Child Psychiatry & Human Development

, Volume 41, Issue 1, pp 15–29 | Cite as

Developmental and Behavioral Performance of Internationally Adopted Preschoolers: A Pilot Study

  • Emma Jacobs
  • Laurie C. Miller
  • Linda G. Tirella
Original Article

Abstract

Most international adoptees (IA) have rapid catch-up of the delays common at arrival. However, it is not known whether development at arrival predicts later abilities or school readiness. Therefore, we comprehensively evaluated language, fine motor, visual reception (VR), executive function (EF), attention (ATT), and sensory skills (SS) in IA preschoolers. We hypothesized that pre-adoptive risk factors, development at arrival, and the post-adoptive environment (time in day care) would predict developmental and behavioral outcomes and school readiness. 37 IA (12M:25F), currently age 4–5 years and previously seen in our clinic (mean arrival age 12 months), were evaluated with standardized tests of development, language, EF, ATT, and SS, along with demographic information, parent interview, and review of arrival clinic records. Fine motor and VR skills at arrival ranged from average to very below average. At followup, most IA were average or above average in fine motor, VR, and language skills, but many had concerning scores for ATT (42%), EF (11%) and SS (48%). Arrival expressive language T scores (Mullen) predicted follow-up scores for expressive language (PLS-4, r = .44, p = .005). Arrival fine motor scores (Mullen) correlated with follow-up auditory comprehension scores (PLS-4, r = .47, p = .002) and inversely with inattention scores (Conners’, r = −.48, p = .003). Arrival visual reception scores correlated inversely with global measures of attention (Conners’ opposition r = −.45, p = .005, ADHD scores r = −.49, p = .002, and to a lesser extent hyperactivity r = −.35, p = .03). Age at arrival was a very strong predictor of many of the outcome measures tested, including language performance, attention regulation, executive function, and sensory processing. Children who spent more time in daycare had significantly more difficulty with emotional control (p = .005). Although IA have good catch-up in specific areas of development, difficulties with ATT regulation, EF, and sensory processing may increase the risk of later school problems.

