International Adoptions: Myths and Realities

Christine Narad; Patrick W. Mason

Disclosures

Pediatr Nurs. 2004;30(6):483-487. 

In This Article

Myth Number Three: The Developmental Delays the Child Experiences in the Institution are Normal and Will Resolve Following Adoption

Acquisition of developmental milestones is of paramount concern when assessing the preadoptive child. Before the adoption, parents should obtain the most recent and accurate assessment possible of the child's developmental milestones. This should then be compared to chronological age appropriate norms. By determining the deviation in the child's developmental milestones based on chronological age, the prospective parents will gain a better understanding of what problems they may face. For example, a 24-month old child with developmental milestones of a 6-month-old is far more concerning than a 24-month-old child with developmental milestones of a 20-month-old.

Developmental delays are common among institutionalized children and understandable given the child's early environment. Some of these delays may be remediable with parental support and an improved environment after adoption. However, the reversibility of delays is not assured: an observed delay may in some cases be the early sign of lifelong physical or cognitive impairment.

Speech and language development is one area commonly needing attention. Because children in institutions often lack consistent primary caregivers with whom to have one-on-one interactions (Zeanahet al., 2002), foundational experiences in language development may be missed - the opportunity to observe a care giver's face, listen to the cooing sounds of the adult, and mimic these sounds for example (Lansdown & Walker,1991). Often the child has had limited exposure and opportunity to observe and practice language skills. As a result,the majority of internationally adopted children will have what Glennen and Masters (2002) term "stop and restart" language development.

To help with English and general language skills, parents should speak to the child and provide an environment rich in vocalization and language stimulation. Initially, getting down at the child's eye level and allowing him or her to watch the parent's mouth move while listening to the sounds is helpful. Often this is the first time the child will have been exposed to how sound is made. Responding in a consistent manner to the child, with pauses between vocalizations, is helpful. Singing songs and playing noise games are also useful. Initially upon coming to the adoptive home, the young child may have arrested language development and may not be making sounds. Older children may have poorly developed native language skills. Either way, parents should be watching for continued advancement in language. While many internationally adopted children will go on to acquire language at rates similar to those born and raised in the U.S., approximately one third of adopted children will have some speech and language difficulties (Glennen & Masters, 2002). Delays in language also may be a signal of other underlying issues, such as neurological impairment or cognitive delays (Glennen & Masters, 2000; Irwin, Carter, & Briggs-Gowan, 2002). For these reason children who are not progressing within the norm should obtain speech and language evaluations, and intervention as needed.

In many cases, children will gain new motor skills once they are in a family. Many institutionalized infant shave been kept in cribs or playpens throughout the day and not given the chance to explore. In some cases the children have been tied to beds or potty-chairs to make keeping track of them easier. These children may become upset with quick changes in position or movements from one surface to another as well as when presented with large open spaces, like a playroom. They may lack understanding of where their body is in space and may not understand that their limbs are able to help them get from one place to another. Given these early experiences, gross and fine motor skill delays are common following adoption. None the-less, the newly adopted child should be assessed for underlying medical conditions that may contribute to weakness or delay.

Parents can offer activities that allow children to experience motion and mobility. For example, gross motor development can be encouraged by simply allowing the child to roll or roam around a room and even climb over the parent,or if weakness is present, to move with parental assistance.A variety of textured surfaces can be gradually introduced.Incrementally increasing the space a child is allowed to explore and watching for signs of being either overwhelmed or under stimulated are important.

Fine motor skills, such as discovering one's hands and picking up toys, are often novel for the previously institutionalized infant. Young toddlers may never have had the opportunity to actually hold and explore safe objects. Parents can offer materials such as pizza dough or o-shaped cereals to help children practice grasping.

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