Abstract
This study forms part of a major longitudinal research project collaboration between the Anna Freud Centre, Coram and Great Ormond Street Hospital, which set out to explore adopted children’s and adoptive parents’ outcomes and experiences from middle childhood through to adolescence. In this paper, 17 adoptive mothers of late adopted children, currently in early adolescence (aged 12 to 15 years), were interviewed. The focus of the study draws upon their worries and fears regarding their children during adolescence and as they approach adulthood. The Parent Development Interviews (PDI) were analysed using thematic analysis and generated five overarching themes:
Plain Language Summary
This study draws upon the experiences of adoptive parents, all of whom were mothers, of late-adopted children, currently in early adolescence (aged 12 to 15 years). The study focused on their worries and fears regarding their children during adolescence and as they approach adulthood. Seventeen adoptive parents were interviewed using the Parent Development Interview (PDI) and the data were analysed using thematic analysis and generated five overarching themes:
Introduction
In the UK in 2022, there were 82,170 children looked after, with only 3% of them being successfully adopted (Department for Education, 2023). The number of children waiting to be adopted is increasing, while the number of approved adopters have demonstrated a 20% decline. Most of these adoptions resulted from children entering local authority care following experiences of abuse or neglect. Many of these adopted children will invariably have had a range of negative life experiences, including maltreatment and significant disruptions in care, before being placed with stable and nurturing adoptive families.
Adverse childhood experiences, prior to the adoptive placement, have been increasingly recognised as significant predictors of individuals’ outcomes in adulthood and need to be considered to understand the impact of adoption as well as the challenges that adopted children may face. These adverse experiences interfere with the identified developmental opportunities that result from the experience of parental and family life, especially over the first thousand days. They can have a pernicious and persistent effect (Zeanah, Shauffer and Dozier, 2011). Initially, interest in the impact of the early disadvantage of high-risk populations emerged from exploring in the general population the relationship of childhood adversity with health in adulthood (Boullier and Blair, 2018; Danese and McEwen, 2012; Felitti et al., 1998). Other important repercussions have also been identified, including poor educational, economic and income outcomes in adulthood (Metzler et al., 2017), suicide (Dube et al., 2001), illicit drug use (Dube et al., 2003) and premature mortality (Brown et al., 2009).
These adverse outcomes observed in adopted children are likely to be caused by a combination of risk factors to which they can be exposed both before and after birth. Prenatal risk factors include genetic predispositions, such as biological parents’ intellectual disabilities and mental health difficulties (Smoller and Finn, 2003; Vissers, Gilissen and Veltman, 2016), as well as exposure to drugs, alcohol and opioids in utero (Bandstra et al., 2010), with adopted children exposed to prenatal substance abuse being at greater risk for neurodevelopmental, behavioural and neurological diagnoses (Landgren et al., 2010). Postnatal factors, on the other hand, can include maltreatment, neglect and instability in their placement arrangements (Newton, Litrownik and Landsverk, 2000; Rushton and Dance, 2006; Tarren-Sweeney, 2017). Within this context, older age at adoption has been identified as one the strongest developmental predictors, as it represents a proxy for length of exposure to adverse backgrounds prior to being placed with an adoptive family (Howe, 1998b; Palacios et al., 2019). When comparing adolescents placed in infancy to those placed at older ages, David Howe (1997) found that the older placed group showed the highest rates of problem behaviours in adolescence. Other studies indicate that those placed after the age of four years display the most unfavourable developmental outcomes (Nadeem et al., 2017; Vandivere and McKlindon, 2010). Indeed, frequent separations, as well as unpredictable and unstable family environments, have a damaging effect on a child’s welfare (Newton, Litrownik and Landsverk, 2000), often leading to behavioural challenges irrespective of other risk factors (Rubin et al., 2007). Older placed children are at risk of poor mental health, behavioural problems and relationship difficulties (Brown, Waters and Shelton, 2017; Dekker et al., 2017; Hodges and Tizard, 1989; Howe, 1998a; Howe and Hinings, 1987; Juffer and van IJzendoorn, 2007; Quinton et al., 1998; Tizard, 1977). Studies further demonstrate that they remain more at risk for most internalising and externalising disorders (Behle and Pinquart, 2016; Keyes et al., 2008; Miller et al., 2000; Rueter et al., 2009; Selwyn, Wijedasa and Meakings, 2014; Tieman, van der Ende and Verhulst, 2005).
