Relationship and Communication Development in Children Adopted From Abroad

When my grand-daughter was born, I made a conscious decision to visit her every month. Not only did I want to observe her development on a regular basis, I also wanted her to interact with me consistently so we could build a close and loving relationship. She is now 5 years old and we enjoy a wonderfully close relationship. When her brother was born, she had to share her mother and father with him but she was unwilling to share me. She expected her grandfather to play with her brother so that I could spend all of my time with her. Naturally, our grandson developed a close and loving relationship with his grandfather. To this day when we arrive at their house, he first asks “Where is Grandpa?” and seeks to reconnect with his grandfather before he will interact with me. Now they have a new younger brother and it will be interesting to see how his relationship with both grandparents develops.

Infants learn to communicate within the context of contingent, consistent and sensitive face-to-face communication with their caregivers. They are born expecting developmentally appropriate and nurturing care. In fact, they are dependent upon such care to thrive and survive. Through consistent, appropriate and individually sensitive interactions, infants learn how to trust their caregivers, share emotions, regulate negative emotions, and associate nonverbal communication such as facial expressions and tone of voice with certain emotions (Baldwin & Moses, 1994; Butterworth, 1994; Moses, Baldwin, Rosicky, & Tidball, 2001; Smith, 2005). These early interactions help infants learn that when they are uncomfortable they can cry and most often an adult will make them feel better. Eventually they learn to regulate their distress at the sight of the caregiver’s smiling face, when they hear their caregiver’s calming voice, or as soon as the caregiver picks them up. Infants develop trusting relationships based on the consistent and contingent care they receive from sensitive caregivers and through these relationships they learn to draw inferences from their communicative, cognitive and social interactions.

Unfortunately not all children receive positive, contingent and consistent care. Many children experience maltreatment during their infancy or toddlerhood with the majority of maltreatment cases involving neglect (Children’s Bureau, 2011). The U.S. Department of Health and Human Services describes maltreatment to include: a) physical abuse, b) sexual abuse, c) emotional abuse, or d) child neglect. Physical abuse can be physical harm of a child or placing a child at risk of being harmed such as witnessing spousal abuse. Neglect can include not meeting the child’s physical, educational, health care, or emotional needs (Hildegard & Wolfe, 2002).

Research on maltreated children provides evidence that maltreatment results in poor developmental outcomes (Wolfe, 1999). Children experiencing maltreatment have been reported to demonstrate poorer cognitive, receptive and expressive language performance and social-emotional development when compared with their peers (Culp et al., 1991; Eigsti & Cicchetti, 2004; Hildegard & Wolfe, 2002; Wolfe, 1999). Although placement into foster care families moves children into safer environments, children continue to display weaker social-emotional development and language performance and children who experience more transitions in care tend to demonstrate poorer performance (Pears & Fisher, 2005; Windsor, Glaze, Koga & the Bucharest Early Intervention Project Team, 2007).

Children who are raised in orphanages experience maltreatment (Johnson, 2000, 2005; Miller, 2005) and when adopted by families from a different country, the children often experience disrupted language acquisition.  Orphanage care in countries with few resources or poor economies, provide less than adequate care. Many orphanages operate with large child to adult ratios and provide limited health care, poor nutrition, and little to no social or educational stimulation. Once children are adopted, many of the adopted families do not speak the children’s birth language and may not have resources to provide continued instruction in the child’s birth language. Thus, the children quickly stop speaking and listening to their birth language and become monolingual speakers of their adopted language (Hwa-Froelich, 2009, 2012). Research has documented rapid acquisition of the adopted language (for a review see Hwa-Froelich, 2012). However, recent research provides longitudinal evidence of expressive language delays (Cohen, Lojkasek, Zadeh, Pugliese, & Kiefer, 2008; Gauthier & Genesee, 2011; Glennen, 2007). In a recent meta-analysis, Scott and colleagues (2011) report that international adoptees demonstrate poorer language performance on behavioral measures than on survey measures and when compared with peers rather than standardized test norms. They found that while there was great variability in language performance during the preschool ages, children adopted from abroad were not significantly different from their nonadopted peers. However, there was a greater likelihood of poorer language outcomes at school-age or older ages. In other words, maltreatment and disruption in language acquisition may place internationally adopted children at increased risk of language problems.

