Abstract
Despite passage of the 1997 Adoption and Safe Families Act, children prenatally exposed to alcohol, tobacco, and other drugs (ATOD) continue to languish in the child welfare system, partly because of misinformation and uncertainty regarding their outcomes. From a cumulative risk perspective, ATOD exposure is but one of many factors that together influence outcomes. This study is a secondary analysis of cross-sectional survey data collected from adoptive parents receiving subsidies for one or more adopted children. The sample includes 636 children ages 6 through 17. Temporal ordering of risk factors/predictor variables is used in the analyses with adoption designated as the intervention between pre-adoption moderation and post-adoption mediation. Structural equation modeling (SEM) is used because of its ability to handle complex analyses, which has positive implications for the richness of knowledge generated. Risk factors are examined individually and additively to determine degrees of moderation or mediation of the relationship between pre-adoption functioning (PAF) and post-adoption adjustment (PAA)—more risk factors are expected to result in greater effects. Hypotheses 1 states that few statistically-significant differences exist between prenatally-ATOD-exposed and non-exposed children. Hypotheses 2 and 3, respectively, indicate that the relationship between pre-adoption functioning (PAF) and post-adoption adjustment (PAA) is moderated by pre-adoption risk factors and mediated by post-adoption risk factors. The latent variable used to measure PAF is found to be a statistically significant predictor of PAA, producing good model fit. Few statistically-significant differences between prenatally-exposed and non-exposed children are found. ATOD exposure is found to be significantly associated with PAF, but not with PAA—an important finding supporting the notion that positive outcomes are possible despite early trauma. The experience of sexual abuse and number of placements, the two environmental factors, provided stronger individual moderation models than the two prenatal factors, ATOD risk exposure and sex. Due to the low occurrence of the environmental risk factors in this population, the moderation analysis identified a buffering effect. Adoptive parent’s perceived stress provided the strongest individual mediation model. Two potential mediators, child age at survey and adoptive family risk index, did not function well as mediators in this analysis. The total cumulative moderation model had the best model fit supporting the concept of cumulative risk. The cumulative mediation model was penalized for the addition of factors that did not add to the model, resulting in poorer model fit. These findings provide critical information needed to address the multidimensional challenges associated with adoption of prenatally ATOD-exposed children. This study views prenatal ATOD exposure directly and as one of many factors influencing behavioral outcomes. Analysis found a lack of influence of prenatal ATOD exposure by itself on behavioral outcome, which is consistent with current research on prenatal exposure. This finding also is consistent with adoption research that finds time in a stable home environment improves child outcomes. Less apprehension regarding potential outcomes for prenatally ATOD-exposed children may facilitate increased adoption rates. Additionally, increasing the depth of understanding of cumulative risk effects may contribute to development of more effective policies and timely, age- and sex-specific interventions for ATOD-exposed children and their adoptive families.
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