The Dynamics and Cohesion of an Adopted Family Significantly Impacts the Adopted Child’s Cognitive and Behavioral Development

Toddler girl walking holding mother’s hand
With the scarcity of data concerning adopted children, the researchers followed children adopted from institutionalized care to determine the relationship between family environment, behavioral outcomes, and executive function.

The outcomes from pre-adoption adversity on cognition and behavioral development among toddlers was moderated by the positive dynamics of a cohesive and expressive family, according to results of a study published in Pediatric Research.

Children (n=10) adopted by a family in the United States from institutionalized care in Eastern Europe were included in this study. All toddlers spent ≥8 months in an orphanage from the age of 6 months. A group of healthy children (n=19) was used as a comparator group.

Participants were assessed for anthropomorphic measurements, neurocognition, behavior, and endocrine health at baseline and 2 years. Parents responded to a questionnaire which assessed the social climate and family dynamics.

At baseline, adopted children and controls were aged mean 27.5 (standard deviation [SD], 9.3) and 30.7 (SD, 14) months and 6 and 9 were girls, respectively. The adopted children were shorter (P =.002), weighed less (P =.002), and had smaller mid-arm circumferences (P =.034) than the control children.

At the 2-year follow-up no significant anthropomorphic differences between cohorts were observed.

Serum cortisol among the adopted children ranged between 4.2 and 16.3 mg/dL and correlated with time spent in the orphanage (R2, 0.608; P <.06), in which cortisol increased with time spent in institutionalized care. Other endocrine hormone levels and lipids were within normal ranges.

Cognitive scores were lower at baseline among the adopted children (P <.05).

At baseline, the adopted children had higher inhibition (mean, 55 vs 44; P =.05) and emotional (mean, 12.3 vs 8.0; P =.03) scores and lower social-emotional competence scores (mean, 31 vs 51; P =.001). At follow-up, the adopted children had higher inhibition (mean, 59 vs 47; P =.04), inhibitory self-control (mean, 58 vs 46; P =.03), and externalizing symptom (mean, 53.0 vs 40.0; P =.03) scores.

Parent responses to the Behavior Rating Inventory of Executive Function-Preschool assessment were associated with inhibitor control among half of children (F, 4.424; P <.05).

Baseline Family Environment Scale (FES) conflict and control subscales were predictors of higher Global Executive Composite score (R2, 0.91; P =.03), FES achievement scores positively correlated with cognitive scores (R2, 0.433; P =.04), FES cohesion and expressiveness associated with lower internalizing symptoms (R2, -0.9; P =.04), and FES control predicted increased internalizing symptoms (R2, 0.74; P =.03).

This study was limited by its small sample size. However, it was terminated prematurely when adoptions from Eastern Europe were terminated.

These data suggested a cohesive and expressive family environment mitigated the effects of pre-adoption adversity. Children who were adopted to families that had higher conflict or placed emphasis on rules or procedures were at greater risk for behavioral problems.


Keil MF, Leahu A, Rescigno M, Myles J, Stratakis CA. Family environment and development in children adopted from institutionalized care. Pediatr Res. Published online May 26, 2021. doi:10.1038/s41390-020-01325-1