Early maltreatment and poor relationship development can have persistent effects on children’s communication development. Therefore, it is important for professionals to recognize, identify and report cases of maltreatment early and persistently to prevent and stop maltreatment of children. Agencies and professionals must try to provide safe and consistent caregiving environments for children removed from their families and children living in orphanages. Once children have experienced maltreatment, professionals must work closely together with children and their caregivers to facilitate the development of close, safe, and loving relationships as well as the children’s cognitive, communication, and social-emotional development. Consistent assessments to evaluate cognitive, communication, and social-emotional development longitudinally are needed. If children demonstrate developmental delays then early intervention may benefit children exposed to maltreatment and disrupted language acquisition, such as children adopted from abroad.

Disclosure: Some of the information included in this blog was taken from Hwa-Froelich, D. A. (2012). Childhood maltreatment and communication development. Perspectives on School-based Issues, 13(1), 43-53. The author discloses financial benefit from book sales.

References

Baldwin, D. A., & Moses, L. J. (1994). Early understanding of referential intent and attentional focus: Evidence from language and emotion. In C. Lewis & P. Mitchell (Eds.) Children’s early understanding of mind. Origins and development (pp. 133-156). Hillsdale, NJ: Erlbaum.

Butterworth, G. (1994). Theory of Mind and the facts of embodiment. In C. Lewis & P. Mitchell (Eds.) Children’s early understanding of mind. Origins and development (pp. 115-132). Hillsdale, NJ: Erlbaum.

Children’s Bureau. (2011). Child maltreatment 2010. Retrieved from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can

Cohen, N. J., Lojkasek, M., Zadeh, Z. Y., Pugliese, M., & Kiefer, H. (2008). Children adopted from China: a prospective study of their growth and development. The Journal of Child Psychology and Psychiatry, 49(4), 458-468. doi:10.1111/j.1469-7610.2007.01853.x

Eigsti, I-M., & Cicchett, D. (2004). The impact of child maltreatment on expressive syntax at 60 months. Developmental Science, 7(1), 88-102.

Gauthier, K., & Genesee, F. (2011). Language development in internationally adopted children: A special case of early second language learning. Child Development, 82(3), 887-901. doi:10.1111/j1467-8624.2011.01578.x

Glennen, S. (2007). Predicting language outcomes for internationally adopted children. Journal of Speech, Language and Hearing Research, 50, 529-548. doi:10.1044/1092-4388(2007/036)

Hildeyard, K. L., & Wolfe, D. A. (2002). Child neglect: developmental issues and outcomes. Child Abuse & Neglect, 26, 679-695.

Hwa-Froelich, D. A. (2009). Communication development in infants and toddlers adopted from abroad. Topics in Language Disorders, 29(1), 27-44. doi:10.1097/01.TLD.0000346060.63964.c2

Hwa-Froelich, D. A. (2012). Supporting development in internationally adopted children. Baltimore: Paul H. Brookes.

Johnson, D. E. (2000). Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees. In C. A. Nelson (Ed.). The Minnesota Symposia on child psychology: The effects of early adversity on neurobiological development: Vol. 31. Minnesota Symposium on Child Psychology (pp. 113-162). Minneapolis: University of Minnesota Press.

Johnson, D. E. (2005). International adoption: What is fact, what is fiction, and what is the future? Pediatric Clinics of North America, 52, 1221-1246. doi:10.1016j.pel.2005.06.008

Miller, L. (2005). The handbook of international adoption medicine. NY: Oxford University Press.

Moses L. J., Baldwin, D. A., Rosicky, J. G., & Tidball, G. (2001). Evidence for referential understanding in the emotions domain at twelve and eighteen months. Child Development, 72(3), 718-735. http://www.jstor.org/

Pears, K., & Fisher, P. A. (2005). Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: Associations with prior maltreatment and placement history. Developmental and Behavioral Pediatrics, 26(2), 112-122.

