time, given their developmental age
Younger school age children have lower ability to reflect on their experience, they may not know that they are adopted yet and parents would likely participate as informants which may not be so reliable
Current Study HypothesisSlide6
Sample
n=
(adoptees)
n=
n=
(non-adoptees) Placement Date Criteria:
Age Range:
Ethnicity:
Clinical sample:
126
total participants
38
(6 male; 32 females)
88
(27 males, 61 females)
Adopted group participants all met criteria for being placed within family under 12 months of age, born in the U.S.
15.2
years -
17.8
years (
M
= 16.3 years)
66% Caucasian, 11% African American, 20% Hispanic, 3% other
Chosen from an adolescent DBT program at Mental Health Center in NYC Metropolitan AreaSlide7
Measures
Birth Status
Attachment Classification
Borderline Features
Patient Intake Demographic Form
*
included forced choice question of adopted or non adopted (less than 20 minutes to complete)
Adult Attachment Interview
(AAI)
(Main, M., Goldwyn, Hesse, 1985)
60-90 minute semi-structured interview assessing attachment classification in the 4 categories: S/Autonomous, I/Dismissing, I/Preoccupied & Unresolved
Life Problems Inventory
(LPI)
(Miller, A., Wyman, S., Huppert, J., Glassman, S. & Rathus, J., 2000)
Self report questionnaire that assesses BPD features in adolescents across 4 indices: confusion of self (CS), impulsivity (IM), emotional instability (EI) and interpersonal problems (IP) (Less than 30 minutes to complete)Slide8
Analyses and Results
Significant Findings
2-way ANOVA was used to assess the interaction effects of the relationship between birth status, preoccupied attachment and borderline features
p
<.05 level for adoptees with preoccupied attachment and high levels of BPD features
p<.05 for both groups in unresolved attachment
p
>.05 in autonomous and dismissing in both groups
Insignificant Findings
2-way ANOVA was used to assess the interaction effects of the relationship between birth status, preoccupied attachment and borderline features
p
<.05 level for both groups with preoccupied attachment and high levels of BPD features
p
<.05 for both groups in unresolved attachment
p
>.05 in autonomous and dismissing in both groupsSlide9
Results Matrix
S/Autonomous
I/Dismissing
I/Preoccupied
I/Unresolved
Birth Status
LPI
LPI
LPI
LPI
Adopted
.5
.13
.0001**
.03
Non-Adopted
1.3
.16
.05
.03
S/Autonomous
I/Dismissing
I/PreoccupiedI/UnresolvedBirth StatusLPILPILPILPIAdopted1.3 .11.05*.03*Non-Adopted1.3.91.05*.03*
Attachment Classification (Significant findings)
Attachment Classification
(Insignificant findings)Slide10
Discussion
Significant findings
Demonstrates an increased risk- possibly found in the double loss
early disruption in attachment, facilitated by negative adoptive environment (a/ambivalent infant + preoccupied parent= preoccupied teen)
We still expect to see significance in the preoccupation & unresolved status in the NA group because of the insecure attachment trajectory
stronger significance in the adoptive preoccupied group, indicating an additional risk involved; ambivalence in parent child dyad suggests a diathesis for either success or problemsA/Preoccupied group: possible problems within dyad in constructing dual narrative to build cohesive identity-promoting understanding of issues arising in adoption
Insignificant findings
Attachment Theory continues to be supported
The balance of significance between attachment status in each group indicates that in the attachment relationship that may predict risk for children, regardless of birth status
Indicates further exploration on the etiology of increased risk for adopted individuals (see in prior research)Slide11
Sample was small; adoptee group was not large enough to get a clear understanding of moderating risk pertinent to them
Clinical sample; broader, non-clinical sample might delineate the differences between groups more clearly
Ethnicity is skewed to Caucasian group; broader reach for larger sample size would be better to capture larger range of ethnic groups
Gender differences: clearly, larger numbers of females in both groups were present
Study does not assess other contributing factors to these features, such as possible trauma post-adoption, relational violence, sibling relationships, substance use, etc.
Study Limitations