the impact of pre-adoption stress on the romanian adoptees, Lecture notes of History

Download the impact of pre-adoption stress on the romanian adoptees and more Lecture notes History in PDF only on Docsity! THE IMPACT OF PRE-ADOPTION STRESS ON THE ROMANIAN ADOPTEES' TRANSITIONS TO ADULTHOOD AND ADULT ATTACHMENT: PERSPECTIVES OF THE ADOPTEES AND THE ADOPTIVE PARENTS by CRISTINA NEDELCU Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Dissertation Chair: Victor K. Groza, Ph.D. Mandel School of Applied Social Sciences CASE WESTERN RESERVE UNIVERSITY January 2019 1 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Cristina Nedelcu Candidate for the Doctor of Philosophy Degree* Committee Chair Victor Groza, PhD Committee Member Elizabeth Tracy, PhD Committee Member Meeyoung Min, PhD Committee Member Denise Bothe, MD Date of Defense: May 9, 2018 *We also certify that written approval has been obtained for any proprietary material contained therein 4 Sample size ...................................................................................................184 Multicolinearity and singularity ……………………………………………185 Normality, linearity and homoscedasticity, independence of residuals..............................................................................185 Confidentiality and Data Management ...........................................................................185 Chapter 4: Findings .......................................................................................................187 Characteristics of the Sample ..........................................................................................187 Sample bias .........................................................................................................187 Adoptive parents' data .........................................................................................190 Adoptee data .......................................................................................................191 Adoption outcomes .........................................................................................................193 Independent Variables ....................................................................................................194 1. Length of time in institutional care ...............................................................194 2. Pre-adoption stress ........................................................................................194 Dependent Variables .......................................................................................................196 1. Adult transitions ............................................................................................196 a) Markers of Adulthood .............................................................................196 b) Markers Importance ................................................................................197 c) IDEA .......................................................................................................198 2. Adult attachment ...........................................................................................199 3. Control Variables ..........................................................................................200 a) Age at adoption .......................................................................................200 b) Length of time in the adoptive home ......................................................200 c) Type of recruitment .................................................................................200 Summary of Measures ....................................................................................................200 Bivariate analyses ...........................................................................................................203 Multivariate analyses ......................................................................................................208 Transition to adulthood variables ........................................................................209 1. Markers ...................................................................................................209 2. Markers Importance ................................................................................210 3. Identity exploration .................................................................................210 4. Experiementation/Possibilities.................................................................210 5. Negativity/Instability...............................................................................210 6. Self-focused ............................................................................................213 7. Other-focused ..........................................................................................213 8. Feeling in between ..................................................................................213 Attachment variables ..........................................................................................214 1. Attachment data reported by parents ......................................................214 2. Attachment data reported by adoptees ....................................................214 Summary of Findings ......................................................................................................214 Chapter 5: Discussion and Implications .....................................................................218 Brief Overview of Findings ............................................................................................218 Reformulated Research Questions and Hypotheses .......................................................218 Adult Transitions Implications .......................................................................................220 Adult Attachment Implications .......................................................................................225 Other Findings ................................................................................................................226 5 Practice Implications .......................................................................................................228 Policy Implications .........................................................................................................229 1. The best interest of the child is paramount ……………………………..….230 2. The solidarity principle …………………………………………………….231 3. Safeguards to protect children from abduction, sale and trafficking ………………………………………………………..…….231 4. Cooperation between countries and within countries ………………….…..231 5. Automatic recognition of adoption decisions ………………...……………232 6. Competent authorities, central authorities and accredited bodies ………………………………………………………232 7. Guides for good practice ……………………………………………...……232 Strengths and Limitations ...............................................................................................237 Implications for Future Research ....................................................................................239 Summary……………………………………………………………….……….………241 Appendices………………………………………………….…………………………..242 Appendix 1 ……………………………………………………………………..275 Appendix 2 ……………………………………………………………………..267 Appendix 3 ……………………………………………………………………..275 Appendix 4 …………………………………………………………………..…277 Appendix 5 …………………………………………………………………..... 278 Appendix 6 ……………………………………………………………………..279 Appendix 7 ……………………………………………………………………..280 Appendix 8 ………………………………………………………………...…...281 Appendix 9 ……………………………………………………………………..282 Appendix 10 ………………………………………………………………...….283 Appendix 11 ……………………………………………………………………284 Appendix 12 …………………………………………………………………....285 References………………………………………………………………………………286 6 List of Tables Table 1: ...............................................................................................................................74 Table 2: ........................................................................................................................... ... 79 Table 3: ........................................................................................................................... 133 Table 4: ........................................................................................................................... 137 Table 5: ...........................................................................................................................144 Table 6: ............................................................................................................................166 Table 7: ........................................................................................................................... 168 Table 8: ...........................................................................................................................174 Table 9: ............................................................................................................................. 189 Table 10: ......................................................................................................................... 190 Table 11: .........................................................................................................................192 Table 12: .........................................................................................................................193 Table 13: ..........................................................................................................................194 Table 14: .......................................................................................................................... .195 Table 15: ..................................................................................................................... ......196 Table 16: …………………………………………………………...…………………..197 Table 17: ………………………………………………………………………....….…198 Table 18: …………………………………………………………………..…….……..200 Table 19: ………………………………………………………………………………203 Table 20: ……………………………………………………………………………….276 Table 21: ……………………………………………………………………………….277 Table 22: ……………………………………………………………………...………..278 9 The Impact of Pre-Adoption Stress on the Romanian Adoptees' Transitions to Adulthood and Adult Attachment Abstract by CRISTINA NEDELCU Shortly after the 1989 Romanian Anti-Communist Revolution, the Western media exposed an unprecedented humanitarian crisis in Romanian orphanages. As a result, thousands of Romanian children were adopted into the United States, Canada, United Kingdom, the Netherlands and other countries of Western and Southern Europe. A large percentage of these children had a background of institutional care and were subjected to at least some level of pre-adoption stress. The longitudinal studies conducted in the US, Canada and the UK have demonstrated that length of time spent in institutional care and exposure to pre-adoptive stress negatively influenced the development and the attachment of Romanian adoptees at every stage up until late adolescence. This cross-sectional study of Romanian adoptees in early adulthood examines the impact of length of time spent in institutional care and pre-adoption stress on adult transitions and adult attachment. Bowlby's theory of attachment and Arnett's theory of Emerging Adulthood are the theoretical frameworks used in this study. Results from surveys of 139 adoptive parents 61 adoptees suggests that pre-adoption stress and length of time in an institution before adoption were found to no longer influence the adoptees' transitions to adulthood or their ability to feel secure in their relationships during early adulthood. Implications for practice and policy are discussed. Key words: Romanian adoptions, adult transitions, adult attachment, institutional care, pre- adoption stress 10 Chapter 1 Scope of the Problem Introduction When the anti-Communist Revolution of 1989 overthrew Dictator Nicolae Ceausescu, Romania opened up to the world for the first time in 45 years (Gilberg, 1990; Georgescu & Calinescu, 1991; Treptow, 1996). As the Western media entered the country, journalists began relaying stories of political persecution and censorship (Gilberg, 1990; Georgescu & Calinescu, 1991; Groothues Beckett & O'Connor, 1998; Groza, Ileana & Irwin, 1999; Groza & Ryan, 2002). Disturbing images emerged of malnourished children who were housed in overcrowded institutions where child-rearing was performed with expediency and with a belief that the Communist State was a better parent than the children’s parents (Groza & Ileana, 1996; Groza, Ileana & Irwin, 1999; Smyke, Koga, Johnson, Fox, Marshall, Nelson & Zeanah, 2007; Nelson, Fox & Zeanah, 2014). Among these thousands of abandoned children, suffering the most were the ones considered "defective" (Nelson, Fox & Zeanah, 2014, p. 49) or irrecoverable (Groza, Ileana & Irwin, 1999). After a few documentaries exposed the conditions within the Romanian institutions to a worldwide audience, the Western media called attention to the desperate need for an immediate international response to the Romanian orphanage crisis (Groza & Ileana, 1996; Groza, Ileana & Irwin, 1999; Nelson, Fox & Zeanah, 2014; Riddle, Nelson, Fox & Zeanah, 2016). Adoptive families from the USA, Canada and Western Europe entered Romania to adopt these children. Adoption became suddenly an industrious field of international cooperation, often bypassing the bureaucratic and lawful channels 11 (Groza & Ileana, 1996; Groza, Ileana & Irwin, 1999; Borcila, 2014; Popa-Mabe, 2015). For much of the 1990s, Romania readjusted its international adoptions policies, but the changes consisted of weak regulations, little oversight and eventually placing a moratorium on all adoptions (Nelson, Fox & Zeanah, 2014). Despite having to deal with a legal system of bureaucracy and corruption, many of the adoptive families eventually succeeded in adopting (Nelson, Fox & Zeanah, 2014; Popa-Mabe, 2015). With these adoptions, children experiencing severe