Considering the intense and complex ingredients of the adolescent phase for both adoptees and their adoptive parents, it is essential to gather more accurate and comprehensive insights into what these ‘major challenges’ are. Unfortunately, there is limited research into the experiences of adoptive parents, particularly during adolescence. A few studies on their lived experience with adoption conducted by Howe in the 1990s revealed that parents of late adopted children exposed to early adversity, reported their later increased vulnerability to eating disorders, lying, expulsion and exclusion from school, running away and missing from home overnight, theft of both money and property from their adoptive homes, as well as crimes committed outside of home, and, significantly, violence towards other family members (Howe, 1997). Evidently, these early experiences also have the greatest impact on the children’s attachment and the quality of the relationships they will build throughout their lives (Bowlby, 1982). Children adopted at older ages have been shown to have an increased risk for unfavourable emotional and social development, due to feelings of insecurity, anxiety, and, in some cases, confusion and anger, caused by these early negative experiences (Howe, 1996).
Significantly, it is in adolescence that these behaviours and preoccupations with relationships often become more pronounced (Howe, 1996). Adolescents’ heightened emotionality and limited capacity for emotion regulation can be explained by neurobiological processes (Luciana, 2013) and social influences (Ge, Conger and Elder, 2001). They find themselves facing increased demands for maturity, higher expectations for academic achievement and transitions to schools, as well as more intense peer interactions (Eccles et al., 1993). In high-risk populations, adolescence is a period where the impact of adverse experiences and genetic predispositions are often intensified and further predispose individuals to the development of psychological disorders (American Psychiatric Association, 2013; Colvert et al., 2008; Tregeagle et al., 2019; Vandepoel et al., 2014). Moreover, adoptive adolescence itself is shown to be concomitant with increased risks, such as more psychiatric diagnoses, attachment difficulties and affective dysregulation (Pace, Di Folco and Guerriero, 2018). Such risks and manifestations undoubtedly present adoptive parents with significant challenges as they help navigate their child’s developmental challenges and transition through and beyond adolescence (Trentacosta et al., 2008).
Most studies have tended to focus on developmental outcomes and have placed far less emphasis on the impact on adoptive parents (Palacios and Brodzinsky, 2010). The adolescent adopted child clearly evokes concerns and worries for the parents which are intensified by the potential negative influence of peer groups and their involvement in risky behaviours (Bogenschneider and Olson, 1998). Most parents of adolescents struggle to adapt to their new roles during this transitional stage, which is only likely to be compounded by these young people’s early experiences. The self-determination theory, which examined the essential requisites for adolescents’ psychosocial adjustment during this period, emphasised their need for autonomy, competences and relatedness (Deci and Ryan 2000; Ryan and Deci, 2017). Adoptive parents will have already been more likely exposed to higher levels of behavioural and emotional difficulties, which have often been related to children’s disturbances in their early attachments and are now having to facilitate their more vulnerable child. In the survey conducted by Selwyn, Wijedasa and Meakings (2014), a third of parents reported experiencing ‘highs and lows’, a quarter acknowledged encountering ‘major challenges’ and a further 9% reported the adoption to have been disrupted. Furthermore, it was evident from this research that even in the most precarious and disrupted placements adoptive parents’ deep concerns and distress about their children were only reinforcing their commitment to continue supporting them. The challenges of adolescence are also evidenced in how some of the most complex and difficult cases in post-adoption work are with parents and their adopted teenage children (Howe, 1996).
As stated earlier, few studies on adoptive parents’ lived experience have revealed that parents of late-placed adopted children, exposed to early adversity had to face the young person’s increased vulnerability to a vast range of these negative outcomes (Howe, 1997). This has resulted in some adoptive parents admitting feelings of desperation at different stages during adolescence, and some revealing not wanting to go through the adoptive placement ever again (Howe, 1996).
To better support adoptive parents and facilitate adoptive placements, further studies are required to explore adoptive parents’ perception of these challenges and their anxieties and concerns regarding their now adolescent child, in relation to both their current experience and their anticipated worries as they transition from adolescence into autonomous adulthood. It is hoped that this would lead to a clearer image of outcomes in adolescence, which might help us reflect upon how adoptive parents might be supported during this process.
The Current Study
This study draws upon a major longitudinal research project collaboration between the Anna Freud Centre, Coram and Great Ormond Street Hospital, which set out to explore outcomes and experiences of adopted children and their parents from middle childhood through to adolescence, and compared early adopted with late adopted young people.
Within this qualitative paper, however, parental interview data from only the late adopted group are examined to explore those perceptions, insights and anxieties of parents from the most ‘at-risk’ cohort of children. A thematic analysis was conducted on the Parent Development Interview (PDI) (Slade et al., 2004), a schedule used with adoptive parents in the adolescent follow-up phase. Although these interviews were used with some of the adoptive fathers too, for this study, only adoptive mothers of late adopted children were included.
