Adoption Advocate No. 18Posted Nov 01, 2009
State of Adoption from China
By: Elisa Rosman, Ph.D.
In September 2009, the National Council For Adoption (NCFA) hosted a 13-member delegation from the China Center for Adoption Affairs (CCAA). Over the course of twelve days, NCFA helped to educate the Chinese officials on adoption practice in the United States and the experiences of children adopted from China.
This issue of the Adoption Advocate presents statistics on adoption from China and its recent decline, shares information from the CCAA delegation members, reviews current research on children adopted from China and their families, and concludes with a list of additional resources and suggested contacts for those interested in learning more about Chinese intercountry adoption.
The Decline in Adoptions from China
Since 2005, the year in which adoptions from China to the United States peaked at 7,906 children1, there has been a steady decline in the number of adoptions from China, with just 3,852 in 2008. In 2008, the breakdown was as follows:
- 3030 girls
- 822 boys
- 925 infants under 1 year
- 2533 children aged 1 to 4 years
- 394 children aged 5 years and older2
Chinese adoption officials have attributed the recent decline in international adoption to several factors, including the decreased number of children entering orphanages, the growing number of domestic adoptions, and an increased interest among citizens of other countries in adopting Chinese-born children.
As the number of children available for adoption decreased, the Chinese government also established stricter standards for prospective adoptive parents. These new adoption policies established in May 2007 required all adoptive parents to be married and meet age, income, and education requirements. Prospective adoptive parents also cannot have a recent history of taking antidepressants, and cannot be obese.
Although recent statistics indicate there are still more girls than boys being placed for adoption in China, it is possible that the attitude towards infant girls in China is changing. A recent Time article quoted Joshua Zhong, the director of Chinese Children Adoption International in Colorado, who has observed a change in the way individuals in China view having a daughter: "I have friends [in China] who have girls, and they are just so excited."
While China was once considered one of the most stable programs for parents adopting internationally, the wait time has recently become a much bigger factor – and an unpredictable one– for many families. American families who received referrals in August 2009 had waited over three years from the time their dossiers were logged in China, and many are concerned that the wait time will continue to increase.
As a result of the longer wait times, many Americans are turning to China’s Waiting Child program, which is focused on finding families for older children and those with special needs. The visiting CCAA delegation confirmed to NCFA that approximately 50 percent of all intercountry adoptions now taking place are for children with special needs. During their visit, the CCAA delegation learned how adoption agencies are counseling and supporting those families planning to adopt children with special needs, and also took the opportunity to check on the progress of several of the children who have been placed through the Waiting Child program.
The CCAA Delegation’s 2009 Visit
In September of 2009, with NCFA as their national host, the CCAA delegation spent nearly two weeks in the U.S., traveling across the country to meet with adoption advocates, adoption agencies, government officials, and adoptive families.
At the conclusion of the visit, Mr. Lu Ying, head of the delegation and then-director-general of the CCAA, reaffirmed China’s commitment to intercountry adoption as a means of finding permanent families for many of China’s orphans. Director Lu also indicated that the CCAA intends to expand adoption opportunities for orphans in provinces with lower than average rates of adoption, particularly for children with special needs. “I have a strong belief that cooperation with the United States will continue and go forward smoothly,” said Mr. Lu. “It is my sincere hope that we can work closely with the U.S. government, NCFA, and adoption agencies to the greatest extent possible to help the children living in orphanages in China flourish in loving, permanent homes.”
This section provides a review of current research on children adopted from China. Overall, the message is quite clear: Most children adopted from China, though they often experience some delays when they first arrive home, tend to catch up within a relatively short period of time and are, in general, thriving with their families.
Research results are presented in the following areas:
- Growth and Development
- Behavior Issues
- Language Development
- Boys from China
- Adoption/Cultural Issues
- Family Dynamics
Frequently Used Terms
- Internal behavior problems: withdrawn, anxious, or depressed behavior
- External behavior problems: acting out,aggressive behavior
- Assessment: the process of documenting an individual’s knowledge, skills, etc.
