What are some common misconceptions about the needs of internationally adopted children?

Find out in this Q&A with the author of Supporting Development in Internationally Adopted Children

About the author

Dr. Deborah Hwa-Froelich

Deborah A. Hwa-Froelich, Ph.D., CCC-SLP., is a professor in the Department of Communication Sciences and Disorders at Saint Louis University. She is also the founder of the International Adoption Clinic (IAC), a developmental clinic specializing in intervention services for internationallly adopted children and their families.

A recipient of the Angel in Adoption award from the U.S. Congressional Coalition on Adoption Institute, Dr. Hwa-Froelich also received the Louis M. Di. Carlo award for Clinical Achievement from the American Speech – Language – Hearing Association (ASHA), and the Missouri Speech – Language – Hearing Associations's Outstanding Clinician of the Year award.

Dr. Hwa-Froelich has published and presented extensively on the topic of international adoption development, child development, and the effects of cultural and linguistic diversity on communication development and disorders.


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Q: Over the course of your career, you have worked with many children adopted from abroad. If you could clear up one common misconception adoptive parents carry, what would it be?

A: A common misconception many parents have is that love is all the children need. While it is true that many of these children have not received love, and love is essential and important for them to receive following adoption, the misconception that love is all they need leads parents to overlook other factors that may affect their children's health and development. Until parents realize their children may need support services, their children miss out on early intervention services that could benefit their development.

Q: What about the professionals who work with children adopted internationally?

A: Professionals who have little experience or knowledge about internationally adopted children often believe all children have received similar medical care and once adopted will develop just like children who are raised by their biological families. Medical and institutional care, as well as educational practices, vary widely among countries.

Based on these assumptions, medical professionals serving children after they have been adopted may not run appropriate tests or prescribe appropriate medications. Psychologists or counselors may apply behavioral and parenting strategies that could negatively affect the parentchild relationship and the child's social-emotional development.

Early childhood professionals, special educators, and physical, occupational, or speech-language therapists may not understand the different developmental profiles of internationally adopted children; they may assume the children will learn and develop similar to other children or like children who are bilingual. Internationally adopted children have different health and social-emotional needs. They develop differently from nonadopted children and from bilingual children. This book was written in an attempt to address some of these misconceptions.

Q: Some professionals or educators treat children adopted internationally as "typical" English language learners. Is that appropriate?

A: Children adopted from abroad represent a different kind of language learner. Most internationally adopted children are adopted by parents who do not speak the children's birth language or do not have resources to provide exposure and continued language learning in the child's birth language. And some children prefer to listen to and speak their adopted language because this language is linked to more positive emotional experiences. In these instances, birth language attrition occurs quite quickly.

In addition, children who experienced institutional care prior to adoption may have received limited input and social interaction due to the high child-to-caregiver ratios. Thus, communication development is often developmentally delayed.

Given these circumstances, internationally adopted children demonstrate disrupted language learning; following adoption they begin learning an adopted language as a second first language at a later age. The developmental trajectory differs from children learning one language from birth and from children learning two or more languages.

Q: What special factors need to be taken into consideration in determining interventions for internationally adopted children?

A: Although more research is needed to fully understand all the variables that may influence children's outcomes following adoption, some variables have been documented in the literature. These variables include:

a) quality of prenatal care or maternal health during pregnancy

b) age of adoption

c) quality of preadoptive care

d) number of transitions

e) rejecting behaviors

f) adoptive parental sensitivity, and

g) birth language similarities or differences compared to the adopted language

The mother's health during pregnancy affects the health of the fetus. In some instances, there may be substance abuse or no prenatal care. In other instances, the mother may have other medical problems such as mental health disorders. The pregnancy may be a high-risk pregnancy such as the 13th pregnancy for an older mother.

Age of adoption and quality of preadoptive care are often proxies for exposure to adverse care. The longer the duration of adverse care, the poorer the developmental outcomes. Other indications of poor care are scars from severe diaper rash, evidence of persistent, untreated ear infections, and other instances of ignored or unattended health problems. These variables are correlated to poorer developmental outcomes.

