Andrea Bujor
The English Romanian Adoptee study provided critical insights into the long-term impact of early adversity on child development. It defined a range of ‘deprivation-specific outcomes’ including cognitive impairment, ADHD, elevated symptoms of autism, and disinhibited social engagement disorder. While some brain regions showed signs of recovery, many neurodevelopmental challenges persisted into young adulthood. Despite high levels of engagement with mental health services, families report that adoptees’ support needs often remain unmet.
These findings must be interpreted within the specific cultural and contextual nuances of the UK, where institutional care and orphanages have been phased out in favour of adoption and policies aimed at supporting adoptee stability and development. Consequently, it is vital to build on the ERA findings by examining the broader post-adoption experiences of all adoptees. Doing so could reveal parallels with those exposed to early severe neglect and help identify ongoing gaps in support provision.
In our systematic review spanning 77 studies, we found eight areas of unmet support for attachment, neurodevelopment challenges, mental health, addressing early adversity/trauma, educational needs, identity, grief/loss, and contact with birth relatives.
Similar to the adoptees in the ERA studies, adoptees generally formed secure attachments to their adoptive parents. Attachment challenges focused more so on the need to help families adjust post-adoption. While formal attachment diagnoses were rare among studies, some reported general ‘attachment difficulties' which influenced an adoptee’s sense of identity, belonging, and connection to their new environment. Considering the findings of both studies, there remains the need to better differentiate attachment related issues from other mental health issues and to broaden support to address the wider ranges of challenges. Some recommendations from adoptees and their families included the need for greater education about how to build attachments to their adoptees and the need for ongoing support if crises occurred.
Although experiences of adoptees in this review differed from the adoptees in the ERA study in terms of early institutionalisation, early adversity and trauma was still common for adoptees coming from the care system. Trauma included experiences such as neglect, abuse, and frequent moves before adoption. These events had cascading effects on behaviours, relationships, and emotional regulation, suggesting the need for service providers to better recognise the link between behavioural issues and trauma.
Similar to the adoptees in the ERA studies, many individuals in this review struggled with neurodevelopmental challenges. Worryingly, adoptees often struggled to receive appropriate and timely diagnoses, support, and interventions. These findings, taken together with the ERA study, suggest a greater need for service providers to understand the neurobiological and developmental impacts of early adversity, trauma, and risk factors involved with adoptees.
Mental health challenges were elevated among adoptees in this review, despite high service usage. Challenges were complex and similar to above and there seemed to be a misunderstanding from service providers about how mental health challenges related to adoption-specific experiences.
Based on these challenges, it is no surprise that adoptees may require interdisciplinary support. Some adoptees reported elevated struggles in education, including with attention and reading comprehension, a finding reflected in the ERA study where participants reported struggles with educational attainment and further risks on unemployment.
This review found differing support needs from the ERA study for identity, grief/loss, and contact with birth relatives. Some adoptees struggled with their identity development, especially when they had missing or contradictory information about their past. Families reported a greater need for support in using post-adoption tools such as the life story book. Additional support may be required for interracial adoptees as their experience of looking/feeling different from their peers and families could differ. Feelings of loss were connected to a loss of birth family, culture, language, and identity. Negative feelings were elevated when adoptees felt that nobody could understand or connect with their experience. Finally, many adoptees struggled with reaching out to their birth families, as it often brought up mixed emotions and required careful navigation from service providers post-reunion.
The Bottom Line
Despite the positive and loving experiences that come with adoption, some adoptees continue to struggle into young adulthood. Adoptees and their families know what they need and what is missing, but many aren’t getting it. Two areas stood out as urgent- neurodevelopmental support and the role of early adversity/trauma on later mental health outcomes, as reflected in the ERA sample. Although early experiences and backgrounds differ between the two samples, there seems to be some risk factors and considerations at play for adopted individuals. For all adoptees, adoption is forever but for some adoptees, so is the need for support. Thus, we need to re-evaluate the support provided to adoptees and how we can better meet their needs.
About Andrea Bujor
Andrea Bujor, MSc in Psychology & Neuroscience of Mental Health, is deeply passionate about advancing understanding in the field of mental health. Her research interests span a diverse range of topics, including the use of psychedelic-assisted therapy for mental health treatment and the mental health support needs of adoptees. Currently based in Oslo, Andrea works with The Human Aspect, an NGO dedicated to normalising conversations around mental health by sharing real, lived experiences. Through both her research and professional work, Andrea remains committed to reducing stigma and promoting evidence-based approaches to mental well-being.
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