- Expressive language skills: the ability to communicate one’s thoughts, ideas, needs, and wants through language
- Receptive language skills: the ability to understand communication from others
Growth and Development
Cohen, N.J., Loikasek, M., Zadeh, Z.Y., Pugliese,M., & Kiefer, H. (2008). Children adopted from China: a prospective study of their growth and development. Journal of Child Psychology and Psychiatry, 49(4), 458-468.
This study examined the growth and development of children adopted from China during their first two years with their adoptive families. The authors recruited the families of 70 girls who were adopted from China to Canada between the ages of 8 and 21 months (average age:13 months).The girls were assessed within six weeks of arriving in Canada, and again six months,one year, and two years after their adoptions. Thestudy investigators kept track of the children’s physical development (height, weight, and head circumference), cognitive functioning, motor functioning, and language development. At each age check, they compared the girls to a control group of 43 non-adopted Canadian girls.
Physical development: At the initial assessment, the children from China measured significantly lower than their non-adopted counterparts in both height and weight. However, over the next two years, their rate of growth was faster, narrowing the gap between the two groups. Furthermore, even though they were smaller than the children in the comparison group, the adopted children were all within the 50th percentile (of widely used North American norms) for height,weight, and head circumference by the one-year follow-up.
Cognitive development: The authors found that, while the adopted girls had, on average,lower cognitive scores at the time of their adoptions, they had caught up by the two-year check. Motor development: The adopted children had significantly lower scores at the first time point, but were no different from their non-adopted peers by age three.
Language development: At six months post-adoption, the receptive language skills of the children from China were similar to those of their non-adopted peers. However, at the two-year follow-up, the adopted girls’expressive language skills remained lower than their peers.
The authors concluded: “At two years post-adoption [the children adopted from China] resemble Canadian children from a similar family background in most areas of development” (p. 466).
Rettig, M.A. & McCarthy-Rettig, K. (2006). A survey of the health, sleep, and development of children adopted from China. Health & Social Work, 31 (3), 201-207.
These authors surveyed 240 families that adopted children from China between 1992 and 2001. Of these children, 69% were adopted in their first year, 80% were eighteen months or younger when adopted, and 98% were girls. The authors’ findings included the following:
- Sixty-two percent of families reported that their child had a developmental delay upon arrival in the United States, with motor delays being the most common.
- Fifty-two percent of families reported some kind of sleep problem, with the majority of these problems being categorized as minor.
- Nineteen percent of families reported problems with diet or eating; again, the majority of these issues were described as minor.
- Sixteen percent of families reported that their children had problems with social interaction.
- Thirteen percent reported problems with bonding.
- Seven percent reported that their children had been identified as gifted.
- Four percent had been referred for special education services due to special needs(note: for the final two percentages, it is important to remember that very few of the children were school-aged).
The authors concluded their study with the following recommendations for social workers, parents, and educational professionals:
- Children adopted from China should receive complete medical and developmental evaluations as soon as possible after their arrival in the U.S.
- Attention should be paid to the emotional health of the children.
- Families should be assisted in identifying local, state, and national resources for adoptive families, including support groups and parent “mentors” who have also adopted from China.
- Families should be encouraged to learn as much as possible about their child’s culture of origin so that they will be prepared to answer questions honestly and effectively.
Pomerleau, A., Malcuita, G., Chicoine, J-F., Séguin, R., Belhumeur, C., Germain, P.,Amyot, I., & Jeliu, G. (2005). Health status, cognitive and motor development of young children adoptedfrom China, East Asia, and Russia across the first 6 months after adoption.International Journal of Behavioral Development, 29(5), 445-457.
This study investigated the physical, cognitive, motor, and psychosocial development of children in Quebec who were adopted before the age of 18 months. In order to determine the impact of differing pre-adoption experiences, this study included children adopted from China, East Asia, and Russia.
The authors obtained data from the children at the time of their arrival in Quebec, then again three and six months later. The study included 58 children from China, 39 from East Asia, and 26 from Russia. At the first assessment, the children from China and Russia were smaller than the children from East Asia, but the size of the Chinese- and Russian-born children increased more over the course of the next six months.
