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Preparing Families for Adoption of Instiutionalized Children with Special Needs and/or Children At Risk for Special Needs

By Dr. Victor Groza and Daniela F. Ileana

International adoptions have increased since the end of World War II and currently represent about 10% of all adoptions in the United States1. While children are adopted from every continent, different countries have been primary sources for international adoption. Although 6,500 children were adopted from Germany by American families during the years 1963 to 19812, before 1990 most international adoptees came from Asia or South America. Beginning in 1990, international adoptions increased from Eastern and Central Europe. European adoptions, particularly in 1990 and 1991, were predominantly from Romania. By 1992, more children were adopted from the republics of the former Soviet Union rather than Eastern Europe. In 1995, there was an increase in children arriving from China. While the history and culture of each of these countries are different, there are many similarities in their child welfare systems that affect the issues faced by families who adopt internationally.

Child welfare systems, in most emerging countries, are institutional or group-care-based systems, unlike the United States, which is a foster-family-based system. Thus, the overwhelming majority of children adopted internationally have spent time in institutional settings. Many of these children are placed at infancy or shortly thereafter. Most of these children are not orphaned in the traditional sense, in that they still have birth parents who are alive but are unable or unwilling to care for them. Often, these children become part of the child welfare system due to family poverty. There are many similarities in the structure of the institutional systems, even though they are located in different countries. For example, the structure of the system in Romania, as described by Johnson, Edwards and Puwak (1993)3, is similar to the Russian structure, as described by Sloutsky (1997)4. Media reports of those institutions accessible by foreigners in China suggest a similar structure, although the quality of care observed in Chinese institutions is reportedly better then the quality of care in Eastern European or Russian institutions. Nevertheless, understanding the experiences of one cohort of families who adopted internationally may be very helpful to other families, regardless of the country from which they adopted. To have an accurate understanding of international adoption, practitioners must also have an understanding of the risk inherent to children who are institutionalized early in their lives. These risks have implications for preparing families to adopt international and for the delivery of post placement adoption services.

Early institutionalization increases the risk of attachment difficulties5. It can slow the child’s emotional, social, and physical development as well as affect the child’s ability to make smooth transitions from one developmental stage to another 6. Early institutionalization also increases the risks that the child will have psychiatric impairments as an adult 7.

However, it is equally clear that, while institutionalization places children at a great risk for many difficulties, results from adoption studies 8 and recent reports about children form Romania are quite positive 9. Nevertheless, concerns about the effects of early deprivation have received renewed attention as a result of the influx of international adoptees from former communist countries, particularly given the poor conditions of many institutions caring for orphaned or abandoned children 10.

Preparing Families for International Adoption of Institutionalized Children At Risk for Special Needs

General Issues

Preparation is an important part of the adoption process. At a minimum, parents should either receive training, or, in the event the agency facilitating the adoption does not provide training, attend seminars, or read books in the following areas:

· details on the legal and social process of adoption in the United States and abroad;

· issues of abandonment, separation, grief, loss and mourning for adoptees that are evident throughout the life cycle;

· issues of separation, grief, loss and mourning for infertile couples that are evident throughout the life cycle;

· the adoptive family’s life cycle and unique issues in family formation;

· individual and family identity development in adoption;

· unique issues of attachment in adoption;

· outcomes and risks in international adoptions; and

· dealing with unresolved infertility issues.

Financial Issues

Social workers should explore the following financial issues with families as they make their decisions to adopt. Adoptive families should:

· make sure they understand the fees they are being charged and how the fees are determined;

· know that they have the right to question any item or charge that they are incurring;

· determine whether they are responsible for traveling costs and arrangements in a host country, plus any additional fees they might be required to pay once they leave the United States;

· assess if their adoption agencies will pay for needed services after the children are placed in their homes and the adoptions are legalized;

· discern what expenses they will be responsible for if they are not approved to adopt children, or information is included in a home study that would disqualify them in their country of choice in adopting; and

· negotiate what expenses they will be responsible for in the event they change their minds about adopting or change their minds about a child chosen for them if they do not believe an appropriate match has been made.

Medical Care

Parents need to deal with the following issues:

· recognize that medical information received about children from developing countries is often inaccurate;

· obtain as much information as possible from the country of origin before placement;

· schedule a complete medical assessment by qualified U.S. medical personnel once the child is placed in the United States;

· gain a thorough understanding of health insurance coverage and be certain they have written documentation of coverage for the health problems or care of their adoptive children; and

· understand the medical issues they might face.

Day-to-day with the Adopted Child

Parents must realize that many international adoptees come from institutional settings where their needs are not consistently met. It is important for children to know that they can trust their caregivers to respond to their needs upon demand. Parents are encouraged to do the following:

· make sure that children have primary, consistent caregivers (either a stay-at-home parent or nanny) and not be placed in group situations (i.e., day care) for the first year after placement;

· provide structure, consistency, nurture and love;

· take breaks in their daily tasks of parenting in order to function optimally, using respite care as needed;

· recognize what they can and cannot change in their children; and

· understand that adding a child to any family is a stressful time.

