Language Development In Internationally Adopted Children

Initial delays in speech and language are almost universal in children adopted from institutions, with expressive language (talking) usually more delayed than nonverbal social interaction skills. Those of us who work with a lot of adopted children develop a rough sense of what are "typical" orphanage delays, but fortunately, we're also seeing some useful research data on what actually is "normal" language development in internationally adopted children.

The thing to remember (and remind your pediatrician, school district, mother-in-law, etc ...) is that this is not just an ESL or bilingual issue. Internationally adopted children from backgrounds of neglect or inadequate stimulation are usually delayed in their native language.  When they are adopted, they have "arrested" development of that 1st language (unless you happen to be fluent in Russian, Mandarin, etc). They then rapidly lose what abilities they had in their native language, before their "new first language" (English) has time to develop. This leaves them in the "language lurch" for awhile, without functional abilities in either their 1st or 2nd languages.  Not an easy place to be ... this may be partly responsible for those "the honeymoon is over!" behavioral issues that many families experience several months post-adoption.

Sharon Glennen, Ph.D., CCC-SLP, has done a lot of the research on this topic, including a longitudinal study of language development in children adopted as infants and toddlers from Eastern Europe. On her website, she reviews the effects of orphanage care on language development, presents some very useful tables of typical language development in international adoptees, as well as pre-adoption language questions for parents to ask.

Other Resources:

• Our Favorite Books for Speech/Language Delays
• Article from Adoptive Families Magazine on Language in Toddler Adoptees
• Harvard Study of Language Development in Internationally Adopted Children (ongoing)
• Study of Language Development in Children Adopted from China (ongoing)
• RUSH Into English, a CD for Russian children 4-5 years and up to help them learn English

Outcomes of Prematurity

Many international adoptees were born preterm. Premature birth is a risk factor for a number of medical and developmental outcomes, including significant disabilities like mental retardation, cerebral palsy, and profound vision or hearing loss. More subtle, but often functionally significant outcomes like early developmental delays, attentional problems, sensory integration/behavioral regulation issues, and school difficulties are also seen. The degree of prematurity, birthweight, and severity of early newborn complications all impact the risk for these outcomes.

Prematurity Resources:

• Outcomes of Prematurity (1.8 MB - big download) - a textbook chapter that nicely reviews the developmental outcomes of prematurity, with good statistics and tables
• Developmental Outcomes of Premature, Low Birth Weight, and Medically Fragile Infants - a good review article from Medscape (free registration required)
• Prematurity.org - Preemie Parent Information and Support

Head Circumference Issues

Why we care about head circumference issues ...

Dr. Dana Johnson's review article on head size - "Does Size Matter, Or Is Bigger Better?" - says it best. Highly recommended for parents considering referrals with head growth concerns. Growth charts are available here.

How to measure a proper head circumference ...

Bring a non-stretchable measuring tape, and practice a bit first. Wrap the tape snugly around the widest possible circumference - from the most prominent part of the forehead (often 1-2 fingers above the eyebrow) around to the widest part of the back of the head. Try to find the widest way around the head. Remeasure it 3 times, and take the largest number.

Evaluating Growth in Adoptees

Almost every medical report has at least one set of growth measurements. It is always advisable, and usually possible, to request an updated series of measurements on a newly referred child. Growth is an objective measure of the child’s nutritional and medical status and may be the most reliable information available prior to adoption. However, weight errors can occur from measuring children in winter clothes versus unclothed, and height and head circumference seem especially susceptible to erratic measurements, due to technique or old stretched-out measuring tapes. Growth charts specific to children from certain countries are available, but these measurements are usually plotted on the revised United States growth charts (see below). It is generally the pattern of growth over time, rather than growth indices at a specific age, that is of greatest value.

Unfortunately, an orphanage is far from the ideal environment for childhood growth. Many children exhibit evidence of malnutrition and psychosocial dwarfism. Most are stunted in linear growth (height). Generally, we expect children to lose about 1 month of linear growth for every 3 months in institutional care. Although most children who are malnourished and poorly stimulated maintain brain growth, over time even head circumference may not be spared. Microcephaly is a red flag. Children who have microcephaly that is extreme or present from early in infancy may have medical diagnoses other than malnutrition or deprivation, such as fetal alcohol syndrome, a genetic disorder, or a perinatal brain injury. Although most orphans exhibit dramatic catch-up growth after adoption, even in head circumference, it is not yet known whether this recovery of brain mass means that the brain will function normally.

We recommend that you download the revised CDC growth charts for tracking weight, height, and head circumference along with us. These are what we use for children from Eastern Europe, as well as most children from other regions. While there are some ethnic differences in growth, many of the country-specific growth charts are problematic – for example, the China growth charts date from the early 1960s, and may be “normalizing” malnutrition.

For children from China or Korea with borderline growth it may be reasonable, however, to give them the benefit of the doubt. Growth charts for these populations and for premature infants can be found in our Growth Charts section.

If percentiles are confusing at first, think of it this way - a child at the 10th percentile for height is 10th in line of a hundred kids of the same age and gender lined up by height. 50th in line, or 50th percentile, is average. The broad definition of "normal" is from the 3rd percentile to the 97th percentile, or "within 2 standard deviations of the mean", for the engineers out there. But again, trends of growth over time are usually more meaningful than the percentile at any given moment .