Our latest publication
We would like to bring to your attention our latest publication:
- Exploring the relationship between adoption and psychological trauma for children who are adopted from care: A longitudinal case study perspective.
We wrote this paper for a special edition of Child Abuse & Neglect. This special edition was co-edited by our P.I., Dominic and focused on the relationship between adoption and trauma. It will be released in June 2022 and features 14 articles. These articles are available online.
What we wanted to achieve
Dominic wanted to try something quite ambitious for this paper and we weren’t sure if we could make it work for a journal format, the issue as always being word count. The special edition focuses on a current debate in the field which asks if adoption provides a pathway to healing for traumatised children, does it help them to recover from past psychological harm or actually does it create trauma in itself through the very nature of being an adopted child?
Dominic’s idea was to approach the question using a case study approach from three waves of our Care Pathways and Outcomes study data. It would focus on children who had been adopted from care and who took part in the first three waves with a view to a follow-up paper which would then continue the story of our young people into adulthood.
In order to maintain that completeness in the follow up paper, we would include young people who we knew were also present in wave 4. This resulted in the selection of 10 children for consideration in the article. The aim of the article was to explore the relationship between adoption from care and psychological trauma through the lens of the 10 children. The journey would begin pre-care and go through to the teenage years.
What a journey it was. For me, as someone relatively new to the project, it was good opportunity to gain a deeper understanding of the stories of the young people who have contributed to our project. As always, a special thank you to them and their parents/carers and all who have supported this study in the last 22 years.
So, what did we do?
First we constructed two checklists. The first was used to identify occurrences of adversity. These were based on forms of child maltreatment and neglect and it was constructed using definitions of abuse and neglect from the UK Government Guidelines for working to safeguard children – Appendix A.
The second checklist was used to identify evidence of possible psychological trauma. This checklist was collated from psychological trauma literature specific to children adopted from care. One example of this literature is a paper by Rebecca Anthony and colleagues which focuses on adverse childhood experiences in the Wales Adoption Cohort Study.
We then used these checklist to compose our ten case studies. The case studies included qualitative and quantitative data for all 10 children from Waves 1-3 of the Care Pathways study.
It would be perfect if there was a way to include all data and particularly compelling for us was the children and young people in the study told us, and what their parents told us. But the skill is in creating something workable for a journal to publish while maintaining the integrity and core messages from the data.
In addition to this, I feel it is only right to mention how emotional this journey is, how generous our young people and their parents/carers have been to take part in our study. If it is emotional for us to read, how must it be to live these experiences that have been shared with us.
And what did we find?
Please read the full paper for all our findings and read each of the case studies:
- Exploring the relationship between adoption and psychological trauma for children who are adopted from care: A longitudinal case study perspective
The case studies were constructed to begin with Wave 1 which was focused on the period when the children initially entered care and describe early experiences of adversity and possible psychological trauma.
They then progressed to Wave 2 when the children were aged between 4 and 9 years old. They then moved to Wave 3 when the children were aged between 9 and 14 years old. In addition to the case studies relevant quantitative measures were reported.
For the purposes of this blog I will summarise the patterns that were found across the case studies. The pseudonyms used for the children were: Dave, Julie, Eric, Aaron, William, Eve, Steve, Fionn, Madeline and Olivia.
Evidence of possible early psychological trauma prior to entry to care and subsequent adoption. This early trauma manifested itself in early difficulties within the adoptive placement.
She hates you going away ... any time you’re going away, if we’re going on holiday, “will my room be beside yours?”, “will I be close to you?
This was followed by gradual improvement and recovery over time, resulting in the child developing secure attachments to their adoptive parents and being happy with their life. This pattern would fit the experiences of both Dave and Julie.
Evidence of possible early psychological trauma and pre-birth developmental harm from maternal alcohol misuse prior to entry to care and subsequent adoption. This early trauma and pre-birth developmental harm manifested in multiple challenges at the beginning of the adoptive placement, and throughout, particularly in relation to the child suffering from Fetal Alcohol Spectrum Disorder (FASD), although there was evidence that there was some improvement in the child’s behaviour and emotional symptoms over time.
The problems that William had were probably to do with his mood but also because he had FASD, and for a lot of the problems we saw were related to his sleep pattern ... night terrors ... he was absolutely traumatised when you tried to take him upstairs
Despite these challenges, it was clear that the child had developed secure attachments with their adoptive parents and was happy in their life. This pattern would be consistent with the experiences of Eric, Aaron and William.
For more information on FASD, please read Dominic’s guest blog for The Fostering Network.