Keywords

International adoption Adoption Orphanage School readiness 

References

  1. 1.
    Immigrant visas issued to orphans coming to the US (2008) Available at: http://travel.state.gov/adopt.html. Accessed 15 Aug 2008
  2. 2.
    Miller LC (2005) The handbook of international adoption medicine. Oxford University Press, New YorkGoogle Scholar
  3. 3.
    Johnson DE (2002) Adoption and the effect on children’s development. Early Hum Dev 68(1):39–54CrossRefPubMedGoogle Scholar
  4. 4.
    Johnson D (2000) Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees. In: Nelson CA (ed) The effects of early adversity on neurobehavioral development. Lawrence Erlbaum Associates, MahwahGoogle Scholar
  5. 5.
    Dawson G, Ashman SB, Carver LJ (2000) The role of early experience in shaping behavioral and brain development and its implications for social policy. Dev Psychopathol 12(4):695–712CrossRefPubMedGoogle Scholar
  6. 6.
    Gunnar MR (1998) Quality of early care and buffering of neuroendocrine stress reactions: potential effects on the developing human brain. Prev Med 27(2):208–211CrossRefPubMedGoogle Scholar
  7. 7.
    Gunnar MR, Bruce J, Grotevant HD (2000) International adoption of institutionally reared children: research and policy. Dev Psychopathol 12:677–693CrossRefPubMedGoogle Scholar
  8. 8.
    Nelson CA, Zeanah CH, Fox NA, Marshall PJ, Smyke AT, Guthrie D (2007) Cognitive recovery in socially deprived young children: the Bucharest early intervention project. Science 318:1937–1940CrossRefPubMedGoogle Scholar
  9. 9.
    Davies D (2004) Child development—a practitioner’s guide. Guilford Press, New YorkGoogle Scholar
  10. 10.
    Shonkoff JP, Phillips DA (eds) (2000) From neurons to neighborhoods. National Academy Press, WashingtonGoogle Scholar
  11. 11.
    Greenough WT, Black JE, Wallace CS (1987) Experience and brain development. Child Dev 58:539–559CrossRefPubMedGoogle Scholar
  12. 12.
    Newport EL (1990) Maturational constraints on language learning. Cog Sci 14:11–28CrossRefGoogle Scholar
  13. 13.
    Levay S, Weisel TN, Hubel DH (1980) The development of ocular dominancy columns in normal and visually deprived monkeys. J Comp Neurol 19:11–51Google Scholar
  14. 14.
    Albers LH, Johnson DE, Hostetter MK, Iverson S, Miller LC (1997) Health of children adopted from the former Soviet Union and Eastern Europe. Comparison with pre-adoptive medical records. JAMA 278(11):922–924CrossRefPubMedGoogle Scholar
  15. 15.
    Carlson M, Earls F (1997) Psychological and neuro-endocrinological sequelae of early social deprivation in institutionalized children in Romania. Ann N Y Acad Sci 807:419–428CrossRefPubMedGoogle Scholar
  16. 16.
    Cermak SA, Daunhauer LA (1997) Sensory processing in the post-institutionalized child. Am J Occup Ther 51(7):500–507PubMedGoogle Scholar
  17. 17.
    Gunnar MR, van Dulmen MHM, The International Adoption Project Team (2007) Behavior problems in post-institutionalized internationally adopted children. Dev Psychopathol 19:129–148CrossRefPubMedGoogle Scholar
  18. 18.
    Judge S (2003) The impact of early institutionalization on child and family outcomes. Adopt Q 7(3):31–48CrossRefGoogle Scholar
  19. 19.
    Juffer F, van IJzendoorn MH (2005) Behavior problems and mental health referrals of international adoptees. JAMA 293(20):2501–2515CrossRefPubMedGoogle Scholar
  20. 20.
    Kadlec MB, Cermak S (2002) Activity level, organization, and social-emotional behaviors in post-institutionalized children. Adopt Quarterly 6:43–57CrossRefGoogle Scholar
  21. 21.
    Lin S, Cermak S, Coster WJ, Miller LC (2005) The relationship between length of institutionalization and sensory integration in children adopted from Eastern Europe. Am J Occup Ther 59(2):139–147PubMedGoogle Scholar
  22. 22.
    McGuinness T, McGuinness J (1999) Speech and language problems in international adoptees. Am Fam Physician 60(5):1322–1323PubMedGoogle Scholar
  23. 23.
    Morison SJ, Ames EW, Chisholm K (1995) The development of children adopted from Romanian orphanages. Merrill Palmer Q 41(4):411–430Google Scholar
  24. 24.
