How Family Health History Contributes Biologically to Adopted Children’s Mental Health Risk

The mental health of adopted children has long been an area of interest in research and clinical practice, dating back decades into the history of adoption in the Western world. Understanding how family history plays a role in mental health can be empowering but also filled with uncertainty and anxiety.

This article will focus on informing adoptive families about the biological impact of family health history on their adopted child’s mental health. We will discuss how family health history is an important factor, but only one of many pieces in mental health risk. Additionally, we’ll provide insight on how to frame this information and have conversations with your child regarding their health history.

This article is the fourth installment in an educational series aiming to improve health literacy and empowerment for adoptive families when assembling a biological family health history for their adopted child(ren).

How Family Medical History Influences Mental Health

As discussed in previous articles, family medical history is a crucial part of assessing a patient’s risk for particular conditions and diseases. This includes both biological and non-biological factors such as genetics, shared environments and behavioral patterns that can shape long-term health outcomes and disease prognosis.

When it comes to mental health, family medical history is an important part of assessing risk. However, it is only one of many factors that influence one’s risk for a mental or behavioral condition. Conditions like anxiety, depression, ADHD and other mental health disorders can run in families, influenced by both genetics and environment.

A note on the importance of approaching mental health and family health history with empathy, non-judgment and curiosity:

Mental health is a complicated topic to talk about in many families, not just in those with adopted children. Historically, mental health was not always openly discussed or addressed when problems arose. Today, more people are discussing mental health, including family history of mental health, but stigma and shame can often still remain. It’s important to recognize that some cultures may be more or less open to discussing and sharing mental health histories. Thus, it’s important to have empathy and understand the structural, systemic and community impact and barriers that lead to people experiencing mental illnesses or engaging in particular behaviors that influence health, such as sleep, diet, substance use, etc.

As parents, it can be helpful to have discussions about mental health with your child starting at a young age to normalize mental health challenges. One way to discuss this is when talking about what we do to keep our bodies healthy and treat mental health maintenance as another type of hygiene. It’s also important to be mindful of how we talk about birth parents with children because the words we choose and how we share some of the hard information may lead an adopted child to feel ashamed of their biological family history and, in turn, themselves. This is not to say we should not share the hard information, but to do it mindfully, in an age-appropriate manner, and with the support of adoption-competent mental health professionals, if needed.

Environmental and Biological Mental Health Risk Factors Relevant to Adopted Children

Many adopted children, especially those adopted at an older age, experience what are called adverse childhood experiences (ACEs) that can heavily influence the onset of mental illness. The American Psychiatric Association describes ACEs as “disruptions to the promotion of safe, stable, and nurturing family relationships and are characterized by stressful or traumatic events” that occur before the age of 18. Newer research shows that around six out of 10 individuals worldwide report experiencing an ACE before age 16. ACEs were first investigated in the 1990s by Kaiser Permanente in Southern California. This study found that ACEs significantly increase the risk for seven out of 10 leading causes of death in the U.S., revealing the importance of a lifecourse approach to health to prevent early death. Common examples of ACEs include exposure to housing and food instability, parental mental illness, domestic violence, abuse and neglect.

While ACEs as an environmental factor alone can contribute to the onset of mental illness on their own, researchers have also found relationships between ACEs and biological outcomes such as brain development, genetic expression (genes turning “on” and “off” due to environmental factors) and somatic (body) disorders.

Additionally, the mental and physical health of the biological parents can impact the developing child’s health. For mothers, prenatal stress, anxiety or depression can significantly impact child development by altering fetal brain development, which impacts child cognitive and behavioral development. Furthermore, maternal substance abuse can result in several neurodevelopmental consequences for children. The impact of paternal health on a developing fetus/child is a comparatively newer area of research. Researchers have found that advanced paternal age (older than 35) can increase the likelihood of birth complications such as premature birth, low birth weight (LBW) and NICU admission.

At the end of the day, being aware of these risk factors can be useful for family members, caregivers and medical professionals to track early symptoms and signs and provide prevention methods and early intervention treatments if necessary. Remember, family medical history does not directly determine your child’s outcome. Their current environment plays a huge role in their mental and physical health. Continuing to engage in physically healthy behaviors like frequent exercise and healthy eating, as well as emotionally healthy behaviors like open expression of love, discussing feelings, and creating a safe space for honest discussion, are crucial to your child’s mental health and can actually mitigate the risk due to genetic/biological predisposition.