adversity in depriving institutions were placed in resource rich family environments. As an intervention, adoption increases a child’s chances to overcome many of the delays, deficiencies and health issues that they experienced during institutional placements (Fins, 2014; Groza & Bunkers, 2014; Nelson, Fox & Zeanah, 2014). Now, these children are in their early to late-twenties, transitioning into adulthood. Romania: History and Background To comprehend the long-term effects of early deprivation in the lives of Romanian adoptees over the last two plus decades, it is crucial to first understand the historical background. This history directly resulted in the abandonment of hundreds of thousands of children and in the adoption of 7788 young Romanian children with US adoptive families in the 1990's (Bureau of Consular Affairs, U.S. Dept. of State, Dec. 2016). These children arrived in the U.S. in several waves over an 11-year period between 1990 and 2001 with most adoptions occurring between 1990 and 1993 (Groothues, Beckett & O'Connor, 1998; Groza & Ryan, 2002). Despite being the largest country in Southeastern Europe, Romania is slightly smaller than the US state of Oregon (Nelson, Fox & Zeanah, 2014). Over the centuries 14 women who were not deemed to be producing children fast enough, were routinely interrogated and threatened (Horga, Gerdts & Potts, 2013; Nelson, Fox & Zeanah, 2014; Andrei & Branda, 2015; Ghetau & Arghisan, 2016; Kligman, 2016). These measures were aimed at ensuring pregnant women carried their babies to term. In addition, the communist state exerted coercion on non-pregnant women to make them give up birth control and begin multiplying (Horga, Gerdts & Potts, 2013; Nelson, Fox & Zeanah, 2014; Andrei & Branda, 2015; Ghetau & Arghisan, 2016; Kligman, 2016). In 1974, Ceausescu began a program of geographical systematization or collectivism to modernize Romania (Calina, Calina & Croitoru, 2016). Villages were demolished, people were forced to move into assigned apartments, and towns were reconstructed, all with the goal of turning Romania into a "multilaterally developed socialist society” (Hajdu, 2013, p. 20). Systematization began as a program of rural resettlement, aiming to double the number of Romanian cities by 1990. Hundreds of villages were leveled so that the land could be rebuilt into urban industrial centers via investments in schools, medical clinics, housing and industry (Irimie, 2014; Acasandre, 2015; Kulcsar, 2015; Mihalache, 2016). Smaller villages with populations under 1,000 were deemed unnecessary (Irimie, 2014; Acasandre, 2015). Forced removal of the population and deliberate physical destruction took place. Towns that were urbanized fared somewhat better, as old and run-down housing projects were torn down and replaced by high-rise, more modern apartment buildings (Irimie, 2014; Acasandre, 2015; Kulcsar, 2015; Mihalache, 2016). In the mid-1980’s, systematization made its way to the nation's capital of Bucharest. Nearby villages were destroyed, often in service of never-to-be-completed projects such as a canal from 15 Bucharest to the Danube. Additionally, eight square kilometers in the historic center of Bucharest was bulldozed, including the destruction of monasteries, churches, synagogues, a hospital and a large sports stadium (Irimie, 2014; Acasandre, 2015; Kulcsar, 2015; Mihalache, 2016). In all, over 40,000 people were evicted from their homes, often with only a few days’ notice, to make way for the Palace of the People, a building designed to be second in size only to the Pentagon (Irimie, 2014; Mihalache, 2016). Collectivism increased exponentially the negative effects of Ceausescu’s pronatalist policies. Collectivism in Romania resulted in the destruction of individual family homes and the relocation of families to new block housing, often in unfamiliar neighborhoods (van den Berg, 2015; Matei, 2016). This involuntary movement eventually led to the erosion of informal social networks. It further exacerbated the fear of the secret police or Securitate, as it was a time when anything people said could result in the loss of a job or housing, incarceration and even death (Groza & Ileana, 1996; Groza, Ileana & Irwin, 1999). The combination of Ceausescu's urbanization, collectivism and pronatalist policies severely weakened the integrity of Romanian families. While the economic policies of Ceausescu’s government made it difficult for families to afford raising multiple children and collectivism destroyed informal social support networks, state propaganda worked to convince parents that the state could raise children better than families could (Groza, Ileana & Irwin, 1999; Marshall, 2014; Nelson, Fox & Zeanah, 2014; Almas, Degnan, Nelson & Zeanah, 2016). The multiple factors of a precarious economic situation, the erosion of social networks, food shortage, widespread poverty 16 and propaganda substantially increased the number of children that were abandoned or voluntarily left in institutions by their parents (Groza, Ileana & Irwin, 1999; Almas et al., 2014). To care for unwanted and abandoned children, Romania began a system of institutional care based on the Soviet model of residential child care (Espinoza, 2014; Nelson, Fox & Zeanah, 2014). Institutional Care for Romanian Children under Communism 1. General structure of the system. In 1970, the Romanian government created a law to differentiate between two different types of institutions: those for normally developing children and those for handicapped children (Rus, Stativa, Pennings, Cross, Ekas, Purvis & Parris, 2013). From birth to three years old, all abandoned children, regardless of health and developmental status, were housed in institutions called "leagane", a word that translates to mean “cradle”. Some of the children placed in leagane were abandoned in maternity hospitals while others were placed there by families (Groza, Ileana & Irwin, 1999; Nelson, Fox & Zeanah, 2014; Berens & Nelson, 2015). At age three, governmental teams comprised of a pediatrician and a psychiatrist or a psychologist conducted developmental screenings, separating the children into two distinct groups of either developmentally normal or handicapped. However, it should be noted that there were no consistent or objective criteria used to make this determination. In short, children who were considered developmentally normal went to institutions called homes for children, roughly equivalent to U.S. group homes (Nelson, Fox & Zeanah, 2014; Kumsta, Kreppner, Kennedy, Knights & Sonuga-Barke, 2015). The homes were state run and housed children between the ages of 3 and 18. These children attended 19 Irwin, 1999; Clements & Read, 2008; Nelson, Fox & Zeanah, 2014). 4. Institutions for the handicapped. Handicapped children in Romanian institutions received even worse substandard care. The food was of poor quality, the facilities were unkempt, poorly maintained and even often unheated with inconsistent water availability for drinking or washing (Rosenberg, Pajer & Rancurello, 1992; Goldberg, 1997; Groza, Ileana & Irwin, 1999). In one location, Groza, Ileana and Irwin (1999) reported open sewers, the absence of screens on windows to deter flies and mosquitoes, and a pig farm on the side of the facilities. Health care, educational services and rehabilitation programs were non-existent. Many of children in these institutions were infected with Hepatitis B (Rosenberg, Pajer & Rancurello, 1992; Goldberg, 1997; Groza, Ileana & Irwin, 1999). Western physicians who provided assistance at the facilities following the Romanian revolution documented malnutrition, growth retardation, lack of treatment for injuries, abuse, neglect and high child mortality (Rosenberg, Pajer & Rancurello, 1992; Lie & Murarasu, 2001; Sweeney & Bascom, 1995). In 1989, an epidemic of HIV infection contracted during medical treatment was discovered predominately among institutionalized children in Romania. The children were believed to be infected through transfusions of unscreened blood and injections with improperly sterilized equipment. Plasma and whole transfusions were widely used among institutionalized Romanian children for a variety of ailments, including efforts to “strengthen” them if they were of low weight (Groza, Ileana & Irwin, 1999; Nelson, Fox & Zeanah, 2014). By 2000, 60 percent of Europe’s pediatric HIV/AIDS cases came from Romania, most occurring in infants and children living in institutions (Popovici, Apetrei, 20 Zolotusca, Beldescu, Calomfirescu, Jezek & Oxtoby, 1991; Hersh, Popovici, Jezek, Satten, Apetrei, Beldescu & Heymann, 1993; Novotny, Haazen, & Adeyi, 2003; Nelson, Fox & Zeanah, 2014). It was only after the anti-Communist Revolution of 1989 that the magnitude of the problem was recognized. Romanian officials responded with a significant effort to treat the infected children and to prevent new cases of infection. The Romanian medical community partnered with numerous U.S. government medical organizations, including the National Institute of Health (NIH), the Center for Disease Control (CDC), and the US Agency for International Development (USAID) to provide appropriate treatment of infected children (Popovici et al., 1991; Hersh et al., 1993; Novotny, Haazen & Adeyi, 2003; Nelson, Fox & Zeanah, 2014). 5. Humanitarian crisis. With the fall of Communism in Romania in December 1989, Western media began broadcasting images of abandoned children living in overcrowded institutions and under conditions of substandard care, poor hygiene and insufficient developmental stimulation. By this time, Romanian orphanages held thousands of children, among which an estimated 3,000 were infected with HIV. By 1990, there were over 150,000 children in institutions with over 16,000 dying annually of easily treatable illnesses (Groza, Ileana & Irwin, 1999; Nelson, Fox & Zeanah, 2014). Western aid agencies poured into Romania in the early 1990's looking to improve the lives of the thousands of abandoned children. Along with international agencies specialized in child welfare, there emerged many Western families interested in adopting the abandoned Romanian children. However, these well-meaning families quickly learned that the process was fraught with complications, including people profiteering and posing as adoption agents when in fact they had no adoption expertise (Groza, Ileana 21 & Irwin, 1999; Gibbons & Rotabi, 2012). Due to the media exposure of the many issues plaguing Romania’s child welfare system at the time, the country became one of the largest senders of children in international adoption (Dickens & Groza, 2004). Over 7,700 children were adopted from Romania in North America, and several thousands were adopted by families from other countries (Bureau of Consular Affairs, U.S. Dept. of State, Dec. 2016). Approximately 10,000 left Romania during this time for adoption (Dickens & Groza, 2004). International Adoptions and Adoptions from Romania 1. International adoptions. Families who adopt internationally commonly take physical custody of the child directly from an institution. They may have a chance to visit the child at the institution a few times prior to placement. Then they put the child on an airplane, fly across the world, expose them to crowds of people in airports on their way to their destination, all the while the adoptee is surrounded by strangers and new and completely unknown smells, language, voices, food and textures. In this sense, the adoptive placement itself may inherently bring new layers of trauma to the adopted child in addition to the other traumatic events that already occurred in their early lives. The extent to which these struggles negatively affect a child's general development depends on the adoptee's ability to reach a sense of balance between pre-existing vulnerabilities and post-adoption protective factors (Haerens, 2010). Children who are adopted internationally typically enter middle and high-income families and communities that benefit from resource-rich environments and adequate social support post-adoptive placement (Groza, Ileana & Irwin, 1999; Groza & Ryan, 2002). More recently, researchers have begun to focus on features of the adoptive 24 the ERA Study Team, 2003; Groza, Ryan & Thomas, 2008), the adoptees from Romanian institutions had significant attachment, health, developmental, learning, socio- emotional and behavior difficulties, both initially when they were young and first arrived in the country, as well as through early adolescence (Beckett et al., 2002; Abers, Barnett, Jenista & Johnson, 2005; Johnson, Browne, & Hamilton-Giachritsis, 2006; Nelson et al., 2007; Zeanah, Egger, Smyke, Nelson, Fox, Marshall & Guthrie, 2009; Juffer et al., 2011). Some of the most compelling evidence regarding the effects of institutional care on the development and adjustment of the Romanian adoptees has been published by the English and Romanian Adoptees (ERA) study (O'Connor & Rutter, 2000; Kreppner, O'Connor & Rutter, 2001; Rutter, Kreppner, & O'Connor, 2001; Groothues, Beckett & O'Connor, 2001; Croft, O'Connor, Keaveney, Groothues & Rutter, 2001; Beckett et al., 2002; O'Connor et al. & the ERA Study Team, 2003; Beckett, Castle, Groothues, O'Connor & Rutter, 2003; Rutter, O'Connor & the ERA study team, 2004; Beckett, Maughan, Rutter and Castle, 2006; Rutter, Colvert, Kreppner, Beckett, Castle, Groothues, Hawkins, O'Connor, Stevens and Sonuga-Barke, 2007; Rutter, Kreppner, Croft, Murin, Colvert, Beckett, Castle & Sonuga-Barke, 2007; Croft, Beckett, Rutter, Castle, Colvert, Groothues, Hawkins, Kreppner, Stevens & Sonuga-Barke, 2007; Kreppner, Rutter, Beckett, Castle, Colvert, Groothues, Hawkins, O'Connor, Stevens & Sonuga-Barke, 2007; Stevens, Sonuga-Barke, Kreppner, Beckett, Castle, Colvert, Groothues, Hawkins & Rutter, 2008; Colvert, Rutter, Kreppner, Beckett, Castle, Groothues, Hawkins, Setvens & Sonuga-Barke, 2008; Castle, Groothues, Beckett, Colvert, Hawkins, Kreppner, Kumsta, Schlotz, Sonuga-Barke & Rutter, 2009; Sonuga-Barke, Kennedy, Kumsta, Knights, 25 Golm, Rutter, Maughan, Schlotz & Kreppner, 2017). This series of studies employed a longitudinal design and recruited a sample of Romanian children adopted by families living in the UK. The study included three groups. The first group were Romanian adoptees who experienced more than 6 months of institutionalization before the adoption, the second group were Romanian adoptees who experienced less than 6 months of institutionalization and the third group were infants adopted from the UK. The ERA study team considered several characteristics of the adoptive parents, such as adoptive parents’ education levels, their IQ scores, social class, mental health and marriage quality, concluding that variations in adoptive home environments had little or no effect on developmental outcomes of Romanian adoptees (Castle, Rutter, Beckett, Colvert, Groothues, Hawkins, Kreppner, O'Connor, Stevens and Sonuga-Barke, 2006; Kreppner et al., 2007). While these variables do relate to variations in children’s experiences in an adoptive home, they provide an accurate, albeit indirect assessment, of adoptive home features that have been theoretically implicated in adoptee outcomes. In contrast, other researchers examined variables theoretically linked to child outcomes that are likely amenable to change with appropriate support and education of adoptive parents, such as warmth and stimulation in the adoptive home, the parenting style of the adoptive family and the quality of child-parent attachment (Beckett, Groothues, O'Connor & the ERA Study Team, 1998, Rutter & the ERA Study Team, 1998; Beckett et al., 2002; O'Connor et al. & the ERA Study Team, 2003; Lemare & Audet, 2006). These researchers concluded that the above mentioned variables play a significant role in mitigating behavioral problems of Romanian adoptees. Several child related variables were considered important when assessing the 26 developmental outcomes of Romanian adoptees at different ages and stages of development. Length of time spent in institutional care and age at the time of the adoption were two variables that were investigated in numerous ERA studies (Rutter & ERA Study Team ,1998; Groothues, Beckett & O'Connor, 1998; Beckett, Groothues, O'Connor & the ERA Study Team, 1998; O'Connor, Bredenkamp & Rutter, 1999; Croft, O'Connor, Keaveney, Groothues & Rutter, 2001; Beckett et al., 2002; O'Connor et al. & the ERA Study Team, 2003; Beckett, Castle, Groothues, O'Connor & Rutter, 2003; Rutter, O'Connor & the ERA study team, 2004; Beckett, Maughan, Rutter and Castle, 2006). The Romanian adoptees in the UK showed marked developmental delays and various health issues at the time of entry in the country but recovered significantly in their adoptive families. The majority demonstrated significant catch-up in physical and intellectual domains by ages 4 to 6. However, residual deficits persisted in a small group (10%) of children (Rutter & ERA Study Team,1998; Groothues, Beckett & O'Connor, 1998; Beckett, Groothues, O'Connor & the ERA Study Team, 1998; O'Connor, Bredenkamp & Rutter, 1999). Specific deficits in cognitive impairment, ADHD, disinhibited attachment and quasi-autism were found to be associated with duration of time spent in institutional care (O'Connor, Bredenkamp & Rutter, 1999; O'Connor et al., 2000; Kreppner, O'Connor & Rutter, 2001; Rutter, Kreppner & O'Connor, 2001). Groothues, Beckett & O'Connor (2001); Beckett et al. (2002) Beckett et al. (2003) Rutter et al. (2004) , Beckett et al. (2006), Rutter et al. (2007) and Kreppner et al. (2007) reported individual continuity in impairment between ages 6 and 11 that was evident in children who experienced at least six months in institutions. Persistent cognitive impairment (Beckett et al. 2006), disinhibited attachment (Rutter et al., 2007) and 29 researched. Purpose of Current Study As the Romanian adoptees of the 1990's are now transitioning into adulthood, little is known about the long-term impact of their early experiences of severe deprivation that were followed by living in environments rich in resources and social support. The current study examines patterns of adult developmental transitions and the quality of adult attachment of Romanian adoptees who are now transitioning into young adulthood. The study seeks to understand the relationship between specific pre-adoption experiences and the Romanian adoptees' patterns of transitions and attachment styles as adults, and how these young adults compare to normative groups in terms of achieving adult transitions and adult attachment. More specifically, this study examines the effects of length of time spent in institutional care and pre-adoptive stress on Romanian adoptees' adult transitions and adult attachment. Perspectives of the adoptees and those of adoptive parents are being considered. Research Questions The current study will answer the following research questions: Research question 1. After controlling for age at adoption and type of recruitment, how much variance in adult transitions can be explained by length of time spent in institutional care? Research question 2. After controlling for age at adoption and type of recruitment, is length of time spent in institutional care likely to predict adult secure attachment? Research question 3. After controlling for age at adoption and type of 30 recruitment, how much variance in adult transitions can be explained by pre-adoptive stress? Research question 4. After controlling for age at adoption and type of recruitment, is pre-adoption stress likely to predict secure adult attachment? Significance for Practice and Future Research This project is innovative in that there is little information about high-risk groups with a history of trauma from institutionalization. This work has the potential to inform policy, theory and practice in the transition into early adulthood. From a theoretical perspective, a better understanding of how the effects of early deprivation can linger into early adulthood, and how they can be mitigated by environments rich in resources, contributes to adult developmental theory. The foundation of early adulthood as a developmental stage consists of the successful resolution of the polarities present in all previous stages of development, anywhere from the "trust versus mistrust" of infancy to the "identity versus role confusion" of the adolescence (Erikson, 1964). Due to exposure to severe deprivation during their first months to years of life, it is expected that many Romanian adoptees have difficulties in achieving the developmental tasks of young adult stages. Without a successful resolution of the developmental tasks of early adulthood, all subsequent stages of development may be negatively impacted. These subsequent tasks include important domains of human development such as work/career, family relationships, parenting, intimacy, generativity, creativity, integrity, etc. This study helps expand the theory of attachment by providing a better understanding of how variables such as length of time in institutional care and pre- adoption stress may impact adult attachment styles. Secure adult attachment represents 31 the foundation of good marriages (Collins & Read, 1990; Kobak & Hazan, 1991; Treboux, Crowell & Waters, 2004), good quality parenting (Collins & Read, 1990; Pearson, Cohn, Cowan & Cowan, 1994; Adam, Gunnar & Tanaka, 2004) and successful social relationships (Collins & Read, 1990). In contrast, insecure adult attachment could compromise human connection, with long-standing effects in one's marriage, raising children, having friendships or taking care of older parents (Collins & Read, 1990; Kobak and Hazan, 1991; Pearson et al., 1994; Adam, Gunnar & Tanaka, 2004; Treboux, Crowell & Waters, 2004). While it is widely known at this point that institutional care is no replacement for the loving care of families, in some parts of the world, orphanages continue to be popular as societal solutions for abandoned children (McKenzie, 1998; Selman, 2009). Depending on its findings, this study could help build a stronger case for ending institutional care as a social intervention. Examining the concepts central to emerging adulthood beyond typical college students adds to the generalizability of the framework. Arnett's theory college (2000; 2004) applies mostly to white, middle class young adults attending. There are other groups of young adults who do not embrace these developmental pathways: children who grew up in the foster care system (Munson et al., 2013), children involved with multiple systems of care (Tanner & Arnett, 2009; Munson et al., 2013), minority children in the US (Nelson, Badger & Wu, 2004; Arnett, Hendry, Kloep & Tanner, 2011) or children from outside the US (Arnett, 2006) who face other life circumstances than those of middle class American adolescents. Documenting the needs of children exposed to early adversity transitioning into 34 the importance of mitigating, resilience factors, either personal or related to family environment/functioning, and an indication that policies and interventions providing support to adoptees and adoptive families are necessary and do work. Finally, the findings of this study will have significant implications for training social workers, psychologists, educators and other service providers who work with vulnerable youth and adults throughout the life cycle. 35 Chapter 2 Review of the Theoretical and Empirical Literature Overview This chapter examines Bowlby’s (1969) Theory of Attachment and Arnett’s (2004) Theory of Emerging Adulthood as the theoretical frameworks for understanding the Romanian adoptees' transition into early adulthood. The literature relating to Romanian adoptions is subsequently discussed and critiqued through the lens of these two frameworks. Studies related to emerging adulthood and adoption and emerging adulthood and attachment are briefly are briefly discussed. At the conclusion of this chapter, the current study is presented with relevant research questions and hypotheses posed. Attachment The neuroscience of attachment. The human brain undergoes a critical period of accelerated growth from late pregnancy through the second year of life (Shore, 1997; Rice & Barone, 2000; Lipari, 2000; Schore, 2001; Walhovd, Tamnes & Fjell, 2014). Lipari (2000) reports that the human cortex adds 70 % of its mass after birth and grows to 90% of its adult size in the first 3 years of life. The expanding brain is directly influenced by genetics and biology but the environment is also an important factor in shaping and promoting healthy maturation. For brain development to reach an optimal outcome, an infant needs not only adequate nutrients, but also quality care and exposure to consistent, warm interpersonal experiences. During the first 3 years of life, the right brain develops faster than the left side of the brain (Schore, 2010). This is due to the right side of the brain connecting vital 36 functions that support coping with stress and survival (Nolte, 2002; Schore, 2010). The autonomic nervous system is the part of the peripheral nervous system that controls the automatic functions of the body such as heart activity, smooth muscle (organs), and glands. This part of this brain also is divided into the “fight-or-flight” system and the “resting and digesting" system (Peters & Palay, 1970; Ekman, Levenson & Friesen, 1983; Nolte, 2002). The limbic system is a complex system of nerves and networks in the brain whose functions are related to instinct and mood (Rajmohan & Mohandas, 2007; Isaacson & Pribram, 2013). This system controls one’s basic emotions (fear, pleasure, anger) and drives (hunger, sex, dominance, care of offspring). While the limbic system processes emotional information, the autonomic nervous system is responsible for body-based somatic aspects of emotion (Rajmohan & Mohandas, 2007; Isaacson & Pribram, 2013). Both systems undergo a critical period of growth during the first 2 years of life; the maturation of these emotional brain circuits is significantly influenced by early socio- emotional experiences (Schore, 2010; Isaacson & Pribram, 2013). The first 3 years of life is also a time of rapid growth of neural pathways. These neural systems are populations of neurons forming circuits that are either tightly organized in close physical proximity to each other or are distributed throughout the brain (Coan, Schaefer & Davidson, 2006). Neuronal networks are generated by a genetically programmed production of synaptic connections, which is later followed by an environmentally driven process of competitive selection of connections that are most sensitive to environmental stimulation (Chechik, Meilijson & Ruppin, 1999). This process called "parcellation” is a central mechanism of the self-organization in the 39 nervous system engages in the startle reaction, which makes the brain mediate stress by releasing stress hormones such as adrenaline, noradrenalin and dopamine (Chrousos & Gold, 1992; Hennighausen & Lyons-Ruth, 2005; Papoušek, 2007). The increased level of these hormones creates a hyper-metabolic state that can be damaging to an infant's health if it continues for a prolonged period of time. In addition, prolonged periods of stress for infants induce the release of thyroid hormones and vasopressin (Hennighause & Lyons- Ruth, 2005; Papoušek, 2007; Schore, 2010). These substances can produce somatic symptoms such as nausea, vomiting and stomach difficulties (Beebe, 2000). It is not uncommon for infants who are crying for an extended time to experience stomach aches, loss of appetite and/or frequent vomiting. Bowlby (1969) introduced the concept of "attunement" in the mother-infant dyad (p.235). Attunement refers to the mother's ability to understand and respond appropriately to an infant’s cues. When the mother-infant dyad is in attunement, secure attachment takes place (Bowlby, 1969, 1980). When the mother-infant dyad is out of sync, the infant experiences distress and a desire to get back in attunement with the mother. The process of attunement establishes the foundation for negotiating social interactions and provides a blueprint for other relationships in the child's life (Bowlby, 1969; 1980; Schore, 2010). When infants are in attunement, they are emotionally regulated (Schore, 2010). Attunement does not only involve the mother, even though the infant-mother dyad is most important due to the pair’s role in survival and optimal development. Infants can also develop attunement and bonds with caregivers other than the mother (Bowlby, 1969, 1980; Davies & Cummings, 1994). Bowlby (1969) was the first to conceptualize attunement as an attachment system. 