International adoption is becoming increasingly common in English speaking countries. In 2005 there were 22,710 children internationally adopted into the United States. This was a 180% increase in the number of internationally adopted children from 1989-2005. 1)

In the past 30 years, more than 250,000 children have been internationally adopted into the United States.

This page will hopefully give some answers to some common questions professionals may have when they first work with an Internationally Adopted Child (IAC).

The traditional areas that have contributed large numbers of IAC to the United States have been Eastern Europe and Asia. Russia, Romania, China, and Korea have, for decades, been the primary countries of origin for IAC. The demographics of IAC have been broadening, as is reflected in the charts and graphs below. There are currently higher numbers of IAC originating from South America and Africa than had been seen in previous decades. 2)

Below are the U.S. Department of State statistics on the number of Immigrant Visas that were issued for IAC coming to the United States for the years 2008 and 2009. These statistics represent the top twenty countries that IAC have originated from in the past two years. 3)

http://adoption.state.gov/news/total_chart.html

Knowing where a child has been adopted from can give you insights into the type of environment they were in, the possible state of heath they were in at adoption and estimates on how much language stimulation they were exposed to during their pre-adoptive time. Due to a change in Romanian law in 2004, Romanian children can only be internationally adopted by their grandparents. However, professionals should be aware that there were thousands of Romanian children adopted into the U.S. prior to 2004. 4)

The gender of IAC for five of the top twenty countries of origin for 2005 was analyzed. The intent was to discover why 66% of IAC were female, whereas in domestic adoptions 49% were female. The disparity is, for the most part, due to 95% of IAC from China being female. This may be due to China's informal one-child per family policy. In China the majority of children that are abandoned are female, therefore that is the demographic most available for adoption in China. Other countries seem to have similar adoption demographics, in terms of gender, as domestic U.S. adoptions.

5)

Although most adoptive parents desire infants, the process of adoption can be long and drawn-out. Due to regulations in many areas children are over 1 year old before they are adopted. This means that they are spending longer periods of time in their pre-adoption environments. This data is from 2005.

6)

This information is from 2005.

7)

Just like with all children, many factors affect the development of IAC. The following list modified from Johnson & Dole, 1999 covers many factors that affect development of all children as well as some that are typically unique to IAC. This page will touch on the factors that are most different for IAC than peers that were not adopted, or adopted in their country of origin. 8)

9)

What type of environments do IAC live in pre-adoption?

• Institutions/Orphanages are the most common environments for IAC. In one particular orphanage in Romania, the ratio of children to staff was 30:1. For children in environments such as these, they rarely (if ever) have one-on-one attention, and their daily routines are accomplished in groups. Yet there are some orphanages with more promising ratios, such as 5:1 10)
  • Over 88% of IAC come from orphanage environments 11)
  • Growth is profoundly affected by the orphanage/institutional setting 12)
    • For every 3.4 months an IAC spent in a orphanage, they fell 1 month behind typically developing peers in growth.
• Foster Care used to be a more common placement, although always smaller than institutions, but the percentage of IAC found here pre-adoption has been declining. In China some non-profit agencies, such as the Philip Hayden Foundation, have been making efforts to increase the number of family living environments for orphans. In the few homes like this that exist, children and adults are typically at a 3:1 ratio. This helps to support the mental and emotional health of the children. However, many of the children that end up in these foster homes are children that have already been identified with special needs, and may have language delays or disorders related to those diagnoses. 13) Other countries, such as Thailand and Kenya also have some foster care facilities. Currently orphanages are still the predominant environment, typically due to the large number of children, around the world.

Do IAC have feeding difficulties when they come to the United States? The answer to this question, is that some IAC do have feeing difficulties.14) These difficulties can exist pre- and/or post-adoption. These can be due to physical conditions (i.e. cleft palate), developmental delays, differences in delivery (i.e. bottle vs. cup), and/or differences in food type/texture (i.e. porridge or rice in native country vs. cheerios in U.S.). Difficulties may also arise from delayed initiation of solid foods, and a lack of variety of foods. Children often have difficulties with food that needs to be chewed, a preoccupation with the availability of food, and as well as a sensitivity to taste. 15)

What does English language development typically look like for IAC? As with all children, development varies. However, below is information known about how IAC have typically learned English post adoption.