The number of transitions among caregivers and the observation of the child rejecting the adoptive parents may be indications of future social-emotional problems. Children who have experienced adults entering and leaving their lives several times prior to adoption may have difficulty trusting that the adoptive parents will stay and remain in their lives.

However, if children have parents who are able to read, accurately interpret, and respond to their children's communication and needs, they tend to develop close, attuned relationships and have more positive outcomes than children whose parents demonstrate less sensitive parenting behaviors.

Finally, it is important to compare and contrast the child's birth language with their adopted language. Birth language differences may influence acquisition and processing of the adopted language. These differences in language acquisition may be misinterpreted as a language impairment or may affect learning.

Although there may be other variables that should be considered, it is important to gather information regarding these variables for assessment and intervention planning.

Q: You strongly emphasize the importance of assessment and monitoring for disorders and delays. What assessments do you recommend?

A: I would recommend that immediately following adoption, a pediatrician with special training and experience in examining internationally adopted children examine and assess the health and physical development of the child. I also recommend that the child receive a developmental screening/assessment that includes a hearing screening and a feeding assessment if there are concerns about eating behaviors.

Even when children appear to be healthy and within normal range for early development, it is important to reassess them when they become school-aged. Recent research shows that internationally adopted children may catch up with nonadopted peers during the preschool years but fall behind at older ages. It is for these reasons that I also recommend a follow-up evaluation at school age so that if needed, intervention can be initiated.

Q: Perhaps the greatest challenge in working with children adopted internationally is the gap in knowledge of some of their early experiences/health history. How can professionals determine appropriate interventions when they don't know all the facts?

A: The lack of information about the children's health and development prior to adoption is truly challenging. However, professionals can gather important information from the parents' observations and through behavioral testing that can help guide interventions.

At the International Adoption Clinic at Saint Louis University, we conduct ethnographic interviews with all family members involved in the care of the child. This information helps guide our assessment. We conduct an in-depth assessment to add to the information gathered from the parents and other professionals who may have assessed the child. From this holistic perspective, we are able to recommend additional testing and interventions to facilitate the child's learning.

Q: Can you provide an example of how early deprivation can manifest after adoption?

A: Early deprivation can and does result in many different behaviors. Each child presents with a unique profile of strengths and weaknesses and each child may receive different variations of adverse care. Consequently each child may be affected in myriad ways.

Children learn to survive in different ways and the behaviors that result in increased attention or preferred treatment are the behaviors that persist after adoption. For example, if children receive more attention by showing friendly behaviors to strangers, they will continue to demonstrate these behaviors following adoption. If heightened alertness and ability to grab food results in more food, or running results in avoidance of corporal punishment, these behaviors will persist. If passive withdrawal results in receiving less negative attention, a child may persist in demonstrating these behaviors also.

I have seen a wide range of behaviors indicative of insecure relationships that are often misinterpreted by professionals and parents. Professionals working with internationally adopted children need to be aware of the many different ways children may demonstrate insecurity to be able to guide family interventions appropriately.

Q: What are some interventions that have shown promise in assisting with such issues?

A: Some of my longitudinal research documented that children become aware of strangers between 6–8 months following adoption. We recommend that adopted children are primarily cared for by one or both parents during the first 6 months following adoption to help facilitate a close relationship. Supporting the parent–child relationship in all interventions is also recommended. Interventions that are relationship-based are described in detail in chapter 9.

Q: How did your own interest in the development of internationally adopted children arise?

A: Initially, I suggested this population to a monolingual graduate student who wanted to research children from Asian countries. Although at that time I did not realize how closely adoption was related to my own life, it quickly became apparent to me. My mother was the 8th daughter born to a poor farming family in rural China. She was given to an unmarried aunt who provided basic biological care without the nurturing love my mother needed. Since my mother did not receive the love and nurturance she needed as a child, she had no role model to follow when she had children of her own. I also married a man whose father had been domestically adopted. He too struggled to form secure, close relationships.

These personal experiences have influenced and guided my work. It is my hope that this work helps professionals who support adopted children and their families as well as parents in developing attuned relationships with their children.

Supporting Development in Internationally Adopted Children

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