40 This attachment system reportedly lays the groundwork for how one grows and develops bio-psycho-socially their entire life. Bowlby's theory of attachment 1. Overview. Bowlby (1969) developed a revolutionary way of understanding the nature of bonding between infants and caregivers. Based on his observations of infants who were separated from mothers and fathers during long periods of hospitalization, Bowlby's theory provided scholars with new perspectives on evaluating the effects of primary caregivers, particularly mothers, on the well-being of infants. 2. Definitions of attachment. Bowlby defined attachment in young children as "a strong disposition to seek proximity to, and contact with a specific figure, and to do so, in certain situations, notably when frightened, tired or ill" (Bowlby 1969, p. 371). Bowlby (1969) also considered attachment to be a biologically based process designed to sustain an infant's healthy development and resulting in an enduring emotional bond between an infant and his caregiver. He believed that attachments meet an infant's physical and psychological needs and it has adaptive value for infants, by promoting survival. Ainsworth et al. (1979) noted that it may be "an essential part of the ground plan of the human species for an infant to become attached to a mother figure" (p.33). Papalia, Olds & Feldman (1992) defined attachment as a reciprocal, enduring, relationship between infants and caregivers, with both parties contributing to the relationship. In social work practice, attachment refers to an infant’s emotional connection to an adult caregiver identified as an attachment figure (Turner, 2011; Howe, 2014). The infant tends to turn selectively to that adult for comfort and makes efforts to increase proximity to the caregiver when seeking nurture and/or protection. Attachment behaviors 41 are specific, because attachment assumes not only seeking the presence of the attachment figure, but also making efforts to achieve proximity to that person when experiencing distress (Mooney, 2009). Attachment is dynamic; it is not only about the infant’s attachment to the mother or primary caregiver but also about the caregiver’s emotional connection to the infant (Mooney, 2009; Turner, 2011; Howe, 2014). Therefore, attachment is viewed not only as a connection between two people, but more so as a bond that assumes both a desire for regular contact with that person and the experience of distress during separation from that person (Ainsworth, 1979; Mooney, 2009). Attachment is also a life-long developmental process involving increasingly complex physical, cognitive and communicative strategies to interact with others (Bowlby, 1969, 1980). 3. Functions of attachment. The theory of evolution postulates that infants who remain physically close to their caregivers, or whom seek proximity to their caregivers when potentially dangerous situations arise, are more likely to survive and reproduce in adulthood (Hamlin, Wynn & Bloom, 2007; Kiley Hamlin, Wynn & Bloom, 2010). The attachment relationship, as conceived by Bowlby (1969, 1980), fulfills an evolutionarily adaptive function of maintaining human life. Bowlby (1969, 1980) believed that children come into the world biologically pre-programmed to form attachments with others to aid their survival. He viewed attachment behaviors as instinctive. Both infants and mothers have evolved a biological need to stay in contact with each other. Attachment behaviors initially operate like fixed action patterns sharing the same function. Bowlby (1969) argued that infants are born with the tendency to display certain innate behaviors (called social releasers) which help ensure proximity and contact with the mother or the 44 unresponsive and/or are overly intrusive (Bowlby, 1969, 1980; Isabella & Belsky, 1991; Beebe, 2000). While the quality of interactions is regarded as the most important factor building secure attachments (Isabella & Belsky, 1991; Beebe, 2000), the infant's confidence in the caregiver's capacity to protect and comfort also was correlated with the quantity of interactions (Cox, Owen, Henderson & Margand, 1992; Beebe, 2000). Thus, both quality and quantity are important for the development of a secure attachment. Attachment styles. Differences in the quality of attachment have been highlighted by observations of infants and their caregivers from field studies and in a standard laboratory procedures called the strange situation (Ainsworth, Blehar, Waters & Wall, 1978). In the lab, during an approximately 20-minute period, a toddler is exposed to a sequence of events that are likely to stimulate the attachment system. The situation introduces several potentially threatening experiences, including the presence of a stranger, the departure of the mother, being left alone with a stranger and being left completely alone-all in the context of an unfamiliar laboratory setting. During this sequence, researchers have the opportunity to make systematic observations of the child's behaviors, the caregiver's behaviors and the characteristics of their interactions, as well as to compare these behaviors across varying segments of the procedure. Patterns of attachment behavior (Ainsworth et al., 1979) have been distinguished using the strange situation methodology: 1) secure attachment; 2) anxious-avoidant; 3) anxious-resistant or ambivalent attachment; and later (Main & Solomon, 1990), (4) disorganized attachment. Secure attachment in coding schemes has been labeled as Type B attachment. Sixty to 75 percent of low-risk young children are Type B, securel,,y attached to their primary caregivers (Hazan & Shaver, 1990; Baldwin, Keelan, Fehr, Enns 45 & Koh-Rangarajoo, 1996). These children use their caregiver as a base from which they can venture into strange situations, they are comforted quickly, and are reoriented towards play easily. Infants who have a secure attachment actively explore their environment and interact with strangers while their mothers are present. After separation, the infants actively greet their mothers or seek interaction. If the infants were distressed during separation, the mothers' return reduces their distress and the infants resume exploring the environment (Hazan & Shaver, 1990; Baldwin et al, 1996). Anxious-avoidant attachment has been labeled as Type A and anxious-resistant or ambivalent attachment is labeled as Type C; these are two patterns of insecure styles of attachment. Fifteen to 25 percent of children are Type A anxious-avoidant (Vondra & Barnett, 1999). These children, during separation from their caregiver, show lower levels of distress being alone than secure children. They attend to other items in the room, avoid contact with their mothers after separation, or ignore their mother’s efforts to interact. Insecure-avoidant children are more likely to have caregivers who are intrusive and controlling. An analysis of brain chemistry with insecure-avoidant children shows higher levels of the stress hormone cortisol, indicating that while the child’s demeanor is placid, they are highly internally stressed (Barnett & Vondra, 1999). A lesser number of children, 10 to 15 percent of the general population, have been classified as having insecure anxious-resistant or ambivalent attachments (Barnett & Vondra, 1999). These children do not stray far from their caregivers during stress-free periods; they show high levels of frustration and distress at being separated from their caregivers and they are not easily soothed when their caregivers return. Infants who show an anxious-resistant attachment are very cautious in the presence of strangers. Their 46 exploratory behavior is noticeably disrupted by the caregiver's departure. Upon the return of the caregivers these children are less likely to approach for contact and reassurance. The infants appear to want to be close to their caregiver but they are also angry so they are very hard to soothe or comfort (Barnett & Vondra, 1999; Barnett, Vondra & Butler, 1999). They are either highly angered or ambivalent towards their caregiver’s attempts at calming and they resist physical contact after reaching for their caregivers. Insecurely anxious-resistant or ambivalently attached children experience a caregiver who is not responsive to their needs. As such, these children increase their efforts to be noticed by the caregiver by whatever means necessary. They are often more temperamental than their peers and are less likely to be comfortable with physical contact due to an infancy of being rejected during times of stress (Barnett & Vondra, 1999). There are outliers who do not fit into these three attachment styles of children classified as A, B, or C (Barnett & Vondra, 1999). These children are classified as Type D attachment (Main & Solomon, 1990; Bakermans‐Kranenburg, Van IJzendoorn & Juffer, 2005). Type D is a disorganized/disoriented attachment style. These children don’t have a coherent attachment behavioral system, using strategies across A, B and C types (Main & Solomon, 1990; Barnett, Ganiban & Cicchetti, 1999). Type D children are often the children of abusive or neglectful caregivers. The caregivers may also display elevated symptoms of psychiatric illness. Children who are classified as having Type D attachments have been reported to be controlling, authoritarian, and punitive when interacting with peers (Barnett & Vondra, 1999; Bakermans‐Kranenburg, Van IJzendoorn & Juffer, 2005). In disorganized attachment, during the reunion sequence the children behave in contradictory, unpredictable ways that seem to convey feelings of extreme fear, 49 increased disclosure, responsiveness to the loved one, the effectiveness of the loved one in providing comfort and reassurance that reduce distress, and an element of exclusiveness or preferential response to the loved one (Hazan & Shaver, 1990). Fears about loss and abandonment are associated with anxious attachments and result in anxiety about one's current romantic relationships. Adults with anxious attachments tend to be more coercive and mistrustful, often pushing their partners away. They may have difficulty establishing and maintaining romantic relationships as they move from childhood friendships into the more demanding expectations of adult friendships, sexual intimacy and open communication (Tracy, Shaver, Albino & Cooper, 2003). Adults with avoidant attachment have the tendency to emotionally distance themselves from their romantic partners. They seek isolation and make efforts to preserve their independence, which they perceive as being under attack while involved with a romantic partner. They often come off as focused on themselves and may be overly attending to their own comforts and needs. People with avoidant attachment tend to lead more inward lives, both denying the importance of loved ones and detaching easily from them. They often present with anxieties and defenses such as denial, displacement, rationalization and isolation of affect and can easily shut down emotionally. Even in heated or emotional situations they can turn off their feelings and not react (Shaver & Hazan, 1987; Firestone, 1990; Firestone & Firestone, 2004). Adults with disorganized attachments live in ambivalent states of being afraid of being both too close to or too distant from others. They have a working model for romantic relationships that is marked by doubt and insecurity. On the one hand they would like to have their needs met in relationships. At the same time, they believe that 50 getting too close to people will hurt them. They often have fears of being abandoned but also struggle with being intimate. In other words, the person they want to go to for safety is the same person they are frightened to be close to. As a result, they have no organized strategy to get their needs met by others (Shaver & Hazan, 1987; Firestone, 1990; Firestone & Firestone, 2004). People with disorganized attachments tend to find themselves in unstable or dramatic relationships, with many highs and lows. They may even end up in abusive relationships (Firestone, 1990; Firestone & Firestone, 2004). The parenting relationship can also be understood as an elaboration of the attachment representation. Adults who have experienced a secure attachment in their own infancy are more likely to create secure attachment in their children. Adults whose childhood attachments were unpredictable or even hostile are more likely to have difficulty coping successfully with parenting and meeting an infant’s needs (Ricks, 1985; George & Solomon, 1999). For example, in an observational study, parents were examined while their infants were having inoculations. Those parents who had an avoidant attachment style were less responsive to their infants' distress at receiving an injection (Edelstein, Alexander, Shaver, Schaaf, Lovas & Goodman, 2004). However, this is not to say that the quality of adult love relationships or parental behavior are determined solely by the quality of childhood attachment. New relationships and learning experiences intervene to modify the initial attachment representation and expand one's capacity to love another person. In fact, in his later writings, Bowlby (1984) acknowledged the early experiences are not as deterministic as he first thought, recognizing that attachment style can change over the life span and is also dependent on experiences throughout life. 51 Factors that affect attachment. There are several factors already mentioned that contribute to secure attachment and some other factors that negatively impact attachment style. As discussed, the most important factor in the development of attachment is an infant’s experience of caregiver response (Bowlby, 1969, 1980). If a child lacks a responsive caregiver because of an abusive or neglectful parent, or due to being placed in an environment such as an institution without a consistent and responsive caregiver, this has a negative impact on attachment, as both situations thwart responsiveness. A caregiver’s own attachment patterns can predict how their children form attachments (Sterlin, 2006). The Adult Attachment Interview (Main & Goldwyn, 1985; 1998) has been used to determine parental attachment styles. Mothers who described their childhood objectively and coherently, and who expressed value towards attachment relationships, often had securely attached infants and were securely attached as infants themselves (Lyons-Ruth & Jacobvitz, 1999; Van Ijzendoorn, Schuengel & Bakermans- Kranenburg, 1999; Sterlin, 2006). Mothers who were unable to provide examples of positive interactions during their own childhoods and reported that their attachment figures had little to do with their current identity often created avoidant attachments with their infants and were in the avoidant category themselves. Mothers who dwelled on negative experiences, injury, who were overwhelmed and frightened, created anxious/ambivalent attachments. Finally, mothers who described childhoods of fear displayed disorganized attachment (van IJzendoorn et al., 1999; Sterlin, 2006). Thus, a caretaker’s own attachment style can impact attachment with their children. Adolescents who have strong connections (i.e., attachments) with their families, mentors or inspirational others tend to have better developmental outcomes (Selekman & 54 In addition to the lack of responsiveness, trauma and chronic stress negatively impact attachment. In terms of trauma, they type, severity and duration of the trauma can have a negative impact. As a proxy for severity and duration, age at adoption is a critical variable. As age at adoption increases, the duration of pre-adoptive stress or pre-adoptive trauma increases. Also, since family life has a more positive impact on child development, it is also important to examine the length of time the adoptee has been in an adoptive family. Unlike age at adoption as an indicator of pre-adoptive stress or pre- adoptive trauma, length of time in the adoptive family is an indicator of the potential for healing. As such, both age at adoption and length of time in a family (birth, foster and adoptive) will be important to examine in assessing attachment as well as other developmental outcomes. Results about the effects of gender on attachment are somewhat mixed. Ainsworth et al. (1979) in their original study on 106 Baltimore middleclass families found no gender differences in attachment. Several more recent studies found that boys were more likely to be securely attached to their fathers than girls were (Williams & Blunk, 2003; Schoppe‐Sullivan, Diener, Mangelsdorf, Brown, McHale & Frosch, 2006). Boys who have been in low-income, maltreating families have disorganized attachment more frequently (Carlson, Cicchetti, Barnett & Braunwald, 1989). Other studies consider gender a non-relevant contributor to attachment behaviors (Gloger-Tippelt, Gomille, Koenig & Vetter, 2002; Gloger-Tippelt, König, Zweyer & Lahl, 2007). Attachment through the life span. An important question that has been the focus of empirical attention and debate concerns the degree to which individual differences in attachment are attributes of the child or are attributes of the child’s 55 relationship with a specific caregiver. Van IJzendoorn (1995) asserted that it is “nurture” rather than “nature” that accounts for differences in attachment security (p. 388). His hypothesis was substantiated and was further supported by Howes (1999) who found a child may have different attachment classifications with different caregivers. As previously noted, a central tenet of attachment theory indicates that early experiences between young children and their caregivers provide a model for intimate relationships later in one’s life. Although this model is believed to be modifiable by subsequent experiences, Zeanah and Shah (2005) point out that the theory has posited a tendency to deny or resist changes in attachment over time. They suggest that in a stable caregiving environment, one would expect to find stable patterns of attachment, but in environments characterized by significant changes, one would expect less stability. Results from longitudinal studies do not support a linear relationship, as they demonstrate instability of attachment classifications from infancy to adulthood (Hamilton, 2000; Lewis, Feiring & Rosenthal, 2000; Waters, Merrick, Treboux, Crowell & Albersheim, 2000). Individuals whose attachment classifications changed from secure in infancy to insecure in adulthood were more likely to have experienced negative life events and children who demonstrated insecure attachment in infancy were more likely to remain insecure if they experienced negative life events (Grossmann, Grossmann & Kindler, 2005). Pre-Adoption Stress As mentioned earlier, the conditions in the Romanian institutions were deplorable. The Romanian orphanages failed to meet even the most basic needs of the children. There were reports that the children were often tied to beds or restrained by using pieces of clothing (Groza & Ileana, 1996, Groza Ileana & Irwin, 1999; Smyke et al., 2010; 56 Nelson, Fox & Zeanah, 2014). Physical and sexual abuse were common occurrences (Klass, Earls & Eisenberg, 1996; Groza, Ileana & Irwin, 1999; Gavrilovici & Groza, 2007; Frank, Rus et al., 2013; Nelson, Fox & Zeanah, 2014). Corporal punishment of all children was practiced and officially encouraged as appropriate discipline, and staff who did not beat the children were considered weak (Frank et al., 1996). Due to the abuse children received from staff, older children learned to beat the younger children (Rus et al., 2013). Often, the children would spend their day naked because the staff had failed to put clothes on them or they would be sitting in their own urine for hours or days at the time (Ward, 2011). All children, including girls, had their heads shaved, which made it difficult to differentiate the gender of the children (Conn & Crawford, 1999; Ward, 2011). They were also bathed in dirty bath water, bathed three at a time by the workers (Groza, Ileana & Irwin, 1999; Ward, 2011; Nelson, Fox & Zeanah, 2014). Children also would starve to death. Many children had delayed cognitive development and many did not know how to feed themselves (Conn & Crawford, 1999; Ward, 2011). Physical injuries included fractures that had not healed right, resulting in deformed limbs (Ward, 2011). Many children reportedly died of minor illness or injuries such as anemia (Nelson, Fox & Zeanah, 2014). Due to lack of human contact, infants developed without stimulation, which led to self-stimulation such as hand flapping or rocking back and forth. With these characteristics, children were often misdiagnosed to have mental disabilities and forced to move to institutions for the handicapped (Ward, 2011). They were given psychiatric medication to treat their behaviors, or they were tied to their beds to prevent self-harm (Ward, 2011). The harshest fate was reserved to children deemed as irrecuperable, who were considered "unproductive" and assigned to the Labor Ministry 59 disturbances (O’Connor et al., 2003), inattention/ overactivity (Kreppner et al., 2001), or abnormal self-regulatory behavioral patterns (Beckett et al., 2003). Some researchers (Kreppner et al., 2001, 2007; Rutter et al., 2001) report specificity to the adverse outcomes associated with institutionalization such as inattention/overactivity but others suggest that more global deficits may occur (reviewed in Gunnar et al., 2007). Several studies have found a lack of effect of age at adoption on behavioral outcomes (Groza & Ryan, 2002), including a large meta-analysis (Juffer & van IJzendoorn, 2005). Difficulties in separating age at adoption from the quality of pre-adoption experiences, along with variability in the outcome measures, may account for some of the differences in these findings. In summary, the previous sections discussed attachment theory and the research related to the factors that affect attachment and the role of pre-adoptive stressors on adoption outcomes. This next section picks up where most attachment theory and research ends, looking at a number of issues in the transition to adulthood besides attachment. This is roughly the period from 18 to 30 years old. Emerging Adulthood 1. Emerging adulthood as a developmental stage. Arnett (2000) proposed a new theory of development for individuals in their late teens through the late twenties, with a specific focus on ages 18-25, otherwise considered emerging adulthood. He argued that this period is neither adolescence nor young adulthood, yet is theoretically and empirically distinct from both. Arnett (2000) describes those in the emerging adulthood phase as enthusiastic individuals who have left the security of their family to grow into their own relationships and responsibilities. 60 Emerging adulthood is distinguished by relative independence from social roles and from normative expectations. Having left the dependency of childhood and adolescence, although having not yet entered the daily responsibilities of adulthood, emerging adults often explore a variety of possible life directions in love, work, and world views (Arnett, 1994; 1997; 1998; 1999; 2000; 2001; 2002; 2003; 2004). Emerging adulthood is a time of life when many directions are possible, mainly because little about the future has been decided for certain. At this point in one’s life, the scope of independent exploration of possibilities is greater for most people than it will be at any other period of the life course (Arnett, 2002; 2003; 2004). For many people, the late teens through the mid twenties can be the most volitional years of life. Historically, cultural influences often limited the extent to which emerging adults were able to use this time period, because obviously not all young people are able to use these years for independent exploration. Like adolescence, emerging adulthood is a period of the life course that is culturally constructed and not universal for all young adults (Arnett, 2000; 2001; 2002; 2003; 2004). Emerging adulthood is a new concept, developed after the cultural shift in the 1970’s in America and other western countries (Arnett, 2003; 2004). In the 1970’s the wide availability of birth-control, the loosening of strict sexual morality and the pursuit of higher education contributed to moving the average age of marriage and subsequent child rearing with at approximately 10 years, comparing to older generations. This cultural shift pushed the adult obligations of marriage and parenting from age 18 to 30 and later (Arnett, 2004). This contributed to emerging adulthood becoming a time of explorations, new possibilities and of solidifying identities. Arnett (2000; 2002; 2004) gives credence 61 to Erickson’s conflict of identity versus role confusion which Erickson posited occurs during adolescence up to age 18. Arnett argues that an 18-year old adolescent, particularly within recent decades, rarely has a complete grasp on their identity as an individual within society. Arnett contends that it is nearly impossible for the conflict of identity versus role confusion to be overcome until the end of the new stage of emerging adulthood. Further, Arnett proposes the stage of emerging adulthood is decidedly not an extension of adolescence (2004). Emerging adults have the capacity for self-direction, reflection, and independent living that adolescents are not yet able to achieve due to a number of cultural and societal constraints (Arnett, 2003, 2004; Arnett, Žukauskienė & Sugimura, 2014). Adolescents must answer to teachers, parents, and the societal laws of being a minor until they reach age 18. Emerging adults, in contrast, have the freedom to move away from their parents, choose their own timeline for schooling, and, for the most part, are considered legal participants within their world (Arnett, 2004). Yet, emerging adulthood is not adulthood either. When emerging adults are asked if they have reached adulthood, the majority answer neither no or yes, but the ambiguous "in some respects yes, in some respects no" (Arnett, 2004, p.67). This reflects a subjective sense on the part of most emerging adults that while they have left adolescence, they have not completely entered young adulthood (Arnett, 1994; 1997; 1998). Although they do not use a specific name to describe the stage they are in, they regard themselves as being in between the two stages but not necessarily in one stage or the other (Arnett, 2000). 