    O’Connor TG, Rutter M, Beckett C, Keaveney L, Kreppner JM (2000) The effects of global severe privation on cognitive competence: extension and longitudinal follow-up. English and Romanian Adoptees Study Team. Child Dev 71(2):376–390CrossRefPubMedGoogle Scholar
  25. 25.
    Rutter M, Andersen-Wood L, Beckett C et al (1999) Quasi-autistic patterns following severe early global privation. English and Romanian Adoptees (ERA) Study Team. J Child Psychol Psychiatry 40(4):537–549CrossRefPubMedGoogle Scholar
  26. 26.
    Stams GJ, Juffer F, Rispens J, Hoksbergen RA (2000) The development and adjustment of 7-year-old children adopted in infancy. J Child Psychol Psychiatry 41(8):1025–1037CrossRefPubMedGoogle Scholar
  27. 27.
    Tirella LG, Chan W, Miller LC (2006) Educational outcomes of 8–12 year old children adopted from Eastern Europe. J Res Child Educ 20(4):245–254Google Scholar
  28. 28.
    van Londen WM, Juffer F, van IJzendoorn MH (2007) Attachment, cognitive, and motor development in adopted children: short-term outcomes after international adoption. J Pediatr Psychol 32(10):1249–1258CrossRefPubMedGoogle Scholar
  29. 29.
    Miller LC, Chan W, Tirella LG, Perrin E (2009) Outcomes of children adopted from Eastern Europe. Internat J Behav Dev 33Google Scholar
  30. 30.
    Castle J, Groothues C, Bredenkamp D, Beckett C, O’Connor T, Rutter M (1999) Effects of qualities of early institutional care on cognitive attainment. E.R.A. Study Team. English and Romanian Adoptees. Am J Orthopsychiatry 69(4):424–437CrossRefPubMedGoogle Scholar
  31. 31.
    Croft C, Beckett C, Rutter M et al (2007) Early adolescent outcomes of institutionally-deprived and non-deprived adoptees. II: Language as a protective factor and a vulnerable outcome. J Child Psychol Psychiatry 48(1):31–44CrossRefPubMedGoogle Scholar
  32. 32.
    Judge S (2003) Developmental recovery and deficit in children adopted from Eastern European orphanages. Child Psychiat Hum Dev 34(1):49–62CrossRefGoogle Scholar
  33. 33.
    Rutter M, Colvert E, Kreppner J et al (2007) Early adolescent outcomes for institutionally deprived and non-deprived adoptees. I: Disinhibited attachment. J Child Psychol Psychiatry 48(1):17–30CrossRefPubMedGoogle Scholar
  34. 34.
    Verhulst FC, Althaus M, Versluis-Den Bieman HJM (1990) Problem behavior in international adoptees: an epidemiologic study. J Am Acad Child Adolesc Psychiatry 29(1):94–103PubMedGoogle Scholar
  35. 35.
    Verhulst FC, Versluis-Den Bieman HJM, Van der Ende J, Berden GFMG, Sanders-Woudstra JAR (1990) Problem behavior in international adoptees: III. Diagnosis of child psychiatric disorders. J Am Acad Child Adolesc Psychiatry 29:420–428PubMedGoogle Scholar
  36. 36.
    Beverly BL, McGuinness T, Blanton DJ (2008) Communication and academic challenges in early adolescence for children who have been adopted from the former Soviet Union. Lang Speech Hear Serv Sch 39:303–313CrossRefPubMedGoogle Scholar
  37. 37.
    Keyes MA, Sharma A, Elkins IJ, Iacono WG, McGue M (2008) The mental health of US adolescents adopted in infancy. Arch Pediatr Adolesc Med 162(5):419–425CrossRefPubMedGoogle Scholar
  38. 38.
    Mullen EM (1995) Mullen scales of early learning. American Guidance Services, Circle PinesGoogle Scholar
  39. 39.
    Carter AS, Briggs-Gowan MJ (2006) Manual for the infant-toddler social & emotional assessment (ITSEA)—Version 2. Psychological Corporation, Harcourt Press, San AntonioGoogle Scholar
  40. 40.
    Zimmerman I, Steiner V, Pond R (2002) Preschool language scale-4. Harcourt Assessment Co., San Antonio, TXGoogle Scholar
  41. 41.
    U.S. Department of Health and Human Services (2009) Child development assessment tools. http://www.acf.hhs.gov/programs/opre/ehs/perf_measures/reports/resources_measuring/res_meas_cdibb.html. Accessed 2 Jun 2009
  42. 42.
    Conners CK (1997) Conners’ rating scales revised. Multi-Health Systems, North TonawandaGoogle Scholar
  43. 43.
    Gioia GA, Espy KA, Isquith PK (2002) Behavior rating inventory of executive function, preschool version (BRIEF-P). Psychological Assessment Resources, OdessaGoogle Scholar
  44. 44.
    Dunn W (1999) Sensory profile (3–10 years). Harcourt Assessments, Inc, San AntonioGoogle Scholar
  45. 45.
    Centers for Disease Control and Prevention. Epi Info 2004 Version 3.2.2. www.cdc.gov/epiinfo