There are also particular issues that families might need assistance with. These include:

Self-Stimulating Behaviors

· most parents report a decrease in self-stimulating behaviors over time;

· rocking behavior and other self-stimulating behaviors decrease after developmental intervention programs;

· rocking returns when children are either bored, exposed to new situations, or stressed

· for persistent behaviors, assessments need to be conducted with specialists who work with children with developmental disabilities; and

· families may want to explore the use of medication prescribed by pediatricians who have knowledge about the effects of deprivation on children.

Attachment Difficulties or Disorders

The following points are important for parents to gain an understanding of how to intervene with adoptive children who display attachment difficulties:

· behaviors that are not reinforced lose their effectiveness over time, and behaviors that are praised and reinforced are repeated;

· as children experience positive care consistently over time, attachment difficulties become less pronounced;

· the parent-child relationship is the best mechanism for promoting change in attachment;

· attachment patterns change over time as a result of the maturational process;

· parents can help their children examine and understand their past, give their children a vision for the future, and use appropriate and positive physical contact;

· parents need to model and express feelings; modeling and expressing feelings are essential components to facilitating attachment between parents and children;

· parents need to look for opportunities to promote attachment, such as when their children express anxiety or fear, or when they are ill or fatigued; and

· parents may need to learn how to change their expectations of their children and about their relationships with their children.

Language Impairments

· language difficulties are easy to identify;

· families should have their children evaluated by speech specialists; and

· families must work with these specialists in developing language intervention programs.

Auditory Processing Problems

Related to problems with language development are problems with listening, processing and integrating information, which are underlying sources of many learning, language and relationship problems.

· children with auditory processing problems often have speech and language difficulties as well as general learning;

· families should contact local or regional speech and hearing centers or programs for information, assessment, and recommendations; and

· if a child has a language difficulty, he or she may also be at-risk for auditory processing problems.

Educational Difficulties

Language impairments and auditory processing problems often result in educational difficulties. Issues to consider include:

· it is important for families to know that federal laws require local school districts to provide educational, developmental, and related services to children who have, or who are at risk of having, handicapping conditions;

· educational institutions play major roles in screening children for difficulties;

· educational services include remedial education as well as early intervention;

· some adopted children have difficulties with hyperactivity or are vulnerable to attention deficit difficulties;

· parents need to learn negotiating skills to deal with the educational maze; and

· parents need to learn advocacy skills to get educational needs met for their children.

Children’s Mental Health and Psychiatric Difficulties

Emotional and behavioral problems can lead to more serious mental health difficulties.

Comprehensive, multidisciplinary assessment, and treatment by trained and qualified child mental health specialists often are essential for intervention in mental health concerns.

Other Behavior and Developmental Concerns

Parents may have other behavior and development concerns that were not reviewed here. Sometimes, the best interventions for children are not formal services but activities that stimulate their growth and development. In addition to the recommendations above, imaginative play training--training comprised exercises and games to encourage and endorse imaginative play--has been reported to help children..

It is important for families to recognize that adopting internationally poses some risk with children who come from institutions. While most institutionalized children recover from the trauma, others continue to have special needs. Parents need to be prepared and flexible if they plan to be successful as adoptive families.

Copyright 2001 Dr. Victor Groza


1. Barth, R. P., & Berry, M. (1988). Adoption and disruption: Rates, risks and responses. New York: St. Martin’s.
2. Dodds, 1997.
3. Johnson, A. K., Edwards, R.L., & Puwak, H. C. (1993, September-October). Foster care and adoption policy in Romania: Suggestions for international intervention. Child Welfare, 72(5), 489-506.
4. Sloutsky. V. M. (1997). Institutional care and developmental outcomes of 6- and 7-year old children: A contextualist Perspective. International Journal of Behavior Development, 20(1):131-151.
5. Bowlby, 1951; Tizard & Joseph, 1970; Tizard & Rees, 1974, 1975; Tizard & Hodges, 1977; Goldfarb, 1943a, 1943b, 1944, 1955; Kirgan, Goodfield, & Campana, 1982; Magid & McKelvey, 1987.
6. Bowlby, 1951; Dennis, 1973; Freud & Burlingham, 1973; Provence & Lipton, 1962; Spitz, 1945; Kaler & Freeman, 1994; Tizard & Joseph, 1970; Tizard & Rees, 1974, 1975; Tizard & Hodges, 1977; Goldfarb, 1943a, 1943b, 1944, 1955.
7. Frank, Klass, Earls, & Eisenberg, 1996
8. Rathbun, DiVirgilio, & Waldfogel, 1958; Rathbun, McLaughlan, Bennett, & Garland, 1965; Kim, Hong, & Kim, 1979; Harvey, 1983; Tizard, 1991
9. Groze & Ileana, 1996; Macovitch, Goldberg, Gold, Washington, Wasson, Krekewich & Handely-Derry, 1997; Ames, 1997.
10. Ames, 1997; Ames & Carter, 1992; Chisholm, Carter, Ames, & Morison, 1995; Johnson, Miller, Iverson, Thomas, Franchino, Dole, Kiernan, Georgieff, & Hostetter, 1992; Kaler & Freeman, 1994; Sweeney & Bascom, 1995; Groze & Ileana, 1996.

Dr. Victor Groza is an Associate Professor and the Interim Associate Dean for Reseach and Training at Case Western Reserve University in Ohio. He is a prolific author and editor in the field of adoption studies; four books and over 40 professional articles are in publication. His website is
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