2. Characteristics of emerging adulthood. Arnett describes five main domains of those within the stage of emerging adulthood: identity exploration, instability, a self- 64 It is worth noting that in both of the domains of love and work, identity exploration during emerging adulthood is not the sole purpose of preparation for adult roles, but explorations geared towards securing a broader range of experiences before embracing more limiting adult roles. Emerging adults are able to explore and experiment freely, without the commitments of adult life, which are a lot more limiting. This level of freedom is likely to end during the late thirties and beyond that age. It is not uncommon for emerging adults to have many romantic and sexual experiences in the absence of parental supervision and without the pressures of marriage or other enduring commitments. Similarly, some emerging adults try out untraditional work and educational opportunities such as Americorps, Peace Corps, internships or work assignments in the other parts of the country or abroad. Changes in worldviews are often a central part of cognitive development during emerging adulthood. According to Perry (2000), young adults go through several stages of world view formation. Those who attend college, enter the curriculum with a set of views that come from their families of origin. During college, they get exposed to a variety of experiences and points of view, which most likely modify their original worldviews. College students continue to question their views as they gain exposure to additional life events, which makes them open to examine a variety of new world views and to modify them according to new environmental input. Higher education promotes explorations and reconsiderations of worldviews (Terenzini & Pascarella, 1991). Similarly, emerging adults who do not attend college are as likely as college students to undergo changes in their world views, as a part of attaining adult status (Arnett, 1997), but not in the same way as those going to college. Regardless of educational background, 65 emerging adults value the process of reexamining the religions that they grew up with in their families of origin and arrive at their own set of beliefs based on their own insight and self-reflection (Hoge, Johnson, & Luidens, 1993; Arnett, 1999). The identity explorations of emerging adulthood are exciting and liberating for many individuals, but they are not always completely positive on all fronts. Explorations in love often result in heartbreak, just like explorations in work sometimes result in a failure to achieve success. Explorations in worldviews sometimes can result in states of deep confusion, as family of origin beliefs get dismantled, but nothing compelling comes to replace them in meaningful ways (Arnett, 1999). Also, identity exploration is a process that each individual goes through on his/her own pace, which can lead to feelings of loneliness and isolation. b) Instability. Identity exploration and instability go hand in hand. The continuous process of searching for oneself naturally leads to numerous changes in the areas of love, work and education, making emerging adulthood an unstable stage of life (Arnett, 1994, 1997, 2000, 2004; Arnett, Zukausklene, & Sugimura, 2014). Emerging adults have some general idea of how they are supposed to transition from adolescence to adulthood, but this transitioning plan gets frequently modified in the face of various changes related to education, work and love. The average individual changes work environments between the ages of 18 to 29 approximately 8 times, more than during any other life stage (Arnett, Zukausklene, & Sugimura, 2014). Additionally, most emerging adults have several relationships before determining which qualities are important to have in a long-term partner. These revisions of an initial tentative plan are natural consequences of the emerging adults' explorations and provide them with life lessons about themselves and 66 about the practical ways they can employ to build pathways to the future that they envision. Instability is not necessarily a negative concept in terms of the transition to adulthood, but instead it is more of a way of understanding some of the processes that occur during this time. Similarly to the feelings emerging adults experience in regards to identity exploration, this time of great instability can be exciting and thrilling for some young adults. For others, the frequent changes generate vulnerability to anxiety, depression and depleted social supports. c) Self-focus. Arnett (1994, 1997, 2000, 2004) posits that emerging adulthood is the most self-focused time in life. Children and adolescents report to parents, other family members and teachers, are part of a family system that is governed by roles and rules and are bound by standards of behavior at school, in the community and in larger society. Adolescents, although able to enjoy more freedom than younger children, still live at home with their parents and are required to comply with household rules. Teachers set rules and norms of behavior at school and impose standards of safety for communities and standards of performance to enter college and/or secure work. By age 30, 75 percent of young adults in the U.S. are married and have at least one child (Arnett, 2005; Arnett, Zukausklene, & Sugimura, 2014). This means additional sets of rules operating in their newly-created families and new standards of performance in a work field of their choosing where the young adults work hard and strive to succeed and advance with the goal of being able to support themselves, their spouses and children. In contrast, emerging adults have the luxury to focus on themselves. Most of them are largely untied to family obligations and/or enduring work assignments. The concept 69 class or mother’s educational status (Arnett, Zukausklene, & Sugimura, 2014). Emerging adults who leave behind difficult upbringings and did not yet make other commitments further restricting their moves, have an extraordinary opportunity to transform their lives during this stage. It is difficult to disentangle oneself from a troubled family when you continue to live in the same household with parents and other family members who struggle with addiction, depression, abject poverty, domestic violence, etc. During this stage, emerging adults have a chance to step away from family dysfunction, focus on themselves and heal the parts of themselves that are broken. Even those emerging adults who come from families regarded as relatively happy and healthy, individuate from parents and create their own identities during this time. However, Arnett (2000, 2004) notes that regardless of one’s family background, all emerging adults carry the baggage of their families of origin with them and the extent to which they can transform their lives is still a function of these family influences. 3. Markers of adulthood. In the past, social scientists defined adulthood in terms of discrete transitions. The markers of adulthood most commonly used in the past were: leaving home, completing one’s education, entering marriage, and experiencing parenthood. Arnett (2000; 2004) points out that becoming an adult today means becoming self-sufficient and learning to stand alone as an independent person. There are three criteria at the heart of emerging adults’ views of the self-sufficiency required for adulthood: taking responsibility for oneself, making independent decisions, and becoming financially independent (Arnett, 2000; 2004). Responsibility is a word that comes up over and over again in interviews when emerging adults respond to questions of what it means to be an adult, and usually it 70 means responsibility for oneself, not others. In part, taking responsibility for oneself means accepting responsibility for the consequences of one's actions rather than looking for someone else to blame if things go wrong. Making independent decisions is the second most important marker of adulthood. Emerging adults believe that to be considered an adult, a person has to use independent judgment in making decisions, not only on concrete topics such as where to live and what career to pursue, but also in the less tangible areas of what one's beliefs and values should be. Financial independence is a third pillar of adult status for emerging adults. They believe they need to make enough money to “pay the bills” on their own before they can be considered fully adults. Becoming an adult is also defined in terms of independence from parents. Establishing independence from parents is a gradual process that begins well before emerging adulthood, but a major thrust toward adulthood comes with moving out of one’s parents’ household. For many emerging adults, moving out is part of going off to college after high school. It is not just moving out itself that is important as a marker of adulthood, but the way moving out requires emerging adults to take on new responsibilities, make independent decisions, and become more financially independent. Because it is not so much moving out on their own that matters as much as taking on responsibilities, making of independent decisions, and the financial independence of moving out, emerging adults can feel they have reached adulthood even if they have returned home or never left. Learning consideration for others is another marker of adulthood. Emerging adults tend to define what it means to be an adult by learning to stand alone as a self- sufficient person, independent of parents or anyone else and meausre their progress 71 toward adulthood strictly in terms of themselves and their personal development. They live in an individualistic society and go through an individualistic stage of life, and the combination makes their self-focus strikingly high. Eventually they do commit themselves to others through marriage and parenthood, but first they need to demonstrate that they can fend for themselves in the world. Still, even during emerging adulthood one does not necessarily lose sight of the rights and concerns of others. On the contrary, the individualism of their view of what it means to be an adult is tempered by an emphasis on consideration for others. Being self- focused does not mean being selfish, and becoming self-sufficient does not entail becoming self-absorbed. While becoming an adult means learning to stand alone, it also means becoming less self-oriented and more considerate of others. Some emerging adults even place consideration for others at the heart of their conception of adulthood, although these emerging adults are relatively rare. More often, they view self-sufficiency as the most important part of becoming an adult, but temper this focus with concern for others. The word “responsibility” appears to have an elastic meaning, the way emerging adults use the term. It can refer to taking responsibility for oneself - and that is how they use it most often - but it can also be used to refer to responsibility toward others (Arnett, 2000; 2004). It is a paradox of emerging adulthood that becoming more self-sufficient can also mean becoming less self-centered, that learning to stand alone can be combined with learning to be more considerate of others. The same kind of change takes place in one’s relationships with their parents. As emerging adults move away from their parents, they also become closer to them. This is healthy and developmental, a direct result of the 74 5. Studies on emerging adulthood a. Introduction. Arnett developed a theory of emerging adulthood (2000). Between 2005 and 2015 more than 300 empirical studies were published on diverse populations of emerging adults, focusing on different aspects of their development. For the purpose of this project, the review of studies on emerging adulthood was narrowed down to two areas: one, emerging adulthood and adoption, and two, emerging adulthood and attachment. b. Emerging adulthood and adoption. Table 1 presents the studies published on emerging adulthood and adoption between 2000 and 2018. The majority of these studies focused on the adoptive family's communicative openness, particularly on topics related to adoption and on the adoptees' interest in searching for biological family members. This body of research informs adoptive parents about the challenges that their developing children might face during the emerging adulthood years. Ongoing, open communication and unconditional support have been identified to serve as catalysts of this developmental process. 