  46. 46.
    Miller LC, Hendrie NW (2000) Health of children adopted from China. Pediatrics 105(6):E76CrossRefPubMedGoogle Scholar
  47. 47.
    Miller LC, Kiernan MT, Mathers MI, Klein-Gitelman M (1995) Developmental and nutritional status of internationally adopted children. Arch Pediatr Adolesc Med 149(1):40–44PubMedGoogle Scholar
  48. 48.
    Chisholm K (1998) A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Dev 69(4):1092–1106PubMedGoogle Scholar
  49. 49.
    Snowling MJ, Bishop DV, Stothard SE, Chipchase B, Kaplan C (2006) Psychosocial outcomes at 15 years of children with a history of speech-language impairment. J Child Psychol Psychiatry 47(8):759–765CrossRefPubMedGoogle Scholar
  50. 50.
    Stevenson J (1984) Predictive value of speech and language screening. Dev Med Child Neurol 26(4):528–538PubMedCrossRefGoogle Scholar
  51. 51.
    Aram DM, Nation JE (1980) Preschool language disorders and subsequent language and academic difficulties. J Commun Disord 13(2):159–170CrossRefPubMedGoogle Scholar
  52. 52.
    Aram DM, Ekelman BL, Nation JE (1984) Preschoolers with language disorders: 10 years later. J Speech Hear Res 27(2):232–244PubMedGoogle Scholar
  53. 53.
    Tizard B, Cooperman O, Joseph A, Tizard J (1972) Environmental effects on language development: a study of young children in long-stay residential nurseries. Child Dev 43:337–358CrossRefGoogle Scholar
  54. 54.
    Huttenlocher J (1998) Language input and language growth. Prev Med 27(2):195–199CrossRefPubMedGoogle Scholar
  55. 55.
    Tirella LG, Chan W, Litvinova A, Cermak S, Miller LC (2008) Time use in a Russian orphanage. Child Care Health Dev 34(1):77–86PubMedGoogle Scholar
  56. 56.
    Dubrovina I (1991) Psychological development of children in orphanages (“Psichologicheskoe razvitie vospitanikov v detskom dome”). Prosveschenie Press, MoscowGoogle Scholar
  57. 57.
    Glennen SL (2002) Language development and delay in internationally adopted infants and toddlers: a review. Am J Speech Lang Pathol 11:333–339CrossRefGoogle Scholar
  58. 58.
    Glennen SL, Masters MG (2002) Typical and atypical language development in infants and toddlers adopted from Eastern Europe. Am J Speech Lang Pathol 11:417–433CrossRefGoogle Scholar
  59. 59.
    Glennen SL (2005) Five years later: language in school-age internationally adopted preschoolers. Semin Speech Lang 26(1):86–101CrossRefPubMedGoogle Scholar
  60. 60.
    Gindis B (1998) Language related issues for international adoptees and adoptive families. In: Tepper T, Hannon L, Sandstrom D (eds) International adoption: challenges and opportunities. PNPIC, Meadow Lands, pp 98–108Google Scholar
  61. 61.
    Rygvold A-L (1999) Intercountry adopted children’s language and academic skills. In: Rygvold A-L, Dalen M, Saetersdal B (eds) Mine–yours–ours and theirs. University of Oslo, Oslo, pp 221–229Google Scholar
  62. 62.
    Miller LJ, Coll JR, Schoen SA (2007) A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorders. Am J Occup Ther 61(2):228–238PubMedGoogle Scholar
  63. 63.
    Tepper T (ed) (2002) Executive function: http://www.pnpic.org/exec_fun.htm parent network for the post-institutionalized child
  64. 64.
    Stevens S, Sonuga-Barke EJS, Kreppner J et al (2008) Inattention/overactivity following early severe institutional deprivation: presentation and associations in early adolescence. J Abnorm Child Psychol 36(3):385–398CrossRefPubMedGoogle Scholar
  65. 65.
    Colvert E, Rutter M, Kreppner J, et al (2008) Do theory of mind and executive function deficits underlie the adverse outcomes associated with profound early deprivation? Findings from the English and Romanian Adoptees Study. J Abnorm Child Psychol 36(7):1057–1068CrossRefPubMedGoogle Scholar
  66. 66.
    Miller LC (2000) Initial assessment of growth, development, and the effects of institutionalization in internationally adopted children. Pediatr Ann 29(4):224–232PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Emma Jacobs
    • 1
  • Laurie C. Miller
    • 1
  • Linda G. Tirella
    • 1
  1. 1.International Adoption ClinicTufts Medical CenterBostonUSA

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