Older Child Adoption

Since the popularity of international adoption is a fairly recent phenomenon, it is too soon for any long-term studies to have been completed. Most of the recently published books and studies are based on the early Romanian adoptions where the children’s institutional lives were horrendous. However, you cannot simply say that all children’s homes are alike no matter where they are located. Certain issues may have a commonality, yet each child’s story is by its very nature an individual event with its own peculiar history. Know that history and you will know that child. So much is dependent on such factors as whether your child was abused or neglected, in a good children’s home or a bad one, in foster care or raised by a family member, her age, the presence of loving caregivers or not, and length of stay in the home, that it is hard to compare your child with a study.

If you read a study, check its relevance by first checking for the country of origin of the study group, then for the ages of the children, and finally for whether it is a self-selective group. For example, a specialist who treats attachment issues may say that all internationally adopted children have an attachment issue because that is the only population of children that he sees.

One recent study by Dr. Laurie Miller of the Floating Hospital was published in Pediatrics in June 2000. You can find it at http://www.pediatrics.org /content/vol105/issue6/index.shtml#ELECTRONIC_ARTICLE by scrolling down standard deviations for height, 18% for weight, and 24% for head circumference. The duration of orphanage life was inversely proportional to the linear height lag, motor in 55%, fine motor in 49%, cognitive in 32%, language in 43%, and socialemotional in 28%. Elevated lead levels were found in 14%, anemia in 35%, abnormal thyroid function tests in 10%, hepatitis B surface antigen in 6%, hepatitis B surface antibody in 22%, intestinal parasites (usually Giardia) in 9%, and positive skin test results for tuberculosis in 3.5%, none seriously ill. One child each had hepatitis C exposure and congenital syphilis. No child had HIV. Unsuspected significant medical diagnoses, including hearing loss, strabismus, hip dysplasia, orthopedic problems, and congenital anomalies were found in 18% (81/452) of the children.

One finding is that the percent of high lead levels in adopted Chinese children is greater than in other international adoption populations and you should insist that your pediatrician test for lead when you bring your child home. It is an easily correctable condition, if known. This survey also shows that you must also insist that your pediatrician conduct the entire list of recommended tests for adoptive children in order to catch unsuspected problems. As might be expected, scores for height, weight, and head circumference were lower in children with developmental delays as compared with developmentally normal children. Dr. Miller made an interesting finding that delays in language and activities of daily living skills tended to increase with duration of orphanage confinement, whereas delays in other domains did not show this pattern.

Dr. Dana Johnson at the University of Minnesota’s International Adoption female. Children arrived at a mean age of 10.4 months and had been in orphanages for an average of 9.2 months. Of five tests for infectious diseases, 3.5% of Chinese adoptees were found to be positive for hepatitis B; 3.7% tested positive for intestinal parasites; 1.4% tested positive for tuberculosis; 0.8% were found to have syphilis; and none had the HIV virus. In contrast to the study described above, 90% had normal lead levels. In a much smaller sample (19) Dr Johnson found that the area of development with the most abnormality was strength, with 63% of children lagging in development. That was followed by gross motor skills, 58%; fine motor skills, 42%; language, 26%; social skills, 16%; and tone, 5%. Delays usually improved rapidly after arrival, researchers found. Stature was affected with children falling behind one month of linear growth for each 3.4 months in the orphanage. Rickets was not obvious in any child, but biochemical markers indicating early rickets was more likely to be found as children grew older. Hepatitis C seems to cluster in infants from Yangzhou. This may indicate that there is a commonality such as a common clinic using unsterilized needles. This study can be found at http://catalog. com/fwcfc/healthdanajohnson.html.

Other studies of adopted children in general have demonstrated that under normal circumstances, while early experience may confer a temporary advantage, ultimately IQ is strongly determined by genetic factors. In essence, a good environment can help, but only if the genetic groundwork is first present. Environment cannot create intelligence, but it can damage it. Michael Rutter concluded in another study that “…[e]nvironmental effects on IQ are relatively modest within the normal range of environments, but the effects in markedly disadvantageous circumstances are very substantial.” My analogy is that you have no control over the genetic potential of the seed you buy at a greenhouse, but whether it flourishes to its potential depends on the soil you give it.

A summary of some other Chinese-oriented studies can be found at http://www.arches.uga.edu/%7erojewski/WelcomePage.html. Also, there are other studies listed in Dr. Boris Gindis’ articles in the Communique (a professional journal for school psychologists) at: http://bgcenter.com/communique-article.htm. You can also read some in the Pediatric Annals issue on international adoption in Volume 29, Number 4, April 2000. Back issues can be ordered at 856-848-1000. Minnesota study under the auspices of Dr. Dana Johnson of the University of Minnesota’s International Adoption Clinic. The project has provided a wonderful snapshot of adoptive parents and their children. The web site for the International Adoption Project is at http://education.umn.edu/icd/IAP/. Findings from the survey are also on this web site. In February of 2001, surveys were sent to the Minnesota parents of 3,751 children adopted internationally between 1990-1998. Parents sent back 2,299 surveys, a response rate of 61%. The 2,299 children live in 1,857 families. About 50% of the families filled out children live in two parent families (86% married; 2% in a committed partnership). Seven percent live in homes with one parent who has never been married and less than 3% of the children live in divorced or separated families. Ninety-three percent of the fathers were employed full time, and 60% of the mothers stayed at home or worked part-time. The parents were generally very well educated. Over 70% have graduated from college. Over 30% have masters, doctorates, or professional degrees. Moms and dads/partners were very similar in their educations. The household incomes varied considerably with 15% having incomes below $50,000, 27% over $125,000 per year; and 58% of the families with incomes between $50,000 and $125,000.