Language Development Based on the IAC's Age at time of adoption:

• 0-6 months
  • Language development in English for IAC who arrive in the United States before 6 months of age are more likely to have typical language development than IAC who are older. Less time in language poor environments and exposure to English before native language has developed support the likelihood that English language will develop for these infants along a more typical timeline - although they may lag slightly behind as they adjust to the new sounds of English. However, health/medical conditions and physical special needs that the child may be affected by, (i.e.cerebral palsy, Down syndrome, cleft palate, etc.) need to be considered.16)

• 6 -24 months
  • Norms: Adopted between 7-12 months of age, after 9 months of English language the IAC should have 50 words, increasing to over 100 words at 12 months post adoption.17)
  • Refer for early intervention if the child scores below a DQ of 47 on the MacArthur-Bates Communicative Development Inventory: Words Comprehended (MCDI) or below the 15th percentile on the LDS or Rosetti.18)

• 12-24 months
  • Within their first year post-adoption you should not use norms of English monolingual children for comparison.
  • Refer for intervention if, at 2-4 months post-adoption, the child scores below the 20th percentile on three or more subtests on the MCDI and CSBS-DP.
  • Within first 6 months post-adoption, child should be able to achieve above a DQ of 47 on the MCDI Words Comprehended and above a total score of 80 on the Behavior Sample on the Communication Symbolic Behavior Scales (CSBS).19)

• 2 years+
  • Vocabulary: Adopted preschoolers show changes in vocabulary development that are much like those of English infants learning language.
    • Proportion of nouns decreased
    • Proportion of verbs and closed-class items increased
    • Still lag behind typical peer counterparts at 1 year post-adoption. 20)
  • Grammar:
    • Adopted preschools grammar development, when just looking at combining words, is also similar to English infants learning language.
    • Within one year post-adoption, child should fall within normal limits on tests of English language comprehension.
    • Within two years post-adoption, child can be assessed using English monolingual norms to establish presence of disorder.
  • May display competency in everyday language, as opposed to difficulties in academic language skills. 21)
  • Try to get as much information from the child’s case history (e.g. health, developmental milestones, speech and language, etc.) though it is not always available or dependable.

Is English language acquisition affected by native language competence?

Yes. However, under the age of 2 years, infants have not fully developed a strong base in their native language. Internationally adopted children who came into the country with minimal language skills, were at least 18 months old, and had the ability to imitate sounds in their native language, had better English language acquisition later. The skill of imitating is considered a predictor to later English language success. 22)

Typically, no they are not bilingual. For most IAC, they are first monolingual in the language of the country they are born in, and then they become monolingual in English – if there is no longer exposure to their native language. This phenomenon is called subtractive bilingualism and/or subtractive acquisition of language. Without constant usage and input, IAC children will lose their receptive and expressive abilities in their first language. Only when families are able to provide input in both the first language and English, should the IAC be considered bilingual.23) More about bilingualism.

• Expressive abilities in native language lost within 2-4 months of adoption
  • IAC lose the ability to speak in their native language while they are still acquiring English.
• Receptive/Comprehension abilities in native language lost within 4-6 months of adoption 24)

How do you know which IAC are good candidates for early intervention services?