Method
This study reports on adoptive families of a maltreated, late-adopted sample (LA) which formed part of the Adoption and Attachment Study (Coram/Anna Freud Centre) and was funded by the Glasshouse and Tedworth Trusts of the Sainsbury Family Trusts (Principal Investigators Dr Miriam Steele, Dr Jill Hodges and Ms Jeanne Kaniuk). Ethical approval was obtained from the Institute of Child Health Ethics Committee and the Joint Ethical Committee of University College London.
Adoptive families were recruited through five voluntary adoption agencies and two social services departments in the UK. Following initial agreement from the families to participate, they were provided with consent forms alongside written information about the study.
Eligibility
Due to the exploratory nature of the project, inclusion criteria at the initial stage were broad and as set out below:
Late adopted sample: (a) children aged between four to eight years at the time of placement; (b) with previous experience of adversity; (c) having been placed in an adoptive family for no longer than three months at the time of assessment. A sample of 63 late adopted children were initially recruited for the Adoption and Attachment Study in childhood. The children were placed between 42 and 98 months (
Design
Children from the longitudinal Adoption and Attachment Study had been assessed in childhood (Phase 1) at three yearly successive time points. Both adoptive parents were also interviewed at the same junctures using the PDI. These adopted children were then followed up in adolescence (Phase 2) at one single time point. As with the previous phase, adoptive parents were administered the PDI. For this paper, only the PDI data from the mothers will be used.
Sample
The current study draws upon 17 adoptive mothers of 21 children who had been followed up at Phase 2 (Adolescence). All participants were based in the UK. Of these 17, four were lone mothers while the other 13 were either married to or cohabiting with the adoptive father. Four of the parents had previous parenting experience with biological or other adopted children while 13 were novice parents with no previous experience.
All interviews were completed by the primary caregiver (in all cases, this was the mother) whose ages at the time of the interview ranged from 28 to 65 years (
At Phase 2, these adopted children (11 males, 10 females) were between 12.05 and 15.81 years (
Parent reports indicated that 33% of the children had a neurodevelopmental diagnosis or identified learning disability. These included three autistic children, two with dyslexia or dyspraxia, and a further two with non-specific learning disabilities. Out of these seven adolescents, four were attending a special (non-mainstream) school while the other three were receiving additional support within a mainstream setting.
According to social work records of the children’s pre-placement history, those in the late adopted group had undergone multiple changes in caregivers prior to being placed for adoption. This particular sample included between three and 12 caregiver changes. All the adopted children had been with foster carers immediately prior to the current adoption.
Furthermore, these children also had been exposed to a substantial amount of maltreatment: 53% had experienced physical abuse; 72% had witnessed domestic abuse; 97% had been neglected; 20% were victims of sexual abuse; and 97% had been emotionally abused. Most children had been exposed to more than one type of maltreatment.
Finally, communication and contact with the birth family was mostly minimal. Direct contact with the birth parents was only present with two adopted children; in both cases, this was one or two times per year. For a further four participants, there was direct contact with other family members (e.g. grandparents, biological siblings). For 15 (71%), communication was only through letterbox contact.
Measures
A battery of assessments was carried out with both adopted children and adoptive parents at Phase 2. For this paper, only one parent interview was used (PDI) (Slade et al., 2004).
The PDI is a semi-structured clinical interview that taps into parents’ representations of themselves as parents, of their child and of the relationship between them. The interviewee is asked to focus on a current and specific relationship with one child. The parent is then asked to give a number of adjectives describing her child, herself as a mother, and their relationship, and to give examples for these. They are also asked about feelings of joy, pain, guilt and anger as parents, and to consider the child’s feelings in a number of ways. Another set of questions relate to the parent’s thoughts and feelings about their own and the child’s feelings during separations.
The interviews were conducted in person with the adoptive mothers by two trained researchers, and subsequently transcribed verbatim. The training involved two half-day sessions including a practice interview which was evaluated by one of the co-investigators. Interviews in this sample lasted for on average 84 minutes, ranging from 55 to 119 minutes. Although the interview is typically coded with the Reflective Functioning coding system (Slade et al., 2004), this material will be examined thematically with a specific focus on any responses from adoptive parents that relate to concerns, worries or fears in relation to their adopted child. This qualitative focus endeavoured to extract a more enriched sense of how adoptive parents thought about current and anticipated anxieties in relation to their children.
Though the primary focus of the qualitative analysis was around the section of the PDI that specifically focused on the worries and concerns relating to how young people engage with emotionally challenging situations (e.g. anger, worry, sadness), the researchers read through the full transcripts to identify any affective material brought up elsewhere. There were particular parts of the interview that were more focused around the study’s specific questions. This included Section 3 – Affective Experience of Parenting – with questions such as ‘What gives you most pain or difficulty in being a parent to X?’ and the final section – Conclusion – with questions such as ‘What kind of future would you like X to have?’.
