international adoption: an overview of developmental ... · review of studies on internationally...
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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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