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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.

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.

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.

The arrival of a newly adopted child into the family is usually a joyous time. Behavioral concerns arise in many internationally adopted children, most of whom are infants or toddlers at the time of placement with their adoptive families. Problems with feeding, sleeping, and other daily activities are often prominent in the first few weeks after the adoption. Some children display emotional distress and developmental delays; however, most recover rapidly. Anticipatory guidance from the pediatrician can assist families and children with this major life transition.

Nearly 220,000 children have been adopted from other countries by American parents since 1986. Approximately 65,000 children have arrived from China and Russia, mostly in the past 6 years. Most of these children reside in orphanages before adoption, where they may experience malnutrition, environmental deprivation, neglect, and exposure to infectious diseases. After arrival to the United States, international adoptees should undergo specialized screening evaluation for infectious diseases and other conditions. Infectious conditions of special concern include hepatitis B and C, syphilis, human immunodeficiency virus infection, tuberculosis, and presence of intestinal parasites. Before the adoption occurs, the infectious disease consultant may be asked to assist the primary care provider and the adoptive family with advice about travel and review of preadoptive medical records. After the adoption, the infectious diseases consultant may be asked to assess the adequacy of the child's vaccination record from the birth country and to assist in screening, evaluation, and management of infectious diseases.

Background: Helicobacter pylori (H. pylori) infection has been linked to gastritis, diarrhea, peptic ulcers, failure-to-thrive, anemia, as well as predisposition to gastric malignancies. Because many internationally adopted children have diarrhea, failure-to-thrive, and anemia on arrival to the US, we determined the prevalence of HP antibodies among these children., Methods: Serum samples from 226 unselected children from 18 countries who were evaluated in the International Adoption Clinic at New England Medical Center were tested for antibodies to H. pylori. The results of serologic screening were analyzed in relation to age at adoption, site of residence prior to adoption, weight and height, and the presence or absence of anemia, diarrhea, or intestinal parasites., Results: 31% of internationally adopted children had antibodies to H. pylori. The presence of H. pylori-antibodies was associated with residence in an orphanage (vs. foster care) prior to adoption, older age at adoption, and coinfection with intestinal parasites. No direct effects on height or weight were identified; no associations with diarrhea or anemia were found., Conclusions: Internationally adopted children have a high incidence of exposure to H. pylori, as diagnosed serologically. Residence in an orphanage (compared with foster care), older age at adoption, and coinfection with intestinal parasites were more common among children seropositive for anti-H. pylori antibodies.

Many of the >339,000 international adoptees arriving in the USA during the last 25 years are now teenagers and young adults (YA). Information about their long-term social integration, school performance, and self-esteem is incomplete. Moreover, the relation of these outcomes to facets of family function is incompletely understood. We hypothesised that growth, development, and health at arrival would predict the social and academic success of YA adoptees, and that family flexibility would correlate with more favourable outcomes for family and teen. Arrival records of 88 international adoptees aged 15-25 years were reviewed. Adoptees and their parents completed a series of standardised questionnaires. Results showed that self-esteem was good, although 15% were anxious or unhappy. Family stress varied widely and was higher for families with adopted sons. Adoption satisfaction varied, and correlated to family coping skills, inversely to family stress, but not to age, development, behaviour, growth at arrival, gender, or to parental experience. Generally, family flexibility corresponded to more favourable outcomes.

No comprehensive studies have examined the utility of family drawings within the context of international adoption. We examined the relationship of Kinetic Family Drawings by 54 internationally adopted children in the USA (65% female; M age = 8.57 years, SD = 2.1) to demographics, child competencies (Child Behavior Checklist: CBCL/6-18) and parental adoption satisfaction (Adoption Satisfaction Questionnaire: ASQ). Two raters independently scored drawings for: "emotion" (positive, neutral and negative), "boundaries" (unifying and dividing), "family composition" (inclusion of family members), "interactivity" (active or passive) and "self-emphasis." Drawing features moderately correlated with CBCL subscales ("emotion," "boundaries," "drawing composite": r range = -0.43 to 0.31, all p < 0.05) and parental adoption satisfaction ("boundaries": r = 0.42, p < 0.01). Significant drawing differences were also observed by gender, time since adoption, orphanage care and adoption visibility. These findings support the utility of family drawings as an informative, supplemental tool highlighting concerns related to children's pre- and post-adoption experiences, and their impact on family function.

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 less than 3 years and home for less than 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. (Contains 4 tables.)

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. (Contains 3 tables and 1 figure.)

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 = 0.44, p = 0.005). Arrival fine motor scores (Mullen) correlated with follow-up auditory comprehension scores (PLS-4, r = 0.47, p = 0.002) and inversely with inattention scores (Conners', r = -0.48, p = 0.003). Arrival visual reception scores correlated inversely with global measures of attention (Conners' opposition r = -0.45, p = 0.005, ADHD scores r = -0.49, p = 0.002, and to a lesser extent hyperactivity r = -0.35, p = 0.03). 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 = 0.005). 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.

