Internalizing Problems in Adopted Eastern European Adolescents: The Role of the Informant, Early Adversity and Post-Adoption Processes / Problemas Internalizantes en Adolescentes Adoptados de Europa del Este: el Rol del Informante, la Adversidad Temprana y los Procesos Post-adopción

Background: Internationally adopted children who suffered early institutionalization are at risk of a late onset of internalizing problems in adolescence. Both pre-adoption, adversity-related, and post-adoption factors predict variability in internalizing problems in this population. Previous studies have suggested different patterns of parent- adolescent informant discrepancies in adoptive dyads. Method: We analyzed internalizing problems among 66 adolescents internationally adopted from Russia to Spanish families using both the parent- and self-report version of the Strengths and Difficulties Questionnaire and comparing them with a low-risk, community group (n = 30). We assessed pre-adoption and post-adoption factors and evaluated cross-informant discrepancies. Results: Internationally adopted adolescents exhibited more internalizing problems by parent-report than community adolescents, but there were no differences by self-report. Adopted youth showed no discrepancies between parent and self-report, whereas community adolescents reported more internalizing symptoms than their parents. Pre-adoption adversity-related factors predicted parent-reported internalizing problems, while post-adoption factors predicted self-reported internalizing problems. Conclusions: Parent-adolescent informant discrepancies in adopted adolescents from Eastern Europe for internalizing symptoms were lower than in community adolescents. Both adversity-related factors and the lived experience of adoption may influence the development of internalizing symptoms in internationally adopted adolescents.(AU)

Antecedentes: Los niños y niñas adoptados internacionalmente están en riesgo de desarrollar problemas emocionales en la adolescencia. Factores relacionados con la adversidad y con procesos post-adopción predicen variabilidad en problemas internalizantes en esta población. Estudios previos sugieren también diferentes patrones de discrepancias entre informantes en diadas adoptivas. Método: Analizamos los problemas internalizantes en 66 adolescentes adoptados de Rusia a familias españolas, usando el Cuestionario de Capacidades y Fortalezas y comparándoles con un grupo adolescentes de la comunidad (n = 30). Evaluamos factores pre- y post-adopción y discrepancias entre informantes (autoinforme e informe parental). Resultados: Los adolescentes adoptados mostraron más problemas internalizantes por informe parental que los adolescentes comunitarios, pero no hubo diferencias por autoinforme. En el grupo adoptado no hubo discrepancias entre informantes, mientras que el grupo de comparación reportó más síntomas internalizantes que sus progenitores. Factores relacionados con la adversidad predijeron problemas internalizantes por informe parental, mientras que factores post-adopción predijeron problemas internalizantes por autoinforme. Conclusiones: Las discrepancias entre informantes en problemas internalizantes fueron menores en adolescentes adoptados que en adolescentes de la comunidad. Tanto factores relacionados con laadversidad como con la vivencia de la adopción pueden influir en el desarrollo de problemas internalizantes en adolescentes adoptados internacionalmente.(AU)

Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

Trends in "green" and novel methods of pectin modification - A review.

Modification of hydrocolloids to alter their functional properties using chemical methods is well documented in the literature. There has been a recent trend of adopting eco-friendly and "green" methods for modification. Pectin, being a very important hydrocolloid finds its use in various food applications due to its gelling, emulsifying, and stabilizing properties. The adoption of various "green" methods can alter the properties of pectin and make it more suitable for incorporation in food products. The novel approaches such as microwave and pulsed electric field can also be utilized for solvent-free modification, making it desirable from the perspective of sustainability, as it reduces the consumption of organic chemicals. Pectic oligosaccharides (POSs) produced via novel approaches are being explored for their biological properties and incorporation in various functional foods. The review can help to set the perspective of potential scale-up and adoption by the food industry for modification of pectin.

