Florida State University Libraries Electronic Theses, Treatises and Dissertations The Graduate School 2007 A Study of the Pre-Adoption Functioning and Post-Adoption Adjustment of Children Who Have Been Prenatally Exposed to Alcohol, Tobacco and/or Other Drugs Geraldine DeLong Goldman Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] THE FLORIDA STATE UNIVERSITY COLLEGE OF SOCIAL WORK A STUDY OF THE PRE-ADOPTION FUNCTIONING AND POST-ADOPTION ADJUSTMENT OF CHILDREN WHO HAVE BEEN PRENATALLY EXPOSED TO ALCOHOL, TOBACCO AND/OR OTHER DRUGS BY GERALDINE DELONG GOLDMAN A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy Degree Awarded: Fall Semester, 2007 Copyright © 2007 Geraldine DeLong Goldman All Rights Reserved The members of the Committee approve the dissertation of Geraldine DeLong Goldman defended on September 19, 2007. _____________________________________________ Scott D. Ryan Professor Directing Dissertation _____________________________________________ Akihito Kamata Outside Committee Member _____________________________________________ Darcy Siebert Committee Member Approved: _____________________________________ Darcy Siebert, Director, Doctoral Program _____________________________________ C. Aaron McNeece, Dean, College of Social Work The Office of Graduate Studies has verified and approved the above named committee members. ii To my husband, Tom, for loving me. To my daughter, Megan, for teaching me to live courageously. To my grandmother, Frances Lucile Hodges DeLong, for inspiring my love of learning. And to my brother, Barry, who I will miss every day of my life. iii ACKNOWLEDGEMENTS My decision to return to school to pursue my doctorate was the fulfillment of a life-long dream. I am grateful to have had this opportunity, and realize that it could not have happened without the assistance of many generous people. I want to acknowledge their contributions of time, encouragement, humor, love, and friendship. Words can not describe the depth of my gratitude for the unqualified love and support given to me by my family. My husband and daughter have had to make tremendous sacrifices for far too long in order for me to pursue this dream. My brothers, Gary, Mark, and Barry DeLong, as well as my mother Suzanne DeLong, mother-in-law, Betty Goldman, sisters-in-law, Sharon, Joanne, and Roxanne, and best friend, Diane Sparkman, have always believed in me and readily offered encouragement whenever needed. With this kind of support system, I had no choice but to keep moving forward! The faculty and staff at Florida State University’s College of Social Work have been extremely helpful throughout the course of my studies. Dr. Scott Ryan, my major professor, has been outstanding in providing direction and focus to this project and in sharing his data. Dr. Darcy Siebert and Dr. Wendy Crook also have been instrumental in directing me through the academic processes and providing sound guidance at crucial times during my journey. Additionally, I want to thank Dr. Siebert for serving on my committee and for her insightful comments along the way. It has been a privilege to work with them. They each challenged me to take the next step, and I appreciate their willingness to give me the time I needed to do so. Mary Frazier also deserves recognition and thanks for her administrative support and kindness. Moreover, the encouragement given by my fellow doctoral students, especially Blace Nalavany who was there from the beginning, was essential. I want to thank Dr. Akihito Kamata, Department of Educational Psychology, for serving on my committee and for the invaluable direction he provided with the statistical elements of my research and the use of the Mplus program. His influence helped ignite my enthusiasm for statistics, which has been a revelation. Additionally, Florida State University has provided outstanding academic support, especially with its library facilities, both on campus and online. And I want to express my appreciation to Bengt (Professor Emeritus, University of California at Los Angeles) and Linda Muthén for their patience in responding to my many questions and for developing their amazing Mplus program. iv These acknowledgements would not be complete without thanking my supervisors and coworkers at the Department of Children and Families, Substance Abuse Program Office, for creating an environment conducive to the pursuit of knowledge so that we are better able meet the needs of those we serve. They are incredibly talented, dedicated and competent people in challenging positions, and the State of Florida is privileged to employ them. Stephenie Colston, John Bryant, Darran Duchene, and Kay Keller have been especially supportive. In conclusion, I want to express my appreciation to those who made this entire study possible—the Dave Thomas Foundation for Adoption, and the families who participated in the Florida Adoptive Family Study. The families have been extraordinary in their willingness to provide extensive information about their private lives so that we could try to figure out what successful adoptions are all about. This is a wonderful tribute to their children. v TABLE OF CONTENTS List of Tables………………………….