September 2005

Fostering Your Child's Development Following International Adoption

By Barbara Elleman, MHS, OTR/L, BCP, International Adoption Center

Finally, the day has arrived. You have spent months pouring over a picture of your new daughter or son. You have endured the hills and valleys of international adoption. At last you are home and ready to continue the journey into the future with a bright new addition to your family. As the dust settles, you may or may not notice that your child does not perform developmental skills at the same level of children of similar age. It is not uncommon for children who have been adopted internationally to demonstrate altered developmental skills in the areas of motor, language, social, sensory and / or self help skills when compared to their peers. This may be due to the difference in cultural or handling practices, environmental influences, nutrition and / or unknown prenatal or medical complications. Be assured that with your attention and nurturing, your child will likely make rapid gains in developmental skills as he or she adapts to family life.

This article will discuss different developmental skills and opportunities you can provide to foster your child's development in each area. It is important to remember that each child develops at a different rate and a physician or professional familiar with international adoption and child development are the best equipped to provide individual guidance regarding your child. Increasing your knowledge of normal development and the progression of developmental skills will also improve your ability to foster your child's development.

Muscle Strength

Some children adopted internationally may display weaker muscle strength than children born in the U.S. This may be due in part to differences in cultural practices, handling practices (i.e. such as time permitted crawling and playing on the floor), nutrition, or the environment. Poor muscle strength can contribute to difficulties with coordination and motor skills. Frequently a child's muscle strength improves naturally with the stimulation, nutrition and / or opportunities in your home. Activities to improve the muscle strength of your child would be beneficial. You can challenge your child's strength by altering the position or the resistance of the activity. Alter the position of an activity by having your child work arms at shoulder level or higher (i.e. drawing on an easel, placing toys in front of an infant on a stool). Alter the resistance of an activity by adding slightly weighted items (i.e. pushing a laundry basket with a few toys) or increase the challenge of an activity (i.e. walking up and down a hillside or over pillows).

Motor Skills

Children adopted internationally may have decreased gross motor (large movement) skills or fine motor (small movement) skills due to lack of opportunity (i.e. with crayons, balls or scissors) or due to limitations with muscle strength. To stimulate appropriate motor skills in your child:

Familiarize yourself with the normal progression of developmental skills.
Enlist the assistance of a physician or professional familiar with child development to determine your child's motor strengths and weaknesses.
Choose activities that are next in the sequence of development (i.e. if your child has mastered walking along furniture encourage walking with one hand held. If your child can put objects into a container encourage putting a circle into a circle slot. If your child has mastered jumping up and down encourage jumping forward or standing on one foot). Activities chosen should be fun and play for your child.
Adapt activities for difficulty to make them more or less challenging (i.e. for a 3 slot shape sorter place tape over the triangle and square slot and encourage your child to master putting circles in the circle slot before being challenged with all three choices).
Once your child has adjusted to home life, you can consider motor based community programs to stimulate skills such as a gym or activity class. It is important to consider your child's developmental abilities (not just age) when selecting a program.
In some instances, short-term intervention from an occupational or physical therapist and /or a referral to an early intervention program may be beneficial to promote achievement of motor skills.

Language

Your child's language skills are likely to be different from US born children for obvious reasons. Typically children will rapidly gain English skills through stimulation you provide. In general, if your child has developed age appropriate language skills in his or her native language; he or she can be expected to develop age appropriate English skills. Children who lived in an orphanage may have slightly decreased language skills compared to peers living in a home environment. You can maximize your child's English language skills through the following activities:

Read to your child frequently at any age.
Play games with your infant – imitating sounds and repeating sounds he or she makes.
Name things in and around the environment.
Reward and acknowledge any attempt to communicate and imitate the correct pronunciation (i.e. your child points to cup and grunts or screams- say "Oh you want your Cup" or your child points to the dog and says "da" – you say "That's right that's the Dog!")
Incorporate gestures or simple sign language with verbal communication. (This will give your child some means to communicate with you while he or she learns the English language. It can significantly decrease frustration in two- to three-year-olds). Check out the book Baby Signs by Linda Acredolo and Susan Goodwyn.
Children who are learning to walk or mastering new challenging motor skills frequently put talking "on hold" for a short while. This is a normal part of the developmental process. In this instance continue to talk to your child and encourage interactive verbalizations when your child is in a supported position such as sitting in a chair or highchair.
Occasionally, children who were adopted after they have established a native language may struggle with transitioning to the English language. If your child has trouble with understanding or using basic language after six to 12 months in the US it may be helpful to consult with a speech language pathologist or an English as a second language tutor. If you suspect difficulty with pronunciations of speech or use of speech, consult with your physician or a professional familiar with child development and international adoption to determine if a speech and language evaluation is indicated.

Sensory Skills

Sensory integration is the ability to interpret information from the senses and make an appropriate response. Children, who have been adopted internationally, particularly from an orphanage or a minimally stimulating environment, are at risk for dysfunction of sensory integration. Provide your child with an environment rich in sensory opportunities. Encourage activities that stimulate different senses (i.e. touch, movement, sound and sights etc). Watch your child's behaviors and reactions to new sensory experiences. If unusual responses persist over time, it may be helpful to consult with a physician or professional familiar with child development.

Personal / Social Skills

The initial months after arrival home can be a drastically different experience from one family to the next. Your child will need time to adjust to their new environment. You will need time to adjust to the new addition to your family.

Keep this a time of low stress by minimizing stimulating activities and outside distractions. Minimize multiple outings and establish routine for your child.
Recognize that your approach and interaction with your child may be very different from the approach and interaction he or she received from caregivers in an orphanage or a foster parent.
Allow ample time for your child to adjust.

If you become concerned that your child is not adjusting well, consult with a physician or a professional familiar with the adjustment of internationally adopted children (i.e. social worker, psychologist, etc).

The initial period after arrival home with your child is a time of excitement, adjustment and change. You can provide activities to foster your child's development if they are not performing skills consistent with other children their age. In some instances your child may benefit from support from additional services such as occupational therapy, physical therapy, speech therapy, psychology or early intervention programs. Children adopted internationally frequently make rapid developmental gains and changes after arriving home. It is beneficial to have your child evaluated by a physician or a professional familiar with child development and international adoption once you arrive home to help determine developmental skills and provide appropriate referrals and recommendations. While all children develop at different rates, if your child continues to perform skills at a level that is less than expected for his or her age after six to 12 months in the US, it may be beneficial to consider seeking further evaluation.