Parentalidades adotante e biológica: dois lados do vínculo familiar / Adoptive and biological parentalities: two sides of the family bond

Trata-se de um projeto desenvolvido a partir da disciplina de Práticas Integrativas II (Psicologia), em parceria com uma instituição-abrigo. A análise dos casos, a metodologia das ações e as discussões teóricas foram fundamentadas na abordagem sociodramática, enfatizando-se o exercício da criatividade e da espontaneidade como modo de ampliação dos vínculos e reconfiguração das relações, bem como a dramatização como exercício de protagonismo. O presente artigo evidencia a vivência de um grupo de familiares biológicos e adotantes, em um processo que implicou em forte repercussão para os integrantes. Participaram: um casal, que estava finalizando o processo de adoção de seu primeiro filho; uma senhora que desejava reaver a guarda de suas netas, ainda residentes na instituição. O processo grupal deu ensejo a importantes percepções e reflexões, a partir das quais tanto a representante da família biológica, como os pais adotivos ressignificaram seus pontos de vista a respeito da parentalidade.

This is a continuous project in the discipline of Integrative Practices II (Psychology), in partnership with an institution-shelter. The analysis of the cases, the methodology of the actions and the theoretical discussions were based on the sociodramatic approach, that emphasizes the practice of the creativity and the spontaneity as a way of expanding the bonds and to reconfigurate of the relationships; and the dramatization as a practice of protagonism. This paper evidences the experience of a group of biological and adoptive family, in a process that had strong repercussion for the participants. They were a couple who was finalizing the process of adoption of their first son, and a lady who wished to recover the guard of their granddaughters who still were in the institution. The group process evidenced important perceptions and reflections, from which both the representative of the biological family and the adoptive parents re-defined their points of view regarding parenting.

Transitions of Adoptive Parents: A Longitudinal Mixed Methods Analysis.

As adoptive parents create a new family, they face myriad changes both pre-and post-placement of their child. The aim of this study was to describe parent perceptions and depressive symptoms during this transition via reports collected with an online survey. Using content analysis, we analyzed a total of 110 responses from 64 parents at three time points: 4-6weeks pre-placement, and 4-6weeks and 5-6months post-placement. Five main themes were revealed: Transition from uncertainty to a new normal; unique experiences related to adoption; rest/fatigue: out of balance; life stressors; and faith/spirituality. Two subthemes were also identified: previous losses (pre-placement) and joy and love (post-placement). During the transition from pre-to post-placement, adoptive parents experience a unique passage, with both challenges and strengths exclusive to this group of parents. While acknowledging the commonalities of some parenting experiences, healthcare and adoption professionals should recognize the unique dynamics that adoption brings to families.

An evaluation of Neuro-Physiological Psychotherapy: An integrative therapeutic approach to working with adopted children who have experienced early life trauma.

Research into the effectiveness of therapeutic interventions for older children who have experienced multiple forms of trauma within the context of their early development is scant. This article explores the effectiveness of Neuro-Physiological Psychotherapy (NPP): a wrap-around multi-disciplinary, neuro-sequential, attachment-focussed intervention for children and families who present with multiple, clinically significant, emotional and behavioural difficulties. In total, 31 young people and their adoptive parents took part in the study. Baseline measures were repeated and parents and children interviewed. An assessment of the parent/child relationship and child attachment was undertaken but not analysed for this article. Analysis of the repeated measures received statistically significant changes in behavioural regulation, metacognitive executive functioning and externalising and internalising difficulties, alongside an improvement in thought and social problems. An analysis of the parent interviews provided positive results in terms of the children's engagement in education, an absence of further mental health diagnosis or involvement in the criminal justice system. Further hypotheses are posited regarding the impact of the treatment and further research into the effectiveness of the model outlined.

Neuro-Physiological Psychotherapy (NPP): The development and application of an integrative, wrap-around service and treatment programme for maltreated children placed in adoptive and foster care placements.

This article describes the development and application of a wrap-around, multidisciplinary, brain-based, developmental and attachment-focussed intervention for children who have experienced significant trauma in the context of their early life. It outlines the presentation of the children and families who are referred to the service and the model of treatment that they receive. In doing so, it identifies the core components underpinning Neuro-Physiological Psychotherapy (NPP) and links the application of the integrative model to research and practice in the field of neuroscience and attachment and to the use of therapeutic approaches that are beneficial to maltreated children and their adoptive parents. It highlights the need for a neuro-sequential approach that impacts all aspects of the child's life in the effort to redress the impact of developmental trauma with the aim of improving their overall functioning and their ability to develop healthy relationships into the future.

