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Adopted Children: Resolving Anger and Building Trust


My professional work with adoptive and foster children began in 1977 as a consultant at Catholic Social Services in Philadelphia and led to a commitment to work with these youth over the past 40 years.  In addition, my wife and I have been blessed with three adoptive daughters.


Approximately 120,000 children are adopted each year in the United States with adopted youth constituting 1.5 million children younger than age 18 years. Many adoptees have remarkably good outcomes, but some have difficulties. However, some adopted youth experience early life emotional trauma as a result of separation from the birth mother or from prolonged time in care without a secure maternal attachment relationship.  Adoptive parents all too often have not been given knowledge of the potential for significant emotional conflicts in the future because of early life trauma in their child prior that occurred prior to the adoption. Specifically, excessive anger, anxiety, mistrust, severely controlling behaviors and sadness can emerge in these youth. 


The early life trauma in adopted children of the lack of and, in some, seperation from, a secure mother relationship can result in the development of severe mistrust with fears of bonding with adoptive parents, siblings and peers.  Research has shown that the vulnerability of early-maltreated children persists even if they are raised in enriched circumstances (van der Vegt, et al. 2009, b.)

With my colleague at the University of Wisconsin, Madison, Bob Enright, Ph.D., we have co-authored two textbooks in 2000 and in 2014 on the treatment of excessive anger in psychiatric disorders through the use of forgivenes therapy. In the child chapter of each book, the treatment of excessive anger in adopted children is described and includes uncovering and treating anger with biological parents through forgiveness therapy.  

In the numerous research studies of Dr. Enright and in our clinical work, forgiveness therapy not only decreases excessive anger, but it also reduces sadness from life hurts and anxiety/mistrust, while also enhancing self-esteem.  In addition, a process of building trust is essential for recovery from early life abandonment pain and is also described, which can include a Faith component, as in the treatment of addictive disorders.

In my professional experience, people remain prisoners of the past unless they work to uncover sadness and anger from past hurts and then engage in the hard work of forgiveness. In adoptive youth and adults, this would involve working on forgiving a birth parent and others who may have inflicted hurt before the adoption.

The history below is of an adopted girl, Amber, from Russia which is cited in our book. This is a composite case study.


Research Studies on Adoption

 A growing number of studies are examining the mental health of youth and some point to the long term psychological conflicts in those who endured significant adversity in early childhood regardless of the home environment of the youth.  

A study of 1,364 adoptees on the impact of early childhood adversities of international adoptees on adult psychiatric disorders revealed that severe early adversities increase the risk of adult psychopathology, even when children are taken out of their problematic environments. These children had an increased risk of having anxiety disorders, mood disorders or substance abuse disorders into adulthood.  The results suggest that psychiatric disorders may arise de novo after childhood due to early experiences (van der Vegt, et al.,2009, a.)  The experience of early childhood adversity prior to adoption has been shown to increase substantially the level of psychiatric problems, especially when maltreatment was severe. Moreover, the impact of early adversities on psychiatric problems remained markedly stable.

Forgiveness therapy can be effective in addressing the serious early life emotional conflicts in some adopted children that can continue into adulthood. 

A study 2005 of 1,484 young adult intercountry adoptees in the Netherlands demonstrated that the adopted young adults were 1.52 times as likely to meet the criteria for an anxiety disorder as the non adopted young adults.  The adoptees were also 2.05 times as likely to meet the criteria for substance abuse or dependence. The adopted men were 3.76 times as likely to have a mood disorder as non adopted men, (Tieman, W.,et al., 2005).   Also, adoptees, compared to nonadoptees, were less likely to have intimate relationships, to live with a partner, and to be married. Adopted males showed somewhat less favorable outcomes than adopted females (Tieman, W., van der Ende & Verhulst, 2006).  The experience of being adopted approximately doubled the odds of having contact with a mental health professional and of having a disruptive behavior disorder.   


Also, late age at adoption, neglect and institutionalization have been shown to be risk factors for the psychological and behavioral problems in adoptees and families (Fensbo, 2004).  Adoptees placed after infancy may have developmental delays, attachment disturbances, and posttraumatic stress disorder (Nickman, S.L., et al., 2005). 


A 2011 Spanish study demonstrated that adoptees from Eastern Europe had more attentional problems, poor adaptive abilities and poorer interpersonal relationships than the other adoptees ( Barcons-Castel, N., et al., 2011).


Origins of Conflicts

In our clinical experience over the past 40 years, the early emotional pain in adopted children arises from the trauma of having an addicted or negligent mother and/or father, separation from the birth mother, shame, a serious difficulty in trusting because of the experience of maternal rejection, other experiences of neglect in orphanages or foster care, intense jealousy of birth children of adoptive parents, and low self-esteem often related to a poor body image. These youngsters usually do not identify the sadness, anger and mistrust that develops arising from the failure to establish a secure, loving attachment relationship with a birth mother or from the separation from the biological mother or father.  


Forgiveness Therapy

After the development of early life pain is reviewed with the parents and child, the benefits of uncovering and resolving anger with the birth mother and/or father or other caretakers through forgiveness therapy are discussed.  Without forgiveness the early life anger will be misdirected at adoptive parents, siblings and others. In fact, this anger can create severe stress in adoptive homes and in relationships with parents, siblings and peers.


Specific examples of harmful behaviors are identified for the child and family by completing our anger and mistrust checklist cited elsewhere on this website.  

