Early adversity predicts adoptees' enduring emotional and behavioral problems in childhood.

Children adopted from the public care system are likely to experience a cluster of inter-related risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children's mental health post-placement are not well understood. We conducted a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Adoptive parents completed questionnaires at approximately 5, 21, 36, and 48 months post-placement. We used time series analysis to examine the impact of pre-adoptive risk factors [adverse childhood experiences [ACEs], number of moves, days with birth parents and in care] on children's internalizing and externalizing problems, and prosocial behavior over 4 years post-placement. Adoptees' internalizing and externalizing problems remained consistently high over the 4-year study period, but more ACEs predicted increases in internalizing and externalizing problems. Contrary to expectations, more pre-placement moves and time in care predicted fewer problems over time, but exploratory analyses of interactive effects revealed this was only the case in rare circumstances. We identify pre- and post-removal factors that may incur benefits or have a deleterious impact on adoptees' outcomes in post-adoptive family life. Our findings provide knowledge for front-line professionals in the support of adoptive families and underscore the vital need for effective early intervention.