An interesting finding from the surveys was that parents who did not have the referral reviewed by a medical professional were more likely to say the child had more medical problems than they were led to expect, compared to those who had the referral reviewed by a medical professional (23% vs.17%). 67% of parents reported that bonding occurred within a few days, and only 3% were still struggling after one year. (Even if you assume that the first number is high due to parental bias, this shows that bonding eventually occurs for most adoptions within the first year.) Korea (32%), Colombia (11%), China (10%), Russia (7.6%), India (7%), Guatemala (6%), and Romania (5.2%). The lowest instances of illness occurred in Korean children, and the highest were from Colombia, followed by China, Russia, Romania, Guatemala and India. Chronic ear infections were the largest medical problem, followed by vision, speech, behavior, anemia, hepatitis B and hepatitis C difficulties. Immediately after adoption to six months later, most problems occurred in sleeping, with children experiencing nightmares, followed by withdrawal, tantrums, hoarding, feeding difficulties, aggression, and crying. Medical issues were not the predominant issues facing parents after their children passed through the first couple of years. Most parents said their children were as healthy as their nonadoptive peers. Initial incidence of anemia, hepatitis C, elevated lead levels, and syphilis was reported by parents to be low. Hepatitis B was reported by 4% and no cases of HIV were reported. In contrast, speech, hearing, ear infections and vision problems (strabismus) were the most reported.

The age of the child at adoption and the care-taking environment prior to 4 times more likely to be falling behind in some or all classes. If children were adopted at less than six months of age and were well cared for, they did better months with few risk factors were doing very, very well. Thirty-three percent of parents of the 1,483 school-aged children said they were excelling in most or all of their classroom subjects. Forty-four percent of the teenagers had at some time received an award for academic excellence, 20% had received awards for artistic endeavors, and 25% had received awards for athletics. 16% of the children are in gifted classes. School performance seemed to decline as the children became older and were more academically challenged. It has been noted in other studies that complex abstract thinking in the higher grades is more difficult for adoptive kids coming from an institutional environment and that sometimes tutoring or other special services are needed. These findings also to adoption look similar to children who have lived in foster family settings.

Dr. Johnson makes the salient point that a child’s condition does not depend on the country, but on the care. Thus, a blanket statement that Chinese or Korean adoptive children are better or healthier does not really mean anything per se. If you adopt a child from a terrible Chinese institution, then that child will need additional attention. It is the care that matters, not the country. If the children are being placed in foster care at an early age, if they are not being neglected in the orphanage or if there is no exposure to alcohol, that is what is important, not the country. He gave the example of a Russian child who is placed in foster care (and there are a few) as compared to a Korean child who may have FAE. While you can make generalizations, you have to also realize that it is child specific care that is critical.Dr Johnson broke down the risk factors into seven main areas. The risk factors were 1) a birthmother who was malnourished during the prenatal period, 2) prenatal exposure to alcohol or physical needs such as food, clothing or medical care, 5) neglect of basic social needs such as lack of love, affection, attention and cuddling, 6) physical abuse and 7) a child who was in an orphanage, baby home, or hospital for more than 6 months.

He summarized the results as follows:

Europe Latin America Asia Prenatal alcohol/drug exposure 44% 15% 9% Prenatal malnutrition 50% 41% 24% Premature birth 30% 14% 28% Physically neglected 45% 26% 12% Socially neglected 57% 22% 13% Physically abused 13% 6% 3% 6 months or more in an orphanage,

baby home or hospital 79% 17% 13% factors did have significant behavioral and emotional problems and difficulties in school. The parents of these children will have a different parenting experience that those parenting a child without a lot of risk factors. They can still have a successful adoption, just that it is more work. These parents will have to learn to be advocates for their child and educate themselves on the special education system and how it works. Their child may need attachment therapy and may have more medical issues. Nevertheless, parents that are forewarned and forearmed do much better. They can set a level of expectations that is reasonable for their child and this in turn increases their chances of a successful adoption.

The problem with even this large study is that generalizations must be made carefully. There is no way to compare an adoption of a Romanian or has improved. Nor can you compare a 4-year-old Russian child with a 12-yearold Russian child. Further, many parents of Chinese children will tell you that their children have completely bounced back from their deprivations. So all generalizations naturally must come with plenty of caveats and footnotes.