Parent strategies for addressing the needs of their newly adopted child.

The purpose of this study was to describe reflections of nine American parents on the strengths, challenges, and strategies in parenting young children newly adopted from another country. Eight mothers and one father with an adopted child aged <3 years and home for <3 months completed standardized assessments measuring the child's social emotional development, sensory processing, and parental stress. Each parent participated in qualitative interview to discuss challenges and strategies helpful in addressing their children's needs. All parents reported challenges addressing their child's needs in the areas of sleep, feeding, attachment and self-regulation, and soothing. Parents reported similar strategies to address their child's behavioral concerns. Parents also reported on family factors and community resources that supported the success of the adoption. Although many families described their adoptive child as having challenges with multiple daily life activities, parents reported being able to create effective strategies to address many of these challenging behaviors.

Self-regulation in newly arrived international adoptees.

Many newly arrived international adoptees (IA) have difficulties with eating, sleeping, and self-soothing/self-stimulating (SS) behaviors. However, to date the prevalence of these problems and associated risk factors have not been clearly identified. Therefore, we proposed to evaluate 387 IA for the presence of these self-regulation and behavioral difficulties, and examined the relationships between these behaviors and pre-adoptive risk factors including growth measures, orphanage care, age at arrival and presence of medical complications. Data on participants were collected in a retrospective chart review and entered into a standardized data collection sheet by a trained research assistant. This exploratory study included 133 M and 254 F with an average age (M = 16) months at the time of the study. Children in the study represented adoptees from seventeen countries. Forty-nine per cent (49%) of the retrospective sample exhibited SS behaviors, 48% had sleep disturbances, and 34% had eating issues. Many had difficulties in more than one area. Country of origin, pre-adoption residence, and arrival nutritional status all related to the presence of these problems. Hence, self-regulation difficulties are common but both the course and influence of those behaviors on family functioning remains unknown.

Developmental and behavioral performance of internationally adopted preschoolers: a pilot study.

Most international adoptees (IA) have rapid catch-up of the delays common at arrival. However, it is not known whether development at arrival predicts later abilities or school readiness. Therefore, we comprehensively evaluated language, fine motor, visual reception (VR), executive function (EF), attention (ATT), and sensory skills (SS) in IA preschoolers. We hypothesized that pre-adoptive risk factors, development at arrival, and the post-adoptive environment (time in day care) would predict developmental and behavioral outcomes and school readiness. 37 IA (12M:25F), currently age 4-5 years and previously seen in our clinic (mean arrival age 12 months), were evaluated with standardized tests of development, language, EF, ATT, and SS, along with demographic information, parent interview, and review of arrival clinic records. Fine motor and VR skills at arrival ranged from average to very below average. At followup, most IA were average or above average in fine motor, VR, and language skills, but many had concerning scores for ATT (42%), EF (11%) and SS (48%). Arrival expressive language T scores (Mullen) predicted follow-up scores for expressive language (PLS-4, r = .44, p = .005). Arrival fine motor scores (Mullen) correlated with follow-up auditory comprehension scores (PLS-4, r = .47, p = .002) and inversely with inattention scores (Conners', r = -.48, p = .003). Arrival visual reception scores correlated inversely with global measures of attention (Conners' opposition r = -.45, p = .005, ADHD scores r = -.49, p = .002, and to a lesser extent hyperactivity r = -.35, p = .03). Age at arrival was a very strong predictor of many of the outcome measures tested, including language performance, attention regulation, executive function, and sensory processing. Children who spent more time in daycare had significantly more difficulty with emotional control (p = .005). Although IA have good catch-up in specific areas of development, difficulties with ATT regulation, EF, and sensory processing may increase the risk of later school problems.

Health of children adopted from Ethiopia.

OBJECTIVES: Since 2000, American families have adopted 1,700 children from Ethiopia. Little is known about the health and development of these children. PATIENTS AND METHODS: Retrospective chart review of the arrival health status of all 50 (26F:24M) children from Ethiopia/Eritrea seen in the International Adoption Clinic. RESULTS: Prior to adoption, most children resided with relatives; 36% were >18 months old prior to entry into care. More than 50% were true orphans, often due to HIV. Arrival age ranged from 3 months to 15 years (mean +/- SD 4 years +/- 43.8 months). At arrival, growth z scores were near-average (weight -.59, height -.64, head circumference -.09); significantly better than adopted children Guatemala, China, or Russia seen in our clinic. However, some Ethiopian children were significantly growth delayed (WAZ < or =-2, 8%, HAZ 12%, HCZ 18%). Age at adoption did not relate to growth delays. Medical issues on arrival included intestinal parasites (53%, [14% with > or =3 types]), skin infections (45%), dental caries (25%), elevated liver transaminases (20%), latent tuberculosis (18%), and hepatitis B (2%). Age-appropriate vaccines had been administered in 15-77% of children (depending on specific vaccine). Behavior problems were uncommon. Gross/fine motor and cognitive skills were approximately 86% of expected for age. Age correlated inversely with developmental scores for cognition (r = -.49, P = .003). Five children had age reassignments. CONCLUSIONS: Ethiopian/Eritean adoptees differ from other groups of internationally adopted children: they reside for relatively long periods of time with relatives prior to institutionalization, often have uncertain ages, exhibit few behavioral problems at arrival, have better growth, and may have less severe developmental delays. Whether these differences at arrival predict better outcomes for the Ethiopian/Eritrean children is unknown.

Medical diagnoses and growth of children residing in Russian orphanages.

