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An Overview of the Adoption Quarterly Special Issue Presenting Findings from the National Survey of Adoptive Parents (NSAP)

Adoption Advocate No. 34


The National Survey of Adoptive Parents (NSAP) is a new source of data available to those interested in learning more about adopted children and their families. The first nationally representative sample of adopted children, the NSAP is a collaboration sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Administration for Children and Families (ACF), and conducted by the National Center for Health Statistics (NCHS), which are all agencies within the U.S. Department of Health and Human Services (DHHS).

The National Council For Adoption (NCFA) has already presented some findings from the NSAP in Adoption Advocate #22 and Adoption Advocate # 32. However, this winter, the journal Adoption Quarterly published a special issue devoted entirely to research using the NSAP, edited by Laura Radel of ASPE and Matthew Bramlett of NCHS1. This issue contains a wealth of knowledge related to adopted children and their families. This Advocate presents an overview first of the NSAP itself, as introduced in the special issue by Radel and Bramlett, followed by a summary of each research article in the special issue of Adoption Quarterly.

Overview of the National Survey of Adoptive Parents

Conducted from April 2007 to July 2008, the NSAP was included as an add-on to the 2007 National Survey of Children’s Health. The sample size for the NSAP was 2,089 adopted children, including 545 children adopted internationally, 763 children adopted out of the foster care system, and 781 adopted via private domestic adoptions.

The NSAP was designed to learn about families’ adoption-related experiences, as well as how they were faring post-adoption, how many services they utilized, and what needs and challenges remained. Via a phone interview lasting approximately 30 minutes, survey questions addressed the following topics:

  • Characteristics of the child, parent(s), and family
  • Child and parent well-being, including attachment levels and satisfaction
  • Parental reasons for adoption
  • Pre-adoption preparation for parents
  • Level of contact with birth families
  • Services received and needed since the adoption
  • Adoption subsidy payments and Medicaid coverage received as part of adoption assistance agreements (for families of children adopted from foster care)

Thus, all information obtained in the NSAP is from parental report.

Additionally, NCHS conducted an additional survey with families of adopted children with special health care needs: the National Survey of Adoptive Parents of Children with Special Health Care Needs in 2008 (NSAP-SN). The sample size for the NSAP-SN is 1,003 adopted children with special health care needs (CSHCN), including: 225 CSHCN adopted internationally, 457 CSHCN adopted from the foster care system, and 321 CSHCN adopted via private domestic adoptions.

The Well-Being of U.S. Children Adopted from Foster Care, Privately from the United States and Internationally

Sharon Vandivere and Amy McKlindon

This article grew out of existing research finding that children adopted out of foster care tend to experience more negative outcomes than other adopted children. The authors were interested in what explains those differences by adoption type. This article took advantage of the broad scope of the NSAP to address the following questions:

  1. What factors, both pre-adoption and postadoption, are independently related to children’s well-being?
  2. To what extent are differences in children’s well-being across different types of adoption related to the distinct characteristics and factors of those types of adoption?

As Vandivere and McKlindon explain, there is a wide range of characteristics and experiences (both pre-and post-adoption) that can have an impact on children’s outcomes and well-being, and this impact is not always straightforward. For example, if a child has a history of institutionalization, then a social worker may match that child with parents who have different characteristics than they would for a child who did not have a history of being cared for in an institution. Some of the characteristics and experiences the authors point to that prior research shows might be related to child outcomes include:

  • history of institutionalization
  • past abuse and/or neglect
  • older age at adoption
  • disability
  • being part of a sibling group
  • coming from a single-parent family
  • being adopted by a family with older children in the household
  • being adopted by a family living in a smaller community
  • having parents with a lower level of education and income
  • large age gap between parents and children
  • pre-adoptive relationship of the parent and child
  • transracial placements
  • use of post-adoption services
  • religiosity

Vandivere and McKlindon chose to look at child outcomes and well-being in three broad areas: physical health, socio-emotional wellbeing, and cognitive development and educational achievement. The authors first conducted analyses to determine the relationship between adoption type and these three categories of child outcomes. They found that children adopted from foster care were less likely to be in excellent or good health, more likely to have moderate or severe health difficulties and/or diagnoses of an attachment disorder or ADD/ADHD, and less likely to fare well academically (based on indicators such as reading performance, math performance, and level of engagement at school).

