Adopted Children with Autism Spectrum Disorder: Pre-Adoption Adverse Experiences and Psychiatric Comorbidity

Background and Purpose: Children with autism spectrum disorder (ASD) have a higher risk for adverse childhood experiences (ACEs) than typically developing children. An association between ACEs and psychiatric disorders among typically developing children is well documented. Although psychiatric comorbidity is common in children with ASD with rates of 65-94%, it is unknown whether ACEs are associated with psychiatric comorbidity among children with ASD in the context of adoption. Thus, the purpose of the study was to examine the associations between pre-adoption adverse experiences and psychiatric disorders among adopted children with ASD.

Methods: Data for the current study were drawn from the Modern Adoptive Families study (Brodzinsky, 2015). Out of 1,616 participants, this study included 60 adoptive parents of children with ASD. Adoptees with ASD were predominantly Caucasian (58%), male (75%), and adopted from foster care (34%). Most children were 6-12 years of age (30%) or 13-18 years of age (25%). Approximately 90% of adoptees with ASD had clinical diagnostics with at least one co-morbid psychiatric disorders: Attention-deficit/hyperactivity disorder, attachment disorder, anxiety/ Post-traumatic stress disorder (PTSD), depression, fetal alcohol spectrum disorder (FASD), and/or sensory processing disorder. Pre-adoption ACEs were measured by seven dichotomous items (e.g., prenatal exposure to drugs and alcohol, physical abuse, and neglect). Age of adoption was assessed using a single item (1 = less than 12 months, 2 = 12-24 months, 3 = above 24 months). Chi-square tests were used to examine if pre-adoption adverse experiences are associated with psychiatric comorbidity among adopted children with ASD.

Results: Adopted children with ASD who experienced physical abuse were more likely to be diagnosed with attachment disorder [X² (2, N = 60) = 12.91, p < .001] or anxiety/PTSD [X² (2, N = 60) = 7.33, p < .01] than adopted children with ASD with no physical abuse. Adopted children with ASD who experienced neglect were more likely to be diagnosed with attachment disorder [X² (2, N = 60) = 8.86, p < .01], anxiety/PTSD [X² (2, N = 60) = 9.77, p < .01], or FASD [X² (2, N = 60) = 4.35, p < .05] than children with ASD with no neglect. Adopted children with ASD who experienced prenatal exposure to drugs were more likely to be diagnosed with FASD than adopted children with ASD with no prenatal exposure [X² (2, N = 60) = 12.43, p < .001]. Adopted children with ASD who adopted older than 24-month-old were more likely to be diagnosed with anxiety/PTSD than children with ASD adopted before 24 months [X² (2, N = 60) = 10.10, p < .01].

Conclusions and Implications: The results suggest the importance of pre-adoption adversity for psychiatric comorbidity among adopted children with ASD. Furthermore, results provide implications for pre- and post-adoption services with respect to the diagnosis of comorbidity conditions and adoptive parent training and support. Families who adopt children with adverse childhood experiences and ASD may need additional services or training to manage psychiatric comorbidity.