1. Attention Deficit and Hyperactivity Disorder (ADHD)
in Internationally Adopted Children in Spain
Neus Abrines Jaume, neus.abrines@campus.uab.cat
Marre, D; Brun, C.; Fornieles, A.; Barcons, N.; Fumadó, V.
2010 Meeting of the Society for Cross-Cultural Research
SCCR/SASci/AAACIG. Albuquerque, New México.

2. 1. Framework of the research project

3. Framework of the research project
Risk factors and Resilience in Internationally Adopted children
Research project MEC R+D SEJ 2006-2009 15286
International Adoption: social and familial inclusion of the
internationally adopted children. Interdisciplinary and comparative
perspectives
Period 2010-2012: National and international adoption: family,
education and pertinence: interdisciplinary and comparative
perspectives. (CSO2009-14763-C03-01) (subprogram SOCI)

4. 2. Theoretical Introduction

5. ADHD: Prevalence and Etiology
 ADHD: Attention Deficit and Hyperactivity Disorder
 Defined as a neurobiological disorder
 Prevalence: 3 – 7% of children (higher among boys)
 Etiology:
ENVIRONMENTAL BIOLOGICAL
ADHD

6. ADHD: Diagnostic criteria (DSM-IV)
INATTENTION HYPERACTIVITY
(6 or more symptoms) IMPULSIVITY
(6 or more symptoms)
Often has difficulties with:
• Giving close attention to Often:
details. • Runs about excessively
• Sustaining attention • Acts as if “driven by a
• Listening motor”
• Following through • Talks excessively
instructions • Has difficulty waiting
• Organizing tasks and his/her turn
activities • Interrupt
• Symptoms must appear before the age of 7
• One of the symptoms is presented in two different situations
(for example, at home and in the school).

7. ADHD: Differential diagnosis
• Attachment disorders.
• Emotional disorders.
• Anxiety disorders.
• Behavior disorders.
• Chronic brain syndromes.
• Neglect, maltreatment and abuse.

8. ADHD: Treatment
PSYCHOLOGICAL
• Cognitive Behavior
PHARMACOLOGICAL therapy
• Methylphenidate • Social Abilities Training
• Atomomoxetine
• Psychopedagogic
treatment
• Parent training

9. Theoretical Introduction
 A marked increase of ADHD diagnostics in
internationally adopted children it’s been observed
(Bimmel et al. 1990; Verrier, 2003), and this incidence seems to
be higher among children adopted from Eastern Europe
countries (Lindblad et al., 2010; Gunnar & Van Dulmen, 2007).
 In International Adoption, there are several risk factors
which can favor the existence of Attachment Disorders
and these disorders seem to be related to the ADHD
symptomatology. (Franc et al., 2009; Niederhofer, 2009; Erdman,
1998).

10. Theoretical Introduction
 Parenting styles are related with the ADHD symptomatology
and the attachment disorders (Finzi-Dottan, Manor, & Tyano, 2006;
Öngel, 2006).
 The existence of pre-adoptive and post-adoptive factors,
which favor the appearance of ADHD-like symptoms, it’s
been observed (Bimmel et al., 2003). These symptoms can lead
to misdiagnosis of ADHD and can be followed by an
inappropriate treatment.

11. 3. Hypothesis

12. Hypothesis
Hº 1: Differences in the frequency of ADHD-like symptoms,
depending on the country of origin, will be found.
Adopted in
Russia
With ADHD-like
symptoms
Adopted in Adopted in
Adoptats a
China Ethiopia
Europa de l’Est
With ADHD-like With ADHD-like
symptoms symptoms

13. Hypothesis and objectives
Hº 2: The relation between some factors and the existence of
ADHD-like symptoms will be observed.
.
Parenting
styles
Attachment Age at
Pattern adoption

14. 4. Method
 Participants
 Material
 Procedure

15. Participants
 Children aged 7 and 8 years.
 Inclusion requirement: Minimum of 2 years since the adoption date.
 N = 58 (total sample 200)
 More frequent countries of origin
Adopted in Russia Adopted in Adopted in
(n = 24) Ethiopia China
(n = 11) (n = 23)
Boys: 12
Girls: 12 Boys: 6 Boys: 0
Girls: 5 Girls: 23

