During the years 1948 through 1953, some 120 children were seen in private practice. Of this number, 16 were adopted. In checking how this number compared with the numbers of adopted children in the general population, we find that approximately 0.134% of children under 21 years of age have petitions filed for adoption. This number includes not only those placed by public agencies or through independent adoptions but also petitions filed by relatives in whose home the children have lived or by stepparents coming into the home through the marriage of the child’s natural parent. In my series of cases the percentage of adoptive children seen equals 13.3, as compared with the national average of 0.134 (statistics compiled for 29 states). This indicates a hundredfold increase of patients in this category as seen in my practice, compared with what could be expected in the general population. . . .

It was not only the tremendously greater number that was of interest but the symptom pictures of the adopted children, their object relations, parental observations, and the question whether children who are adopted should be told of their adoption as early as has generally been recommended. These points will be discussed in what follows, as is highlighted in the clinical material presented by these cases. . . .

Case 8, a girl of 10 years, was presented for persistent enuresis. She spent most of her time in treatment telling of her fantasies regarding her real parents and her attempts to find her hidden birth certificate that contained the information she sought.

Case 15, a 12-year-old boy, was referred because of lying, stealing, and a lack of integration into the children’s institution into which he had been placed. His activities suggested his desire for affection and a desperate feeling that he would never get sufficient amounts of it. He had constant fantasies of his real mother having red hair and of having the last name of Smith (which was not his adopted family name). . . .

In the foregoing case reports we could see how the idea of adoption had woven itself into the framework of the child’s personality configuration. It played a role in symptom formation and object relationships. It certainly also had an effect in later development, giving the stamp of an antisocial character in one of the cases and in another that of a paranoid delusional system. . . .

It would appear that children who have been adopted have potentially a more fertile soil for development of neurotic and psychotic states.

The knowledge of their adoptive status, so often coming in at the time of the Oedipal conflict, can seem to prolong and actually prevent the resolution of this particular area of personality development. There is a lack of boundaries constituting a self; rather, what can be seen is a diffuseness in poorly integrated identifications.

The anxiety these children manifest often refers to the possibility of returning to their original parents or, having been given up once for undetermined reasons, they may be given up again at some future time—also for undetermined, fantasied reasons. These concepts enhance the feeling of lack of closeness, and we again raise the question as to the timing of the knowledge of adoption prior to the resolving of the Oedipal phase.

The material presented suggests that the immature ego cannot cope with the knowledge of the rejection by its original parents, representing a severe narcissistic injury. The child tends to react to this information by character change or symptom formation. It is, therefore, recommended that the thorough investigation of the child and his environment should be accomplished to determine the method and timing of giving the information of his adopted status.