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Margaret A. Keyes, PhD; Anu Sharma, PhD; Irene J. Elkins, PhD; William G. Iacono, PhD; Matt McGue, PhD

Arch Pediatr Adolesc Med. 2008;162(5):419-425.

Objective  To determine whether adopted adolescents are at excess risk for clinically relevant behavioral and emotional problems.

Design  We examined whether adopted and nonadopted adolescents differed on quantitative indicators of mental health and the prevalence of childhood disorders and whether differences exist between internationally and domestically placed adoptees.

Setting  Assessments occurred at the University of Minnesota from December 11, 1998, to June 4, 2004.

Participants  Adolescents adopted in infancy were systematically ascertained from records of 3 large Minnesota adoption agencies; nonadopted adolescents were ascertained from Minnesota birth records. The final sample included these adolescents with their rearing parents.

Main Exposure  The main exposure was adoptive status: nonadopted (n = 540), international adoptive placement (n = 514), or domestic adoptive placement (n = 178).

Outcome Measures  Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) clinical assessments based on child and parent reports of attention-deficit/hyperactivity, oppositional defiant, conduct, major depressive, and separation anxiety disorders; teacher reports of psychological health; and contact with mental health professionals.

Results  Adoptees scored only moderately higher than nonadoptees on quantitative measures of mental health. Nevertheless, being adopted approximately doubled the odds of having contact with a mental health professional (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.48-2.84) and of having a disruptive behavior disorder (OR, 2.34; 95% CI, 1.72-3.19). Relative to international adoptees, domestic adoptees had higher odds of having an externalizing disorder (OR, 2.60; 95% CI, 1.67-4.04).

Conclusions  Moderate mean differences in quantitative indicators of mental health can lead to substantial differences in disorder prevalence. Although most adopted adolescents are psychologically healthy, they may be at elevated risk for some externalizing disorders, especially among those domestically placed.

Author Affiliations: Department of Psychology, University of Minnesota, Minneapolis (Drs Keyes, Elkins, Iacono, and McGue); Minnesota Institute of Public Health, Mounds View (Dr Sharma); and Institute of Public Health, University of Southern Denmark, Odense (Dr McGue).

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