Thursday, November 08, 2007

Dr. Tam's Research Study

Hi all - Donna here.

Still waiting for the info about concurrent adoptions.

I saw this newsletter posted on the canadiansadoptingfromchina list and thought you might be interested in reading it. Some of you might've already read it if you're on that list. I remember being contacted by Dr. Tam just after we came home from China with our oldest daughter, asking if we would like to participate in this study. We chose not to only because we were already participating in a study being done by the Hincks Dellcrest Centre here in Toronto.

The results from both studies (thus far) seem to be quite similar. The only difference with the one done by the Hincks was that it showed of all the areas of development, speech & language seemed to be the most common delay amongst the children, BUT, that the majority of them caught up within 1 year.

Being a Mom to 2 children from China myself (and in dealing with families post-adoption in my job), I can attest to the results of this study.

Figured of most interest to all of you would be Dr. Tam's meeting with the CCAA. Alot of it is information you probably already have, but still interesting nonetheless.

Take care.

University of South Florida, 4202 E. Fowler Ave., EDU162, Tampa, FL 33620-8335 Tel: 813-974-6496 ● Fax: 813-974-5814 ●

Mission: The China Adoption Research Program at the University of South Flori­da seeks to conduct rigorous longitudinal developmental research on child and fami­ly outcomes associated with the adoption of children from China, and to use the findings of such research to inform the adopted children’s teachers, active and prospective adoptive families, as well as policy makers, managers, consultants, support groups, and agencies involved in the adoption process.

Director & Research Team Leader:
Dr. Tony Xing Tan
Psychological and Social Foundations
Tel: 813-974-6496 ● Fax: 813-974-5814

Members of the Research Team:
Robert F. Dedrick, Ph.D.
Educational Measurement & Research
Kofi Marfo, Ph.D.
CRCDL & Psychological and Social Foundations

Dear Parents:

I hope you are doing well.

In this letter, I will be sharing with you my meeting with the CCAA officials on August 14th of this year, and some prelimi­nary results on parents’ report of their children’s development.
Thank you very much for helping me with the research for the second time. I was able to gather data from 670 families (out of the 853 families in the 2005 phase of the study). Unfortunate­ly, there were about 120 families who participated in the 2005 study but their contact information was no longer valid. I am hoping that they will get in touch with me after reading this newsletter.

The 2007 study is designed to learn about the adopted child-ren’s development since 2 years ago. In this phase of the study, I focused on preschool children’s sleep patterns and sleep prob­lems. For the school-aged children, I focused on their social skills and academic skills. I asked the parents to fill out a blue form (the same as the one they filled out in 2005) called the Child Behavior Checklist (CBCL). I also asked them to fill out a Social Skill Rating System (SSRS) and Sleep and Parenting Sur­vey (for preschool children only). In this phase I also asked par­ents if they would be willing to ask their adopted children’s teacher to fill out a survey. I am sending the parents the surveys for the teachers this week.

I have again arranged the findings in a Q & A format so that you can choose to read the ones that interest you. I hope you find them informative.

On August 14th, I met with the CCAA officials in their new building. While there, I noticed that the CCAA was busy welcoming children in Beijing for heritage tours. When I was at the office of the deputy director Ms. Chu XiaoYing (who was the Director of Document Review office in 2002 when I last visited), I noticed a large poster with many photos of the adopted children (current photo, current residence, adoption photo, orphanage, as well as a short mes­sage the child wrote to CCAA). I believe a couple of the children are actually in my study.
At the CCAA, I had individual meetings with Ms. Chu and Ms. Tie Ling (Director of Infant and Todd­ler Care). I also had a brief meeting with Mr. Ji (Di­rector of Domestic Adoption) (who was Director of the Matching Office in 2002 when I last visited). I did not get the opportunity to meet with Mr. Lu (Di­rector of CCAA). Hopefully, when I visit again, he will have time to meet.

My meeting with Ms. Chu focused on the current CCAA policy. We discussed some of the policy changes that had evoked strong reactions from the adoptive parents. The discussions were open and Ms Chu offered her insights that might help us better un­derstand the policy change. The summary of the dis­cussions are as follows:

1. Why did CCAA change the adoption policy giv-en that it has been working well?

According to Ms. Chu there were no fundamental changes in the CCAA adoption policy. The current practice was a reaction to the decrease in the number of children available for adoption. As the number of children decreases, it is necessary for CCAA to iden­tify families that are deemed to be most suited to raise the orphanage children.