Credibility was ensured primarily by ensuring that all identified interview transcripts were read by the co-investigator (SH) and co-author (NA) and that this continuous and informative process of re-reading transcripts and consulting with one another culminated in the identification of the super- and subordinate themes that are reported in this paper. Following this stage, 50% of the interviews were double coded in order to examine whether the participants’ interviews elicited material that fitted the specific themes. There was high agreement across the superordinate and subordinate themes (88% agreement) with scores across themes ranging from 82% to 100%. Throughout the process, data were subject to precise attention to individual details. It should be noted that the researchers involved in both the interviewing and coding did not have either direct or indirect personal experience of adoption.
Reflexivity
Both interviewing and qualitative analysis will have been heavily influenced by the researchers’ interpretation of the data. It was naturally important for the researcher to critically reflect on any biases and demonstrate self-awareness of any preconceived notions that might affect the analysis (Mills and Grant, 2009). All researchers who conducted and analysed the interviews received a comprehensive training in these methods and also supervision from the study’s advisory group, which included both individuals who were experienced and involved in adoption work and those with an experience of either being adopted or having adopted themselves. Following the initial extraction of themes, these were discussed and reflected upon with some of these individuals so as to make sense of them in a meaningful way. By doing so, the analysis was kept free from bias as much as possible.
Planned Analysis
A thematic analysis (TA) was conducted with the aim to provide an understanding of the adoptive parents’ concerns and worries about their now adolescent adoptive child. According to Braun and Clarke (2006), TA is focused on the identification and interpretation of themes, that is patterns of meaning within a dataset. The specific approach selected was atheoretical and inductive; it examined both manifest/semantic and latent themes within the narratives.
This part of the study looks exclusively at 17 parents of 21 late adopted children. This focus on late adopted individuals was chosen to obtain a slightly more homogeneous group with regards to pre-placement risk factors including adoption placement over the age of four years, maltreatment and neglect.
Results
This study extracted five superordinate themes that related to adoptive parents’ concerns and worries about their adolescent children. These five themes were:
Although these individual themes had their own discrete ingredients and meanings, they were expected to interplay. Overall, parents struggled to sustain feelings of hope amid the challenges, and many spoke with ambivalence: I don’t know, I think it could go either way, I really do. I think she could, you know, get a job, get a flat, find a boyfriend, be reasonably okay or she could end up in prison. (Tia, daughter, 13) She hasn’t come to the crossroads I don’t think yet. But whether she’ll turn left or whether she’ll turn right, basically we don’t know what will happen. (Lacey, daughter, 14)
Vulnerability
The first superordinate theme captures those facets of an adopted child’s life that might make them susceptible or open to risk or disadvantage across different contexts. This comprised four subordinate themes:
Impressionability
One of the most expressed worries from adoptive parents was about how their child’s ‘low self-esteem’ would impact upon their peer relations, making them particularly susceptible to influences and pressures from peers. This subtheme was evident in 18 (85.7%) of the interviews: I think she strives to do the right thing … I think her choices might be slightly determined by what somebody else thinks is the right thing for her. (Maya, daughter, 14) I worry about what will happen to him when he gets older, what he'll do, to be honest. I really worry that he is very much a follower of some people. (Kelvin, son, 13) I’m worried about people taking advantage of him. That worries me a bit in terms of they’ll take advantage of him financially. (Fred, son, 15) I worry about her future … she hasn’t got a good sense of her boundaries; you know, I worry about, is she gonna get pregnant, is she gonna be on drugs, is she, you know, literally anything. (Iona, daughter, 14)
Safety
Another concern related to the child’s own risks in remaining safe and not putting themselves in perilous situations. This was often linked to the child’s own emotional immaturity. This subtheme was evident in 15 (71.4%) of the interviews: You know, I worry about her confidence, I worry that [how] she’s gonna get on because she’ll be too scared to open her mouth and you know, I’m not confident that she’s gonna keep herself safe. (Dana, daughter, 12) She’s a very attractive girl and as I said before, for a body of a 17-year-old, she’s only got a mind of a 10-year-old, and I feel she could put herself in a position she wouldn’t know how to [handle]. That’s one reason. How we prevent that happening I don’t know. (Bella, daughter, 15)
Relationship Decision-Making
Although the vast majority of adopted individuals in this study were in early adolescence, anxieties were expressed about choices that their child might make or had made in relation to sexual and romantic relationships. This subtheme was evident in 12 (57.1%) of the interviews.