The study authors wanted to determine which factors might have played a role in the children’s different outcomes. They found that the children whose height, weight, and head circumference indicated better nutritional status upon arrival had somewhat higher cognitive and motor scores six months later. They also found that the children with low or high muscle tone, retarded growth, microcephaly, or other signs of neurological problems upon arrival tended to have lower cognitive scores later in the study.
Comparing the ages of the children at arrival, the study authors found that younger children, in general, showed more positive outcomes at the follow-up times of three and six months. They determined that the best predictors of mental and physical outcomes were the child’s age at arrival, height to age ratio, and neurological indicators. “Thus, it appears possible to change a deficient developmental trajectory associated with negative early experiences when medical signs are not extreme and when the depriving conditions are not sustained for a very long period,” the study concluded. “The qualities of the adoptive environment, including good parental schooling level, high family financial resources, and adequate parental practices, should also be considered as determinant factors when assessing the global improvement of the adopted children” (p. 455).
Tan, T. (2009). Two-year follow-up of girls adopted from China: Continuity and change in behavioral adjustment. Manuscript in preparation. Tan, T. (2009). Impact of pre-adoption adversity on preschool-age adopted Chinese girls’ initial adaptation to adoption and current behavioral adjustment: Longitudinal data. Manuscript in preparation.
Dr. Tan conducts a longitudinal study to assess the development and adjustment over time of girls adopted from China by American families. Phase 1 of the study began in 2005 with a survey of 853 families (with a total of 1123 children adopted from China). Phase 2 followed in 2007, when 674 of the families (representing a total of 842 girls) completed follow-up surveys.
The first article mentioned above addresses three primary questions:
- How does the behavior adjustment of girls adopted from China change over time?
- How does their suboptimal behavior change over time?
- What role does the age of the girls at the time of their adoptions play in their behavior adjustment?
Dr. Tan divided the adopted girls into three groups: a preschool cohort (girls in preschool for both phases of the study); a transition cohort (girls who moved from preschool to primary school between Phases 1 and 2); and a school-age cohort (girls who were primary school age in both phases). Parents completed the Child Behavior Checklist (CBCL) in both phases, which provided scales for rating Internalizing Problems (e.g., anxiety), Externalizing Problems (e.g., aggression), and Total Problems.
There were changes in the girls’ CBCL scores over time. For the preschool cohort, their internalizing behavior scores increased between 2005 and 2007. For the transition cohort, there was an increase in all three areas. For the school-age cohort, there was no change in any of the three areas over time.
Dr. Tan also compared the girls’ scores to those of a “normative” sample in the United States. The preschool cohort of girls adopted from China scored significantly lower than children in the control sample; the transition group scored lower in Phase 1, but not in Phase 2; and the school-age cohort was similar to the comparison group in both in phases. Dr. Tan found a strong continuity in behavioral problems; girls who demonstrated these problems in Phase 1 were likely to continue them over time. Also, girls who were adopted over the age of 12 months showed higher rates of suboptimal behavior.
Dr. Tan’s study concluded with the following information for practitioners:
- Adopted Chinese girls’early behavioral adjustment is predictive of their later adjustment.
- In some cases, primary school entry presented more challenges for the adopted Chinese girls than it did for their non-adopted peers.
- Girls adopted from China do not seem to have a higher risk for suboptimal behavior than non-adopted children.
Dr. Tan’s second article mentioned above explored the impact of pre-adoption adversity on outcomes for adopted children.
This study focused on two primary questions:
- How did preschool-aged girls adopted from China initially adjust to their adoptions,and how was their behavioral adjustment over time?
- How is the initial adjustment and behavioral adjustment over time affected by age at the time of adoption, and by experiences of pre-adoption adversity?
This study surveyed 452 girls who were in preschool for both Phase 1 and Phase 2. Dr. Tan noted pre-adoption adversity by asking parents about a range of observable signs and symptoms, including lice/fleas, scars, rashes, etc. He also asked whether there were any developmental delays at the time of adoption.
Dr. Tan determined a child’s initial adjustment to adoption by asking her parents about their child’s behavior the first two weeks after adoption. For example, parents were asked if their child avoided eye contact during that period. As with the first study by Dr. Tan, the CBCL was used to describe behavior problems.