• For IAC under 12 months at adoption, and who have been in their adoptive home for 16 months, a score falling below the 15th percentile on the Language Development Scale (LDS) or the Rosetti, is a good indication of later language deficits 25)
• For IAC between the ages of 11-23 months at adoption, and who have been in their adoptive home for 6 months, language scores on the MacArthur-Bates Communicative Development Inventory (MCDI) and the Communication Symbolic Behavior Scales (CSBS) should be within 1.25 standard deviations of the mean. This places their abilities in the average range. If their language scores are not within 1.25 SD, then it is predictive of later language deficits.26)

• IAC Under 2 years of age: 27)
  • A diagnosis known to affect development (eg. cerebral palsy, fetal alcohol syndrome, Down syndrome, etc.)
  • An identified health or medical problem (eg. malnutrition, tuberculosis, club feet, impaired vision or hearing, etc.)
  • A small head circumference - less than 5th percentile on a growth curve appropriate to the child's country of origin.
  • Absent or poor eye contact
  • Self-stimulating behaviors which are not diminishing (eg. rocking, head banging, etc.)
  • Significant developmental delays greater than those typically seen in IAC from similar environments
  • Abuse
  • Limited or absent vocalizations
  • Excessive irritability or inconsolability
  • Any combination of the above factors
• IAC 2 years or older - the guidelines for children under 2 years still apply 28)
  • Aggressive or violent behavior
  • Poor attention span (not related to language)
  • Decreased language/articulation skills in native language
  • Indiscriminate friendliness
  • Inappropriate behavior
  • Poor memory
  • Attachment issues
  • Learning delays
  • Any combination of the above factors

• Overall Guidelines 29)
  • It is important to avoid standardized evaluations. The results will not be valid and most children show significant changes in their development within the first several months after arrival. Remember, most standardized tests are normed on monolingual English speaking children, and/or children who have been exposed only to English if they are not yet speaking.
  • Use functional activities to gather information about the child, play with the child.
  • Use dynamic assessment: the “test-teach-retest” method will reveal a more accurate view of the child's abilities
  • Ask the parents if they have seen changes in the child in the time since the child was adopted. If the parents report they have not seen changes, the child should be followed closely, as most children make developmental changes quickly.
  • A general guideline is that for each 3 months in an institution, a child will lose approximately 1 month of development. See pre-adoption environments.
  • Neurological development assessments may be most helpful for young children (less than 20 months) to rule out neurological problems such as cerebral palsy. IAC, especially those from institutional settings, may have medical conditions that they were not been diagnosed with pre-adoption.
  • Have an interpreter present for children over 3 years of age (at time of adoption) to ascertain if the child has age-appropriate language skills in the language of his/her country of origin.
  • Adapt the session to the age of the child and the length of time the child has been in the adoptive home.
  • Newly arrived adoptees are difficult to evaluate, even under optimal conditions. Try to perform the developmental assessment when the child is at his or her best. Consult with the parent as to an appropriate time in the child's schedule, so the child has been fed, will be well rested, etc.
  • Although most IAC are not bilingual, look at the Assessment page for more ideas on reducing bias and increasing validity of assessments in populations that are not considered “mainstream.”

Do school age IAC need different considerations?

• Older children that have been internationally adopted are going to be losing their native language abilities at a faster rate than there are gaining English language abilities. For this reason, RTI or dynamic assessment will be the best and most accurate way to discern whether they have a language difference or disorder.30)

• Although many IAC score in the average range on language tests, it is important to keep in mind that they commonly have deficits in higher language functions (humor, figurative language) and pragmatic skills 31)

What cognitive differences/effects are seen in IAC children?

Glennen (2007) gives this analogy: each child is born with the potential for normal development. The longer a child is exposed to environmental deprivation, the more their potential is diminished, creating a child whose language and cognitive abilities are still arranged within a typical curve, but the curve's position has been altered down. Once the child has been adopted though, the new enriched environment counters the previous deleterious effects. Typical language use and cognition are typically reached 1-2 years post-adoption for children adopted before the age of 2. 32)

When looking at nonverbal and reading comprehension, when an IAC is less than 6 months of age at adoption they have better performance, and are closer to average when tested later. Children adopted at older ages, have poorer performance, a larger discrepancy from the mean of children who were adopted in the UK from the UK (same country adoption). This particular data applies to long term affects, not short term. The negative findings apply to what deficits remain years after adoption and learning the English language. 33)

