Adopted Children with Asthma: Effects on Parental and Placement Outcomes

Background: Asthma is a chronic inflammatory condition that contributes to caregiver’s financial, emotional, and relational distress (Cousino & Hazen, 2013; Everhart, Fiese, & Smyth, 2008). Past studies have outlined a pathway in which asthma increases parental stress, and decreases parents’ ability to implement positive parenting skills and effectively manage asthma symptoms, thus ultimately impacting both family relationships and child health outcomes (Wood et al., 2015). About 10% of children under 18 years old suffer from asthma (Bloom, Cohen, & Freeman, 2011), with elevated rates among adopted children (Bramlett, Radel, & Blumberg, 2007). Yet, little is known about specific outcomes of adopted children with asthma and their families. The aim of the study is to examine the relationship between asthma and parents’ stress, caregiver commitment and placement stability among a population of adoptive families.

Methods: We analyzed data from a 2008 Post-Permanency Survey. The survey collected demographic information and family caregiving experiences of a random sample of 437 adoptive parents and legal guardians from a state in the United States. Asthma diagnoses were reported by caregivers. Parental stress was assessed using four items that were scored on a 3-point Likert scale. Responses were combined to create a continuous score (mean=8.12, SD=2.0). Caregiver commitment was measured using five items that were rated on a 5-point Likert scale. Responses were summed to a composite score (mean=20.94, SD=3.55). Placement disruption was coded as a dichotomous variable. Multivariate analyses were conducted to explore the relationship between these different types of disabilities and parental stress and caregiver commitment. Hierarchical regression was also conducted to assess the importance of a set of predictors on the outcomes.

Results: A total of 9.34% of the caregivers reported their child had asthma (n = 43). Asthma was the most frequently-reported chronic health issue and the second highest concern among all special needs in the sample. Multivariate analyses found a significant association between having a child with asthma and parental stress (β = .09, p < .05), controlling for child’s age, gender, race, behavior, and co-occurring disabilities; and parents’ age, marital status, education, and income. Partial F-test in hierarchical regression indicated the added behavioral problems and multiple disabilities as a whole were statistically significant in explaining the variances in the parental stress outcome(F* = 4.37 > F [α = .05; 1, 387]). However, we did not find a significant relationship between having a child with asthma and caregiver commitment or placement disruption.

Implications: The current study extended previous literature by demonstrating an association between a specific category of children’s special needs and adoption outcomes (Helton, 2011; Sen & Yurtsever, 2008). This study’s findings suggest despite high stress levels, adoptive caregivers develop positive coping mechanisms to manage stress and preserve the child’s placement. Future research should investigate potential sources for increased parental stress, including higher financial burden related to caring for a child with asthma and more challenges to positive post-adoption family adjustment. Additionally, protective factors in adoptive families leading to long-term placement stability should be identified to support post-adoption families.