The data indicate that initial difficulties adjusting to the adoption, as well as developmental delays at the time of adoption, did in fact predict behavior problems at both Phase 1 and Phase 2. If a child was older at the time of her adoption or had experienced more pre-adoption adversity, she was more likely to have a difficult initial adjustment, but neither age nor pre-adoption adversity were necessarily predictors of future behavior problems.
Rojewski, J. W., Shapiro, M. S., & Shapiro, M.(2000). Parental assessment of behavior in Chinese adoptees during early childhood. Child Psychiatry and Human Development, 31, 79-96.
The authors studied 44 families with adopted children from China. A total of 45 children were studied (one family had adopted two children from China), 39 girls and 6 boys. Because of the small number of males, the authors did not include the boys’ scores in their data analysis (this is common in studies of children from China due to the lower number of boys placed for adoption).
The authors used the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC) in order to learn parents’ perceptions of their children’s behavior. The BASC gathers information in nine different categories of behavior problems: hyperactivity, aggression, conduct problems, anxiety, depression, somatization (overly sensitive to minor physical problems), atypicality (immature behavior that is considered unusual), withdrawal, and attention problems. Overall, behavior scores within these categories fell within the normal expected range.
The authors wanted to determine whether three different factors influenced the behavior scores: the child’s age at adoption, the child’s current age, and the length of time the child had been with his/her adoptive family. They found that, for age at adoption, there was no significant difference in behavior scores for children adopted before 18 months of age as compared to children adopted after 18 months of age. Concerning the child’s current age, all of the children’s average scores were within normal range; however, children over the age of three were described as having more hyperactive and aggressive behavior than children under three, while children in the younger age group were found to demonstrate more withdrawn behavior. Finally, comparing children who had been with their adoptive families for less than two years with those who had been with their families for more than two years, the authors found that the latter were more likely to score higher on the hyperactivity scale, the aggression scale, and the somatization scale.
In their conclusion, the study authors pointed out that some researchers suggest the behavior problems among children adopted internationally become much more apparent in adolescent years, so perhaps the children in this study were simply too young to experience those issues. This, they said, illustrates the need for long-term, longitudinal research of children adopted internationally.
The authors concluded: “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” (p. 94).
Gunnar, M. R., van Dulmen, M. H. M., & the International Adoption Project Team (2007). Behavior problems in post-institutionalized internationally adopted children. Development and Psychopathology, 19, 129-148.
This study examined the behavior problems in children who had been adopted after being institutionalized by comparing children who were adopted post-institutionalization to adopted children who had never been institutionalized. They also examined the relationship between the child’s age at adoption and later behavior problems, and compared the rates of behavior problems based on the area of the world from which the children had been adopted.
This study included 1,948 adopted children in Minnesota between the ages of 4 and 18 at the time of the study, all of whom had been adopted between 1990 and 1998. Of these children, 899 made up the post-institutionalized group; these children had spent 75% of their lives prior to adoption in an institution. The comparison group consisted of 1,038 children who had spent less than four months in an institution. Three hundred seventeen of the children were from Russia/Eastern Europe, 1,062 were from Asia, 557 were from Latin America/the Caribbean, and 12 children were from other areas.
In order to determine behavior problems, parents completed the Child Behavior Checklist (CBCL). Most children did not exhibit any type of behavior problem. Of those who did, attention problems were the most common; however, even for post-institutionalized children who were 24 months or older at adoption, the number exhibiting behavior problems was still less than half the total sample.
Fifty-one percent of the post-institutionalized children were completely problem-free, while 11% demonstrated pervasive problems. In the comparison group, 65% demonstrated no problems, and 5% had pervasive problems. While long-term institutionalization did not predict either internalizing or externalizing behavior problems, adoption at the age of 24 months or older was a predictor of both. Institutionalization did predict attention problems and social problems. The study authors found that length of time in the adoptive home was also a factor in both internalizing and externalizing problems; i.e., as a child’s time in the adoptive home increased, so did her scores on both of these behavior scales. It may be that problem behaviors become more apparent to parents as the children age.
The authors found that children adopted from Russia/Eastern Europe were more likely to exhibit behavior problems than children from other areas. They also noted that racial identity and being a member of a racial or ethnic minority could become more of an issue as the children age.