ACEs and adverse environments can be challenging to learn about and emotionally process. However, they present an opportunity for you to have important conversations within your family about resilience and reform on multiple levels. At children’s individual levels, resilience can look like practicing healthy routines and self-care, goal-setting and maintaining a hopeful outlook in the face of adversity. At a community and family level, this can look like practicing these individual behaviors together, keeping one another accountable and supporting and encouraging one another. Forming resilience at a more systematic and structural level can look like raising awareness about the experiences of adopted children and advocating and discussing reform in education, healthcare and policy.

As a parent, it is imperative to prepare your child on how to handle intrusive questions about their adoption story and set boundaries with others. In the face of these emotional and sensitive challenges, children can grow their resilience by learning to communicate with others in a respectful but firm manner. The Cradle facilitates the W.I.S.E. Up!® program developed by the Center for Adoption Support and Education (C.A.S.E.), which is designed to empower adopted and foster children to decide if, when, and how to share their stories.

There are many other publicly available resources from trusted and credible institutions on child health that tackle forming resilience and its importance in childhood development, including A Guide to Resilience from The Center of the Developing Child at Harvard University.

How can parents talk with their child about difficult aspects of family health history in an age-appropriate way?

Conversations about family medical history, especially when they involve addiction, mental illness or chronic disease, can feel daunting. But avoiding the topic altogether can leave children to fill in the gaps on their own, which may actually induce further stress down the line. The goal isn’t to share everything at once, but to create ongoing, age-appropriate conversations. Below, we’ve included some general points to consider:

• Start with age-appropriate honesty: Children benefit from truthful information that matches their level of understanding. Young children may benefit from simple, concrete explanations, such as describing addiction in very simple terms, and mental health in terms of managing strong thoughts and emotions, with an emphasis that it is not the child’s fault Older children and teens may be able to handle more nuanced discussions, including how health, environment and choices interact with one another to compound their risk for mental illness and how their own choices are incredibly important for their health. The National Alliance on Mental Illness (NAMI) has several resources and activities to help start these discussions with young children.
• Talk about sensitive topics without stigma: When discussing topics like substance use or mental illness, use neutral, non-judgmental language, frame conditions as health challenges that can result from one’s environment and background, not personal failings. Emphasize that people with these conditions can receive support and live healthy, fulfilling lives. This helps children understand that these experiences are part of a broader human reality, not something shameful or defining. Young children can benefit from learning via storytelling and representation. The Child Mind Institute is a reputable child mental health non-profit that has curated a list of books to help children (up to age 12) learn about several mental health topics.
• Avoid genetic determinism: One of the most important messages you can share is that family history is not destiny. Even when there is increased risk, lifestyle choices, environment and relationships matter. Early awareness and preventive care can lead to better outcomes and make a true difference.
• Frame the conversation as empowering: Rather than presenting family health history as a limitation, it can be reframed as a tool. You might say: “This information helps us take care of your body and mind,” or “Knowing this means we can ask good questions and get the right support.” When children understand their health history as useful knowledge, it can foster a sense of agency rather than fear.
• Keep the conversation open over time: Children’s understanding of health and identity evolves. What they need will look different as they grow older. Revisit conversations, invite questions without pressure and acknowledge uncertainty when information is missing. Even saying something like, “We don’t know everything, but we can keep learning together,” can be grounding and reassuring.

Helping Build Your Child’s Health Narrative

For adoptive families, family medical history may never feel complete, but it doesn’t have to be in order to be meaningful. There is grief and ambiguity in the missing parts, but what matters most is sharing what you do know, partnering with mental health professionals and medical providers to make sense of that information, and creating space for honest, ongoing conversations as your child grows and their questions evolve.

Family health history is not just about risk. It opens up a broader and complicated conversation about understanding, connection, humility and ambiguous grief. When approached thoughtfully, it can become a powerful tool for helping your child feel informed, supported, and empowered in their health journey. In the next article, we will discuss in more depth the emotional impact of learning about family medical history, preparing children on how to communicate and protect their privacy about their health history with others, as well as the impact of culture and identity on their experiences in healthcare.