Smith, A. D. (2005). The inferential transmission of language. Adaptive Behavior, 13(4), 311-324. doi:10.1177/105971230501300402

Windsor, J., Glaze, L. E., Koga, S. F., & the Bucharest Early Intervention Project Core Group. (2007). Language acquisition with limited input: Romanian institution and foster care. Journal of Speech-Language-Hearing Research, 50, 1365-1381. doi:10.1044/1092-4388(2007/095)

Wolfe, D. A. (1999). Child abuse: Implications for child development and psychopathology. Thousand Oaks, CA: Sage.

 

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University professor and Director of the International Adoption Clinic with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and disrupted development.

 

Swallowing and Feeding Issues with Internationally Adopted Children

Vegetables in Whole Foods Market


Photo by Masahiro Ihara

My children were “picky eaters.” One would only eat peanut butter and jelly, frozen pizza, chicken nuggets or macaroni and cheese. The other one would only eat frozen pizza and hot dogs. Neither of them would eat any vegetables. If it was green, it was considered inedible! Needless to say, cooking for them was a challenge. Somehow they survived and are both healthy adults who eat more variety than I ever thought they would.

Many of our food preferences are based on our food experiences. Children residing in orphanages have feeding experiences that are affected by the number of staff available to feed large groups of infants and toddlers. Parents have reported observing children left in their cribs with bottles propped up to allow self-feeding, given plates of food too hot to eat without utensils to feed themselves, and children fed pureed instead of solid foods. These experiences may not only affect physical growth and nutrition but also adversely affect eating and swallowing development. Some researchers have reported a wide range of eating and swallowing problems from clinical samples including (a) chewing problems, (b) preoccupation with food availability, (c) gorging and (d) sometimes becoming omnivorous (Johnson & Dole, 1999). Others found that 15% (21 of 144 children adopted from Romania) continued to have chewing and swallowing problems at 6 years old, 2 to 5 years following adoption (Beckett, et al., 2002). Beckett and colleagues also found that if solid food was not introduced before the age of 1 year, more of these children had continued eating and swallowing problems. Many of the children seen at the Saint Louis University International Adoption Clinic present with eating and swallowing difficulty or unusual oral motor problems such as facial tics or intermittent velopharyngeal closure during speech and swallow.

Children adopted from abroad are at risk of having eating and swallowing problems. Practitioners are advised to explore the presence of oral motor sensitivity, eating and swallowing problems with the client or client’s family. If problems were observed or continue to occur, a thorough assessment of oral motor structures and function and possibly an assessment of eating and swallowing behaviors may be needed. If children demonstrate eating disorders related to mental health issues such as bulimia or anorexia, it is important to refer them to clinical psychologists or counseling and family therapists.

References

Beckett, C. M., Bredenkamp, D., Castle, J., Groothues, C., O’Connor T. G., Rutter, M., & the
English and Romanian Adoptees (ERA) Study Team. (2002). Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Journal of Developmental and Behavioral Pediatrics, 23(5), 297-303. http://journals.lww.com/jrnldbp/pages/default.aspx

Johnson, D. E., & Dole, K. (1999). International adoptions: Implications for early
intervention. Infants and Young Children, 11, 34-45. Retrieved from:
http://www.peds.umn.edu/iac/prod/groups/med/@pub/@med/documents/asset/me
d_49295.pdf

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University professor and Director of the International Adoption Clinic with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and disrupted development.

 

Hearing Health and Development Following Adoption

LOUD speaker


Photo by woodleywonderworks

All my life I have been blessed with excellent hearing perception and health. Now due to my mold allergies, I have started to have fluid in my middle ear when the humidity and mold count rises above normal. The extra fluid in my ears has annoyingly affected my hearing acuity and balance. On one hand, I now understand how children feel when they have otitis media but on the other hand, I want to get rid of this ailment as quickly as I can! Naturally I sought the advice of an audiologist who completed impedance testing. As it turns out, my tympanograms showed only a small loss of flexibility in the tympanic membrane and fell in the low normal range. Typically most medical professionals would not treat a patient who exhibited these symptoms preferring to wait until the patient demonstrated consistent flat tympanograms or infection. Although I exhibit neither of these conditions, the small amount of fluid in my ear has significantly reduced my hearing acuity especially in noisy environments like the classroom. I wonder how can children focus and learn when they have fluid in the middle ear?

