International Adoption: An Overview of Developmental Considerations

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Early Intervention Training Program at the University of Illinois at Urbana-Champaign

presents

International Adoption: An Overview of Developmental Considerations

Kaitlyn Olson, M.D. Fellow, Developmental Behavioral Pediatrics

University of Chicago

Today’s Presenters

Kaitlyn Olson, MD Developmental and Behavioral Pediatrics

Fellow Department of Pediatrics

University of Chicago

Today’s Moderators

Maria Matticks Consultant

Early Intervention Training Program , UIUC

Michaelene M. Ostrosky Head and Goldstick Family Scholar,

Special Education, University of Illinois

Alissa Jones Research Specialist

Early Intervention Training Program, UIUC

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Who do we have participating with us today? A. Parent/caregiver B. Early Interventionist C. CFC Staff D. Administrators E. Other (list in Chat Room)

If you are an interventionist, what is your discipline? A. Physical Therapist B. Occupational Therapist C. Speech Language Pathologist D. Developmental Therapist E. Other (list in Chat Room)

International Adoption: An Overview of Developmental Considerations

Kaitlyn Olson, M.D. Fellow, Developmental Behavioral Pediatrics

University of Chicago

Session Outline

• Background

Session Outline

• Background

• Adoption Process

Session Outline

• Background

• Adoption Process

• Transition Home

Session Outline

• Background

• Adoption Process

• Transition Home

• Medical Comorbidities

Session Outline

• Background

• Adoption Process

• Transition Home

• Medical Comorbidities

• Developmental Challenges

Your Experience

In your work for Early Intervention, have you cared for a child who has been internationally adopted?

Yes or No?

History

1693

History

1693 1729

History

1693 1729 1851

History

1693 1729 1851 1939-1945

History

Rates of International Adoption

0

2000

4000

6000

8000

10000

12000

1 2 3 4 52010 2011 2012 2013 2014

Rates of International Adoption

International Adoption Today

1 in 40 US Children are

Adopted

International Adoption Today

1 in 40 US Children are

Adopted 6441 Adopted

internationally into the US

International Adoption Today

269 Adopted in

Illinois

International Adoption Today

Korea

El Salvador

International Adoption Today

China

International Adoption Today

Korea

El Salvador

China

Congo

Haiti Ethiopia

Ukraine

Uganda

How familiar are you with the international adoption process?

A. Very familiar-- I know it like the back of my hand B. Sort of familiar-- I understand the basic steps involved C. I know the process is complicated, but that’s about it D. Wait? What is adoption?

Adoption Process: Parent Perspective

Adoption Process: Parent Perspective

Adoption Process: Parent Perspective

Adoption Process: Child Perspective

Adoption Process: Child Perspective

• Institutional living

• Limited stimulation

• Limited play/toys

• Limited food

• Overwhelmed/inconsistent caregivers

• Widespread infection

Adoption Process: Child Perspective

Average age 22 months

Long period of: Neglect

Inconsistent caregiving Lack of appropriate developmental stimulation

Adoption Process: Child Perspective

Overwhelmed!

World of deprivation and neglect

Strangers • Smell different • Look different • Eat different food • Sound different • Have expectations

Transition Home

Transition Home

Very little time to: • Get to know child • Child acclimation • Set-up for family challenges

Have you gotten sick while traveling internationally?

A. Yes- it was horrible! B. Mildly ill C. No- I have not gotten ill during my travels D. No- I have never traveled abroad

Medical Comorbidities

Medical Comorbidities

• Poor/no prenatal care

• Drug/alcohol abuse

• Maternal infectious disease

• Maternal chronic illness

Medical Comorbidities

Medical Comorbidities

• Poverty • Neglect • Malnutrition/nutritional deficiencies • Stunting/poor growth • Infectious disease/parasitic infections • Poor dentition • Vision/hearing impairments

Medical Comorbidities

19% General US Population

Medical Comorbidities

19% General US Population

39% International Adoptions

Developmental Considerations

Assessing Development

• ~50% meet criteria for global developmental delay • Screening tools are not validated

Assessing Development

Assessing Development

Early scores do NOT predict later functioning!

Long Term Outcomes

In what developmental domain do internationally adopted children usually

“catch-up” first? A. Expressive/Receptive language B. Gross motor C. Fine motor D. Social-emotional development E. Cognition

Assessing Development

• Gross motor skills catch up first

Assessing Development

• Gross motor skills catch up first

• Visual motor skills catch up next

Assessing Development

• Gross motor skills catch up first

• Visual motor skills catch up next

• Last: speech/language & cognitive

Speech & Language Development

Speech & Language Development

Brief period of language loss is not unexpected

Attachment

Attachment

• Never bonded with a caregiver • Multiple caregivers • Inconsistency

Attachment

What to do?

• Listen • Reassure Attachment takes time!

Adoption Language

Adoption Language

Sleep

Play

Feeding

Feeding

Feeding

You are taking care of a young child who has recently been adopted from an orphanage in another country. During your visit, you notice that he frequently bangs

his head, rocks, and abnormally moves his fingers. What is the most likely diagnosis?

A. Autism spectrum disorder B. Fetal alcohol syndrome C. Unspecified genetic disorder D. Expected behavior

Sensory Challenges

Sensory Challenges

Behavior

Parental Challenges

Summary

• Developmental delays are common

• Children demonstrate great “catch up”

• Key to caring for these children: fostering attachment

References • Bureau of Consular Affairs, U.S. Department of State. Intercountry adoption: FY annual reports on intercountry

adoption. https://travel.state.gov/content/adoptionsabroad/en/about-us/publications.html. • Eckerle JK, Hill LK, et al. Vision and hearing deficits and associations with parent-reported behavioral and

developmental problesm in international adoptees. Matern Child Health J. Apr 2014. • Gunnar MR, van Dulmen MH, International Adoption Project Team. Behavior problems in postinstitutionalized

internationally adopted children. Dev Psychopathol. Winter 2007. • Johnson D. International adoption: what is fact, what is fiction, and what is the future? Pediatr Clin N Am. Oct

2005. • Jones VF, Committee on Early Childhood Adoption and Dependent Care, Hugh PC, et al. Comprehensive health

evaluation of the newly adopted child. Pediatrics. Jan 2012. • Jones V. The pediatrician’s role in supporting adoptive families. Pediatrics. Oct 2012. • Juffer F, Finet C, et al. [Attachment and cognitive and motor development in the first years after adoption: a

review of studies on internationally adopted children from China]. Prax kinderpsychol kinderpsychiatr. 2015. • Miller L. Immediate behavioral and developmental considerations for internationally adopted children

transitioning to families. Pediatr Clin N Am. Oct 2005. • Tarmann A. International adoption rate in U.S. doubled in the 1990s. Population Reference Bureau.

http://www.prb.org/Publications/Articles/2003/InternationalAdoptionRateinUSDoubledinthe1990s.aspx. • TLC Child & Family Services. A timeline history of adoption in the United States.

http://tlc4kids.org/blog/admin/01-09-2015/timeline-history-adoption-us. • Vandivere S, Malm K, et al. Adoption USA: A chartbook based on the 2007 national survey of adoptive parents. • Wilbarger J, Gunnar M, et al. Sensory processing in internationally adopted post-institutionalized children. J

Child Psychol Psychiatry. Aug 2010.

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