The authors used logistic regression to determine the characteristics and experiences (listed above) independently associated with outcomes for children. Some of the relationships they found include:

  • Children who lived in institutions were half as likely to have “excellent” or “very good” language arts/reading performance skills.
  • Older age at placement was associated with more negative outcomes in health, socioemotional well-being, and educational achievement.
  • Children whose parents believed they had been abused or neglected were more likely to have health problems and socio-emotional difficulties.
  • No consistent relationships between parent demographic characteristics and child outcomes were found.
  • Among children adopted by nonrelatives who did not know the children previously, those with open adoptions were less than half as likely as those with closed adoptions to have a health status rated as “excellent” or “very good.”
  • Compared to only children, adopted children who had siblings adopted by (but not born to) their parents were less likely to have health difficulties or be diagnosed with ADD/ADHD.
  • Older age was associated with more negative outcomes for children.
  • Attending monthly religious services was associated with more positive outcomes.

Once establishing the above relationships, the authors wanted to learn whether these associations could explain the relationships between adoption types and outcomes for children. They found that the apparent connection between adoption type and a given outcome disappeared when the above characteristics were included in the statistical model. However, in this expanded statistical model (which included the characteristics above), children adopted privately within the United States were still likely to fare better than those adopted from foster care in the areas of moderate or severe health difficulties, being diagnosed with ADD/ADHD, and “excellent”/“very good” math performance.

The authors conclude: “[A]doption type is independently associated with only a few of the well-being indicators examined here. The analysis presented here is not intended to downplay the disparities by adoption type in well-being that exist in the population of adopted children, but rather to shed light on some of the factors that might explain these differences and the degree to which they do so…[W]e hope that the findings presented here inspire deeper and more finely tuned analyses of the predictors of well-being among adopted children. Further information is needed about the effects of openness, trans-racial placement, single parenthood, and low socioeconomic status, among other factors, on adopted children, and on the circumstances that best support children and families in these situations.”

Exploring Motivations To Adopt

Karin Malm and Kate Welti

This study was designed to explore reasons why parents adopt and whether those reasons differ across different types of adoptions. This knowledge can be very important in designing adoption recruitment programs as well as for understanding the ways in which different motivations might impact adoption outcomes and overall success. The research addresses the following questions:

  1. What are the factors that motivate parents to adopt and to choose a specific type of adoption?
  2. Do parents who choose one type also consider (or use) others?
  3. What are the child and parent characteristics associated with different motivations?
  4. Is family and parent well-being associated with parents’ motivation to adopt?

In answering these questions the authors decided to narrow their focus to children whose parents had not known them prior to adoption, because parental motivation might be different for parents who knew the children prior to adoption. The sample size for this study was 1,185 adopted children and their families.

Malm and Welti chose to look at the following measures of parent and family well-being:

  • whether the parent felt that the parent-child relationship was “very warm”/“close”
  • whether the parent felt that the parent-child relationship was “better than [he or she] ever expected”
  • whether the parent felt that having the child in their life was “better than [he or she] ever expected”
  • whether the parent coped “very well” with the demands of parenting, and
  • whether the parent was not aggravated during the preceding month

When looking generally at motivations to adopt, the study authors found that the two most frequent motivations for adoption were (1) providing a permanent home for a child and (2) expanding the family. The third most common reason was infertility.

When breaking this down by adoption type, the authors found that parents adopting privately were less likely to want to provide a permanent home for a child and more likely to be motivated by infertility. Furthermore, for each of the three types of adoption, there was a different “number one” reason for adopting: Parents adopting internationally thought “it would be too difficult to adopt from the U.S.”; families adopting from foster care thought that adopting from the U.S. foster care system was “less costly than adopting internationally or privately”; and parents adopting privately within the U.S. wanted an infant.

Interestingly, the authors also found that many parents considered multiple types of adoption. For example, 45 percent of all children who were adopted internationally had parents who also considered foster care and private domestic adoption. To further study this issue, the authors examined families who had completed two separate adoptions. Seventy-eight percent of children adopted internationally and 79 percent of children adopted via private domestic adoption had parents who completed a second adoption of the same type. For children adopted from foster care, this percentage was only 35 percent, while 56 percent of children adopted from foster care had parents who adopted again through private means. (Note: The percentage of repeat adoptions from foster care was much higher (80 percent) when the parents knew the child prior to adoption.)