Children who reside in orphanages around the world may receive less than adequate medical care. Otitis media is often untreated and children’s hearing is not tested or monitored (Bledsoe & Johnston, 2004; Johnson, 2000). Due to the lack of attention to hearing health, it is not unusual for children to become accustomed to the symptoms of ear pain, imbalance, and poor hearing acuity. When parents adopt these children, they may expect the children to demonstrate behaviors of discomfort when ill. However, because of the lack of attention to hearing health, the children do not show symptoms of pain or lack of balance and the parents may not recognize when to seek medical care. At the International Adoption Clinic at Saint Louis University, I have seen children with undiagnosed hearing loss and ear infections, some of whom had previously seen a pediatrician the day before.

Additionally, children residing in orphanages are cared for by a rotation of adults where the child to adult ratio may be high. Johnson reported on conditions of care in Romanian orphanages where children were often left in their cribs/beds, received little if any social interaction from caregivers, and had few experiences with toys or educational stimulation. As a result, children’s hearing experiences were unmentored and they may not have learned which sounds were meaningful to attend to or what certain sounds meant.

Sometimes years after they were adopted, some children who passed a hearing screening and audiological evaluation did not alert to environmental sounds (whistles, knocks on the door, telephones, or their name being called). I have also seen children who have difficulty attending to and discriminating speech from noise as well as children with an undetected/undiagnosed hearing loss. Without careful assessment by professionals with expertise with internationally adopted children, these children may slip through the cracks and not receive appropriate services.

It is important to conduct a thorough evidence-based assessment when an internationally adopted child is referred or presents with hearing, speech, language, or attention problems. Hearing screenings including otoscopic evaluation, impedance audiometry and sound field or pure tone audiometry should be included unless the child has recently been evaluated by an audiologist. An in-depth case history of hearing, attention, speech and language behaviors and development should be collected. If the child passes all audiological measures, the speech-language pathologist should also assess the child’s knowledge of meaningful sounds as well as hearing discrimination and perception in quiet and noise and in some cases, additional audiological assessment for auditory processing disorder may be warranted.

References

Bledsoe, J. M., & Johnston, B. D. (2004). Preparing families for international adoption.
Pediatrics in Review, 25(7), 241-249. Retrieved from: http://bit.ly/kEy1iU

Johnson, D.E. (2000). Medical and developmental sequelae of early childhood
institutionalization in Eastern European adoptees. In C.A. Nelson (Ed.), The
Minnesota symposia on child psychology: The effects of early adversity on
neurobehavioral development (Vol. 31, pp.113-162). Minnesota Symposium on
Child Psychology.

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University professor and Director of the International Adoption Clinic with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and disrupted development.

Language Development after Adoption

animal dominos


Photo by woodleywonderworks

My husband and I met our children and our grandchildren at a restaurant the other day. I stayed with my grandchildren at the table while their parents were busy gathering the children’s and their food. As I was monitoring all the activity and sat down beside my granddaughter, she remarked, “You’re very quiet today!” Coming from a 4 year-old, it sounded quite hilarious and made me think that she must have heard and stored this adult-like statement to retrieve it for the appropriate moment. This is an example of the process of language acquisition. Children listen to, process, store, retrieve, and produce language in dynamic and flexible ways. It is, at times, an amazing process to document and observe.

For internationally adopted children, they begin listening to and producing their birth language. After adoption, they often stop listening to and expressing their birth language to focus on learning an adopted language. For some children, their adopted families are able to provide a nanny or teacher who continues to speak to their children in their birth language while the parents and community may speak the children’s adopted language. Several researchers have documented the rapid acquisition of the adopted language where adopted children score within normal range on most standardized general language and articulation tests in their adopted language by 2 or 3 years post-adoption (Glennen, 2007; Hwa-Froelich & Matsuo, 2010; Roberts et al., 2005). Yet other studies have documented that internationally adopted children use special services more often, may have problems with social communication (Glennen & Bright, 2005), and have poorer school achievement than same-aged peers (van IJzendoorn & Juffer, 2010).

