Pre-adoption and post-adoption factors associated with internalizing problems in adopted children and adolescents: A systematic review

Abstract

This systematic review examined pre- and post-adoption factors associated with internalizing problems in adopted children and adolescents. Forty observational studies published between 1998 and 2024 were included, identified through searches across seven databases and screened according to PRISMA 2020 and JBI guidelines. Eligible studies assessed anxiety and depression with validated instruments in samples of adoptees under 18 years. Findings showed that pre-adoption risks, such as older age at placement, maltreatment, and institutional care, were associated with higher levels of internalizing symptoms. However, results were heterogeneous, with several studies reporting null or inconsistent effects. Post-adoption factors showed more consistent patterns: parental warmth, sensitivity, family cohesion, and open adoption communication emerged as protective, whereas parental depressive symptoms, parenting stress, rejection behaviors, and family conflict were linked to greater risk. Differences across reporters (parents, teachers, children) highlighted the importance of multiinformant assessment. Overall, the findings suggest that while pre-adoptive adversity contributes to vulnerability, modifiable family and contextual processes play a central role in shaping adoptees’ emotional adjustment. These results underscore the developmental potential of adoption and emphasize the value of family-centered post-adoption supports. Future research should adopt longitudinal, multi-informant, and culturally diverse designs to clarify causal pathways and inform targeted interventions.