There was quite a clear distinction between sexes with worries that adolescent males would be at risk of entering into relationships prematurely and getting girls pregnant, while adolescent females were often seen to be at risk of becoming pregnant and being in undesirable or unsafe relationships. In the example below, the parent catastrophises about a worst-case scenario while also drawing attention to the risk from her daughter’s physical attractiveness: The future we don’t want is five kids by five different blokes, and she gets beaten about and boy, I mean she’s a pretty little girl, so boys will be sniffing round. (Lacey, daughter, 14) She’d got the guts to say no cause we were a bit worried that if someone sort of makes a fuss of her, sort of makes her not happy but all over her, she’d take it as, not love, but she’d want more and more and she’d be worried, ‘if I don’t have sex with him, then he’d be gone’. (Lacey, daughter, 14) The thing I never guessed as a parent is that I would worry much more about my son making somebody else’s daughter pregnant than I would of my own daughter getting pregnant. (Ben, son, 14) Her future and if she’ll ever have a relationship, proper relationship with anybody, if she’ll ever feel that warmth that you get from having relationships with people, because you can’t, she can’t ask people for help; she gets completely frozen. (Denise, daughter, 13)
Additional Needs
A final subordinate theme explained the many additional needs that these children were presenting, including physical, mental health and learning ones. For some, these worries were not sparked by actual diagnosis, but more by their child’s unexplained needs and ‘differentness’. This subtheme was evident in eight (38.1%) of the interviews: He doesn’t easily fit in anywhere, and I don’t think he has a will. I think he’ll always be different. (Fred, son, 15) My worry for him is really whether he’d get pushed to the bottom of the pile and, you know, not achieve what he could achieve. (Tom, son, 14) The things she worries about most were where will she go for a job because of her dyslexia, and is she, is she going to be very disappointed if she tried, if she chooses to do something and that she might go back to losing her self-esteem. (Pippa, daughter, 14)
Violence
This second theme refers to the adopted child’s own aggressive and violent impulses and how they might be directed towards either themselves or others. This theme was made up of two subordinate themes:
Harm To Others
Here many adoptive parents spoke about their child’s aggression and how these escalations might result in people being hurt. Although it was most common among parents of boys, it was by no means exclusive. This subtheme was evident in 11 (52.4%) of the interviews.
Concerns My biggest worry in the past was his aggression. I know, but hugely temperamental and aggressive. (Daryl, son, 15) My husband is not going to let me carry on where I’m actually going to get, you know, some injury to my person, I mean. (Tia, daughter, 13) It used to be that he’d get himself into really big trouble because he was so violent. (Kai, son, 14)
Harm To Self
Though less common, several adoptive parents spoke about ways in which their children’s aggression might result in them being the victim and hurting themselves. This subtheme was evident in six (28.6%) of the interviews.
Within this theme were instances of adoptive parents referring to their child’s violent wishes and suicidal ideation: I worry about his mental health … his impulsivity and risk-taking. So that he might injure himself apparently. (Fred, son, 15) I fear he will get very low and end up doing something to harm himself. (Billy, son, 15)
Derailing Opportunities
This third superordinate theme describes the anxieties that any stability and positivity created in their home could easily be broken and sabotaged through their child’s choices and behaviours. This is comprised of two subordinate themes:
Lost Opportunities
Here, adoptive parents observed how their child dismissed guidance as they traversed through their early adolescence. In many cases, parents feared that opportunities would be impaired and, though they did not always express this, that they would cascade into a very negative cycle. This subtheme was evident in 17 (81.0%) of the interviews: So, I worry, I don’t worry about his safety, well, I do a bit. I, I worry that he’s ruining opportunities given to him. (David, son, 13) What’s going to happen to him in the next couple of years, I think. Because he’s throwing away all the opportunities and getting into so much trouble at the moment. Is he going to have any kind of education at all in the next couple of years? That sort of thing. (Robbie, son, 14)
Catastrophic Fears
Many adoptive parents’ fears were catastrophic, relating to how their child’s behaviour could unseat any progress they were making.
In some cases, these worries were quite mild and perhaps typical among parents of adolescents. This subtheme was evident in nine (42.9%) of the interviews: I always have this thought that she might get into trouble, you know – she’s getting to the age where she might get into trouble and I don’t know. (Pippa, daughter, 14) So, I’d worry most that he would get really dreadfully hurt in some horrible fights and that he’d get into trouble as a result of that and get a bad reputation and now I think that could still happen. (Ben, son, 14) I think mostly I worry about him being shot, you know. (Billy, son, 15) The other thing is I could see him getting a girl pregnant really young, and I wouldn’t want him to, I wouldn’t want that to happen. (Fred, son, 15) It’s him offending; it’s him doing something … I just feel he’s so vulnerable with himself, let alone vulnerable with other people who might take him the wrong way … he’d end up in prison, imagine him in prison. I mean he’d be so vulnerable. (Calum, son, 13)
Autonomy
This fourth superordinate theme relates to the child’s struggle for independence and how that might tally with the parent’s own sense of agency and worries about the child’s needs. This theme is made up of two subordinate themes:
Autonomy Readiness
The first subordinate theme concerns the parent’s perception of their child’s capacity to forge an independent existence. Given these children’s adversities characterised by great discontinuity and maltreatment, there were strong concerns about how they could manage a more autonomous existence. This subtheme was evident in 13 (61.9%) of the interviews.