2. Single parents have been shown to be just as successful in raising adopted Chinese children, why are they not allowed to adopt any longer?

Again Ms. Chu suggested that it was not because they did not believe in the single parents’ ability to raise children. It is because of the limited number of children available. She also raised questions about whether adolescence will present more challenges for the adopted children, especially those from single-parent households.

3. Why is it taking so much longer than before to adopt?

Ms. Chu commented that this was occurring because there were too many applications piled up. The CCAA must process these applications before they can get to the newer ones. We talked at length about how the extended waiting might have affected the children as well as the parents. I mentioned that ex­tended waiting might push people away from China and some parents might experience major life events while waiting, which might lead to a change of plans and decisions to adopt (I borrowed these thoughts from another adoptive mother). Ms. Chu was sympa­thetic about this but was unable to offer any better solutions. I subsequently visited their matching office again. This time, there were between 12-16 staff members working (in 2002, there were fewer staff members working on matching). Some of them have their cubic walls covered with baby headshots. I asked Ms. Chu about matching and she said it was more like an intuition than science. The staff mem­bers typically read through the applications to gain some sense of whom the adoptive parents are and based on that, they try to find a child that they believe is the best match.

4. Why is that the new policy requires a very high income? Many families who have adopted and raised Chinese children would not have been able to do so if the policy was in place at that time.

Ms. Chu said that it was not true that they required an income of about $80,000. She said they wanted the potential adoptive parents to show evidence of assets of at least such a value. She commented that it would be much easier for a family to qualify if they own their house/apartment.

5. Will the policy change back after the Olympics?

Ms. Chu said that the Olympics did not have any­thing to do with the policy change. I suspect that the CCAA is not responsible for policy-making/change. It is likely that the Ministry of Civil Affairs plays a central part in policy issues. As evidence, while in China I visited an orphanage and was somewhat sur­prised to find out that among the staff members greet­ing me was the Director of Civil Affairs from the lo­cal city. She was clearly the person “in charge” from what I could tell.

6. Will the adopted children one day have easier ways to locate their birth parents?

Ms. Chu felt that the current reality of child aban­donment makes it very difficult to search. She said usually they would tell the adoptive parents that it is not likely that the birthparents will be located. She was very curious about the recent case of a child in the Netherlands who found and reunited with her birth family (parents and two older sisters), who live in a remote part of Chongqing.

7. Has there been an increase in post-adoption disruption?

Ms. Chu said that she was not aware of the increase. She mentioned that while the CCAA was sad to hear that some of the adoptions did not work out, they were unable to do much once the adopted family left China.

8. Is it possible that China will close international adoption if the number of children continues to decrease?

She did not believe that this would happen any time soon. She cited South Korea as an example. She sug­gested that more children out of wedlock would like­ly become a source of international adoption.

Meeting with Ms. Tie

As I am very interested in using research to inform child care in the orphanages, I scheduled a meeting with Ms. Tie, Director of the Infant and Toddler Care Program. In addition to talking about the current pol­icy change (her response was similar to that of Ms.
Chu), I focused on what was needed to improve the child-caring quality in the orphanages. Ms. Tie men­tioned that the CCAA was very interested in finding effective ways to identify high-risk children so that early interventions could be implemented in a timely manner. She felt that some systematic applied re­search on these children while they are in the orpha­nages would be very useful. Additionally, Ms. Tie also mentioned that the CCAA was interested in find­ing better ways to identify potential adoptive parents for older children. I told Ms. Tie that as a researcher, I would be happy to take on the task of developing usable tools that could be used to identify high-risk children, to help train staff members, and to help identify potential parents for older children. The dis­cussions are still at a very preliminary stage. There are several things to consider very carefully. For in­stance, is there a way to ensure that children who are identified as high-risk indeed receive intended early interventions (instead of being removed from the list of potential adoption)? Additionally, Ms. Tie made it very clear that copyright of any research results would belong to the CCAA. This makes it hard for researchers who might be interested in conducting research in the orphanages. Of course, funding is also very big concern as the CCAA would not be willing to sponsor any of the research initiatives. I am cur­rently brainstorming and conversing with other re­searchers regarding this issue. It might be possible to work with other organizations to test some of the ideas first.