More than 230,000 children have been adopted from other countries by American parents since 1989, including more than 72,000 from Eastern Europe. Many arrive with growth and development delays, and medical problems. Yet, little is known about the long-term outcomes for these children. Therefore, we assessed long-term developmental, neurobehavioral, and educational performance outcomes in a group of adopted 8- to 12-year-old children from Eastern Europe. A parent questionnaire was mailed to families of school-age Eastern European adopted children who had been in the United States for two years or more. Of the 81 children (33M: 48F) described in the returned surveys, 84 percent were 3 years old or older at adoption. Sixty-one percent of the children received special education services, and 32 percent received occupational therapy. Fifty-two percent had language disorders, 38 percent had attentional problems, and 36 percent had learning disabilities. Thirty-five percent had multiple neurodevelopmental diagnosis. Thirty-two percent of the children had post-traumatic stress disorder; these children were older at adoption than those without this problem (p = 0.04). Anxiety and depression each occurred in 19 percent of children; 66 percent of those with depression also had anxiety (p = 0.0001). Most children attended school willingly (70 percent), had a best friend (63 percent), and got along their parents (75 percent). Although nearly two-thirds of the internationally adopted children received special education services and 35 percent had multiple neurodevelopmental disorders, most children displayed remarkable social, peer, and family integration skills. (Contains 5 figures.)

Intercountry adoptees (ICAs) face life-long challenges within their ecological contexts that warrant exploration. Adoptees' visible adoptions make them susceptible to microaggressions. This study examined the relation between racial and adoption microaggressions (RMAs, AMAs) and youths' belonging-to-family among 98 French intercountry adopted adolescents. Moderators of this relation were also explored (visibility, identity connections to country-of-origin or adoption, and parent-adoptee communication challenges). More RMA experiences were correlated with weaker belonging-to-family; logistic regression analyses revealed that stronger identity connections to country-of-origin exacerbated this correlation. The nature of these microaggressions was similar to those noted in previous studies on ICAs. [ABSTRACT FROM AUTHOR]

France receives a relatively large number of international adoptions. However, little is known about the frequency and types of microaggressions experienced by adoptive parents and internationally adopted adolescents in France. Unusually, France functions legally as a colorblind society, where race is not officially recognized. Therefore, we surveyed adoptive parents and adopted adolescents regarding their feelings of difference and experience of prejudice – related to both adoptive status and country of origin. Some respondents reported that special needs represented an additional area of stigma. Family belonging, adoption identity, and adoption visibility all impacted the experience of microaggressions by French internationally adopted adolescents and their parents. [ABSTRACT FROM AUTHOR]

Many of the >339,000 international adoptees arriving in the USA during the last 25 years are now teenagers and young adults (YA). Information about their long-term social integration, school performance, and self-esteem is incomplete. Moreover, the relation of these outcomes to facets of family function is incompletely understood. We hypothesised that growth, development, and health at arrival would predict the social and academic success of YA adoptees, and that family flexibility would correlate with more favourable outcomes for family and teen. Arrival records of 88 international adoptees aged 15–25 years were reviewed. Adoptees and their parents completed a series of standardised questionnaires. Results showed that self-esteem was good, although 15% were anxious or unhappy. Family stress varied widely and was higher for families with adopted sons. Adoption satisfaction varied, and correlated to family coping skills, inversely to family stress, but not to age, development, behaviour, growth at arrival, gender, or to parental experience. Generally, family flexibility corresponded to more favourable outcomes. [ABSTRACT FROM AUTHOR]

• 54% of international adoptees in France, Italy, Norway, and Spain had ≥ 1 special need. • Learning disabilities (40%) and ADHD (30%) were most common. • Patterns of special needs diagnoses differed in the 4 receiving countries. • Mothers' adoption satisfaction was similar in all 4 receiving countries. • Child ADHD, behavior/psychiatric issues related to lower mothers' adoption satisfaction. The extent and nature of SN among international adoptees at adolescence in different receiving countries (RC) has not been completely described, nor have differences between children of Eastern Europe (EE) and non-EE origin been fully assessed. Furthermore, the impact of SN on parent adoption satisfaction has not been systematically assessed or compared between RC. In 4 European RC (1) determine the prevalence and type of SN among internationally adopted adolescents, (2) compare these for children of EE and non-EE origin, (3) relate SN to mothers' adoption satisfaction. 685 mothers of internationally adopted adolescents in four different RC (France n = 246, Italy n = 322, Norway n = 60, Spain n = 57) completed on-line surveys including (a) child's medical, behavior, psychological, or school problems, (b) Pinderhughes' Adoption Satisfaction Questionnaire. Mothers reported that 54% of the adolescents (58 %M, arrival age:53.53±40.35 months, current:14.98±1.70 years, 44% EE origin) had at least one SN. Learning disabilities were most common (40% of adolescents), followed by ADHD (30%), and medical issues (21%), but patterns differed by receiving country. Except for speech/language problems, the frequency of specific SN (developmental delay, attention deficit hyperactivity disorder [ADHD], behavior problems, learning disabilities, psychiatric issues, prenatal alcohol exposure) varied significantly between RC. The frequency of these conditions between children of EE and non-EE origin also varied by RC. Mothers' adoption satisfaction did not differ significantly between RC; the presence of ADHD, behavior and/or psychiatric problems consistently related to mothers' adoption satisfaction in all 4 RC. The relation to mothers' ASQ and the presence and number of SN was assessed by hierarchical linear regression, controlling for child demographic characteristics. Both the presence and number of SN negatively predicted mothers' adoption satisfaction. Child's age at adoption (and to a lesser extent, current age) also negatively predicted mothers' ASQ score. SN were relatively common among internationally adopted adolescents in 4 European RC, but the pattern of specific conditions and relationship to mothers' adoption satisfaction differed among RC. However, ADHD, behavioral and/or psychiatric problems consistently related to mothers' ASQ in all 4 RC. In regressions controlling for demographic characteristics, the presence of any SN and the number of SN related to mothers' adoption satisfaction. SN represent an additional stress on adoptive families; further work is needed to understand how differences in RC may impact post-adoption adjustment and experiences. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]