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| |    Developmental and Emotional Issues in International Adoption by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Most internationally adopted children have led hard lives. Many have lived in institutions that barely met their physical and emotional needs, while those who have had loving foster parents have had to endure the pain of leaving them behind. Not surprisingly, parents often worry about the long-term effects of such traumatic early experiences. The good news is that most internationally adopted children grow up to be emotionally healthy. They may feel disoriented or experience grief at first, but most make strong, loving connections with their new families. On the whole, they also do well developmentally. Early on, nearly all show signs of delayed growth and development by U.S. standards, but most catch up within two or three years. If learning or attention problems show up later, these typically respond to the usual educational and medical treatments. Sadly, not all internationally adopted children do this well. Some have severe developmental and emotional problems. Therapy for these problems often takes many years and can be financially and emotionally draining. And it may not work completely. Early relationships and age are critical No one can predict the outcome for any given child, but we know that the critical factors are the quality of the child's early relationships and the child's age when adopted. Infants need loving human contact. Ideally, they learn to love and trust one person or a few adults who care for them consistently. This care does not have to be perfectly sensitive or perfectly consistent--it just has to be (as one child psychiatrist famously put it) "good enough." Tragically, many children grow up in institutions where they receive far too little of this essential loving care. Different orderlies feed and change them, but no one talks to them, holds them, or plays with them. With 30, 40, or even 60 children to care for, even the most kindhearted attendant cannot possibly meet the majority of the children's emotional needs. In these circumstances, infants learn to comfort themselves. They use rocking, rubbing, and other repetitive behaviors as a substitute for human contact. Without the relationships that underlie language development, they don't learn to communicate. And they often have great difficulty forging trusting relationships. The emotional deprivation is not always this extreme, of course. Sometimes a caretaker picks a particularly attractive or lively child to give extra attention to. Although other children from the same institution end up with terrible problems, that child may come out unharmed. In yet other institutions, conditions are far worse. The children suffer from cold and hunger as well as physical and sexual abuse. International awareness and advocacy are helping to do away with such hellish places, but they still exist. How long a child experiences institutional life is critically important. Children adopted before age six months usually recover emotionally, even if they have experienced severe deprivation. After that, the risk of emotional problems rises. After two or three years in an institution, the likelihood of long-term emotional problems is quite high. Tough decisions While many children adopted from overseas end up doing wonderfully, the hard truth is that some do not. Developmental-behavioral pediatricians and other experts can help parents weigh the risks. Only the parents know how strong their need is for a child and how much uncertainty and difficulty they can bear. Parents who make the decision to raise a child who may have severe problems are heroes. But parents who search their souls and decide that they cannot raise such a child also have acted courageously.
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