Brief Meeting with Mr. Ji

Finally my brief meeting with Mr. Ji Gang, Director of Domestic Adoption, taught me something quite interesting. He told me that about 20,000 to 30,000 children were adopted domestically a year (I assume he was talking about recent statistics).
Overall, I found the CCAA to be very interested in learning about the children, their adoptive families, their schooling, and their overall life experiences as adopted individuals. They are eager to find out whether over the years there is any improvement in the children’s developmental status at the time of adoption. I am currently compiling data on the per­centage of children with delays by year of adoption (e.g., 2004 versus 2000) and by provinces. I will use the data that I collected while at Harvard in 2002 and the data that I collected in 2005 and 2007. Hopefully, this will give the CCAA a better picture of the condi­tions of children at adoption over the decade.

They are very excited to hear that some of the child­ren have done exceptionally well (e.g., in 2000 One child was featured by the Australia Post on a special sheetlet of 25 stamps) (I recently learned that the same child, now in high school, has just won a writ­ing award and is now one of six finalists at the na­tional level). They want to know where these high achievers were adopted from and what their adoptive parents were like etc. On the day that we met, Ms. Chu was actually getting ready to host an 11-year old boy in her home. She was very excited and wanted to make sure that the child would enjoy the experience. She mentioned that she wanted to do some “Ameri-can-like” things at home so the child would feel more comfortable. I suggested that it would be just fine for her to conduct her life as she usually would, so that the child could learn about Chinese culture.

Preliminary Research Findings

In my meetings with Ms. Chu and Ms. Tie, I also shared with them some information about the re­search that I have conducted. In addition to sharing with them that the Chinese children showed favorable post-adoption development, I also discussed a few findings that seemed to indicate elevated risks (e.g., observed signs of neglect at the time of adoption, de­velopmental delays at the time of adoption, sleep problems, learning disabilities, and identity develop­ment issues). I believe some of these findings are also of great interest to the adoptive parents.

Below is a summary of these findings (Some findings were from the 2005 Data).

1. Observed signs of early neglect and later development.

In 2005, parents were asked to report whether they observed any of the listed 11 signs (e.g., scars, rash­es) on the children on the day of adoption. We only asked parents to check on signs that could be easily observed. Data analysis showed that more signs were associated with more adjustment problems in the children. One of the ways that I interpret the results is that these signs reflect, to some degree, quality of care that the adopted children received while they were in orphanages. More signs of early neglect re­flect poorer quality of early experience, which might have presented more challenges in these children’s post-adoption development. I have not looked at the recent data to see if these signs continued to have an impact on the children’s behavioral development or social skills. I am hoping that as time goes by, the impact of the children’s orphanage experience will gradually diminish. From a policy perspective, this finding points to the critical need to ensure that ade­quate care be provided to orphanage children.

2. Sleep problems among the adopted children.

As a group (total: 410 children), from 2005 to 2007, preschool-aged adopted children’s sleep problems did not seem to decrease, despite the fact that many psy­chologists have believed that as children get older they are likely to experience fewer sleep problems (I did not ask parents about older children’s sleep prob­lems). In 2005, about 9% of the children had sleep problems severe enough to be considered clinical or borderline clinical. In 2007, about 7% of the children were in this range.

Sleep problems in children seem to have a distinctive etiology (as compared to other behavior problems). So far, factors such as age at adoption, current age, foster care prior to adoption, developmental delays at adoption and signs of pre-adoption neglect have all failed to explain the adopted children’s sleep prob­lems. In the 2007 survey, I asked parents more ques­tions about their children’s sleep problems/patterns, their family sleep arrangements, and how they felt about bed-sharing. The data showed that 43% of the children require an object (e.g., teddy bear) to sleep, 31% do not want to sleep alone most of the nights, 21% are afraid of sleeping in the dark, about 20% suck thumb/fingers, 17% frequently come to parents’ bed at night or early in the morning, and about 12% kick and thrash a lot when asleep. Frequent night­mares and night terrors only occur in about 2-3% of the children. Note that it is common for one child to have several of these behaviors.

