The Impact of Clinical Child Behavior Challenges on Child and Family Wellbeing and Post-Adoption Instability: A Multivariable Analysis

Background/Purpose: Close to 15% or more of children adopted out of the U.S. child welfare system face challenges, including post-adoption instability and strained family relationships. However, little research has examined the impact of child behavioral challenges that require clinical intervention on post-adoption instability. The purpose of this study was to examine how significant child behavioral challenges, indicated by clinical scores on the Child Behavior Checklist Problems scale (CBCL) were related to post-adoption instability—either formal foster care reentry or informal placement changes (e.g., running away from home). Also, this study examined how externalizing child behaviors (i.e., those directed toward others, such as aggression) and internalizing child behaviors (I.e., those directed toward the self, such as depression) were associated with post-adoption instability.

Methods: A total of 383 adoptees and/or adoptive parents were surveyed as part of the NSCAW Adoption Study (see overall symposium abstract). The NSCAW surveys asked adoptees and their adoptive parents about child and parent demographics, family relationships, and placement stability. Adoptees were identified as having clinical child behavioral difficulties if their CBCL score was above the clinical cutoff. The CBCL was completed by caregivers shortly after the child’s maltreatment report, while adoptees were in foster care, and after adoption. Post-adoption foster care reentry and informal instability were examined for adoptees who ever had a clinical CBCL score across five NSCAW waves as compared to those who never had a clinical CBCL score—for the total scale and externalizing and internalizing subscales. Bivariate analyses were first estimated. Then, multivariable regression models for each of the three CBCL scales/subscales, with propensity score weighting, were estimated to determine the impact of child behavioral challenges on instability after controlling for adoptee age at adoption, race, history of sexual abuse, and kinship with their parent, as well as parent age at adoption.

Results: Bivariate analyses indicated that 44% of adoptees who ever had clinical total CBCL clinical scores experienced post-adoption instability, respectively, as compared to 23% of adoptees who never had clinical total CBCL scores (p < .000). This pattern of higher post-adoption instability for those with clinical CBCL scores was also present for both the externalizing and internalizing subscales (p < .000 and p = .001, respectively). Multivariable models with propensity score weights showed that, after controlling for covariates, having a clinical score on the total, externalizing, or internalizing CBCL scale/subscale was associated with about 135%, 139%, and 103% higher risk of post-adoption instability than those without clinical CBCL scores (p < .000, p < .001, and p = .005, respectively).

Conclusion/Implications: This study supports previous post-adoption literature which suggests child behavioral challenges strain family relationships. Even after controlling for several covariates using propensity score weighting, adoptees who ever had a clinical CBCL score were more likely to experience post-adoption instability. These findings highlight the importance of focusing risk assessment and intervention efforts on families who have the most difficulty managing children’s behaviors.