International Adoption and Clinical Practice

By Heidi Schwarzwald, Elizabeth Montgomery Collins, Susan Gillespie and Adiaha I. A Spinks-Franklin

No matter how positive the intent of prospective parents, international adoption is fraught with emotional, medical, administrative, linguistic, and geopolitical issues. And while a wide range of professionals supports adopted children and their families in adjusting to the inherent changes and disruptions, the pediatrician's tasks--identifying and treating existing health problems and preventing numerous others--are particularly complex.

 

International Adoption and Clinical Practice equips pediatricians with a comprehensive set of tools for establishing a long-term care plan and creating interventions to promote healthy development. This concise guide overviews the intricacies of the international adoption process and how they can affect the pediatrician's job, from potential pitfalls in collecting medical data from a child's birth country to tracking health concerns into adolescence and young adulthood. Developmental and behavioral issues including attachment, language acquisition, identity development, and consequences of abuse and neglect are also examined in this context. Figures, tables, and reference lists complement current information on topics such as:

• Epidemiology and demographics of international adoption.
• Pre-adoption evaluation of medical records.
• Guidelines for diagnostic testing, screening, laboratory evaluations, and immunizations.
• Common mental health issues faced by adopted children and their families.
• Long-term and adult outcomes of international adoption.
• Relevant policy issues and areas for future study. 

Every child deserves a safe and healthy home, and International Adoption and Clinical Practice gives pediatricians an in-depth framework for helping to make this possible as children make the transition to a new country and the next stage of their lives.

• Language: English
• Publisher: Springer
• Release date: Mar 13, 2015
• ISBN: 9783319134918

Book preview

© Springer International Publishing Switzerland 2015

Heidi Schwarzwald, Elizabeth Montgomery Collins, Susan Gillespie and Adiaha I. A Spinks-FranklinInternational Adoption and Clinical PracticeSpringerBriefs in Public Health10.1007/978-3-319-13491-8_1

1. Epidemiology of International Adoption

Heidi Schwarzwald¹  , Elizabeth Montgomery Collins²  , Susan Gillespie³   and Adiaha I. A. Spinks-Franklin⁴  

(1)

Texas Children’s Health Plan Center for Children and Women Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

(2)

Section of Retrovirology & Global Health Texas Children’s Hospital Center For International Adoption; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

(3)

Retrovirology and Global Health Texas Children’s Hospital Center For International Adoption, Houston, New York, USA

(4)

Meyer Center for Developmental Pediatrics Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA

Heidi Schwarzwald (Corresponding author)

Email: [e-mail]

Elizabeth Montgomery Collins

Email: [e-mail]

Susan Gillespie

Email: [e-mail]

Adiaha I. A. Spinks-Franklin

Email: [e-mail]

Keywords

International adoptionInter-country adoptionLegal process of adoptionProcess of international adoption

Demographics of Adoption

Since 1997 there have been large changes in the number of children being adopted internationally into the United States, the ages of these children and the gender. Peaking in 2004, the number of children being adopted into the United States has continued to decline since then (Fig. 1.1) . There has also been a striking equalization in the gender of children adopted internationally (Fig. 1.2). Initially, most children were female, however in recent years the number of boys and girls has approached parity. One possible explanation is the number of adoptions in the late 1990’s and early 2000’s from China. Adoptions from China have traditionally been girls. Finally, the proportion of children under the age of one at the time of adoption has been decreasing (Fig. 1.3). Several factors effect this change. First, the process of adoption is taking more time as more safeguards are in place (see Chap. 6). Also, the demographic of parentless children supports an older age at adoption . Worldwide, 95 % of all children orphaned are over 5 years of age (UNICEF 2007). UNICEF defines an orphan as a child who has lost at least one parent.

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Fig. 1.1

Total number of international adoptions into the United States 1997–2013. (Data source: http://​adoption.​state.​gov/​)

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Fig. 1.2

International adoptions into the United States, by sex 1997–2013. (Data source: http://​adoption.​state.​gov/​)

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Fig. 1.3

International adoptions into the United States by age, 1997–2013. (Data source: http://​adoption.​state.​gov/​)

Country of Origin

Throughout the late 1990’s and early 2000’s adoptions from Asia have clearly dominated. Until recently, China and Russia consistently had been among the most popular countries for inter-country adoption. However, as perceptions, economic vitality, and laws have changed, different countries have emerged. These trends are addressed in detail in Chapter 6. However, as the following figures illustrate, the change in countries of origin have been striking. The decrease in children from European countries also contributes to the increase in inter-racial adoptions. This trend has also added to the psycho-social complexity of international adoption , as discussed in Chapter 4.