In terms of sleep arrangements, about 11% of the children co-sleep with their parents, around 55% of the children sleep alone in their own bedroom, and 23% of the children share a bedroom with their sibl­ings. Single parents are more likely to co-sleep with their children. For most families, co-sleeping oc­curred after the parents had exhausted options in managing their children’s sleep problems. Overall, adoptive parents tend to be rather neutral towards co-sleeping. Many parents commented that if it is needed, they would use it. The most frequently cited method used to help improve the child’s sleep pat­terns is strict/consistent bedtime routines.

Interestingly, I found that very few parents asked their children’s doctors about co-sleeping. For those who did ask, the doctors usually discouraged it. Fam­ilies who struggle with this issue tend to use the adoptive community as a resource. When these par­ents do ask questions about co-sleeping, they fre­quently received mixed messages. The adoptive par­ents’ extended families also frequently discourage co-sleeping. This is not surprising as solitary sleeping is heavily favored in the Western culture. I suspect that culture preference to solitary sleeping might make it hard for parents to ask about co-sleeping. I will be sharing with you more findings on children’s sleep behaviors soon.

3. Preschool–age adopted children’s behavior problems over time.

For the preschool-age children (total: 400 children), from 2005 to 2007 (The average age of the children was 2.5 years in 2005 and 4.5 years in 2007) their Internalizing Problems (e.g., anxiety, withdrawn) in­creased significantly but there was no significant change in Externalizing Problems (e.g., aggression). I am currently looking deeper into the data to find out more about why there was such a big increase in their internalizing problems. From 2005 to 2007, the num­ber of children who were in the clinical/borderline clinical category increased from 7% to 12% for In­ternalizing Problems. For Externalizing Problems, the number of children in clinical/borderline clinical cat­egory remained 5%. For the normative sample in the US, 17-20% of children of this age range are in clini-cal/borderline clinical category. Thus, the Chinese children are still better adjusted than the US norma­tive sample, even if they have more Internalizing Problems than two years ago.

4. School-age adopted children’s behavior problems over time.

For the school-age children (total: 276 children), from 2005 to 2007 (The average age of the children was 8.8 years in 2005 and 10.6 years in 2007) their behavior problems did not change much over 2 years. However, the number of children who fell into clini-cal/borderline clinical category increased from 15% to 20% for Internalizing Problems (e.g., depression, anxiety) and remained at about 15% for Externalizing Problems (e.g., aggression). Among the US norma­tive sample, about 18% of the children in this age range are in clinical/borderline clinical category. In other words, the school-aged Chinese children’s be­havior profile is very similar to that of the U.S. nor­mative sample.

5. Adjustment of children who have crossed over from preschool age into school age.

From 2005 to 2007, 194 children had “crossed over” from the preschool group to the school-age group. For 130 of them, they have entered grade school; for the rest (64 children), although they are of school age they have not yet started grade school. For the 130 children who have entered grade school, the number of children in clinical/borderline clinical category of Internalizing Problems increased from 10% to 18%; the number of children in clinical/borderline clinical category of Externalizing Problems increased from 5% to 12%. For the 64 children who have not started grade school, the number in clinical/borderline clini­cal category in Internalizing Problems increased from 12% to 21%; the number of children in clini-cal/borderline clinical category in Externalizing Prob­lems remained at about 9%.
For the 64 children, I will be asking their parents to complete the older version of the blue form (i.e., for children who have started school). Their input will help me understand whether it is age increase or school environment/experience that contributed to the increase in maladjustment in the adopted children.

6. Between Preschool and School-aged children, why is there a big jump in number of children in clinical/borderline clinical range?

