After School Programs
Many children receive most of their recreational experiences through these programs. Coaches can be wonderful mentors and for some families after school programs eliminate some daycare needs.

Audiologist
An audiologist provides intervention strategies and services for individuals with deafness or hearing impairments.

Classroom Teacher
Your child’s classroom teacher is the person who will spend the most time with your child and will know her best. A classroom teacher is a valuable resource for helping identify any educational, emotional or social issues the child may be having in school.

Early Intervention Services
Every state offers an early intervention program to help identify infants and toddlers (up to age three) who may have developmental delays or disabilities. An evaluation is completed to determine the child’s cognitive, physical/motor, speech, language, social, emotional and adaptive development. A physician or the local school district can direct families to those services.

Educational Advocate
An Educational Advisor or Advocate helps parents work with the child’s school. As an additional member of an Individual Education Plan (IEP) team, an Educational Advocate provides additional experience and expertise to get the best outcome for the child.

Occupational Therapist
An occupational therapist is a licensed health professional who provides strategies and services to assist individuals with motor or sensorimotor functions, including fine motor manipulation, self-help, adaptive work skills, and play or leisure skills.

Physical Therapist
A physical therapist is a licensed health professional who works with individuals with motor or sensorimotor functioning in such areas as mobility and positioning.

School Counselor
A school counselor may assist in the identification of a child’s needs and may help to determine appropriate responses.

School Nurse
A school nurse provides medical care during the school day, monitors allergic reactions and may administer medication needed during school hours.

School Psychologist
A school psychologist assists in the identification of a child’s behavioral, social, emotional, educational and vocational needs and helps to determine appropriate responses.

School Social Worker
A school social worker is trained to assess a child’s educational needs including social, emotional, behavioral and adaptive needs. She provides intervention services including individual, group, parent and family counseling and serves as liaison between home, school and community.

Special Education Instructional Specialist
The special education instructional specialist provides ongoing support to special and general education instructional personnel. The specialist helps to identify and plan for the least restrictive environment appropriate for the child.

Speech-Language Pathologist
A speech-language pathologist provides intervention strategies and services related to speech and language development as well as disorders of language, voice, articulation and fluency.

Transportation Specialist
A transportation specialist works with the school district to provide special transportation and equipment for students with disabilities.

Tutoring Services
Many children can benefit from short or long-term use of a tutor. Families receiving federal (and some state) subsidies should look to the schools for help rather than Children and Family Services.

Sensory Integration Dysfunction is a neurological disorder which causes difficulties processing sensory information. Sensory information is sensed normally but perceived abnormally, causing pain and confusion. Children raised in institutions are particularly at risk for disorders of sensory integration (DSI) because they have not been provided with enough sensory stimulation. Orphanage environments are often quiet places with bare walls and few toys. Children may have little time outside the building or in the community. Children are seldom held and played with, and may be fed only on formula or puréed foods.

Screening Questions:

• Does the child like to be held?
• Is she comfortable being moved?
• Does she appear upset when laid back for a diaper change or to be dressed?
• Does the child avoid interactions with others?
• Does she initiate play?
• Does she touch and explore toys?
• Does she avoid certain types of toys (fluffy, slippery, noisy)?
• Does she mouth toys or avoid mouthing toys?
• Does she only use her fingertips?
• Does she freeze or avoid entering a noisy or visually busy room?

Our The Journey of Attachment provides more information about sensory integration as does the on-demand webinar Sensory Integration and Self-Regulation: Tips For Parenting Sensational Kids.

Diagnosis of the condition may be complicated by the fact that it is similar to, and may coexist with many other conditions, including autism spectrum disorders, ADHD, speech delays, learning disabilities, and reactive attachment disorder. An occupational therapist can conduct tests and observe the child to determine if there is a problem and in what areas. The therapist can then design a program of treatment that addresses the problem areas.

If you have ever felt overwhelmed by a large store or by a noisy eatery, or annoyed by a clothing label that irritates you, you have a glimpse into how your child may experience a classroom, playground, or even a touch.

Attachment is defined as the reciprocal, affectionate enduring emotional bond between individuals. A child forms a bond of trust with a caregiver who consistently meets the child’s needs and this bond serves as a model for later attachments. Children who were abused or neglected in early life, and those who have been raised in institutions, are at risk for attachment disorders because they did not learn to form these relationships.

Attachment disorders vary in severity from an initial adjustment to long-term Reactive Attachment Disorder (RAD) which may be labeled Early Developmental Trauma or Post Traumatic Stress Disorder (PTSD).

Children with attachment disorder may display the following behaviors:

• Manipulative, superficially engaging, or “charming”
• Little eye contact
• Indiscriminately affectionate with strangers
• Lacking ability to give/receive affection
• Destructive to self, others, animals, material objects
• Stealing
• Hoarding or gorging food, abnormal eating patterns
• Chronic, crazy, obvious lying
• Lack of conscience
• Preoccupation with fire, blood, gore
• Accident prone
• Lack of impulse control

Many parents find it difficult to parent children with attachment disorders. The children do not respond to parental concern and discipline in the way that parents expect. Children with attachment issues may reject displays of love and affection or may use them in a manipulative fashion. Traditional forms of discipline like “time outs” may be unsuccessful with attachment disordered children, since they actually prefer to be left alone.

