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Adopted children in the UK can face enduring mental health and behavioural problems. New research found no improvement in children's mental health four years after they were adopted. The children's emotional and behavioural problems increased with the number of adverse childhood experiences they had. These adverse childhood experiences include abuse, neglect and unstable living arrangements.

Researchers looked at children’s experiences before they were adopted, such as maltreatment, the number of times they moved home and how long they spent in care. They then looked at data on the children’s psychological health after adoption.

They found that adoption in itself was not linked to an improvement in mental health. The researchers recommend that adoptive parents and social workers should have as much biographical information as possible about a child’s life before and during care. This could help identify possible mental health problems early.

This Alert features in our evidence Collection: Adverse childhood experiences: what support do young people need? Read the Collection

What’s the issue?

US studies have found that adopted children are at a greater risk of experiencing emotional and behaviour problems than non-adopted children.

Most adopted children in the UK are taken into care because of maltreatment by their birth parents. They are more likely to have experienced adversity at an early stage of life (including abuse, neglect, and unstable living arrangements) than the general population.

Previous research found children who are older at the time of their adoption are more likely to experience psychological and behaviour problems. Children over four are more troubled than children who are younger when they are adopted. Researchers wanted to identify other risk factors which contribute to children's emotional and behavioural problems in the first four years after being adopted.

What’s new?

Researchers explored the contribution of multiple risk factors to mental health and behavioural problems in adopted children. They looked at the number of days spent with birth parents and in care; the number of homes the children had lived in; and any experience of childhood abuse and neglect.

They found that in the UK:

  • adopted children can experience lasting mental health problems with no improvement seen in their mental health four years after being adopted
  • those with a greater number of adverse childhood experiences were more likely to have mental health and behaviour problems
  • unexpectedly, children who had more home moves and time in care before adoption had fewer behavioural problems over time. However, exploratory analyses showed this was only the case in rare circumstances, and may have included stays where children are cared for by family members such as grandparents.

Ninety-six families reported on their adopted child’s mental health at regular intervals for the first four years after adoption. The study also used data from social worker records containing biographical information on the adopted children. This research was carried out as part of the Wales Adoption Cohort Study which aims to identify early support needs of adoptive families in Wales.

Why is this important?

Adverse experiences in childhood have previously been linked to poor mental health. This research highlights the need for effective strategies to support adopted children after they move to their permanent home. Knowing more about which childhood events are most likely to negatively impact mental health could help healthcare professionals, social workers and parents find better ways of supporting adopted children.

The findings suggest that health and social care professionals, and adoptive parents, need as much biographical information as possible about a child’s life before and during care. This could help identify possible mental health problems early, so support and treatment can be arranged. The study supports new recommendations which emphasise the importance of gathering information on an adopted child’s mental health from everyone involved in their care.

What’s next?

Social workers could develop plans to help adoptive parents recognise possible mental health problems in their children.

This study found once children had spent approximately 550 days in care, previous adverse childhood experiences no longer had a negative impact. It is possible the home environment offered by foster families might lessen the effects of early adversity on children’s mental health.

The researchers involved in this study are carrying out further work on the social and emotional development of children adopted from care. They will also investigate how early school experiences of adopted children in the UK impact the risk of developing mental and behavioural problems.

You may be interested to read

The full paper: Paine A, and others. Early adversity predicts adoptees’ enduring emotional and behavioural problems in childhood. Eur Child Adolesc Psychiatry 2020; online ahead of print

Additional research on emotional and behavioural issues in adopted children: Paine A, and others. The neurocognitive profiles of children adopted from care and their emotional and behavioural problems at home and school. Child Neuropsychology. 2020;16;1-20

A study on how adoptive families respond to contact with children’s birth siblings who live elsewhere: Meakings S, and others. Birth sibling relationships after adoption: the experience of contact with brothers and sisters living elsewhere. British Journal of Social Work. 2016;30:386-396.

Research examining risk factors for mental health problems in adopted children: Paine A, and others. Charting the trajectories of adopted children’s emotional and behavioral problems: the impact of early adversity and post-adoptive parental warmth. Development and Psychopathology. 2020;1-15

A study on depression and anxiety in adoptive parents: Anthony R, and others. Depression and anxiety symptoms of British adoptive parents: a prospective four-wave longitudinal study. International Journal of Environmental Research and Public Health. 2019;16:5153

The impact of parenting styles on adopted children’s mental health: Anthony R, and others. Adverse childhood experiences of children adopted from care: The importance of adoptive parental warmth for future child adjustment. International Journal of Environmental Research and Public Health 2019;16:2212

Research on post-traumatic stress following adoption from care: Anthony R, and others. Patterns of adversity and post-traumatic stress among children adopted from careChild Abuse Negl. 2020;7:104795 

Funding: The study was funded by Welsh Government. Amy L. Paine was funded by The Waterloo Foundation and is currently funded by the Economic and Social Research Council.

Conflicts of Interest: None declared by the study author. JS was a member of the advisory group when the study was set up in 2014. She has had no contact with the study since 2016 and was not involved with the analysis or publications.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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Study author

Securing adoptive placements is an important step in enabling many children to lead fulfilling lives but ongoing support should be available. This should include health visitors, school support and family therapy.

Our findings highlight the value of having as much biographical information about a child’s life before and during care as possible. This information needs to be shared with foster carers and adopters in a professional and sensitive manner.

Amy Paine, Postdoctoral Researcher and Lecturer in Developmental Psychology, Cardiff University


This study emphasises the importance of taking a thorough history of a child’s early experiences. The impact of maltreatment is long-lasting and simply placing for adoption does not in itself resolve mental health difficulties. There is a strong argument for adoption support services to include professionals with a range of skills and from different backgrounds.

Social workers have to analyse and summarise a mass of complex and sometimes contradictory information. It might help to consider a scoring system for the number of adversities the child has experienced and for it to be included in the Child Permanence Report and support plans.

Julie Selwyn, Professor of Education and Adoption, University of Oxford

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