For some parents, their children’s needs made it difficult for them to imagine it: … when he is 17, the whole idea of will he be able to cope independently, hold down a job, take orders from someone, live on his own in a place of his own, have a family. I don’t know, it seems a long way off, and will he be able to, you know, be independent of us? (Jesse, son, 14) He will always be dependent to a certain extent on somebody and there will always be certain aspects of his life that won’t go right. But I just want him to be fulfilled and happy and in charge of himself, as self-determining as he can be. (Kai, son, 14) I hope he doesn’t leave home too early, but also I hope he doesn’t get stuck here either. (Fred, son, 15)
Loss Of Parental Agency
The second subordinate theme was much more focused on the parent’s own sense that their role was dwindling in potency. Here, they felt they did not hold the same influence they possessed when their child was younger. The adoptive mothers spoke evocatively about wanting to steer their child on the right path. This subtheme was evident in 14 (66.7%) of the interviews: It’s just the worry of what she’s gonna do and when, and whether we can be there to sort of put her on the right track, you know. And the worry is that we can’t get her on the right track, you know. (Iona, daughter, 14) She mixes with lots of people and they don’t always know about the people that they’re mixing with and you just have to hope that when they go out of town, they’re not messing about, getting up to things they shouldn’t do. (Denise, daughter, 13) It affects me because he wouldn’t be able to defend himself, say, on public transport. (Kai, son, 14) I need to protect him of people that are not very nice to him … others at school or girls for that matter. (Damian, son, 15) I suppose I worry, I think if I die tomorrow, who’d look after him? I worry who will, or how he’ll grow up. (Fred, son, 15)
Anxieties About The Birth Family
This final theme refers to the presence of the adopted child’s birth family in their current life. Although for the large majority, birth family played a minimal role, for others, the adoptive parents were conscious of the child’s past experiences with them. This theme was made up of two subordinate themes:
Fear Of Repetition
In most cases, adoptive parents spoke about this at a more unconscious level as they either observed or anticipated negative behaviours in their children that would have been partly explained by their past. As these adoptive parents’ children embarked upon adolescence, more challenging behaviours were being confronted. This subtheme was evident in eight (38.1%) of the interviews: Well, specifically I would worry if she became like her, you know, like her birth mother and all that sort of stuff. That is, if she got pregnant at 16 or whatever, that sort of stuff. Got hitched to some ghastly boy, have this whole thing started all over again. (Tahera, daughter, 14) She would grow up and have the same lifestyle [as her birth mother] because a lot of the things that she was doing, and I could really see, see her, see a lot of the mother in her behaviour. (Sophie, daughter, 13)
Role
Although not very common, the second subordinate theme is orientated around the actual presence of the birth family and the child’s wishes or intentions to contact or connect with them. This subtheme was evident in four (19.0%) of the interviews.
In the example below, the adoptive parents’ anxieties related to the birth family being a place for their child to threaten to return to if he was at all unhappy in his life: He’s a bit volatile, and he could run away. I suppose that’s what I mostly worry about. He’s of an age where, I mean last year he did really want to run up to meet his birth parents … and he got it all planned; he got packed; he’d got his sword with him and he’d saved up some money and he’d got his, you know, the whole kit to go and cycle there. (Kelvin, son, 13)
Discussion
Within this study, we examined the concerns and anxieties that adoptive mothers described about their adolescent child. We chose to only explore those who had adopted late placed children, who are known for suffering far more negative pre-adoption experiences, including significant discontinuity of care and maltreatment. The rationale for focusing on this population was guided by the expectation that this particular group of adopted children would be more challenging and complex to parent given their pre-placement histories. These early risk factors have been increasingly recognised as impacting outcomes in adolescence and adulthood (Boullier and Blair, 2018; Danese and McEwen, 2012; Felitti et al., 1998). Such unfavourable outcomes are apparent already in early adolescence (Nadeem et al., 2017; Vandivere and McKlindon, 2010), as clearly illustrated by an increased display of behavioural problems (e.g. Rubin et al., 2007).