Though rare, in some cases internationally adopted children appear to be developing the necessary prerequisite skills for academic and social success but later on begin to have learning difficulty. I have assessed children between 1 to 4 years after adoption and have had a few children demonstrate speech, language, and cognitive delays later as opposed to early in their post-adoption development. For some children, their developing relationship with their parents may not develop which may adversely affect the children’s communication or their inattentive and overactive behaviors begin to negatively affect their learning and development. For other children, their speech fails to mature and what were considered developmental articulation errors at 2 years of age, become delayed articulation or phonological problems at 6 years of age. Because of these cases, I recommend that families seek follow-up evaluations if their child continues to demonstrate speech or communication problems at older ages or if the child develops new and different speech or communication problems.

References

Glennen, S. (2007). Predicting language outcomes for internationally adopted children.
Journal of Speech, Language and Hearing Research, 50, 529-548.
doi:10.1044/1092-4388(2007/036)

Glennen, S., & Bright, B. J. (2005). Five years later: Language in school-age
internationally adopted children. Seminars in Speech and Language, 26(1), 86-
101. Retrieved from https://www.thieme-connect.de/ejournals/toc/ssl

Hwa-Froelich, D. A., & Matsuo, H. (2010). Communication development and differences in children adopted from China and Eastern Europe. Language, Speech, and Hearing Services in Schools, 41, 1-18. doi:10.1044/0161-1461(2009/08-0085)

Roberts, J. A., Pollock, K. E., Krakow, R., Price, J., Fulmer, K. C., & Wang, P. P. (2005).
Language development in preschool-age children adopted from China. Journal of
Speech, Language, and Hearing Research
, 48(1), 93-107. doi:10.1044/1092-
4388(2005/008)

van IJzendoorn, M. H., & Juffer, F. (2010). Adoption is a successful natural intervention enhancing adopted children’s IQ and school performance. Current Directions in Psychological Science, 14, 326-330. doi:10.1111/).0963-7214.2005.0039.x

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University associate professor and International Adoption Clinic coordinator with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and international adoption.

Assessing Language Development in Internationally Adopted Children


Photo by ClaTalpa

Being the proud grandmother of two bright and charming grandchildren, I can’t help but keep track of their development. My son often asks me to “assess” his children’s development. He, like many parents, hope that their children are like Lake Wobegone residents in that they are all above average. My grandson is like most toddlers, babbling and using CVs and CVCs with meaning but sometimes we adults have to fill in missing consonants and words to arrive at his intended communication. Still my son wants to know, is he developing typically?

Parents who have adopted children from abroad often ask me the same question, is my child developing like other children who have been adopted from abroad? Before children are adopted, they are born in different countries of origin and exposed to different birth languages ranging from African or Asian languages to Russian or other Slavic languages. When children have been exposed to different languages and are adopted by a family who does not speak the child’s birth language, the child stops listening to or expressing his or her birth language within 3 to 6 months (Nicoladis & Grabois, 2002). Regardless of the child’s birth language (Russian, Korean, or Chinese), research studies, clinical reports and case studies have provided evidence that children between the ages of 1 and 5 years old who are adopted from different countries demonstrate similar phonetic and phonological development with little first language interference (Glennen, 2007, 2009; Pollock, 2007). If a child demonstrates poor intelligibility or delayed articulation or phonological development, they should be referred for assessment by a speech-language pathologist familiar with research on internationally adopted children.

References

Glennen, S. (2007). Predicting language outcomes for internationally adopted children. Journal of Speech, Language and Hearing Research, 50, 529-548. doi:10.1044/1092-4388(2007/036)

Glennen, S. (2009). Speech and language guidelines for children adopted from abroad at older ages. Topics in Language Disorders, 29(1), 50-64. doi:10.1097/TLD.0b013e3181976df4

Nicoladis, E., & Grabois, H. (2002). Learning English and losing Chinese: A case study of a child adopted from China. The International Journal of Bilingualism, 6(4), 441-454. doi:10.1177/13670069020060040401

Pollock, K. E. (2007). Speech acquisition in second first language learners (Children who were adopted internationally). In S. McLeod International guide to speech acquisition (Pp. 107-112). New York: Thompson-Delmar Learning.

More abstracts of Karen Pollock’s research on speech-language development in children adopted internationally

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University associate professor and International Adoption Clinic coordinator with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and international adoption.