Malm and Welti were also interested in the role of infertility as a motivating factor. The authors found that children whose parents were motivated by infertility had slightly higher levels of parent/family well-being. When they ran a statistical model that included parent and child characteristics, they found that the relationship between infertility and well-being diminished. They conclude, “[O]ur findings show that parents who reported infertility as a motivator do find happiness with adoption. Adoption agencies may wish to target more recruitment efforts and publicize adoptive parents’ happiness to infertile couples through a variety of media outlets.”

Adoptive Family Relationships and Healthy Adolescent Development: A Risk and Resilience Analysis

Kathleen L. Whitten and Scott R. Weaver

This study was designed to look specifically at adopted adolescents in order to determine the relationship between adolescent risk factors, the adoptive parent-adolescent relationship, and adolescent outcomes. This investigation is based on the “catch-up model” which holds that adoption is a protective factor that helps adolescents display positive outcomes, even in the face of risk factors (e.g., experience of institutionalization, abuse or neglect, transracial adoption, and older age at placement).

For this study, Whitten and Weaver examined only adolescents in the NSAP sample (ages 13 to 17), bringing the sample size to 701. They also looked at 228 of these adolescents who had been adopted transracially. They were interested in the following research questions:

  1. If background characteristics and risk factors are controlled for, is positive parentchild relationship quality associated with higher school achievement and fewer problem behaviors, protecting against the negative effect of pre-placement abuse and/or neglect?
  2. Among the transracially adopted subsample, is greater parent support for racial identity development associated with more positive outcomes?

The outcomes that the authors chose to examine were:

  • School achievement (measured by the child’s performance in math and reading/language arts)
  • Frequency of skipping school or class • Whether the adolescent had been suspended or expelled in the past year
  • Past policy trouble
  • Substance abuse

Using structural equation modeling, and accounting for pre-adoption abuse, the authors did find that the quality of the parent-child relationship was positively associated with lower odds of cutting class/school, lower odds of being suspended, lower odds of reporting substance abuse or police trouble, and better performance in language arts and reading. Despite these positive findings, there was not support for the hypothesis that the parent-child relationship protects again the negative effects of pre-adoption abuse.

Looking specifically at the subsample of families with transracial adoptions, the authors found a similar pattern: the quality of the parent child relationship was positively associated with lower odds of cutting class/school and lower odds of substance abuse or police trouble.

The authors conclude that, “our study lends some support for using a risk and resilience model for examining adoptive family relationships and child outcomes. The finding that good parent-child relationship quality is associated with better behavior and school achievement lends support to policy makers who promote adoption and to adoption professionals whose home studies, education, and post-placement visits promote solid parent-child relationships. Finally, it should provide encouragement to adoptive families.”

Cultural Socialization Practices in Domestic and International Transracial Adoption

M. Elizabeth Vonk, Jaegoo Lee, and Josie Crolley-Simic

This article stems from the growing body of literature illustrating how important it is for parents who adopt transracially to help their children learn about their culture, and how racial socialization practices are related to positive outcomes for children. The authors of this study wanted to learn about cultural socialization from the parents’ perspective, in both domestic transracial and international transracial adoptions. Their study explored the relationship between cultural socialization practices and each of the following:

  • demographic variables
  • adoption- and child-related factors
  • parents’ perceptions of closeness to their children
  • parental satisfaction with adoption.

The three research questions were:

  1. For parents of transracially (international and domestic) adopted children, what are the differences and similarities in the use of nine specific cultural socialization practices that they engage in?
  2. How are demographic and adoption variables related to cultural socialization practices among families of transracially adopted children?
  3. Among parents of transracially adopted children, how are the nine specific cultural socialization practices (listed below) related to parental perceptions of closeness to their children and satisfaction with adoption?

While there were 2,089 children in the full NSAP sample, only 802 were adopted across racial, ethnic, or cultural lines, so only those were used for this study. Of those, 438 were adopted domestically (through foster care or private domestic adoption), and 364 were adopted internationally.