The five overarching themes generated from this study were
The first superordinate theme,
Some of the vulnerability was also seen within their child’s often complex neurodivergent and mental health needs which only compounded their capacity to navigate the different social contexts they were exposed to (Hodges and Tizard, 1989; Howe, 1998b; Howe and Hinings, 1987; Quinton et al., 1998; Tizard, 1977).
The second superordinate theme,
The third superordinate theme,
The fourth overarching theme,
The final superordinate theme,
These themes are all ones that were observed by David Howe in his interviews with parents of late placed adopted individuals, who relayed parents’ experiences of increased vulnerability at this stage to their children’s significant internalising and externalising psychopathology, as well as antisocial behaviour, including violence and crimes (Howe, 1997). Although adopted children have often been identified to be at greater risk for developmental outcomes throughout all stages of their lives, studies have rarely investigated adoptive parents and their experiences. Insight into adoptive parents’ worries for their children can provide a more holistic understanding of the adoptive experience and the areas in which adoptive families might benefit from support. Emotionality itself was not identified as a theme, but it appears as a meta-theme across these five superordinate themes, given that it explains how the adolescent child’s heightened emotionality and reduced capacity to regulate themselves was now being additionally challenged by social influences, which they were having to both make sense of and navigate.
Strengths And Limitations
This study contributes to the adoption literature by exploring the adoptive parents’ expectations about the adoption experience. There is very limited qualitative research exploring these experiences and processes throughout the placement, both when the adopted child is placed in infancy/childhood and in adolescence. The focus of this study was directed towards the parents’ worries and fears about their adolescent child who was adopted. To date, our appreciation of these challenges and concerns have been mostly examined through studies around epidemiology, prevalence and symptomology. We are aware that those adopted are likely to have more psychological and behavioural difficulties in adolescence and that their progression into adulthood is associated with many negative outcomes. What remains unexplored is how these adoptive parents perceive, reflect upon and experience these challenges, many of which they were already being exposed to.
Reflecting on the thematic analyses, these findings draw upon transcripts from all the adoptive parents of late placed adolescents which amounted to 21 separate accounts. The interview was broad with its focus on all facets of the parenting experience, including the child’s needs and relationships within and outside the family. This approach allows a window into the parents’ perceptions and expectations of the child’s presenting situations in early adolescence and the anticipated future. This represents a unique sample of parents with adopted children who had protracted pre-placement histories in care for between four and eight years. These children’s experiences were of significant discontinuity, maltreatment and neglect.
As with all qualitative studies that examine a single sample, in this case adoptive mothers of late placed adolescents, we are merely drawing out the themes elicited from the interviews. There is no quantifiable way of comparing these responses to a sample of either adoptive parents of early adopted children or biological adolescents. Although data from the wider study contained an early adopted sample, where there had been no recorded indicators of discontinuity or maltreatment, it felt more important to make sense of the patterns of meaning that this specific group of adoptive parents reflected upon in relation to their children.
We are fully aware that adolescence is a turbulent phase for all families (Coakley and Berrick, 2008; von Korff, Grotevant and McRoy, 2006) and this study merely provides the qualitative parental experience of adopters of late adopted children, considering that we know that difficulties in adolescence will be accentuated for those adolescents with such adverse and traumatic experiences. Many of the parents explained their worries as stemming from their children’s pasts, but we need to remain circumspect in how we make sense of these findings.
In addition, generalisation to families with other populations within adoption, including those adopted in infancy or internationally, must be made with caution. Similarly, further investigations are required to determine the worries and challenges of single-parent families, as well as families who decide to adopt sibling groups. Finally, it must be added that there were several mothers in the sample who were interviewed separately in relation to siblings who were placed with them and who are likely to have had similar histories. This might have impacted upon their responses and the subsequent themes.
The authors chose to specifically examine the more negative thoughts, as in the anxieties and fears, in relation to the adopted adolescents. The salient questions that were mostly eliciting these perceptions emerged from mainly open questions which would have allowed for more positive content (e.g., What are you feeling about your child’s future?) as well as those that were more tailored to specifically pull out their fears (e.g., When you worry about your child, what do you find yourself thinking about?). We are mindful that this paper might present a skewed picture of how parents think about their child’s future when of course a few parents were able to express confidence, belief and hope in how their child’s trajectory might look. It must, however, be stated that although some questions were more positively orientated (e.g., What do you wish for?), content in relation to the more hopeful responses of this cohort of parents was limited and submerged by the anxiety-inducing and catastrophising material.