75 Table 1. Empirical Studies on Emerging Adulthood and Adoption Citation Purpose Sample(s) Methodology Major Findings Grotevant, H. D., Rueter, M., Von Korff, L., & Gonzalez, C. (2011). Post-adoption contact, adoption communicative openness, and satisfaction with contact as predictors of externalizing behavior in adolescence and emerging adulthood. Journal of Child Psychology and Psychiatry, 52(5), 529- 536 Study examined the relation between 1) post‐ adoption contact between adoptive and birth family members; 2) adoption communicative openness, and satisfaction with contact and 3) adoptee externalizing behavior in adolescence and emerging adulthood. The sample included 190 families of infant‐ placed, domestic adoptees during childhood, adolescence, and emerging adulthood. Structural equation modeling (SEM) was used to analyze predictors of externalizing behavior from adoptive parents and adolescent reports; adoption communicative openness (based on reports of adoptive mothers), and satisfaction with contact (reports by adoptive parents and adolescent). Externalizing behavior showed moderate stability across childhood, adolescence, and emerging adulthood. Contact and adoption communicative openness were related to each other, but not to externalizing behaviors in adolescence or emerging adulthood. Wrobel, G. M., Grotevant, H. D., Samek, D. R., & Korff, L. V. (2013). Adoptees’ curiosity and information-seeking about birth parents in emerging adulthood: Context, motivation, and Study examines whether emerging adult adoptees’ curiosity mediates the associations between the predictors of internal and external barriers/facilitators and openness level and the outcome of information- Data were drawn from a sub-sample of adoptees who participated at Waves 2 and 3 of the Minnesota / Texas Adoption Research Project (MTARP) Wave 2 data were collected between 1996 and 2001, All variables were drawn from Wave 2 and Wave 3 adoptee interviews. At Wave 2, open-ended questions were answered on a variety of topics, including adolescents’ experiences, feelings, knowledge, and attitudes Curiosity proved to be an exceptionally strong predictor of seeking information about adoptees’ birth parents. Greater curiosity yielded more information- seeking. Curiosity partially mediated the 76 behavior. International Journal of Behavioral Development, 37(5), 441-450 seeking. In addition, the content of identified barriers and facilitators are described. from 156 adopted adolescents (75 boys and 81 girls) ranging from 11 to 20 years of age (mean age ¼ 15.7 years). Wave 3 data were collected between 2006 and 2008 from 169 adopted emerging adults (87 male, 82 female) ranging from 21 to 30 years of age (mean age ¼ 25.0 years). All children had been adopted as infants about his/her adoption and kinship networks. At Wave 3, open-ended questions were asked about school and occupation, religion, close relationships, and adoption. Responses from both waves were coded. Openness arrangements were also coded. impact of internal barriers upon information-seeking. The relationship between internal barriers and curiosity was positive; more internal barriers were associated with greater curiosity and more subsequent information-seeking. Farr, R. H., Grant, Marsney, H. A., & Grotevant, H. D. (2014). Adoptees' Contact with Birth Parents in Emerging Adulthood: The Role of Adoption Communication and Attachment to Adoptive Parents. Family Process, 53(4), 656-671 Study examined how adoptees’ attachment to adoptive parents and family adoption communication are related to birth parent contact during emerging adulthood. The original sample included 190 adoptive families with children (N = 171, M = 8 years, range = 4–12) at Wave 1. At Wave 2, 156 adoptees participated (75 boys, 81 girls) and they were between 11 and 20 years old (M = 16 years). In Wave 3, which is the focus of this article, 167 emerging adult adoptees participated. The sample of adoptees was 51% Adoptees participated in a semi-structured interview about their adoption and birth family experiences, responded to a series of online questionnaires regarding their relationships with their adoptive parents, and reported on demographic information about their employment, school history, living arrangements, and relationships. Current feelings of attachment The results indicate that relationships with adoptive parents continue to play an important role in adoptees’ experiences of birth family contact into adulthood, regardless of whether adoptees had current contact with birth parents. Overall, while adoptees were more satisfied with contact when there was current birth parent contact, 79 c. Emerging adulthood and attachment. Table 2 presents the studies published on emerging adulthood and attachment between 2000 and 2018. These studies generally support the notion that parents provide the foundation for the development of relationship competence and high-quality intimate relationships throughout adolescence and into emerging adulthood. A majority of these studies investigate the relationship between attachment styles in childhood and support the argument that secure parental attachment relationships develop into script-like representations, which are then used to negotiate intimate relationships in a satisfying way during adulthood; insecure patterns of attachment to parents lead to a sense of insecurity during emerging adulthood. 80 Table 2. Empirical Studies on Emerging Adulthood and Attachment Citation Purpose Sample(s) Location of Study Methodology Major Findings Pitman, R., & Scharfe, E. (2010). Testing the function of attachment hierarchies during emerging adulthood. Personal Relationships, 17(2), 201-216 Study investigated the shift of attachment functions from parent to peer. Participants were undergraduate students in an introductory psychology course from two campuses of a liberal arts university. Three hundred and two students participated. Complete data were available for 267 participants, and 35 participants did not complete at least one questionnaire. The mean age of the participants was 20.08 years (SD = 3.87). Most participants were female (79%, n = 210 221) USA The Relationship Scales Questionnaire (RSQ; Bartholomew & Horowitz, 1991; Griffin & Bartholomew, 1994a, 1994b) was used to assess attachment in several close relationships. The Center for Epidemiological Studies Depression (CES–D; Radloff, 1977) measured affective symptomology and current depressive symptoms. The Attachment Network Questionnaire (ANQ; Trinke & Bartholomew, 1997) was used to assess the order of attachment figures in the network hierarchy. Both attachment anxiety and avoidance were associated with distress; however, the strongest association was with attachment anxiety. Individuals who report low levels of attachment avoidance report receiving more social support than individuals who report high levels of avoidance. Findings suggest that individuals remain with their family because they hold positive views of some family members, in particular mothers, and report that they are trustworthy and available in times of distress. On the other hand, these findings also suggest that individuals may shift to peers because they hold negative views of their family (i.e., high attachment avoidance with mother and/or father) and report that they are unavailable, distrustful, rejecting, and uncaring in times of distress. Nosko, A., Tieu, T., Lawford, H., & Pratt, M. W. This study investigated reports of parenting and family patterns in For the first wave, participants were recruited through 16 high schools in central Ontario, Canada. Canada At age 17, participants reported their gender, high school grade averages, rating of family income, and Participants who reported having benefited from positive parent– child relations at age 17 also were more likely to report a secure adult 81 (2011). How Do I Love Thee? Let Me Count the Ways: Parenting During Adolescence, Attachment Styles, and Romantic Narratives in Emerging Adulthood. Developmental Psychology, 47(3), 645-657. relation to questionnaire measures of attachment styles obtained from participants at age 26. Secondly, it investigated the relation of parenting during adolescence and attachment style to the quality of the romantic relationship at age 26. Third, they described the global themes of the romantic narratives that participants told at 26 Eight hundred and ninety- six students (544 girls, 352 boys) volunteered to take part in the longitudinal study. The fourth and most recent wave was conducted when participants were age 26; the sample consisted of 100 individuals (68 women, 32 men). parent educational attainment. At age 26, they reported their age, relationship status, and level of education they had attained. Participants were asked at age 26 whether they were currently in a committed romantic relationship or not. When participants were 17, multiple measures of parenting style and family patterns of behavior were administered. These measures were combined in order to create an overall parent– child relations index on them as a person attachment style at age 26. In contrast, those who reported more negative parent– child relations at age 17 reported a more avoidant attachment style at 26. Quality of parenting when participants were age 17 coherently predicted their attachment styles at age 26. Correlational analyse showed that parent– child relations reported when participants were 17 were not significantly associated with measures of the quality of their relationships at age 26 but were positively related to higher levels of intimacy as reflected in their romantic relationship stories. Among the attachment styles, one significant relationship was found: avoidant attachment was related to ratings of the quality of romantic relationships from the stories. More specifically, avoidant individuals reflected lower levels of relationship quality as expressed in their narratives. Doumen, S., Smits, I., Luyckx, K., Duriez, B., Vanhalst, J., Verschueren, K., & Goossens, L. (2012). The study examined attachment-related emotions as a mediating variable in the associations between identity styles and perceived peer relationship The sample consisted of 343 undergraduate psychology students from a large university in the Dutch-speaking part of Belgium (mean age ¼ 18 years; SD ¼ 1.62; 80% Belgium Participants completed Version 4 of the Identity Style Inventory (ISI-4; Luyckx, Lens, Smits, & Goossens, 2010; Smits et al., 2009). Attachment anxiety and attachment avoidance were measured For 2 out of the 3 identity styles (i.e. the information-oriented and the diffuse-avoidant identity style), a specific pattern of associations with attachment related emotions and peer relationship quality was found. The information-oriented subscale related positively to 84 During Emerging Adulthood. Social Indicators Research, 121(3), 833-847 addition to considering direct associations between these variables, the study investigated indirect pathways through peer attachment (friend attachment and romantic attachment) in emerging adulthood 25 years (M = 20.38; SD = 3.93) adolescents’ perceptions of their attachment to their parents and peer. The Italian version (Picardi et al. 2000, 2002) of the Experiences in Close Relationships (ECR), developed by Brennan et al. (1998), was employed to assess romantic attachment. The Italian version (Di Fabio and Busoni 2009) of the Satisfaction with Life Scale (SWLS), developed by Diener and colleagues (Diener et al. 1985; Pavot and Diener 1993), was employed to assess life satisfaction indicated that the association between attachment to friends and life satisfaction was not significant. Individuals involved in romantic relationships have been found to interact more with romantic partners than with others, such as friends. Together these results support the hypothesis that romantic attachment has a stronger direct influence on life satisfaction compared to attachment to friends, probably due to the dominant role that romantic partners achieve in emerging adults’ affective world. Moreover, results show that the direct association between parental attachment and life satisfaction was significant for attachment to father but not significant for attachment to mother. Lane, J. A., & Fink, R. S. (2015). Attachment, Social Support Satisfaction, and Well-Being During Life Transition in Emerging Adulthood. The Counseling Psychologist, The study examines the extent to which emerging adults experiencing normative life transitions rely on attachment and social support satisfaction to maintain well- being. A total of 213 emerging adults completed surveys. USA The Experiences in Close Relationships Scale–Short Form (ECR-S; Wei, Russell, Mallinckrodt, & Vogel, 2007) was used to assess adult attachment. The Social Support Questionnaire (SSQ6; I. G. Sarason, Sarason, Shearin, & Pierce, 1987) was used to assess satisfaction with available social supports. Satisfaction With Life Scale (SWLS ; The results revealed that social support satisfaction fully mediated the association between attachment anxiety and well-being. However, social support satisfaction did not mediate the association between attachment avoidance and well- being. These findings collectively suggest that attachment anxiety, but not attachment avoidance, is associated with social support satisfaction. The association between attachment avoidance and 85 43(7), 1034- 1058. Watson, Clark, & Tellegen, 1988) was used to measure life satisfaction well-being remained significant after accounting for social support satisfaction, whereas the association between attachment anxiety and well-being was fully mediated. Passanisi, A., Gervasi, A. M., Madonia, C., Guzzo, G., & Greco, D. (2015). Attachment, Self-Esteem and Shame in Emerging Adulthood. Procedia - Social and Behavioral Sciences, 191, 342-346 The study hypothesized a connection between insecure attachment styles, low self- esteem and feelings of shame. In particular, it was postulated that preoccupied and fearful attachment styles would be associated with lower self-esteem and higher feelings of shame. The study was conducted on a group of 209 university students (121 females, 58%), between the ages of 19 and 24 (M=21.66, SD=1.59). Italy Participants were administered three self- report measures during University lessons: the Experience of Shame Scale (ESS; Andrews, Qian & Valentine, 2002); the Rosenberg Self-Esteem (RSE; Rosenberg, 1965); and the Relationship Questionnaire (RQ; Bartolomew & Horowitz, 1991). Statistical analyses showed that females had significantly lower self-esteem and higher experiences of shame than males. Results showed that experiences of shame were positively predicted by both preoccupied and fearful attachment styles. Emotionally dysregulated emerging adults are not expected to manage their emotional arousal, subsequently becoming overwhelmed by feelings of shame. Schimmenti, A., & Bifulco, A. (2015). Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment This study aimed to look at the effects of childhood experiences of neglect/abuse and insecure attachment styles in the development of anxiety disorders in a high-risk sample of adolescents/emerging The sample consisted of 160 youth just over half of whom were female (52%, 83). Participants were aged between 16 and 30 (M = 20.63, SD = 4.46). UK Standardized interview measures were used to assess demographic characteristics, childhood experience of neglect and abuse to age 17, attachment style at interview, and the 12-month prevalence of anxiety disorders. Interviews took place in the family homes or the The 12-month prevalence of anxiety disorders was quite high in this sample: 18% of participants suffered from an anxiety disorder including generalized anxiety disorders, social phobia or panic with or without agoraphobia. Among participants with anxiety disorders, females had more than double the rate of males consistent with the literature (Kessler, Chiu, 86 styles. Child and Adolescent Mental Health, 20(1), 41-48 adults. research offices, they were audiorecorded and administered by trained researchers. Structured Clinical Interview for DSM- IV Axis I Disorders (SCID- I; First, Gibbon, Spitzer, & Williams, 1996). Childhood Experience of Care and Abuse (CECA; Bifulco, Brown, & Harris, 1994). The CECA interview was used to assess childhood adversities before age 17 Demler, & Walters, 2005; Wittchen, 2002). In this study, two of the CECA scales related to lack of care (i.e., the neglect and the antipathy scale) were associated with anxiety disorder. There was no association with role reversal or any of the abuse scales. Antipathy was the most robust predictor of anxiety disorders. Almost the half of the participants were rated as having an insecure attachment style. Among the insecure attachment styles at the ASI, the Anxious styles showed predictive association with the 12-month prevalence of anxiety disorders. Kumar, S. A., & Mattanah, J. F. (2016). Parental attachment, romantic competence, relationship satisfaction, and psychosocial adjustment in emerging adulthood. Personal Relationships, 23(4), 801-817 This study had 4 goals: 1) to explore the relations between continuous ratings of parental attachment and psychosocial adjustment; 2) to examine whether romantic competence and romantic relationship satisfaction serve as mediators between parental attachment security and psychosocial functioning ; 3) to A total of 188 students at a mid-sized regional university in the mid- Atlantic region of the United States participated in the current study. The sample consisted of both women (74.9%) and men (25.5%), where the average age was 19.65 years (SD =3.51 USA In order to assess an individual’s level of attachment to his or her parental figures, the study used the IPPA (Armsden & Greenberg, 1987). In order to assess an individual’s level of romantic competence in his or her relationship, the study used the RCI (Davila et al., 2009). In order to assess an individual’s level of satisfaction with his or her relationship, the study used the Couple Satisfaction Index (CSI; Funk & Rogge, Study found that secure attachment relationships with both mothers and fathers were linked to positive adjustment outcomes. When examining the mediational links between participants’ attachment to their mother and psychosocial adjustment, romantic competence and relationship satisfaction mediated that link to a significant degree. However, romantic competence and relationship satisfaction were not shown to be the mechanisms through which father attachment is linked to positive adjustment outcomes. The results evidenced that secure 89 The proceeding discussion focused on the theory of attachment and the transition to adulthood. The last part of this chapter focuses on the specific population of interest to this study: Romanian Adoptees. Review of Studies on Romanian Adoptions Introduction. Studies of Romanian children adopted into various countries showed several consistencies. To date, most studies report that Romanian adoptees had significant physical and medical problems at the point of entry into their receiving countries (Johnson et al., 1992; Marcovitch et al.,1995, 1997; Groza & Ileana, 1996; Fisher et al., 1997; Rutter & the ERA Study Team, 1998, Mainemer, Gilman & Ames, 1998; Groza, 1999; Groothues, Beckett & O'Connor, 2001; Gunnar et al., 2001; Rutter, Kreppner & O'Connor, 2001; Beckett et al., 2002). Many children had cognitive delays when they first arrived in their adoptive homes (Johnson et al., 1992; Morison, Ames & Chisholm, 1995; Benoit et al., 1996; Groze & Ileana, 1996; Marcovitch et al., 1997; Groza, 1998; Groza, Proctor & Guo, 1998; Rutter & the ERA Study Team, 1998; O'Connor, Bredenkamp & Rutter, 1999; Morsion & Ellwood, 2000; Croft et al., 2001, 2007; Rutter, Kreppner & O'Connor, 2001; Beckett et al., 2002, 2006; Groza & Ryan, 2002; Horksbergen et al. 2002, 2003; Rutter et al. & the ERA Study Team, 2004; LeMare & Audet, 2006; Sonuga-Barke et al., 2017). Children who had spent little time in institutions had fewer physical, medical, and cognitive problems than did children who had spent longer periods in institutional care (Groza & Ileana, 1996; Groza, 1998; Groza, Proctor & Guo, 1998; Rutter & the ERA Study Team, 1998; O'Connor, Bredenkamp & Rutter, 1999; Morison & Ellwood, 2000; Croft et al., 2001; Rutter, Kreppner & O'Connor, 2001, 2007; Beckett et al., 2002, 2006). However, some children who had not 90 lived in an institution also exhibited significant problems (Fisher et al., 1997) and some children from globally depriving institutions exhibited little to no problems (Groza & Ileana, 1996; Marcovitch et al., 1997; Groze, Ileana & Irwin, 1999; Kreppner, O'Connor and Rutter, 2001; Groothues, Beckett and O'Connor, 2001; Rutter; Kreppner and O'Connor, 2001; Beckett, Bredenkamp and the ERA Study Team, 2002; Beckett et al., 2002, 2006; Rutter et al. & the ERA Study team, 2004; LeMare & Audet, 2006). As a group, the children were classified as having high risks. The physical and cognitive development of many adopted children showed physical growth after their adoption, resulting in functioning that was in the average ranges within a few years of their adoption (Morison, Ames & Chisholm, 1995; Groza & Ileana, 1996; Groza, 1998; Markovitch et al., 1997; Rutter et al. & the ERA Study Team, 1998; Groothues, Beckett & O'Connor, 2001; Kreppner, O'Connor & Rutter, 2001; Rutter; Kreppner and O'Connor, 2001; Rutter et al. & the ERA Study team, 2004; Beckett et al., 2006; Stevens et al., 2008), except for a small group of the most impaired children. These positive changes were inconsistent with what many theories of development would have predicted. Many studies documented that most of the children displayed insecure attachment patterns, indiscriminant friendliness and disinhibited attachment, rather than a specific attachment to an adoptive parent (Morison, Ames & Chisholm, 1995; Markovitch et al., 1997; Chisholm, 1998; O'Connor, Bredenkamp & Rutter, 1999; O'Connor & Rutter, 2000; Rutter, Kreppner & O'Connor, 2001; O'Connor et al. & the ERA Study Team, 2003; Rutter et al., 2007; Stevens et al., 2008). Romanian adoptees exhibited behavioral problems. These problems, although rarely reaching the level to qualify these children for diagnosable mental health disorders, nonetheless impacted the 91 quality of life of the adoptee and the family through adolescence (Groze & Ileana, 1996; Mainemer, Gilman & Ames, 1998; Croft et al., 2001; Groza, Ryan & Cash, 2003; Rijk et al., 2006; Sonuga-Barke et al., 2017). The studies of Romanian adoptees were conducted in the US, UK, Canada and the Netherlands. Several themes have emerged. First, most of the children had health problems documented early in their adoption. Second, most of the children had developmental delays from which they recovered within the first few years of adoption. Three, some peculiarities in attachment were noted. Forth, some Romanian adoptees exhibited emotional difficulties and behavioral problems. The following section discusses the Romanian adoption studies in more detail. Health problems. Frequently reported health problems associated with institutionalized Romanian children were failure to thrive (Johnson et al., 1992; Nelson, Fox & Zeanah, 2014), intestinal parasites (Marcovitch et al., 1995), anemia (Fisher et al., 1997), the prevalence of the Human Immunodeficiency Virus (HIV), and the Hepatitis B Virus (HBV) (Johnson et al., 1992; Marcovitch et al. 1995, 1997; Nelson, Fox & Zeanah, 2014). According to the World Health Organization, the incidence of pediatric AIDS in Romania reached 1,094 documented cases, with 683 infected children (62%) living in institutions. Hepatitis B virus infection also reached epidemic proportions among Romanian infants and children adopted from institutions (Rudin, Berger, Tobler, Nars, Just & Pavic, 1990; Nelson, Fox & Zeanah, 2014). Johnson et al. (1992) is one of the earliest studies that researched the health of Romanian adoptees coming into the United States. This clinical based study examined cases at the University of Minnesota Hospital and the New England Medical Center 94 experiences of Romanian adoptees and their subsequent experiences in the US, gathering data from adoptive families across the U.S. via 10 support groups for families that had adopted Romanian children between 1990 and 1993. Surveys for 475 children were returned. At the time of placement, the average age of a child was 1.7 years. Ninety percent of the children had been in their adoptive home for three or more years. According to the parents, 47 percent of the children had only lived in institutions before adoption, 33 percent of children were adopted directly from their birth families, and the rest had spent time in a combination of settings. At the time of adoption, most children were below the normal range in weight (60%) or height (49%). Parents reported problems with bed wetting (19%), the adoptee having an activity level too high for the child’s age (21%), rocking or other forms of self-stimulation (16%), oversensitivity to touch, sights, or sound (18%), and under-reactivity to stimulation or pain (11%). Children who had lived in an institutional setting were more likely to be below normal weight and height at adoption, and presented with more bed wetting, self-stimulating behavior and high activity level. In addition, children who had been institutionalized for longer periods had more of these problems than did children institutionalized for shorter periods. Fisher et al. (1997) examined the experiences of Canadian families who adopted from Romania by comparing three groups: 1) 46 children adopted from Romanian orphanages after having spent a significant time in an institution (RO); 2) 29 Romanian children adopted earlier in life with little institutional experience (RC); and, 3) 29 non- adopted children Canadian born (BC) matched by age and gender to the adopted children. The median age of the three groups of children at the time of the study was 25 months. The children in the RC group had been in adoptive homes longer than the RO children. 95 Parents of RO children were interviewed in their homes for approximately 2.5 hours. Interviews with parents in the CB and RC groups were conducted by telephone. Fisher et al. (1997) found that many RO children had eating problems, often refusing solid food or eating too much. Eight-five percent of the RO children had a medical problem. The other findings of this study will be discussed under the section on developmental concerns. Marcovitch et al. (1997) continued the work of Marcovitch et al. (1995). From the original sample of 105 families, 53 percent (n=56) agreed to participation in further research. Of the 56 children, 37 were institutionalized for under 6 months and 19 were institutionalized over 6 months. The data was compared to 34 healthy Canadian born children. At the time of the assessment, the children’s ages ranged from 3-5 years old. Nineteen of the children had been in an institution for longer than six months before placement, and as a result, were older than the other children. The remaining 37 children had spent less than 6 months in institution or had been adopted directly from their birth parents. Marcovitch et al. (1997) found that the previously reported health problems were completely resolved for both groups of Romanian adoptees when the adoptees were of age 3-5. More findings from this study will be discussed under the section on developmental concerns. Mainemer, Gilman & Ames (1998) conducted a cross-sectional study of 39 Canadian families who adopted 87 children, 23 of these children were Romanian adoptees who spent 8 months or more in an institution prior to adoption, 23 were Romanian adoptees who spent less than 4 months in an institution, and 41 were Canadian born healthy children. The study used snowball sampling from families known to researchers and from families enrolled in a service program providing in-home services 96 to children with developmental difficulties. Parents who adopted Romanian children who spent more than 8 months in an institution prior to adoption reported more stress related to the children health and behavioral problems. Eating difficulties, rocking, banging heads and self-injurious behaviors were the type of issues mentioned by the parents. Rutter, et al. & the ERA Study Team (1998) examined the physical development of 111 Romanian children adopted by English families before the children’s 2nd birthday. Half of the children were raised entirely in an institution before their adoption, 20 percent were raised primarily in an institution, and only 9 percent had been raised in a family setting. The Romanian children were compared to a group of 52 English children who had been adopted by UK families before the age of 6 months. The children were 4 years old at the time of the study. Most of the Romanian adoptees were in poor health upon entering the UK. Half the children were below the 3rd percentile in weight at the time of adoption, 34 percent were below the third percentile on height, and 3percent were below the third percentile on head circumference. The other findings of this study will be discussed under the section on developmental concerns. From 1998 on, UK researchers conducted follow up evaluations of the Romanian adoptees and the comparison group (Groothues, Beckett & O'Connor, 1998; Beckett, Groothues, O'Connor & the ERA Study Team, 1998; Rutter & the ERA Study Team, 1998; O'Connor, Brenednkamp & Rutter, 1999; Croft et al., 2001; Groothues, Beckett and O'Connor, 2001; Rutter, Kreppner and O'Connor, 2001; Beckett, Bredenkamp & the ERA, 2002; O'Connor et al., 2003; Rutter, O'Connor and the ERA Study Team, 2004; Beckett et al., 2006; Croft et al., 2007; Rutter et al., 2007; Stevens et al., 2008; Sonuga- Barke et al., 2017) as part of the English and Romanian Adoption Project (ERA). The