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  INTRODUCTION

        For some time, mental health professionals have noted a large proportion of conduct disorders and extreme antisocial behavior among clinically referred adopted children and adolescents as compared with their nonadopted counterparts (Menlove, 1965; Offord, Aponte, & Cross,1969; Sabalis & Burch,1980; Schechter, Carlson, Simmons, & Work, 1964; Weiss, 1985). Although the influence of genetics may partially account for this pattern (Graham & Stevenson, 1985; Herrnstein & Wilson, 1985; Mednick, Gabrielli, & Hutchings,1984), a growing body of clinical literature (Brinich, 1980; Easson,1973; Kirschner, 1990, 1992; Kirschner & Nagel, 1988; Nickman,1985; Toussieng,1962) as well as firstperson accounts by adult adoptees (Lifton, 1988, 1994) have identified unique psychological problems encountered by adoptees during childhood and adolescence. Complications in identity formation and adoption-related psychopathology, fantasies, and behavior are the most commonly cited examples. Especially in cases involving a genetic predisposition for behavioral disorders, such psychological complications are seen as critical factors in the etiology of antisocial psychopathology in adoptees.

        The renewed focus on psychopathology among adoptees has fostered controversy. Some parties have argued against the delineation of adoption-specific psychiatric or psychological disturbances, warning that adoptees and adoptive parents might be stigmatized and that prospective adoptive parents might be discouraged from adopting (Bartholet, 1993; Feigelman, 1986; Klagsbrun,1986). Nonetheless,the adoption community increasingly acknowledges emotional problems that may be engendered by traditional, "closed" adoptions (in which the identities of the birth parents are kept from the adoptive parents and child, and vice versa). As a result of this new awareness, proponents of "open" adoptions (arrangements in which all parties are known to

  each other [Chapman, Dorner, Silber, & Winterberg, 1987a, 1987b; Lifton, 1988, 1994]) and advocates of disclosing closed adoption records are challenging the adoption establishment. Indeed, most observed cases of the "adopted child syndrome" have occurred in children who were adopted during infancy through closed adoptions.

        The adopted child syndrome refers to an extreme form of adoption-related psychopathology, including provocative, antisocial behaviors as well as associated personality disturbances that are superficially similar to those found under the DSM-IV diagnosis of conduct disorder (American Psychiatric Association, 1994). The adopted child syndrome can be differentiated from the latter diagnosis by underlying adoption-specific psychodynamics, greater emotional vulnerability, accessibility to and motivation for therapy, and better prognosis (Table 1).

        Although the prevalence of acting-out disorders among clinically referred adoptees is widely reported in the literature, the term adopted child syndrome remains controversial. Furthermore, although many unique issues and related clinical problems are not uncommon among adopted children, it has not been established whether serious emotional and behavioral problems occur more frequently among adoptees than nonadoptees in the general population. Adoption per se does not necessarily give rise to psychopathology; however, it must be considered a risk factor-perhaps a precipitating one--in some families deemed dysfunctional in terms of key adoption issues and parent-child interactions.

DESCRIPTIVE CHARACTERISTICS

Acting-out behaviors, specific personality and interpersonal relationships, ideational content, and psychodynamics characterize the adopted child syndrome.

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