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Fig. 1.4

Region of origin by year 1997–2013. (Data source: http://​adoption.​state.​gov/​)

A323749_1_En_1_Fig5_HTML.gif

Fig. 1.5

Trends of inter-country adoption by region 1997–2013

Legal Process of Adoption

For families adopting internationally, there are many legal documents and processes that need to be followed . The process can be lengthy so that by the time a family presents to the provider with a file on a potential adoptee, they have invested a great deal of time, energy and emotion. This can heighten the anxiety and the pressure for a quick but thorough review. Figure 1.6 is a brief review of the process. The United States State Department has a booklet entitled Intercountry Adoption A to Z designed to assist families.

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Fig. 1.6

Process of intercountry adoption

Conclusion

Changes in the country of origin for children adopted internationally changes the health risks anticipated at the time of adoption. As the countries of origin change, this also changes. Hence, understanding the trends in inter country adoption helps the pediatric provider prepare to support children and their families as they transition from their country of origin to their new country.

References

http://​www.​unicef.​org/​media/​media_​45290.​html

http://​adoption.​state.​gov/​

Intercountry Adoption From A to Z. http://​adoption.​state.​gov/​content/​pdf/​Intercountry_​Adoption_​From_​A_​Z.​pdf

© Springer International Publishing Switzerland 2015

Heidi Schwarzwald, Elizabeth Montgomery Collins, Susan Gillespie and Adiaha I. A Spinks-FranklinInternational Adoption and Clinical PracticeSpringerBriefs in Public Health10.1007/978-3-319-13491-8_2

2. Best Practices in Care and Treatment of Internationally Adopted Children

Heidi Schwarzwald¹  , Elizabeth Montgomery Collins²  , Susan Gillespie³   and Adiaha I. A. Spinks-Franklin⁴  

(1)

Texas Children’s Health Plan Center for Children and Women Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

(2)

Section of Retrovirology & Global Health Texas Children’s Hospital Center For International Adoption; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

(3)

Retrovirology and Global Health Texas Children’s Hospital Center For International Adoption, Houston, New York, USA

(4)

Meyer Center for Developmental Pediatrics Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA

Heidi Schwarzwald (Corresponding author)

Email: [e-mail]

Elizabeth Montgomery Collins

Email: [e-mail]

Susan Gillespie

Email: [e-mail]

Adiaha I. A. Spinks-Franklin

Email: [e-mail]

Keywords

International AdoptionPre-adoptionMedical HistoryDevelopmental DelaysFetal Alcohol Syndrome

Pre-adoption Evaluation of Medical Records

Once parents have been approved for international adoption , they will receive information about a child that is eligible for adoption by either receiving a referral from their adoption agency, by expressing interest in a child identified from an on-line reference list or, in some situations, parents initially travel to the country of adoption where only then are they are presented with an eligible child for consideration. Parents then have a limited amount of time to accept or decline the child being considered, sometimes as little as 24–48 h. In order to make informed decisions about accepting the referral, prospective parents will often seek assistance from a pediatrician, or a pediatric international adoption specialist to review the information to identify potential health risks and conditions.

Typically, information provided to parents will include medical records, photographs and sometimes videos. Depending on the country of origin, the quality of the medical records and the validity of recorded diagnoses are quite variable. Medical terminology varies among countries and translation of medical records into English introduces another potential mechanism for error. Medical records including growth points and laboratory results may be up to date or many months to years out of date. There may or may not be birth history available. Often photos and videos will not be dated. Despite these constraints however, the pediatrician should carefully review all available information to inform parents of possible medical, behavioral, social, or psychological problems that the child may have and the anticipated work-up, treatment and prognosis of those problems. The pediatrician should describe the problems in clear and straightforward language to enable the parents to understand the issues and make informed decisions. The pediatrician does not evaluate whether the child is normal or abnormal, but instead the goal is to interpret the data in terms of risk for morbidity, chronic illness and need for immediate or long-term care. Parents most often want to know if the problems identified might prevent the child from becoming healthy, independent adults.

Very few children adopted internationally would be classified to be at low risk for having future medical, behavioral, social, or psychological problems. Factors associated with being classified as low risk are being followed by a pediatrician or healthcare provider since birth, having a history of normal growth and development, living in a community setting as opposed to being institutionalized, and being younger at the time of adoption. A child assessed as being at average risk for future issues suggests that the child is at risk of having the known sequelae of institutionalization but no other diagnoses of serious medical conditions. An assessment of a child having a high risk for future issues acknowledges that the child is at higher risk for poor outcomes not only because they have been raised in an institution and/or other neglectful environment, but also because of abnormal historical, physical and/or developmental findings. These might include extremely low birth weight, the history of maternal drug or alcohol use, facial characteristics of FAS or other congenital syndrome, microcephaly, extremely delayed or regression of developmental milestones, older age, or a myriad of other factors. Specific issues to address in the medical records are summarized in Table 2.1.

Table 2.1

Review of Medical History and Previous Records