16. Material
 Family data questionnaire
 ADHD Symptoms
• Behavioral Assessment System for Children (BASC) (Reynolds y Kamphaus, 1992)
o Attention problems
o Hyperactivity
 Parenting styles:
• Egna Minnen Beträffande Uppfostran (EMBU)
(Perris, Jacobsson, Lindström, Von Knorring, and Perris, 1980)
o Rejection
o Overprotection
o Favouring
o Emotional warmth

17. Material
 Attachment pattern
• Friends and Family Interview (FFI) (Steele & Steele, 2006)
o Semi-structured interview (30 min.)
o Video-recorded and transcribed
o Double coded (Reliability inter-raters = 90%)
o Assess the attachment pattern according to:
1. Coherence 5. Peer relations
2. Reflective functioning 6. Sibling relations
3. Evidence of secure base 7. Anxieties and defense
4. Evidence of self esteem

18. Procedure
1. Contact the Pediatric Service of the Hospital Sant Joan de Déu,
specialized in international adoption.
2. Select the sample, according to the age.
3. Invite the families to participate
4. Inform and give an appointment to the families who showed their interest.
5. Assess the child (45 min.)
6. Obtain the results of the assessment
7. Return to the families a Psychological report
8. Statistical analysis of the data

19. 5. Results

20. Hyperactivity and country of origin

30
Results
25
2
20
10
15 Clinical scores
Normal scores
10 21
14
5
Girls from
5
6 CHINA
0
Russia China Ethiopia
 Attention problems and country of origin
30 ↓
25
Less hyperactivity
symptoms
3
20 7
15 Clinical scores p: 0,02
Normal scores
10 20
17 4
5
7
0
Russia China Ethiopia

21. Results
LESS
Girls from HYPERACTIVITY
CHINA SYMPTOMS
Age at
adoption Sex
NO SIGNIFICANT
DIFFERENCES

22.  Age at adoption (months)and country of origin Results
60
50
40
Russia
30
Ethiopia
51,3
20
China Age at
10
27,33 adoption
12,83
0
Russia Ethiopia China
 Hyperactivity and age at adoption (months)
40
35
30
RELATED WITH
25
20
HYPERACTIVITY
15
35 SYMPTOMS
10 21,97 p:0,02
5
0
Normal scores Clinical scores

23.  Attachment and Attention problems
40
Results
35
3
30
25 Secure
20
32
11
Clinical scores
Normal scores
Attachment
15
10
5 12
0
Secure Insecure
↓
 Attachment and hyperactivity Less hyperactivity
40 symptoms
35 p:0,001
30
7
25 ↓
20 Clinical scores
15 28
10
Normal scores Less attention
10
5
13
deficit
0
p: 0.055
Secure Insecure

24. Parenting styles
 Overprotection correlates with:  Rejection correlates with:
• Hyperactivity. (Pearson’s r = .31; p: 0,05) • Attention problems.
(Pearson’s r = .31; 0.05)
• Attention problems. (Pearson’s r = .37; p: 0.01)
 An Insecure attachment is related with more rejective parents (p: 0.04):
1,44
1,42
1,4
1,38
1,36
1,34
1,42
1,32
1,3
1,28
1,31
1,26
1,24
Secure Insecure

25. 6. Conclusions

26. Conclusions
1. Girls adopted from China show less Hyperactivity symptoms.
2. When older adopted, the probability to show Hyperactivity symptoms
increases.
3. The secure attachment pattern seems to be related to less existence of
ADHD-like symptoms.
4. An overprotective parent style correlates with Hyperactivity and Attention
problems.
5. A rejective parent style correlates with Attention problems.
6. An Insecure attachment seems to be related with more rejective parents.

27. Conclusions
 Limitations of the research project:
o Size of the sample
o Unequal distribution of the groups
o Absence of a control group from general population

28. Acknowledgements
 To the Pediatric Service of the Hospital Sant Joan
de Déu, (Barcelona).
 To all the families who participate in the research
project.