I have also been very baffled by this finding. Among the non-adopted children, the number of children in clinical/borderline clinical category seems rather con­sistent (between 18-20%) for both preschool and school-age children. This is, however, not the case for the Chinese children. There are several possible explanations: a). Transitioning to grade school is more challenging to the adopted Chinese children than non-adopted children. If this is the case, it is conceivable that the Chinese children will have a harder time during school age. However, this specu­lation does not explain why these children continue to show more problems (e.g., after they have com­pleted the transition) than we would have expected based on their preschool adjustment. b). School envi­ronment, coupled with the children’s increased un­derstanding of adoption, makes it more challenging for the Chinese children. It is possible that as the children get older and start spending more time with­out their parents, they will learn to deal with ques­tions that many other children would not have to face (e.g., Why are you adopted? Why do you look differ­ent from your parents?). c). Methodologically, it may also be possible that the form that I use (the Blue form that you filled out) might have led to more children at school-age to score in clinical/borderline clinical range. The blue form (called the Child Beha­vior Checklist) has a preschool version and school-age version. Even though the two versions largely overlap, they do have some differences. However, I should point out, that these two versions have not been reported to create discrepancies among children who are not adopted. I am hoping to talk with some parents whose children have recently transitioned from preschool to elementary school, to learn more about whether the transition tends to be more difficult for the adopted children.

More importantly, in order to learn how the school environment might affect the adopted children, I think a better source of information would be the children’s teachers. I would like to see if information provided by the children’s teachers can offer some insights into their school adjustment. For parents who have agreed to pass along a survey to their children’s teacher, I will be sending them a survey soon.

I will be sharing with the research findings periodi­cally.

Tan, T. X. (2007). History of early neglect and mid­dle childhood social competence: An adoption study. Adoption Quarterly, 9 (4), 59-72.
Dedrick, R. F., Tan, T. X. & Marfo, K. (in press). Factor structure of the child behavior checklist/6-18 in a sample of girls adopted from China. Psychological Assessment.
Tan, T. X., Dedrick, R. F. & Marfo, K. (2007). Factor Structure and Clinical Implications of Child Be­havior Checklist/1½-5 Ratings in a Sample of Girls Adopted from China. Journal of Pediatric Psychology, 32, 807-818.
Tan, T. X., Marfo, K. & Dedrick, R. F. (2007). Spe cial needs adoption from China: Child characte­ristics and behavioral adjustment. Children and Youth Services Review. 29, 1269-1285.
Tan, T. X., & Marfo, K. (2006). Parental ratings of behavioral adjustment in two samples of adopted Chinese girls: Age-related versus socio-emotional correlates and predictors. Journal of Applied Developmental Psychology, 27(1) 14-30.
Tan, T. X., & Yang, Y. (2005). Language develop­ment of Chinese adoptees 18-35 months. Early Childhood Research Quarterly, 20, 57-68.
Tan, T. X. (2004). Child outcomes of single-parent adoption from China: A comparative study. Adoption Quarterly, 8(1), 1-20.
Tan, T. X. & Nakkula, M. J. (2004). White parents’ attitudes toward their adopted Chinese daughters’ ethnic identity, Adoption Quarterly, 7(4), 57-76.


Johnny said...

Excellent research to learn about.

Mamacita said...

Yes, thanks for sharing this. It is really interesting to read about the sleep issues. Sometimes I feel like the Lone Ranger....I'm certainly not alone in the Chinese adoption community, according to Dr. Tam's study. I think I need to do some additional attachment work before Sugarlips enters Kindergarten. Luckily, so far she really likes school.

redmaryjanes said...

That is very informative. Well worth the time invested to read through it. Thank you for posting.

kerri said...

I am happy to report our transition from pre-school to kindergarten has been very good. There have no issues (as of yet),Jennifer gets along well with classmates, her academic standings are above average.
We addressed the class during Chinese New Year about Jennifer's birthplace and her adoption. We sent projects for the children to do, Mommy made a dragon for the kids to preform the dragon dance with, had red envelopes and some chinese dessert.
The students loved the event and were beautifully curious about Jennifer being from China and being adopted, they thought this was awesome.
I have made the teachers aware of any issues that may arise, they are very aware and have done their research(very happy with their involvement).
Thanks for sharing this.

MotherMotherOcean said...

I was interested in the part about cosleeping. We kept our son in our bed when we first got him and for a few weeks after. Now he is sleeping in his own crib, in our bedroom. The transition was really easy on us and him.

It is an interesting study. Would love to see the actual data from the study.

Wendy said...

Wow! Thanks for sharing! I have some reading to do.