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

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.

ADHD-like symptoms and attachment in internationally adopted children

“…The existence of a higher presence of attention problems and hyperactivity among internationally adopted children compared to the general population has been suggested by several authors (Simmel, Brooks, Barth, & Hinshaw, 2001;Jacobs, Miller, & Tirella, 2010;Lindblad , Ringbäck Weitoft, & Hjern, 2010). In this regard, our results showed that the scores for the Hyperactivity and Attention problems scales obtained by the group of children adopted from Ethiopia and Eastern Europe were higher than expected, but lower for the group of girls adopted from China.…”

“…"Significant problem" scores for hyperactivity were found for 14% of children and Attention regulation parameters scored as "atypical" for inattention, hyperactivity and ADHD traits, respectively in 26, 42 and 28% of the children (Jacobs, Miller, & Tirella, 2010). In the same study, the age at arrival was found to be a very strong predictor of many of the outcome measures tested, including Hyperactivity and Attention deficit, with children who were younger at arrival scoring better in each of these areas.…”

“…Unfortunately none of these three studies included a sample of children adopted from other countries, in order to compare the results of children adopted form Eastern Europe countries. However Jacobs et al (2010) in the United States, assessed a sample of 37 internationally adopted children and found no relation between the country of origin and scores in executive function and attention skills.…”

Associations between early life adversity and executive function in children adopted internationally from orphanages

“…The only studies of EF in preschool PI children used parent report to assess EF problems using the Behavior Rating Inventory of Executive Function Preschool Version (BRIEF-P) and reported mixed results. One study found no differences compared with a normative sample in adopted preschool children aged 2-5 y (14), whereas another found that 11% of children aged 4-5 y had EF problems in the clinical range according to parent ratings (34). The third study did not include a comparison group (35); thus, the authors were only able to conclude that parents of PI children reported more EF problems than teachers did.…”

Sensory Integration Therapies for Children With Developmental and Behavioral Disorders

“…Hubel and Wiesel were among the first to document the important effects of early experience (eg, deprivation) on the way visual sensory input is processed in the brain. [2][3][4][5] Animal and human research is beginning to explore how other senses are processed and integrated [6][7][8][9][10] and how those processes are disrupted in specific syndromes (eg, autism, 11,12 schizophrenia 13,14 ) and by specific experiences (eg, institutionalization, international adoption 15,16 ).…”