There is a general consensus that the physical and psychological development of adopted children is significantly better than that observed in children who have grown up in institutionalization, foster care or in their biological families when they are not involved in their upbringing.
Evolution of illnesses detected on arrival
Regarding physical health problems, physical and psychological developmental delays (psychomotor and cognitive), as well as adaptation, attachment and behavioral disorders, which are most frequently detected on arrival in children adopted from abroad, are usually resolved after the first year of living with the adoptive family.
In cases with significant physical or psychological developmental delays, recovery may take more than three years and may not be absolute. In particular with regard to psychological improvement in the cognitive area, it is dependent on the level of delay present on arrival and 15% of children do not recover absolutely after three years of follow-up.
Mental health evolution
Short- and medium-term follow-ups show that most are adequately adapted and bonded and do not present mental health disorders. No significant differences have been observed in the prevalence of self-esteem problems with respect to the general infant-juvenile population.
Adoptees over two years of age who have suffered pre-adoption adversities (prenatal alcohol exposure, prematurity, abuse, neglect or chronic malnutrition) and who have lived in institutions for a prolonged period of time (more than six months) are at greater risk of presenting mental health disorders. The more adversities that accumulate, the greater the risk of developing mental health disorders.
Visits to mental health services or the pediatrician are mainly due to conduct disorders, attention deficit/hyperactivity disorder (ADHD), and cognitive and language disorders. Social adjustment and attachment disorders are rare. Among the behavioral disorders, those that manifest externally, such as behavioral disturbances, aggression or impulsivity, predominate, compared to internalizing disorders, such as shyness or information processing problems, and are more frequent and serious when adolescence is reached. The prevalence of ADHD is five to eight times higher than that observed in the general child and adolescent population. Cognitive and language disorders and social adjustment and attachment disorders are more frequently observed among those who were adopted above six years of age.
Successful versus broken adoption
In general, the process of international adoption is successful and most families and children experience it with satisfaction after an initial period of adjustment. But this does not mean that the process is without its challenges, risks and difficulties. About 10% of adoptive families do not adapt to the new situation and 1% of international adoptions break up, a percentage that triples when the child was older than six years at the time of adoption. In many of these cases there have been failures in suitability and pre-adoption training or mismatches between the application profile and the matching profile. To avoid or reduce these painful situations, it is necessary to know when to refer these families to specialized psychosocial intervention services.