In the analyses, the authors used parents’ responses on whether or not they participated in the following nine cultural socialization practices:

  • Involvement in religious, social, tribal, or recreational groups or activities reflecting the child’s race, ethnicity, or culture
  • Choosing child care providers, teachers, or other role models of or similar to the child’s race or ethnicity
  • Having family friends who share the child’s racial, ethnic, or cultural background
  • Reading books to the child about his/her racial, ethnic, or cultural group or heritage
  • Participating in holidays that reflect the child’s race, ethnicity, or culture
  • Preparing foods associated with the child’s racial, ethnic, or cultural background
  • Choosing multiracial or multicultural entertainment, such as movies or plays, that reflect the child’s race, ethnicity, or culture
  • Living in or moving to a racially or culturally diverse neighborhood
  • Living in or moving to a neighborhood in which the child can attend racially and culturally diverse schools

The authors chose to use the following adoption- and child-related variables:

  • Open adoption agreement
  • Post-adoption contact with the birth family
  • Child’s special health care needs status
  • Parent participation in adoption support group
  • Post-adoption attendance at educational sessions
  • Post-adoption use of online resources related to adoption issues

Using these factors, the authors found some differences between the domestically adopted group and the internationally adopted group. Children in the domestically adopted group were more likely to have special health care needs, open adoption agreements, and post-adoption contact with birth families. Participation in support groups for adoptive parents, post-adoption education, and use of web-based post-adoption resources was low for all families, but those in the internationally adopted group were more likely to use this last resource.

Looking specifically at cultural socialization practices, the practices most commonly endorsed by all families were: reading racial/ethnic books; preparing foods associated with children’s racial, ethnic, or cultural background; having friends who share their children’s ethnic or cultural background; and choosing multiracial or multicultural entertainment.

The authors used the adoption and childrelated variables to try to predict participation in specific cultural socialization practices. The relationships they found included:

  • Within the group that had adopted internationally, families with Chinese children were more likely to engage in cultural socialization practices.
  • Within the domestically adopted group, families with black children were more likely to engage in cultural socialization practices.
  • Having a biological child was associated with increased participation in cultural socialization practices.
  • For the families with internationally adopted children, parents’ participation in postadoption education and/or post-adoption online resources was a predictor of three practices (choosing child care providers, teachers, or other role models similar to the child’s race or ethnicity; family having friends who share the child’s racial or ethnic or cultural background; and reading books to children about their racial, ethnic, or cultural groups).
  • For families who adopted domestically participation in a parent support group was positively associated with four practices (choosing child care providers, teachers, or other role models similar to the child’s race or ethnicity; family having friends who share the child’s racial or ethnic or cultural background; reading books to children about their racial, ethnic, or cultural groups; and choosing multiracial or multicultural entertainment that reflects children’s race or ethnicity). Also in this group, the use of post-adoption online resources was negatively associated with living in a culturally diverse neighborhood.

The authors also explored the relationship between the cultural socialization practices and parents’ perceptions of closeness to their children and satisfaction with adoption. They found that, for families with internationally adopted children, choosing multiracial/multicultural entertainment was associated with higher levels of closeness and satisfaction, and that the celebration of cultural holidays was associated with lower levels. There was no relationship at all for parents of domestically adopted children, or for the larger sample of all parents with transracially adopted children.

The authors conclude by noting that the practices that transracial adoptive families use tend to be those that require little or no contact with individuals of the child’s race/ethnicity. This may be problematic, for it may be those contacts and relationships that actually provide the greatest support to transracially adopted children as they grow and develop. The authors state, “Adoption agencies must continue to grapple with this issue, both with social workers and with prospective [transracial] adoptive parents. If social workers are not aware of the importance of integrative cultural socialization, they are not likely to adequately prepare parents for this aspect of parenting. Parents must both be made aware of its importance and educated with resources to know where to begin.”

When Stepparents Adopt: Demographic, Health, and Health Care Characteristics of Adopted Children, Stepchildren, and Adopted Stepchildren

Matthew D. Bramlett

This study focuses on a population about which very little is known: stepchildren adopted by their stepparents. While the NSAP specifically excluded adopted stepchildren from its sample, Bramlett was able to use data from the National Survey of Children’s Health, 2007, the survey that was used to identify NSAP-eligible children. While there is a substantial body of research demonstrating that stepchildren tend to show more negative health and wellbeing outcomes than children in intact biological families, there is a scarcity of research that specifically examines differences for stepchildren who are adopted by their stepparent.

This study compares stepchildren both to nonadopted stepchildren and to adopted children who were not stepchildren, in order to see which group adopted stepchildren more closely resemble. Overall, the author found that:

  • Adopted stepchildren are more like stepchildren in terms of a child’s demographic characteristics, in that they are more likely to be older and born in the United States, and less likely to be non- Hispanic Asian.
  • Adopted stepchildren are more like adopted children in terms of the household socioeconomic characteristics; i.e., both adopted stepchildren and adopted children are more likely to be in households in which the parents have higher incomes and higher levels of education.
  • Adopted stepchildren are more like stepchildren in terms of their overall health needs, but more like adopted children in terms of their access to health care. Thus, as a group, adopted stepchildren have the double advantage of having both a lower level of health care needs and a higherlevel of access to quality health care.