If an adoptive child regularly overreacts in anger or in controlling behaviors, we regularly explore the possibility that there may be unresolved anger with a birth parent, significant others or caretakers.  Many adopted youth express a disbelief initially that their present excessive anger, often expressed in passive ways, or mistrust could arise from unresolved early life hurts.  However, we encourage them to trust in our knowledge of child development and experience and try to follow our advice.  We then recommend that an adopted child engage in a cognitive forgiveness exercise of thinking about trying to forgive, for example, a troubled birth mother who may have had a very difficult life, caretakers or other relatives.  As forgiveness therapy is utilized regularly to master angry feelings, emotional overreactions slowly diminish as the degree of inner anger diminishes.  The work of forgiveness with these youth is regularly challenging because of their difficulty in trusting.. The case study below demonstrates the forgiveness therapy with an very mistrustful and angry adoptive child from Russia, Amber.


The hostile feelings in some adopted children, as was the case with Amber, can be a defense against fears of being betrayed. These youngsters often will only work at changing hostile behavior after they understand their great difficulty in trusting the birth mother or father and after their trust in their adopted parents has grown significantly.  When the trust in these children grows, their overreactions in anger decrease.  Until this occurs, these youth can manifest intensely controlling behaviors in the adoptive family.


The History and Treatment of an Adopted Girl

Amber was an intelligent nine-year-old girl who was adopted from Russia at the age of five with her two-year-old brother. After being taken away from her drug addicted mother who was a prostitute, Amber was placed in a strict orphanage and later related being treated in a harsh manner there. Her adjustment to her family and community was quite difficult. She distanced her adoptive parents, children in the neighborhood, and anyone who tried to befriend her. She became increasingly angry and later engaged in violent behavior toward her mother.


The therapist told Amber, You have every reason to feel very angry about what happened to you in Russia with your mother and in the orphanage. However, that anger has never left you and now you are misdirecting at your mother and others. Why not try to think that you want to forgive your birth mother rather than take that resentment out on your mother? I have seen forgiveness diminish the anger in other adopted children. Amber denied this anger for months.


At home her mother was told to tell her that she didn't deserve her hostile aggressive treatment and that if she could forgive her birth mother her anger would diminish and, in all likelihood, their relationship would improve.


Amber slowly acknowledged that she had felt a great deal of resentment toward her birth mother for her addictive behavior and for failing to protect both her and her brother. She also expressed anger toward the caretakers of the orphanage in Russia. Painful memories emerged in which she recalled hitting her birth mother in Russia when she was drunk. It was suggested to Amber that at the present time she was misdirecting intense hostile feelings that she had for her birth mother toward her adoptive mother and was using her anger as a defense to keep everyone at a distance.


Amber was given handwritten forgiveness notes to take home and work on between sessions. These notes stated, (1). I want to stop misdirecting my anger at those who don't deserve it. (2). I want to try to understand that my birth mother was sick with a drug addiction and I want to try to forgive her. (3.) I want to let go of the anger from Russia so that I can be free and not controlled by the past. She was challenged to trust people more than her mother had ever been able to trust. It was stated that unless she took these steps, she might be as lonely, unhappy, and fearful as her birth mother.

Amber’s mother would regularly tell her in the early stages of using forgiveness that she was overreacting in anger toward her adoptive parents and that they did not deserve the anger that was meant for those who hurt her in Russia.  Her mother would then ask her forgiving her birth mother.  She would also correct Amber's intensely controlling behaviors and ask her to reflect that she was now safe and protected in her family.  The work of forgiveness was challenging but slowly Amber recognized that she was overreacting in anger and mistrust and that now she had a trustworthy mother and father.


As she worked on trust and forgiveness of past hurts, Amber became aware that some good could come from her pain. She expressed the desire to become a health professional and someday go back to Russia to help children who had suffered in the same manner as she. As her resentment diminished and her trust grew, she became much less defensive and hostile toward her parents and her peers.



While forgiveness therapy is sufficient for resolving the anger in the majority of angry adoptive children,  some may need medication to help stabilize their mood and to assist them to master their excessive anger and mistrust.  SSRIs have been effective, but some youth may need medication for explosive and aggressive anger such as Depakote, which is also highly effective in diminishing the irritability in bipolar disorders.  The historical exploration of the intrauterine period of development has revealed in a number of young adopted males that their fathers had difficulties with aggressive impulses which were also present in these males.  This strong anger is often misdirected at the adoptive mother or siblings.  Daily forgiveness of the birth father is recommended then in addition to the use of medication.  This anger can be so strong that the work of forgiveness needs to occur for a period of time primarily on the spiritual level.


The Role of Faith

In Christian families faith can play a helpful role in the healing the childhood betrayal wounds of sadness, anger and mistrust . When the child is unable to forgive, he/she is encouraged to give the anger and controlling behaviors to God.  Also, some Catholic adopted children report benefits from taking their anger to the sacrament of reconciliation, especially if they have uncovered inner rage with a birth mother or father. In addition, a meditation upon being protected by God can decrease anxiety and controlling behaviors. 


When a severe birth mother betrayal wound is uncovered, as with Amber, Catholic parents have found benefit in encouraging a relationship of their adopted child with Our Lady as the other loving and protective mother who was present in early childhood and in the present.  This spiritual meditation can increase an adopted child's trust or safe feeling in life and reduce the unconscious fear of being abandoned or rejected.  



Adoptive children are a special gift to parents and the parents to the child.  The majority of the adoptees have no serious mental health problems, although many of them had adverse early experiences.  There is every reason to be hopeful that emotional and behavioral conflicts in adoptive children can be resolved.

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