According to the Journal of the American Academy of Child and Adolescent Psychiatry, successful adoption requires that the child attach to his new family. This concept is important even though the idea of adoption contains an element of the opposite--rejection and relinquishment. For this reason, the issue of loss is very important to the adoptee, as well as his adoptive and birth parents. The child adopted from overseas may feel rejected not only by birth parents but also by his entire country of origin.
Studies of the adopted child show that he very often experiences some type of "loss". It might be the loss of his family and relational environment, loss of his self-esteem as a consequence of his being moved or given up, or "status loss" as a result of feeling stigmatized within the family or within his society. Also, previous abuse or neglect can color a child's expectation of what a caregiver is like, and affects his ability to form a solid, quality attachment.
Adoptive parents also suffer types of losses related to adoption. Many couples struggle with infertility, and the adopted child may sense his parents' ambivalent feelings about adoption. Dynamics in the parents' extended family may also play a role. Long delays between the child's placement and the adoption being finalized may also affect the parents' attachment to their adopted child.
Also, tension inevitably occurs when the adopted child expresses need for information regarding his birth parents. Open adoption, which allows varying degrees of contact between the birth parents, adoptive parents, and the child, appears to be gaining success in the United States. In one study, those adoptive mothers who had contact with the child's biological mother before birth tended to feel more favorably toward her, and the contact was continued for the child's first two years, leading to better outcomes.
Special problems arise when a child is adopted after months or years in institutionalized care. There can be problems with attachment when children from institutions are adopted after eight months of age. Some children may recover from their attachment problems after adoption, and cognitive and other delays tend to improve with time. One study showed that Romanian-born institutionalized children showed substantially normal cognitive and social functioning later, after being adopted and raised by families. A small percentage of those children appeared to have persistent deficits, however, suggesting that institutional deprivation could lead to some form of early damage.