The focus in the wider study was on late adopted children and their parents, a population with a significant amount of adversity and risk. It is important to state that there were questions and content within these parent interviews, which fell outside the specific focus of this study, that suggested strengths and self-determination within both the adoptive parents and their children. Interestingly, the principal open questions that asked the parent to imagine the child’s trajectory invariably led them to more difficult places given that they were very preoccupied with both their child’s complicated set of risk factors and the current presenting problems they were viewing in early adolescence. Future studies within this population should examine these strengths and resilient factors. Indeed, there is so much emphasis placed on psychopathology or mental illness that we can neglect attending to the side of strength, the side of what we’re good at (Seligman, 1999). Although the themes that emerged in this study are all negative in their content, from another vantage point, given that these young adolescents had experienced such discontinuity and adversity in their early years, we are perhaps guilty of failing to acknowledge the strengths and characteristics within both adoptive parents and adopted children that have allowed them to reach this place. A more strengths-based approach in future might allow for a more considered study of what is going well, how this is working and how to build on it (Barwick, 2004). A further integration of the dynamic between the strengths and challenges will be the natural next step. A final note of consideration is that this is a study on perceptions of the future and again, will have been significantly influenced by the parents’ knowledge of the child’s pre-placement past and how those risk factors might impact.
Implications For Practice
This paper explores parental perceptions of adopted children’s struggles in adolescence and the anxieties and concerns elicited by the risks that this stage brings about. The findings presented have several potential implications. As we reflect upon policy and practice with adopted individuals and their families, it is clearly critical that parents’ concerns about these challenges are thought about at the time of placement, perhaps by both incorporating evidence-based knowledge about these challenges and drawing upon other adoptive parents’ own subjective experiences. Furthermore, this paper only looked at parents’ experiences in early adolescence and considering that the intensification of issues at this stage of development is quite well documented, along with some of the intergenerational anxieties that might emerge concerning the birth family, additional post-adoption care at this stage feels crucial in order to allay these concerns and any re-emergence of anxieties experienced during pre-placement stages.This is especially true considering that support services for both those adopted, who are now in adolescence, and their adoptive parents are scarce (Rushton and Dance, 2002). This great need is evidenced by an overpowering and poignant set of perceptions in this study about young people being seen as potentially unsafe, impressionable to others, at risk to themselves and others, and making judgements that disrupted their own future. It felt like an amplification of how parents in low-risk populations might view their child.
Adoption is a lifecycle experience in which each developmental period is characterised by novel adoption stresses (Brodzinsky, Smith and Brodzinsky, 1998) and clearly parents need ongoing guidance and support, particularly during adolescence, a period which is known to be highly challenging in most populations. Given that adolescence heightens the adverse experiences, it increases the risks of the young person developing behavioural and emotional disorders (e.g. Colvert et al., 2008; Tregeagle et al., 2019) and further psychiatric conditions (Pace, Di Folco and Guerriero, 2018), intervening at this stage is essential to help parents navigate this period. With adequate expert support, training and resources, adoptive parents can be helped to address the strains and challenges that might occur. Increasingly, adoption agencies bring in experienced adoptive parents and adoptees to tell their stories which often provide the realistic preparation.
Future Research
In order to better support adoptive parents and facilitate adoptive placements, further studies are required to explore both adoptive parents’ wishes regarding what sort of help they would want as well as their perception of these challenges and their anxieties and concerns relating to their adolescent child, both in relation to their current experience and their anticipated worries about their child’s transition through adolescence into autonomous adulthood. It is hoped that this would lead to a clearer image of adoption through adolescence, which might help reflect upon how adoptive parents of late adopted children might be supported during this process. Future research will benefit from exploring parents’ experiences and also comparing this high-risk sample to parents of both early adopted individuals and biological children, so that we can have a context within which to better understand these results. It would also be important to focus energies on parental interventions in adolescence so as to examine their impact on containing and bolstering them through this period. Naturally, these interventions would need to be evaluated to establish their efficacy and experience.
Conclusions
Studies have drawn upon the more qualitative experiences of adoptive parents, but few have done so with a focus on adolescence, a period where developmental challenges and difficulties are often intensified, so precipitating additional concerns and worries for the adoptive parents.
Overall, this study adds further evidence to the very limited field on adoptive parents’ experiences and perceptions of their now adolescent adopted child. Importantly, the emerging themes are indicative of significant anxieties and worries about their child’s skills, resources and capacity to navigate the transition from adolescence to adulthood. What has emerged from this study is that adoptive parents were deeply concerned about their young adolescent’s current and future wellbeing. The five themes included those that suggest the adopted individuals were vulnerable to external pressures which could result in destructive consequences. The language used was often catastrophic in relation to the child’s impulses towards themselves and others, the pernicious influences around them, the potential intrusion of the birth family, and the loss of a more normal trajectory with positive life changes.
Footnotes
Declaration Of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.