Many techniques are available to parents to promote attachment. The most important thing is having direct involvement with the child’s day-to-day care. The more caregivers, the less likely the child will form an attachment to the parent. Children should spend as much time with parents as possible, and engage in activities that foster closeness, touch, and eye contact.

Consider therapy. Seek a trained therapist who has experience with early trauma and attachment. This is a specialty within the therapy field. Often therapists who have worked with children in the state’s child welfare system will be useful to help both parents and children cope with past experiences and to A trained therapist can work with the child and the parents to help the child cope with past experiences and to develop empathy and attunement for each other.

Most internationally adopted children do form attachments to their adopted families, although the process may take months or even years.

The Journey of Attachment provides much more information about this topic.

Adopted children often have behavioral challenges that are the result of time spent in institutional settings. These behaviors may be transient, but they can be challenging for the adoptive family. The older the child at placement, the more likely they are to exhibit behavior problems, the problems are more serious, and they persist for a longer time.

When they first arrive in their new home adopted children may grieve the loss of familiar surroundings and caregivers. This grief may manifest itself in feeding difficulties, sleep disturbances, limited language, or lack of eye contact. Most children will recover with time but some families find they need the assistance of an adoption-competent therapist.

Children reared in orphanages may display signs of autistic-like behavior: lack of eye contact, aloofness, lack of interactive play, lack of interest in peers, language delays – that comes from long-term sensory and social deprivation. Some of these behaviors may manifest themselves in the first days spent with the new parents, and are an adaptive response to being placed in the care of strangers. While these children have significant impairment of social and communication skills, they should improve over time.

While physical conditions and ailments are often the focus at time of referral, placement, and homecoming, mental health should not be ignored. Children adopted internationally have likely experienced trauma and may need therapy to address those issues.

Trauma

Trauma is neglectful, chaotic, abusive, and/or threatening experiences encountered by a child once or over a prolonged period of time. The abuse could be physical, sexual or psychological and trauma can happen in utero. Multiple placements in foster homes or living in an orphanage is trauma. So is neglect or being exposed to alcohol in the womb. Inherited vulnerable biology and/or insults to the brain caused by trauma experienced by children before this placement is considered a tough start. Most children adopted internationally have had a tough start in life.

These tough starts may result in poor attachment, behavioral control issues, cognition impairment, or other issues. While tough starts create challenges, there is hope. Proper treatment and support are important and start as early as possible.

For more on trauma, see our Tough Starts Matter series.

Anxiety and Depression

Studies show that the rate of anxiety and depression in adopted kids is more than double that of the general population. Depression, while usually associated with lethargy in adults, often looks like anger in kids. Anxiety typically sounds fearful in adults, but looks more like avoidance, annoyance or off the wall behavior in children.

For more on anxiety and depression, see our webinar Anxiety and Depression in Adopted Children which is available on-demand.

Most children adopted internationally will acquire a new language quickly and begin losing their first language within a few months of arrival. However, it is not uncommon for internationally adopted children to have language delays in their primary languages. Language proficiency may be delayed for many reasons, but the most likely is a lack of language exposure in an institutional setting. The new language acquisition is being built on a shaky language foundation.

A language assessment should be part of the child’s complete evaluation within two months of arrival home. A qualified bilingual speech therapist or psychologist specialist would be best, but a trained interpreter may be sufficient. Language ability should be assessed, to determine if language delays are part of global developmental delays. Tests should include a check to determine if language delays are related to hearing loss.

The most important thing a parent can do to counterbalance the effects of early language deprivation and facilitate language acquisition is to immerse the child in a language-rich environment. Parents need to talk as much as possible – labeling objects and expressing feelings – and encourage the child to respond verbally.

Some children may have no apparent difficultly learning a new language but will demonstrate problems later. A child may have conversational language ability at home, but not have a mastery of the “cognitive language,” which is the basis of reasoning, literacy and academic learning. Cognitive language problems may not appear until the child begins school and displays learning disabilities.

A child with early language delays and learning disabilities may have an auditory processing disorder. Auditory processing disorders are disabilities in handling auditory information. Children with this disorder have difficulty attending to auditory information. They may be sensitive to sounds and be readily distracted, and may be unable to filter out background noise to concentrate on verbal instructions. A qualified audiologist or speech-language pathologist can conduct an assessment for auditory processing disorder. This disorder is also found in children within their first language, especially boys with a diagnosis of ADHD.

Finally, consider meeting your child part way. From the time you choose a country, start working on learning the local language. Like children, some adults learn languages faster than others but anything you learn will come in handy and be appreciated. And the effort will remind you how much we ask of our newly-placed children.