Speech-Language Development in Children Adopted from The China Project at the University of Alberta (multiple publications).
This project builds on previous results indicating that, for most preschool-aged children who are two or more years post-adoption, speech and language outcomes are very good. The authors hope to provide speech-language pathologists with a description of “normative” development for children adopted from China. The ultimate goal of the study is to create developmental charts for children adopted from China for use by parents and professionals.
In 2001, the study team began a longitudinal study of language development with over 150 children from the United States and Canada, with parents completing a questionnaire every three months until their child is approximately three years old. While this study is still in progress, preliminary findings can be shared. For children adopted before the age of one year, their vocabulary and sentence length at the end of the study is similar to those of a comparison group of monolingual, U.S.-born English speakers. Children adopted between 13 and 18 months communicate almost as well as those in the comparison group by 6 months post-adoption.
Team members also examined language skills and academic performance in school-aged children. Two separate studies used the Children’s Communication Checklist, 2nd edition (CCC-2) and the Academic Competition Evaluation Scales (ACES) for children in elementary school. They found that the children adopted from China scored in the same range on the CCC-2 as their non-adopted, U.S.-born peers. On the ACES, the children from China scored as well or better than their non-adopted, U.S.-born peers.
Boys from China
Rosman, E. (2009, April). Painting a picture: What we know about boys from China and their families. In T. Tan (Chair), Adopted Chinese children: Qualitative studies on gender, public discourse, and parental concerns. Symposium presented at the annual meeting of the Society for Research in Child Development, Denver, CO.
Due to the relatively small number of Chinese boys placed for adoption, the bulk of research on intercountry adoption from China focuses on girls. This study was designed to provide a snapshot of boys adopted from China and their families.
For this study, 61 parents completed surveys. Forty-three of the boys in the study were adopted through the Waiting Child program (China’s adoption program for children with special needs, mentioned previously in this issue of the Adoption Advocate), with cleft lip and cleft palate the most common problems. Interesting findings include:
- Parents were generally not shocked to receive a boy, as 51% had requested a boy (in many cases, it was a specific boy identified via the Waiting Child program).
- Overall, families in this study received positive responses to their adoptions from friends and family, with 80% mentioning some form of positive response or a response no different from when they adopted a girl.
- Over half of the parents had no concerns specific to adopting a boy.
- The majority of parents voiced positive comments about their son’s adjustment, saying it was “easy,” “easier than expected,” or “the same as older kids,” etc.
- The children in this study appeared to have fewer sleep problems than has been reported in other studies of children from China. Fifty-four percent reported either no major sleep problems or described their children as sleeping particularly well (e.g., “our son is a great sleeper”).
- When parents were asked about the challenges unique to adopting a boy from China, they most often mentioned lack of support and/or a natural peer group for their son due to the predominance of adopted Chinese girls, as well as the difficulty in explaining to their son the reason for his abandonment.
Overall, the families in this study felt extremely positive about the process of adopting a boy from China, and were eager to share their experiences. The majority reported that their sons were adjusting well, sleeping well, and not presenting unique or overwhelming challenges.
When parents did voice a concern, it was typically in an area where progress can and should be made. First, families adopting sons from China need more resources, as the majority of families with children from China have adopted girls. Second, families adopting boys from China need help in framing their sons’ stories. The knowledge that boys are also adopted from China and a greater awareness of their experiences might also help change the way adoption stories are told in the Chinese adoption community at large. As one mother stated, “I wish that there was more knowledge about boys from China, that they do indeed exist. That it would be seen as normal and not an aberration.”
Rojewski, J.W. (2005). A typical American family? How adoptive families acknowledge and incorporate Chinese cultural heritage in their lives. Child and Adolescent Social Work Journal, 22(2), 133-164.
This study examined the extent to which adoptive parents acknowledge and support their child’s cultural heritage. Parents were recruited via the Internet, and 79 adoptive parents of Chinese-born children completed the survey. The 79 children represented were between the ages of 10 months and 11.3 years, and the average age at time of placement was 11.9 months. For this study, Dr. Rojewski used a cultural attitudes survey that he created.