Foetal trauma, body memory and early infant communication: a case illustration.

This paper presents the complex case of a male patient who started life as an unwanted pregnancy and adoptee in an era of socio-cultural shame and blame. When able to contact his birth mother later in life, he experienced a number of confronting synchronicities as well as visions which he felt were related to failed abortion attempts and to other pre- and post-natal events. The case material lends weight not only to Freud's, Ehrenwald's and FitzHerbert's assertions that the earliest form of mother-infant communications is telepathic in nature but that this mode of communication can be retained if emotional trauma inhibits normal developmental processes. Contemporary neuroscience research is presented supporting the hypothesis that emotional memory can become imbedded in the psyche/soma of the foetus. Such memory traces can later emerge into imagery and/or words if the traumatic impingement has been substantial enough and if other defensive strategies are in place. Clinical implications are then suggested regarding analysts' attention to the emotional conditions underpinning their patients' conceptions and foetal development; the connection to projective identification components of the countertransference as being aspects of the earliest telepathic mother/infant communication channel and the need for reductive analyses in analyst training programmes.

Increased health-care utilisation in international adoptees.

INTRODUCTION: Several studies have documented that international adoptees have an increased occurrence of health problems and contacts to the health-care system after arriving to their new country of residence. This may be explained by pre-adoption adversities, especially for the period immediately after adoption. Our study aimed to the assess health-care utilisation of international adoptees in primary and secondary care for somatic and psychiatric diagnoses in a late post-adoption period. Is there an increased use of the health-care system in this period, even when increased morbidity in the group of international adoptees is taken into consideration? METHODS: This was a Danish register-based cohort study examining health-care utilisation in a multivariable two-part model. The prevalence of selected outcomes and the quantity of use were assessed in a late (year three, four and five) post-adoption period. The cohort comprised internationally adopted children (n = 6,820), adopted between 1994 and 2005, and all non-adopted children (n = 492,374) who could be matched with the adopted children on sex, age, municipality and family constellation at the time of adoption. RESULTS: International adoption increased the use of all services in primary care, while in secondary care only few areas showed an increased long-term morbidity. CONCLUSION: International adoptees use medical services in primary care at a higher rate than non-adoptees some years after adoption. Excess use of services in secondary care is also present, but only exists in selected areas. FUNDING: none. TRIAL REGISTRATION: not relevant.

An extended Swedish national adoption study of alcohol use disorder.

IMPORTANCE: Alcohol use disorder (AUD) runs strongly in families. It is unclear to what extent the cross-generational transmission of AUD results from genetic vs environmental factors. OBJECTIVE: To determine to what extent genetic and environmental factors contribute to the risk for AUD. DESIGN, SETTING, AND PARTICIPANTS: Follow-up in 8 public data registers of adoptees, their biological and adoptive relatives, and offspring and parents from stepfamilies and not-lived-with families in Sweden. In this cohort study, subtypes of AUD were assessed by latent class analysis. A total of 18,115 adoptees (born 1950-1993) and 171,989 and 107,696 offspring of not-lived-with parents and stepparents, respectively (born 1960-1993). MAIN OUTCOMES AND MEASURES: Alcohol use disorder recorded in medical, legal, or pharmacy registry records. RESULTS: Alcohol use disorder in adoptees was significantly predicted by AUD in biological parents (odds ratio, 1.46; 95% CI, 1.29-1.66) and siblings (odds ratio, 1.94; 95% CI, 1.55-2.44) as well as adoptive parents (odds ratio, 1.40; 95% CI, 1.09-1.80). Genetic and environmental risk indices created from biological and adoptive relatives acted additively on adoptee AUD liability. Results from biological and adoptive relatives were replicated and extended from examinations of, respectively, not-lived-with parents and stepparents. Multivariate models in these families showed that AUD in offspring was significantly predicted by AUD, drug abuse, psychiatric illness, and crime in not-lived-with parents and by AUD, drug abuse, crime, and premature death in stepparents. Latent class analyses of adoptees and offspring of not-lived-with parents with AUDs revealed 3 AUD classes characterized by (1) female preponderance and high rates of psychiatric illness, (2) mild nonrecurrent symptoms, and (3) early-onset recurrence, drug abuse, and crime. These classes had distinct genetic signatures in the patterns of risk for various disorders in their not-lived-with parents and striking differences in the rates of recorded mood disorders. CONCLUSIONS AND RELEVANCE: Parent-offspring transmission of AUD results from both genetic and environmental factors. Genetic risk for AUD reflects both a specific liability to AUD and to other externalizing disorders. Environmental risk reflects features of both parental psychopathology and other aspects of the rearing environment. Alcohol use disorder is a heterogeneous syndrome and meaningful subtypes emerged from latent class analysis, which were validated by patterns of disorders in biological parents and specific psychiatric comorbidities. The general population contains informative family constellations that can complement more traditional adoption designs in clarifying the sources of parent-offspring resemblance.