……….……………………………………...………….ix List of Figures……………………….…………………………………………………………....x List of Acronyms….………….………………………………………………………………......xi Abstract……………..…………………………………………….……………..……..…….…..xii 1. INTRODUCTION ………………………………………………………………………..…...1 A Study of the Post-Adoption Adjustment of Children Who Have Been Prenatally Exposed to Alcohol and/or Other Drugs 2. THEORETICAL FRAMEWORK: Transactional Model of Child Development and Cumulative Risk……….........……….…………………………….....………………………...6 A Brief History of Adoption in America………......…..………………………………......6 Research on Alcohol, Tobacco, and/or Other Drug Exposure…………………..…….…..8 Theoretical Perspectives on Adoption..…….…………………………..……...…………10 Medical/Psychological/Developmental Perspectives..………….…………..……10 Social/Ecological/Systems Perspectives…………………………………............15 Transactional Model of Development and Cumulative Risk……………..…..………….17 Use of the Cumulative Risk Model in this Study.…………………………..….……...…19 3. LITERATURE REVIEW: Factors Related to Child Developmental Outcome in ATOD-Exposed Adopted Children…........…...…......…………………..……………………22 Pre-adoption Child Risk Factors (Moderator Variables)……………………………...…22 Prenatal ATOD Exposure Risk…..………………………………...…………….23 Prevalence Rates……………………………………………………........25 Methodological Issues……….…………………………...……………...27 Issues with Verifying Drug Use….……………………………..……… 27 Measurement of Prenatal ATOD Exposure…...………………......…….31 1. Attributional Bias…………………………………….………31 2. Prenatal ATOD Exposure Risk Scale………………………..32 Poly-Substance Exposure ….………………………………………….…33 Genetics………………..…………………………………………….…...34 Drugs of Use and Abuse…..…….………………………..………..………….…34 Alcohol…………………………………………………………………...34 Cocaine/Crack…………..………………………………..…………........37 Marijuana….………………………………………………………...…...39 Tobacco…..………………………………………………………………42 Opiates…………………………………………………………………...44 Psychotropic Medications/Tranquilizers/Anxiety Reducers………….… 46 Amphetamines.…………………………………………………………...47 Hallucinogens……………………………………………………………49 vi Inhalants…..……………………………………………………….……..50 Other………..……………………………………………………….…...51 Summary…..……………………………………………………………..51 Sex……………..…………………………………………………………………52 Experience of Pre-Adoption Sexual Abuse.…...…………………………...….....54 Number of Placements……………………..…………………………………….54 Post-Adoption Family Risk Factors (Mediator Variables)……………………..……..…56 Adopted Child Age at Survey…………………………………….……………...56 Adoptive Family Risk Index………………..……………………………………57 Adoptive Parent Perceived Stress…..……………………………………………59 4. RESEARCH QUESTIONS AND HYPOTHESES……..………………………………........61 Research Questions.……………………..……………………….…………………...….61 Hypotheses and Rationales……………………………………………………................62 5. METHODOLOGY..…………………..………………………..………………………….....67 Research Design.…………………………………………………………………..……. 67 Reliability and Validity..…….....…………………..………………………………..…...68 Sample Criteria and Data Collection.……….….………………………………...70 Variables: Operationalization and Instrumentation.………………….…….....………...71 Predictor Variable…………………...…………………….…………………..…72 Pre-Adoption Functioning………...…………………................……..…72 Pre-Adoption Child Risk Factors (Moderator Variables)…..……………………73 Prenatal ATOD Exposure Risk……..……..………………….……….....73 Sex.…….……………………………………………………………..…..76 Severity of Sexual Abuse…….....……………………….………….........76 Number of Placements…………………………………...…………..…..77 Post-Adoption Family Risk Factors (Mediation Variables)….……………...…..77 Child Age at Time of Survey………….………………………………....77 Adoptive Family Risk Index…………...……..………………..………...77 Adoptive Parent Perceived Stress………..…..……….………….…....…79 Outcome Variable.……….………………………………………………..….….80 Post-Adoption Adjustment/Externalizing Behavior...…………….…......80 Data Analysis Plan…….………………………………………...……...............…. ……82 Data Cleaning…….……………………………………………..................……..83 Descriptive Statistics………………………………………………………..……83 Missing Data...….……………………………………………….…………….....84 Structural Equation Modeling….………………..……………………….….…...86 Power, Effect Size, and Sample Size…………………………………………….87 Research Question #1: Direct Effects Analyses………….………………….…..89 Research Question #2: Moderation Analysis...………………………………….90 Research Question #3: Mediation Analyses…….………….………………...….92