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Our Past May Not Be Our Future: Adoption and Mental Health

Trauma from institutional care overwritten by adoption during adolescence.

Teenagers’ mental health receives a lot of attention from families, educators, and the psychological community, given trends of greater anxiety and depression that emerge around that age.

One group of teens that has been the focus of recent and exciting new research is “post-institutionalized” teens—meaning, adolescents raised as infants and young children in orphanages prior to adoption (Gunnar et al.). Growing up in an orphanage can hinder healthy development because orphanages are often under-resourced environments where children are unable to be adequately cared for (Gunnar et al.). Researchers studying the effects of adoption and early adverse experiences on children have traditionally found that children who grew up in institutions have physical and emotional difficulties, such as ADHD symptoms, aggressive/disruptive behavior, and elevated emotional reclusion/anxiety symptoms (Slopen et al.; Wiik et al.).

Source: Source: Depositphotos

Why do these challenges specifically affect adopted youth? Stress early on in life leads our brain to function and develop differently (Van Tieghem et al). Our brain’s Hypothalamic-Pituitary-Adrenal (HPA) Axis, which manages how we cope with and respond to stress, changes in children who grew up in institutions. Normally, when the HPA Axis reacts to stress, cortisol, the hormone that helps our body respond to stress, spreads more throughout the brain. However, studies of post-institutionalized children have shown that their HPA Axis, cortisol levels, and amygdala (the brain region that processes emotions) do not work as they do in typically-developing children. Past research has shown that their HPA Axis in post-institutionalized children underreacts to stress, and their resulting levels of cortisol are too low (Gunnar et al.) Having a low amount of cortisol may sound like a positive thing at first, but it is actually detrimental because our bodies need to release a healthy amount of cortisol in order to respond appropriately to stress (Zorn et al.). Indeed, when levels are too low, individuals are at risk for mental illnesses (Zorn et al; Gunnar et al.). Additionally, because they are not sensitive enough to stress, they might take risks more than youth with “normal” cortisol response. In addition, brain structures responsible for emotion reactivity, like the amygdala, grow to be too small in post-adopted youth (Van Tieghem et al). When the amygdala is not its proper size, individuals are likely to face anxiety and depression-related symptoms.

Promising New Findings

In a recent study published in 2019, a research team led by Dr. Megan Gunnar of the University of Minnesota investigated whether post-institutionalized youth experience changes in their HPA Axis functioning and cortisol levels as they advance in puberty, relative to controls: that is, youth without any history of institutionalization or adoption.

They studied a total of 218 children between the ages of 7 and 15 years old who were either adopted before the age of 5 years from institutionalized care or had no history of adoption. Since they were interested in monitoring changes in cortisol over time, the researchers assessed the pubertal stage and stress responses of children over a period of two years. At each appointment, the researchers determined the children’s stage of puberty using physical changes in the body as indicators. To measure the children’s cortisol levels, the children completed a task intended to induce stress. In this task, kids are asked to complete a story by providing their own details aloud and do complex subtraction operations aloud (Allen et al. 2017). During this time, the children also provided a saliva sample to measure their cortisol levels in response to the task. Since cortisol represents HPA function (Van Tieghem et al.), researchers were able to deduce how the HPA system was working in these youth at various time points by measuring their cortisol levels.

What did they find?

Low HPA reactivity in childhood is not set in stone. In post-institutionalized youth currently living in positive home environments, cortisol levels increased markedly as they entered and matured through puberty. Therefore, it seems that teens who are provided positive and stable living environments by their adoptive families, such as loving parenting and adequate resources, undergo a natural “updating” process within their HPA Axis. Specifically, the HPA Axis is able to update or “recalibrate” itself when presented with warmth from the adoptive family during puberty. In this way, adoptive families can play an incredible transformative role in allowing their post-institutionalized children the best chances for a positive future.

Source: DepositPhotos
Source: DepositPhotos

We already know that parental support and supportive home environments are crucial for all teens throughout their youth (Guan et al.). This new work suggests that positive home environments can aid in the recalibration process of stress responses for adopted children and adolescents as they enter puberty and, potentially, for children who have had other types of early trauma (Gunnar et al.). Although puberty can be a time of incredible uncertainty and pressure for youth, this new research shows that it can also be a period of transformation that can confer a healthier future to teens from traumatic pasts. Indeed, because of puberty, teens’ pasts may not be their future.

Samantha Aubé (Summer research fellow at Yale) and Reuma Gadassi Polack (postdoctoral fellow at Yale) also contributed to this post.


Allen, A.P., Kennedy, P.J., Dockray, S., Cryan, J.F., Dinan, T.G., & Clarke, G. (2017). The Trier Social Stress Test: Principles and practice. Neurobiology of Stress, 6, 113-126.

Guan, S.A., Bower, J.E., Almeida, D.M., Cole, S.W., Dahl, R.E., Irwin, M.R., Seeman, T.E., McDade, T., & Fuligni, A.J. (2016). Brain, Behavior, and Immunity, 57, 134-143.

Gunnar, M.R., DePasquale, C.E., Reid, B.M., Donzella, B., & Miller, B.S. (2019). Pubertal stress recalibration reverses the effects of early life stress in post-institutionalized children. Proceedings of the National Academy of Sciences, 116(48).

Skrove, M., Romundstad, P., & Indredavik, M.S. (2013). Resilience, lifestyle, and symptoms of anxiety and depression in adolescence: the Young-HUNT study. Social Psychiatry and Psychiatric Epidemiology, 48, 407-416.

Slopen, N., Kubzansky, L.D., McLaughlin, K.A., & Koenen, K.C. (2013). Childhood adversity and inflammatory processes in youth: A prospective study. Psychoneuroendocrinology, 38, 188-200.

VanTieghem, M., Korom, M., Flannery, J., Choy, T., Caldera, C., Humphreys, K.L., Gabard-Durnam, L., Goff, B., Gee, D.G., Telzer, E.H., Shapiro, M., Louie, J.Y., Fareri, D.S., Bolger, N., & Tottenham, N. (2020). Longitudinal changes in amygdala, hippocampus, and cortisol development following early caregiving adversity. Psyarxiv.

Wiik, K.L., Loman, M.M., Van Ryzin, M.J., Armstrong, J.M., Essex, M.J., Pollak, S.D., & Gunnar, M.R. (2011). Behavioral and emotional symptoms of post-institutionalized children in middle childhood. Journal of Child Psychology and Psychiatry, 52(1), 56-63.

Zorn, J.V., Schur, R.R., Boks, M.P., Kahn, R.S., Joels, M., & Vinkers, C.H. (2017). Cortisol stress reactivity across psychiatric disorders: A systematic review and meta-analysis. Psychoneuroendocrinology, 77, 25-36.

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