Adopted adolescents' overrepresentation in mental health counseling: Adoptees' problems or parents' lower threshold for referral?

Brent C. Miller, Xitao Fan, Harold D. Grotevant, Mathew Christensen, Diana Coyl, Manfred Van Dulmen

Research output: Contribution to journalArticlepeer-review

103 Scopus citations


A larger proportion of adopted adolescents receive mental health counseling than do their nonadopted peers. Adoptees might have more problems that require counseling, or their adoptive parents might have a lower threshold for referral (or both). Objective: To test the hypothesis that both the extent of adolescents' problems and their adoption status would predict whether adolescents receivcd psychological counseling, after controlling for family demographic characteristics. Method: Two large data sets collected from 1994 through 1996 by the National Longitudinal Study of Adolescent Health (Add Health) were used. In parallel analyses of the 2 data sets, hierarchical logistic regression models were implemented to assess the incremental effects of problem behaviors, family characteristics, and adoption status on adolescents receiving counseling. Results: Selected adolescents' problems and family demographic characteristics were significant predictors for having received counseling, but, after controlling for these variables, adoptees were still about twice as likely as nonadoptees to have received counseling. Conclusions: Prevalence of problems, adoptive family characteristics, and adoption status must all be taken into account to understand why adoptees are more likely to receive counseling. Clinicians should be sensitive to issues that are especially salient in adoptive families.

Original languageEnglish (US)
Pages (from-to)1504-1511
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number12
StatePublished - 2000

Bibliographical note

Funding Information:
This research is based on data from the Add Health project, a program project designed by J. Richard Udry (Principal Investigator) and Peter Bearman and funded by grant P01-HD31921 from the National Institute of Child Health and Human Development to the Carolina Population Center, University of North Carolina at Chapel Hill, with cooperative funding participation by the National Cancer Institute; National Institute on Alcohol Abuse and Alcoholism; National Institute on Deafness and Other Communication Disorders; National Institute on Drug Abuse; National Institute of General Medical Sciences; National Institute of Mental Health; National Institute of Nursing Research; Office of AIDS Research, NIH; Office of Research on Women's Health, NIH; Office of Population Affairs, DHHS; National Center for Health Statistics, Centers for Disease Control and Prevention, DHHS; Office of the Assistant Secretary for Planning and Evaluation, DHHS; and National Science Foundation. Persons interested in obtaining data files from the National Longitudinal Study of Adolescent Health should contact Add Health Project, Carolina Population Center, 123 West Franklin Street, Chapel Hill, NC 27516-3997; e-mail: [email protected] .

Funding Information:
The authors gratefully acknowledge support provided by grant HD 36479 from the National Institute of Child Health and Human Development , to Brent C. Miller, Principal Investigator. Helpful suggestions about adjusting analyses for the complex sampling design were provided by Steven Heeringa, Director of Surveys and Technologies at the Institute of Social Research, University of Michigan.


  • Adolescents
  • Adoption
  • Counseling
  • Mental health


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