No evidence of early psychological trauma or pre-birth developmental harm prior to entry to care and subsequent adoption. In this instance, there were no early difficulties at the start of the placement or throughout, with development progressing normally, and secure attachments formed. This pattern is consistent with the experience of Fionn.
Evidence of early psychological trauma and inherited intellectual disability prior to entry to care and subsequent adoption. This led to some early difficulties in the adoptive placement, and although the developmental deficits continued to raise challenges, there was some improvement over time, and the child had developed secure attachments to the adoptive parents and was happy in their life. This pattern would reflect the experiences of Eve and Steve.
No evidence of psychological trauma prior to entry to care but evidence of possible psychological trauma in the transition from foster care to new adoptive placement. The lengthy duration of the initial foster placement supported the formation of secure attachments with foster carers, and the ending of these relationships through movement to adoptive placement did appear to have been psychologically traumatic for the child. This led to early difficulties in the adoptive placement.
If it was just her and me all the time and we wouldn’t have the boys to rub us up the wrong way, it would probably have worked out better, but it will work out
However, these resolved over time and the child developed new secure attachments with the adoptive parents and was happy with their life. This pattern was consistent with the experiences of Madeline.
Evidence of psychological trauma prior to entry to care and evidence of possible psychological trauma in the transition from foster care to new adoptive placement. The lengthy duration of the initial foster placement supported the formation of secure attachments with foster carers, and the ending of these relationships through movement to adoptive placement did appear to have been psychologically traumatic for the child. Combined with the possible early trauma prior to entry to care, this manifested itself in early difficulties in the adoptive placement.
Quite difficult at the start, there wasn’t an immediate bond, child was quite withdrawn ... if you lifted her it was like carrying a piece of wood ... no interaction at all
However, these resolved over time and the child developed new secure attachments with the adoptive parents and was happy with their life. This pattern was consistent with the experiences of Olivia.
What can we conclude from the work?
What was very clear from the case studies was that the early lives of children adopted from care almost without exception reflect complex and often multiple adverse experiences or situations. The birth parents of adopted children have very complicated challenges and struggles in their lives, and these have prohibited them from parenting their children meaning the children must be provided with alternative homes, parents or carers. Adverse experiences for these children may often include pre-birth experiences and be contributed to through genetics.
It is not unexpected that having to be taken into care and being adopted will evoke feelings of ambivalence, confusion and sadness. What we found was the relationship between adoption and trauma mainly reflected a picture of psychological trauma occurring for these children prior to entry to care, with adoption then facilitating some degree of recovery over time. Other studies have also shown this capacity for nurturing relationships to aid recovery. One such study was by Palacios and colleagues.
We did find some evidence of psychological trauma extending beyond the pre-care experience, and into adoption, where children had been living in an established foster placement for an extended period of time prior to movement to the adoptive placement, resulting in the child’s attachments with their foster parents being effectively severed.
In these instances, it could be argued that there was the possibility that they were psychologically traumatised by their adoption. However, in the two instances where this occurred, it was clear that the children did go on to form new secure attachments with their adoptive parents and were happy.
Apart from the two instances of possible traumatic transition from foster care to adoption, there were no examples of data gathered during any phase of the study, for any of the other children, that indicated being adopted, or being an adopted child, was traumatic for them in any way, shape or form. They were all secure and content in their lives, despite the health difficulties that many were experiencing.
Where there implications for policy and practice?
Of course. There were three areas raised in the paper which highlight areas for improvement.
- There were cases when children may have experienced psychological trauma due to removal from an established foster placement into an adoptive placement. Greater efforts to expediate the process would be helpful and also where that is not possible, supporting the maintenance of these well-established placements.
- A striking finding from the process was the psychological presence in the children’ lives of their birth parents in a way that created sadness and confusion. Support from specifically trained practitioners would allow the children to understand their adoptive journey. The theory of ambiguous loss is a fascinating and compelling one and will be covered in our next blog.
- It was clear from almost all the case studies that the early stages of adoptive placement are challenging. In particular where FASD or learning disabilities play a part, these could persist longer.
The recommendation from us to help with these issues is the establishment of a formal link worker for every child adopted from the care system who would support parents with the specific and challenging needs adoption can bring.
A final word
The findings of this piece of work affirm the capacity of adoption to help children who have experienced early psychological trauma to recover from those difficulties, and to provide a home for those suffering from a range of disabilities where they feel content and happy with their lives.
Yet, even though these children are being supported by adoptive parents as best as they can, it is clear that more could be done by local authorities to support these families, particularly when dealing with very challenging health and educational needs.