Children’s experiences prior to adoption and their developmental status at the time of adoption influence their outcomes (Balenzano, Coppola, Cassibba, & Moro, 2018). Children who experience neglect and fear and lack an early bond to a caregiver may experience difficulty regulating emotion and conflict. Biological mothers who choose to adopt may have experienced physical or mental health problems that interfered with their ability to care and form a bond and might be passed on. In other cases, the child may have experienced neglect, deprivation, and trauma, which influence adjustment (Grotevant & McDermott, 2014). Many children adopted from international orphanages arrive with experiences that are harmful, as discussed in the accompanying Cultural Influences on Development feature, Internationally Adopted Children.
Cultural Influences on Development
Internationally Adopted Children
International adoption has become more common in the United States, and there are important challenges that adopted children and families face.
Thierry Esch/Paris Match via Getty Images
Over the past five decades, international adoption has become commonplace. In many countries throughout the world, children are reared in orphanages with substandard conditions—without adequate food, clothing, or shelter and with poorly trained caregivers. Such orphanages have been found in a number of countries, including China, Ethiopia, Ukraine, Congo, and Haiti, accounting for over two thirds of internationally adopted children (U.S. Department of State, 2014). Underfunded and understaffed orphanages often provide poor, nonnurturing care for children, increasing the risks for malnutrition, infections, physical handicaps, and growth retardation (The Leiden Conference on the Development and Care of Children Without Permanent Parents, 2012). With high infant-to-caregiver ratios, children available for adoption often spend a significant amount of time deprived of consistent human contact.
Few internationally adopted children enter the United States healthy and at age-appropriate developmental norms. Not surprisingly, the longer the children were institutionalized, the more developmental challenges they face (Jacobs, Miller, & Tirella, 2010). Physical growth stunting is directly associated with the length of institutionalization, but catch-up growth is commonly seen after adoption (Wilson & Weaver, 2009). As with growth, the time spent in an orphanage predicts the degree of developmental delay. Longer institutionalization is associated with delays in development of language, fine motor skills, social skills, attention, and other cognitive skills (Mason & Narad, 2005; Wiik et al., 2011).
Speech and language delays are among the most consistent deficiencies experienced by internationally adopted children, especially those adopted after the age of 1 (Eigsti, Weitzman, Schuh, de Marchena, & Casey, 2011). However, more children reach normative age expectations 1 to 2 years postadoption (Glennen, 2014; Rakhlin et al., 2015). Generally, the younger the child is at adoption, the more quickly he or she will adapt to the new language and close any gaps in language delays (Mason & Narad, 2005). Some research suggests internationally adopted children are prone to long-term deficits in executive function likely due to neurological factors (Merz, Harlé, Noble, & McCall, 2016). The presence of a high-quality parent–child relationship promotes development of language, speech, or academic outcomes, and most children reach age-expected language levels (Glennen, 2014; Harwood, Feng, & Yu, 2013).
As adolescents, all children struggle to come to a sense of identity, to figure out who they are. This struggle may be especially challenging for internationally adopted children who may wonder about their native culture and homeland (Rosnati et al., 2015). Frequently, adolescents may want to discuss and learn more yet inhibit the desire to talk about this with parents (Garber & Grotevant, 2015). Parents who assume a multicultural perspective and provide opportunities for their children to learn about their birth culture support adopted children’s development and promote healthy outcomes (Pinderhughes, Zhang, & Agerbak, 2015). Internationally adopted children seek to understand their birth culture and integrate their birth and adopted cultures into their sense of self (Grotevant, Lo, Fiorenzo, & Dunbar, 2017). A positive sense of ethnic identity is associated with positive outcomes such as self-esteem in international adoptees (Mohanty, 2015). Although there are individual differences in the degree of resilience and in functioning across developmental domains, adopted children overall show great developmental gains and resilience in physical, cognitive, and emotional development (Misca, 2014; Palacios, Román, Moreno, León, & Peñarrubia, 2014; Wilson & Weaver, 2009).
What Do You Think?
In your view, what are the most important challenges internationally adopted children and their families face? Identify sources and forms of support that might help adopted children and their parents.
For many children, emotional differences are transitional. Research has suggested that most children show resilience in the years after adoption, but some issues continue (Palacios & Brodzinsky, 2010). Those who develop a close bond with adoptive parents tend to show better emotional understanding and regulation, social competence, and also self-esteem (Juffer & van IJzendoorn, 2007). This is true also of children who have experienced emotional neglect, and those effects hold regardless of age of adoption (Barone, Lionetti, & Green, 2017).
Table 2.6
Sources: Akolekar, Beta, Picciarelli, Ogilvie, and D’Antonio (2015); Chan, Kwok, Choy, Leung, and Wang (2013); Gregg et al. (2013); Odibo (2015); Shahbazian, Barati, Arian, and Saadati (2012); Shim et al. (2014); Theodora et al. (2016).
Prenatal Diagnosis
Prenatal testing is recommended when genetic counseling has determined a risk for genetic abnormalities, when the woman is older than age 35, when both parents are members of an ethnicity at risk for particular genetic disorders, or when fetal development appears abnormal (Barlow-Stewart & Saleh, 2012). Technology has advanced rapidly, equipping professionals with an array of tools to assess the health of the fetus. Table 2.6 summarizes methods of prenatal diagnosis.
The most widespread and routine diagnostic procedure is ultrasound, in which high-frequency sound waves directed at the mother’s abdomen provide clear images of the womb represented on a video monitor. Ultrasound enables physicians to observe the fetus, measure fetal growth, judge gestational age, reveal the sex of the fetus, detect multiple pregnancies (twins, triplets, etc.), and determine physical abnormalities in the fetus. Many deformities can be observed, such as cardiac abnormalities, cleft palate, and microencephaly (small head size). At least 80% of women in the United States receive at least one prenatal ultrasound scan (Sadler, 2015). Three to four screenings over the duration of pregnancy are common to evaluate fetal development (Papp & Fekete, 2003). Repeated ultrasound of the fetus does not appear to affect growth and development (Stephenson, 2005).
Ultrasound technology provides clear images of the womb, permitting physicians to observe the fetus, measure fetal growth, judge gestational age, reveal the sex of the fetus, detect multiple pregnancies, and determine physical abnormalities in the fetus.
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Fetal MRI applies MRI technology to image the fetus’s body and diagnose malformations (Griffiths et al., 2017). Most women will not have a fetal MRI. It is often used as a follow-up to ultrasound imaging to provide more detailed views of any suspected abnormalities (Milani et al., 2015). Fetal MRI can detect abnormalities throughout the body, including the central nervous system (Saleem, 2014). MRI