Center for Developmental Adoption Medicine
1400 Old York Road, Suite D
Abington, PA 19001
phone: 1-888-817-7303
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April 2008
Is My Child OK?
A Complex Question for Parents of International Adoptees

By Davida P. Harlem, Ph.D

All parents who bring a baby into their lives watch anxiously as the child grows. They all want to know the answer to an overarching question: Is my child OK?

The question is especially urgent for adoptive parents. They undertake the care of children whose early experiences may not be fully recorded. If medical records exist at all, they can be riddled with gaps. Information about the birth mother’s pregnancy and opportunities for development before the child reaches his or her adoptive family can be sketchy. For the growing number of families adopting children internationally, these uncertainties are magnified because studies show that international adoptees are the most high-risk pediatric group in the U.S.

Three-quarters of internationally adopted children come from institutional care in countries with low per capita income and with difficulty providing adequate nutrition and health care. These factors affect development in the early years and can have long-term impact on learning skills as well as social and emotional growth. At facilities like the Center for Developmental Adoption Medicine, the goal is to help help adoptive parents address their children’s developmental needs, including the unique needs of children adopted internationally.

An estimated 75 percent of international adoptees show some developmental delay. Some resolve on their own; some require intervention. But it’s difficult to separate what can resolve on its own from what needs intervention. Early identification of delays allows for prompt management and reduces the likelihood of delays during the school years. Delays can lead to behavior problems. If they are not managed, behavior problems can affect self-esteem, adjustment and interaction with peers.

Although parents often want to know if their child’s development is on track or how to recognize developmental delays, they should first understand that what to expect in a baby’s development varies. International adoptees, for example, may have spent much more time in a crib and may have had limited language.As a result, these children may have some catching up to do.

Through careful observation of four areas of development crucila for infants, toddlers and preschoolers—play and learning, language, motor skills, and social and emotional behavior—parents can formulate questions that can help them determine if they need another pair of eyes looking at their child's development.

Here are some questions adoptive parents may wish to keep in mind as they observe their child’s development in four critical areas:

Play and learning
• How is the child playing and solving problems at his/her age level?
• What is the quality of play?
• Does it include explorative, imitative and interactive play?
• What can be done to encourage or advance play and learning skills?

• Considering the child’s age in an international adoption, do we have a good sense of where the child was in language development at the time of adoption?
• Was the child young enough to be at the receptive language stage or at the expressive stage?
• In older children with established language skills, what are the considerations when the essential need is to start over?

Motor skills
• What kind of activities does the child exhibit during floor time?
• During group gym time?
• What activities are helpful in building motor skills and strengthening muscles?

Social and emotional behavior
• How is the child adjusting to a new routine and to sleeping and eating patterns?
• How is the child bonding to parents?
• How is the child forming attachments?

Some parents may need nothing more than reassurance that their child is indeed OK. Others may need specific recommendations tailored to meet their child's unique needs. In both instances, caring professional help is available to guide parents as they strive to create a stable and loving environment for their children.

Dr. Harlem, in private practice for 25 years, received her Ph.D in child/school psychology from the University of Pennsylvania with a clinical internship in developmental/psychological pediatrics at Children’s Hospital in Philadelphia. She also holds a master’s degree from Penn in psychological services. She is affiliated with Abington Memorial Hospital where she serves as the developmental psychologist to the Neonatal Follow-up Program. The pre- and post-adoption services provided by the Center for Developmental Adoption Medicine are detailed at