The causes of parent-offspring transmission of drug abuse: a Swedish population-based study.

BACKGROUND: While drug abuse (DA) is strongly familial, we still have limited knowledge about the causes of its cross-generational transmission. METHOD: We examined DA ascertained from national registers in offspring of three family types from the Swedish population [intact (n = 2,111,074), 'not-lived-with' (n = 165,315, where biological parents never lived with their offspring) and 'step' (n = 124,800 offspring)], which reflected, respectively, the effects of genes + rearing, genes only and rearing only. We replicated these results in three high-risk co-relative designs. RESULTS: Combined across mothers and fathers, the hazard ratio (HR) for DA in offspring given DA in parents was 3.52 in intact, 2.73 in 'not-lived-with' and 1.79 in stepfamilies. In 968 biological full or half-sibling pairs one of whom was reared by and the other never lived with their parent with DA, the HR for DA was greater in the reared than 'not-lived-with' child (HR 1.57). In 64 offspring pairs of a parent with DA, the HR for DA was greater in a reared biological v. step-parented non-biological child (HR 3.33). In 321 pairs of offspring of a parent with DA one of whom was a not-lived-with biological child and the second a step-parented non-biological child, the HR for DA was greater in the biological v. stepchild (HR 1.80). CONCLUSIONS: Both genetic and environmental factors contribute substantially to parent-offspring resemblance for DA. The general population contains informative family constellations that can complement more traditional adoption designs in clarifying the sources of parent-offspring resemblance.

Mapping the unconscious maintenance of a lost first language.

Optimal periods during early development facilitate the formation of perceptual representations, laying the framework for future learning. A crucial question is whether such early representations are maintained in the brain over time without continued input. Using functional MRI, we show that internationally adopted (IA) children from China, exposed exclusively to French since adoption (mean age of adoption, 12.8 mo), maintained neural representations of their birth language despite functionally losing that language and having no conscious recollection of it. Their neural patterns during a Chinese lexical tone discrimination task matched those observed in Chinese/French bilinguals who have had continual exposure to Chinese since birth and differed from monolingual French speakers who had never been exposed to Chinese. They processed lexical tone as linguistically relevant, despite having no Chinese exposure for 12.6 y, on average, and no conscious recollection of that language. More specifically, IA participants recruited left superior temporal gyrus/planum temporale, matching the pattern observed in Chinese/French bilinguals. In contrast, French speakers who had never been exposed to Chinese did not recruit this region and instead activated right superior temporal gyrus. We show that neural representations are not overwritten and suggest a special status for language input obtained during the first year of development.

Effects of parental depressive symptoms on child adjustment moderated by hypothalamic pituitary adrenal activity: within- and between-family risk.

Child hypothalamic pituitary adrenal (HPA) activity was investigated as a moderator of parental depressive symptom effects on child behavior in an adoption sample (n = 210 families). Adoptive parents' depressive symptoms and child internalizing and externalizing were assessed at 18, 27, and 54 months, and child morning and evening HPA activity measured through salivary cortisol at 54 months. Children's daily cortisol levels and day-to-day variability were tested as moderators of longitudinal associations between parent and child symptoms at within- and between-family levels. Mothers' symptoms related directly to child internalizing, but child evening cortisol moderated effects of fathers' symptoms on internalizing, and of both parents' symptoms on externalizing. Different paths of within-family risk dynamics versus between-family risk synergy were found for internalizing versus externalizing outcomes.