• Differences in activity level (fidgety, impulsive, active), organization (frequently loses things, difficulties with transitions, easily distracted, short attention span) and social-emotional behaviors (has trouble getting along with others, overly sensitive or anxious, easily frustrated, has tantrums or is unusually uncooperative) can be seen in children with a history of institutionalization even less than 2 months pre-adoption, even after an average of 3 1/2 years of living with their adoptive families (Kadlec & Cermak, 2002).
  • The parents of children institutionalized less than 2 months pre-adoption reported significantly more problems in the three above domains than the parents of the children in the control group (American-born).
  • The children who were institutionalized for more than 6 months pre-adoption (6-48 months) scored significantly higher in the three domains than all other groups of children (those less than 6 months and the control group).
  • All IAC who were institutionalized demonstrated a high incidence of sensory issues and problems. 34)

• Child Behavior Checklist (CBCL):35)
  • IAC instutionalized 8+ months
  • Rated 11 months post adoption: high CBCL problem scores. 2% at a level recommending professional help.
    • Higher internalizing scores
    • Feeding problems (i.e. refusing solids) - 33%
    • Gorging - 30%
    • Stereotyped Behaviors - 84%
    • Withdrawl from siblings - 23%
    • Withdrawl from peers - 32%
  • Rated 3 years post adoption:
    • Continued behavior problems
    • 36% with a CBCL score above the clinical cutoff of “typical”
    • High externalizing scores
    • Descriptions given:
      • Aggressive
      • Anti-Social
      • Under-controlled
      • Rageful
      • Oppositional
    • Classroom descriptions:
      • Distractible
      • Hyper active
    • 35% had no serious problems
    • 35% had 1-2 serious problems, but were making progress
    • 30% had three or more serious problems 36)

• Potentially Harmful Behavior:37)
  • Indiscriminate friendliness - often part of attachment disorders in IAC, they need to be carefully monitored as they may be overly trusting of people they do not know.
  • Fixation with food and gorging - typically limited to edible items, but some children will eat anything they can find, such as plants and chemicals.

• Attachment Behavior:38)
  • IAC adopted before they were 4-6 months old displayed normal attachment behaviors
  • IAC who were in an institutional environment 8+ months had lower attachment scores
    • 1/3 of these children still had atypical attachment patterns 3 years post adoption
    • Also more indiscriminate friendliness for IAC in institutions for long periods

Websites

• Language Development in Internationally Adopted Children - http://pages.towson.edu/sglennen/index.htm
• Philip Hayden Foundation: China Orphan Outreach - http://www.philiphayden.org/
• U.S. Department of State - http://travelstate.gov Statistics, information, and legalities of international adoption
• Child Welfare League of America Child Welfare - http://ndas.cwla.org Statistics and information about adoption

Readings

• Croft, C., Beckett C., Rutter, M., Castle, J., Colvert E., Groothues C., Hawkins A., Kreppner J., Stevens S., Sonuga-Barke E.(2007) Early adolescent outcomes of institutionally-deprived and non-deprived adoptees. II: Language as a protective factor and a vulnerable outcome.Journal of Child Psychology and Psychiatry, 48, 31-44
• Glennen, S. (2007). Predicting language outcomes for internationally adopted children, Journal of Speech, Language, and Hearing Research, 50, 529-548.
• Glennen, S. (2007) Speech and language in children adopted internationally at older ages.Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 14, 17-20.
• Glennen, S. (2007) International Adoption Speech and Language Mythbusters. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 14, 3-8.
• Hwa-Froelick, D.A. (2007). Infants and Toddlers Adopted Abroad: Clinical Practices Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 14, 9-12
• Johnson D., Dole K. (1999). International adoptions: implications for early intervention Infants and Young Children, 11, 4, 34-45.
• Kadleec M.B., & Cermak S.A. (2002). Activity level, organization, and social-emotional behaviors in post-institutionalized children.Adoption Quarterly, 6, 43-57.
• Scott, K., & Roberts, J. (2007). Language Development of Internationally Adopted Children: The School-Age Years Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 14, 12-17.
• Snedecker, J., Geren, J., & Shafto, C. (2006) Starting Over International adoption as a natural experiment in language development. Psychological Science, 18, 79-87.