AIMS: Survey the health of young children residing in Russian orphanages. METHODS: Retrospective chart review of all 193 'healthy' young children (105M:88F, age range 2-72 months) residing in orphanages in Murmansk, Russia. RESULTS: Mothers of these institutionalized children had complex histories including chronic health problems (38%), use of tobacco (41%), alcohol (39%) and illicit drugs (7%). Frequent diagnoses of the children included rickets (21%), foetal alcohol syndrome (10%), anemia (6%), developmental delay (11% mild, 25% moderate, 28% severe), behavioural problems (60%) and 'perinatal encephalopathy' (46%<1 year of age). At orphanage entry, growth delays were common (underweight 34%, short stature 25%, microcephaly 34%). During orphanage residence, height z scores further decreased (p=0.01), but head circumference improved (p<0.0001, paired t-tests). Head circumferences increased significantly in 62% of microcephalic children. Smaller children (z score<-2) at entry exhibited more rapid growth (z score/month) for weight (+0.24 vs. -0.12, p=0.04), height (+0.81 vs. -0.65, p=0.0001), and head circumference (+1.02 vs. -0.10, p=0.0004). Growth correlated with child developmental status. CONCLUSIONS: Young institutionalized children in Murmansk have complex medical status, social histories and frequent growth and developmental delays. Anthropometric measurements-particularly head circumference-improved during orphanage residence in children who entered with more severe growth delays.

Fetal alcohol spectrum disorders in children residing in Russian orphanages: a phenotypic survey.

BACKGROUND: Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories. METHODS: Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories. RESULTS: Thirteen percent of children had facial phenotype scores highly compatible with prenatal alcohol exposure and 45% had intermediate facial phenotype scores. These scores correlated with maternal gravidity and age. At least 40% of mothers in whom history was available ingested alcohol during pregnancy; some also used illicit drugs and tobacco. Z scores for growth measurements corresponded to phenotypic score, as did the degree of developmental delay. Children with no or mild delay had significantly lower phenotypic scores than those with moderate or severe delay (p = 0.04); more than 70% of children with high phenotypic scores were moderately or severely delayed. CONCLUSIONS: More than half of residents of the baby homes in Murmansk, Russia, have intermediate (45%) or high (13%) phenotypic expression scores suggesting prenatal exposure to alcohol. Despite good physical care, stable daily routine, availability of well-trained specialists, and access to medical care, these vulnerable children show significant growth and developmental delays compared with their institutionalized peers.

Health of children adopted from Guatemala: comparison of orphanage and foster care.

OBJECTIVE: Since 1986, American parents have adopted >17300 children from Guatemala. This study assessed the health, growth, and developmental status of 103 Guatemalan adopted children (48 girls; 55 boys) after arrival in the United States. Physical evidence suggestive of prenatal alcohol exposure and adequacy of vaccinations administered were also reviewed. METHODS: Retrospective chart review was conducted of 103 children who were evaluated after arrival in the United States in an international adoption specialty clinic, and a case-matched study was conducted of a subgroup of 50 children who resided in either an orphanage or foster care before adoption. Mean age at arrival was 16 +/- 19 months. Before adoption, 25 children resided in orphanages, 56 resided in foster care, and 22 resided in mixed-care settings. The 25 children who had resided in orphanages before adoption were matched for age at arrival, interval from arrival to clinic visit, and gender with a child adopted from foster care. Health and developmental status of these matched pairs were compared, allowing the first direct comparison of children raised in orphanages or foster care before adoption. RESULTS: Mild growth delays were frequent among the children. Mean z scores for weight, height, and head circumference were, respectively, -1.00, -1.04, and -1.08. Children from foster care had significantly better z scores for height, weight, and head circumference than those from orphanage or mixed care. Among children who were younger than 2 years at arrival, growth measurements correlated inversely with age at arrival. Infectious diseases included intestinal parasites (8%) and latent tuberculosis infection (7%). Other medical conditions included anemia (30%), elevated lead levels (3%), and (using strict criteria) phenotypic facial features suggestive of prenatal alcohol exposure (28%). Adequacy of vaccine records from Guatemala was assessed: 28% met American Academy of Pediatrics standards for vaccine administration. Unsuspected significant medical diagnoses, including congenital anomalies and ocular, neurologic, and orthopedic problems, were found in 14%. Most children were doing well developmentally (80-92% of expected performance), but 14% had global developmental delays. Cognition, expressive and receptive language, and activities of daily living skills correlated inversely with age at arrival for children who were younger than 2 years at adoption. Among the 50 matched children, those who resided in foster care before adoption had better measurements for height, weight, and head circumference at arrival to the United States. Moreover, those who resided in foster care scored significantly better for cognitive skills than those who had previously resided in orphanages (96.3% of age-expected compared with 88.3% of age-expected); other skills did not differ between the 2 groups. No differences were found between the 2 groups of children related to prevalence of medical diagnoses or phenotypic evidence suggesting prenatal alcohol exposure. CONCLUSIONS: Guatemalan adoptees display similar overall patterns of growth and developmental delays as seen in other groups of internationally adopted children, although not as severe. Younger children had better growth and development (cognition, language, and activities of daily living skills) than older children, regardless of location of residence before adoption. Among children who were matched for age, gender, and interval from adoption to evaluation, those who had resided in foster care had better growth and cognitive scores than children who had resided in orphanages before adoption. These findings support the need for timely adoptive placement of young infants and support the placement of children in attentive foster care rather than orphanages when feasible.