He found that while parents only occasionally discussed adoption with their children who were under two years of age, the frequency of these conversations increased as the children grew older. In contrast, discussions focused on the children’s culture of origin did not change with age.
Parents were uniformly positive in their responses to questions about the benefits and importance of exposure to Chinese cultural heritage, the ability of their children to identity with both Chinese and American culture, the relevance of Chinese culture to personal adjustment, and the role of a child’s Chinese heritage in his or her personal identity. Among the children studied, their awareness of their Chinese birth culture increased from the youngest age group to the oldest age group. When asked about how Chinese culture and history were represented in home life, the largest portion of respondents said that they occasionally celebrated Chinese holidays or festivals, and parents reported that books were the most frequently used tool for learning about Chinese heritage (with videos, music, and art used less often).
The author concludes: “Very few parents either ignored or rejected the presence of Chinese cultural heritage in their families. Frequency of activity designed to recognize and integrate Chinese cultural heritage was consistent and fairly frequent across all three age groups, undoubtedly reflecting the strong beliefs parents had about the importance and benefits attributed to acknowledging cultural heritage. This strong commitment to acknowledging their child’s birth cultural heritage has been recognized (e.g.,Tessler et al., 1999) as a defining characteristic of most parents with children adopted from China. Despite the strong commitment to acknowledge Chinese culture and heritage, parents did not report a growth in their knowledge about China and Chinese culture comparable with their child’s age” (p. 159-160).
Tessler, R., Adams, G., Houlihan, L., & Groza, V.(2004). Mother–daughter relationships among Chinese and Romanian adoptees. International Journal of Child and Family Welfare, 1, 26– 43.
This study explored the parent/adopted child relationship in middle childhood, comparing outcomes for children adopted from Romania with outcomes for children adopted from China. The study was based on questionnaires answered by parents, all with children between 8 and 12 years of age. There were 80 mothers with adopted daughters from China and 54 mothers with adopted daughters from Romania. The researchers used the Child Behavior Checklist (CBCL) to determine children’s behavior problems, and studied mother-daughter relationships based on a survey they created.
Overall, the scores measuring the quality ofthe mother/daughter relationships were very high; e.g., 84% of all the mothers surveyed reported getting along very well with their daughters. However, the study authors did find that, compared with the sample of mothers who had adopted from Romania, mothers of daughters from China experienced more closeness, respect, trust, and better communication, and generally got along better with their daughters.
The authors suggested that one possible explanation might be the child’s age at adoption, with a younger age at the time of adoption associated with a more positive mother/daughter relationship. The level of behavior problems among children were significantly related to the mother-daughter relationship, with the children adopted from Romania demonstrating more problems overall. The authors noted that the children adopted from Romania were, on average, adopted at older ages, and therefore they were exposed to longer periods of institutionalization than their Chinese counterparts: “The results of the current study extend those of previous research on international adoption by showing how attachment difficulties nested in different child welfare systems may affect the mother-daughter relationship by influencing its early trajectory” (p. 40).
- United States Department of State. (nd). Total adoptions to the United States.Washington, DC: Author.Retrieved October 1, 2009 from http://adoption.state.gov/
- United States. Department of Homeland Security. (2009). Yearbook of Immigration Statistics: 2008.Washington, D.C.: U.S.Department of Homeland Security, Office of Immigration Statistics. Retrieved October 1, 2009 from http://www.dhs.gov/xlibrary/assets/statistics/yearbook/2008/ois_yb_2008.pdf
- Webley, K. (2009, June). Behind the drop in Chinese adoptions. Time, 173, 55.
Additional Resources and Contacts
- University of Minnesota, International Adoption Project
- University of Minnesota, International Adoption Medicine Program and Clinic
- TCU Institute of Child Development
- China Adoption Research Program at the University of South Florida
Contact:Dr. Tony Tan, firstname.lastname@example.org
- Dr. Nancy Cohen’s Longitudinal Study at the Hincks-Dellcrest Centre, Ontario, Canada
Contact:Dr. Nancy Cohen, email@example.com
- Dr. Karen Pollock’s Study of Language Development at the University of Alberta, Canada
Contact: Dr. Karen Pollock, firstname.lastname@example.org