A randomized targeted amino acid therapy with behaviourally at-risk adopted children.

BACKGROUND: Increasing numbers of children are at-risk for behavioural and emotional disorders, a phenomenon contributing to increased use of pharmacological interventions for paediatric clients. Adverse side effects and other risks associated with pharmacological approaches have helped fuel interest in nutritional interventions for behaviourally at-risk children. METHODS: The current randomized clinical trial evaluates the efficacy of a neurochemical intervention involving the glutamine and glutamate analogue L-theanine and 5-hydroxytryptophan, the precursor for serotonin, with children adopted from traumatic backgrounds. RESULTS: Results include significant increases in urinary levels of the biomarkers for serotonin and gamma-aminobutyric acid, coupled with significant decreases in parent reports of the children's behaviour problems. CONCLUSIONS: While further research is needed, these initial findings are encouraging and are consistent with a growing number of studies indicating the efficacy of nutritional approaches to help behaviourally at-risk children.

Multi-agency and specialist working to meet the mental health needs of children in care and adopted.

Many of the children and young people who are looked after in foster and residential care or are adopted have complex mental health needs that are not well met by traditional mental health services. These vulnerabilities stem from an interaction between pre- and post-care experience, and often include trauma, attachment and developmental difficulties. It is now widely recognized that these children are best served by dedicated services provided by professionals with expertise in meeting the needs of looked after and adopted children. This involves effective joint working between health, education and social care services and requires supportive policies and structures at all levels of the organizations. This paper will explore the strengths, challenges and barriers of multi-agency and specialist working to meet the needs of these vulnerable children and young people.This will be illustrated with case examples drawn from a multi-agency service in Worcestershire, UK.

Science and pseudoscience in developmental disabilities: guidelines for social workers.

Individuals with a developmental disability can now be provided a variety of empirically supported treatments that have been shown to be useful in promoting educational attainments, social and vocational skills, and self-care, and in reducing behavioral problems. Unfortunately, a large number of pseudoscientific or bogus therapies continue to be offered to this population and their families. We review the characteristics of pseudoscientific and bogus treatments and provide several examples of unsupported or harmful interventions offered by contemporary social workers and other human service professionals, to the detriment of people with disabilities. We encourage social workers to identify pseudoscientific interventions and avoid providing these, in favor of using empirically supported treatments.

Latent tuberculosis infection in children: a call for revised treatment guidelines.

BACKGROUND: Guidelines for latent tuberculosis infection do not consider drug-resistance patterns when recommending treatment for immigrant children. OBJECTIVES: The purpose of this research was to decide at what rate of isoniazid resistance a different regimen other than isoniazid for 9 months should be considered. METHODS: We constructed a decision tree by using published data. We studied 3 regimens considered to be effective for susceptible organisms: (1) isoniazid for 9 months, (2) rifampin for 6 months, and (3) isoniazid for 9 months plus rifampin for 6 months. In addition, we evaluated a regimen of isoniazid and rifampin for 3 months. Our base case was a 2-year-old child from Russia with a tuberculin skin test reaction of 12 mm. We assumed a societal perspective and expressed results as cost and cost per case of tuberculosis prevented. We conducted sensitivity analyses to test the stability of our model. RESULTS: In our baseline analysis, rifampin was the least costly treatment regimen for any child arriving from an area with an isoniazid-resistance rate of >/=11%. Treatment with isoniazid plus rifampin was the most effective but would cost more than $1 million per reactivation case prevented. Isoniazid would become the least costly regimen if any of the following thresholds were met: rifampin resistance given isoniazid resistance of more than 82%; rifampin resistance given no isoniazid resistance of >9%; cost of rifampin more than $47/month; effectiveness of rifampin lower than 63%; effectiveness of isoniazid higher than 74%; and cost of pulmonary tuberculosis less than $7661. Isoniazid and rifampin for 3 months was the least costly for all cases from areas with isoniazid resistance of <80% as long as the regimen's effectiveness was >50% for susceptible bacteria. However, this assumption remains to be proven. CONCLUSION: Because of the high prevalence of isoniazid resistance, rifampin should be considered for children with latent tuberculosis infection originating from countries with >11% isoniazid resistance.