Bramlett concludes by pointing to the need for recognizing and studying adopted stepchildren as a unique subgroup: “Adopted stepchildren are like adopted children in some (socioeconomic and health care) dimensions and like stepchildren in other (demographic and health) dimensions; by the same token, they are unlike adopted children in some dimensions, and unlike stepchildren in other dimensions. Thus, if sample size permits and data are collected in such a way that these families can be identified as adoptive stepfamilies, their differences from other subgroups of adopted or stepchildren should be accounted for in analyses.”

Legal and Informal Adoption by Relatives in the U.S.: Comparative Characteristics and Well-Being from a Nationally Representative Sample

Laura F. Radel, Matthew D. Bramlett, and Annette Waters

Since the passage of the Adoption and Safe Families Act (ASFA) in 1997, there has been a marked increase in the number of children adopted from foster care by relatives. However, research on this population remains scarce, as it does for children adopted privately by relatives and children who are cared for by kin without being legally adopted. This study uses data from the NSAP and from the National Survey of Children’s Health to explore how children adopted by relatives and children living informally with relatives compare on measures of child health and well-being.

Looking first at demographic characteristics of children adopted by relatives and those informally living with relatives, estimates suggest that there are 436,000 children in the U.S. who have been formally adopted by relatives, and 1.7 million living with relatives who have not formally adopted them. The authors examined a range of demographic and socioeconomic characteristics (such as race/ethnicity, family income, family education, etc.), and found that there were virtually no significant differences between these two groups of children. However, while there were no significant differences between these two groups, children formally and informally adopted by relatives do differ from both nonadopted children and adopted children overall. Whether legally or informally adopted by relatives, these children are more likely to be black and to live in households with lower education levels and lower income, and less likely to live in households in the highest income categories.

The authors also examined the children’s health characteristics and health insurance status. Overall, they found that children adopted formally by relatives and children adopted informally appeared similar to one another, yet, both groups appeared to have different outcomes than other adopted children and nonadopted children. For instance, they were less likely to be in “excellent” or “very good” health, less likely to have “excellent” or “very good” dental health, and more likely than nonadopted children (but equally likely as adopted children) to have special health care needs, asthma, and behavioral problems.

Despite their similarities, there were a few differences between children adopted by relatives formally and children adopted informally. Those adopted formally by kin were more likely to be receiving special education services, more likely to have been diagnosed as having a developmental delay, less likely to be severely overweight (for those children aged 10 to 17 years), and only half as likely to have been uninsured the previous year.

Looking at family, school, and neighborhood characteristics, again the children adopted formally and informally by relatives were similar in many ways. However, in some respects, the children who had been formally adopted were faring better. The children formally adopted by relatives had parents who were less likely to report parental aggravation and more likely to have someone to turn to for day-to-day emotional support with parenting. These children were also more likely to live in a relatively safe neighborhood, and to attend religious services. Both children adopted formally and informally by relatives were more likely than other children to have repeated a grade, and less likely to participate in extracurricular activities. They were also less likely to have parents in “excellent” or “very good” physical and mental health.

The authors conclude, “[D]emographically and socioeconomically there are virtually no differences between children adopted by kin legally and informally, although these groups are both distinct from children overall and from the general population of adopted children. Children legally and informally adopted by relatives are also more similar than different in their health status and measures of well-being. This suggests that support services needs of families caring for relatives’ children are likely to be very similar, regardless of the child’s adoptive status or involvement in the child welfare system. Service providers may wish to consider whether children and families with various custody statuses are able to access supports.”


  1. Radel, L.F. & Bramlett, M.D. (Eds.) (2010). The National Survey of Adoptive Parents: A new data resource. Adoption Quarterly, 13 (3/4), 147-301

Additional Notes

​The issue of Adoption Quarterly summarized in this Adoption Advocate provides a wealth of information about adopted children and their families. In their commentary at the end of the issue, editors Radel and Bramlett urge researchers to continue to explore the research possibilities that the NSAP holds and describe some of the untapped research potential in the NSAP data. There is still so much to be learned about adoptive children, adoptive parents, their challenges, and their strengths. Special thanks to Matthew Bramlett for reviewing this article.