What information should I expect/request from the adoption agency and orphanage?
This varies from country to country. We get minimal information from China, more from most other countries. Ideally, we would like to know any maternal history, the child’s birth history (prenatal care if any, birth weight, height, and head circumference, gestational age, Apgar scores), medical examinations, tests, and hospitalizations. Ongoing measurements over time are extremely helpful to assess growth. Current developmental milestones (vocalizing, sitting alone, eating semisolid food, strong eye contact) are also helpful. Sometimes statements are available from the caregivers about the child’s personality, demeanor, and skills. It’s very helpful if the orphanage doctors give an opinion about whether the child has any signs of fetal alcohol syndrome. Descriptions of the child’s verbal abilities and determination of the child’s ability to hear are also extremely valuable, but not commonly available.
Which country has the healthiest children?
We have seen healthy, developmentally appropriate children from every country represented in our clinic. We have also seen children who will need medical treatment and/or special support services from every country. The early experiences (even pre-natal) of deprivation affect children regardless of their country of origin. Experiencing multiple or prolonged periods of neglect, deprivation, abuse, and inconsistent caregivers places children at higher risk for developmental problems. Developmental delays, attachment problems, sensory integration dysfunction, and long term learning and language difficulties are now increasingly recognized. However, many if not most kids do amazingly well. Each child we see at the clinic is a beautiful little person enjoying a new life and family. Each has his/her own unique personality and learning styles!
Can you predict attachment disorder or emotional problems from pre-adoptive material supplied by the adoption agency?
No. As with problems associated with maternal substance abuse, symptoms may not be evident initially. Difficulties with bonding and attachment may not surface until after children have made the initial transition to their new family. It is difficult at first to distinguish transient from lasting concerns within the first few months home. A child’s response to the intimacy of family life cannot be predicted.
How is Fetal Alcohol Syndrome diagnosed? Why is it important to consider?
This is a difficult diagnosis to make, especially since information about maternal alcohol use is almost never available. Small size at birth, and subsequent growth delays are found in most children exposed prenatally to alcohol. Head circumferences (which measure brain growth) are most typically affected. Characteristic facial features may be seen in some children: these include a thin upper lip, absent or undeveloped "cupid’s bow", long and flat philtrum (the area between the nose and the upper lip which normally has two vertical ridges separated by a groove or indentation), epicanthal folds (tiny folds on the inner corners of the eyes), flattened midface or scooped nose, and low-set ears.
We worry about fetal alcohol exposure as it frequently causes developmental delays, sleep disturbances, irritability, restlessness, sensory hypersensitivity, hyperactivity, tactile and auditory defensiveness, and information processing problems. Children may have difficulties reading non-verbal cues and problems generalizing what they have learned from one situation to another. Adolescents may show poor social and daily living skills.
What can I expect during my appointment at the International Adoption Clinic?
Appointments generally last 2 hours. The first hour is the comprehensive developmental assessment of cognition, language, motor, social-emotional, and self-care skills, with a Developmental Specialist, Dr. Linda Tirella. The second hour is with Dr. Laurie Miller, for a comprehensive medical evaluation. Please bring any medical history, current information (lab work, x-rays, early intervention or school reports) to the appointment. If additional testing is necessary, your visit may exceed two hours. Please book as soon as your travel plans are finalized. We like to see children within 1-4 weeks after arrival in the U.S. We also gladly see children who have been home for longer periods, for evaluation of medical or developmental issues.