An Adopted Child's Body and Mind, a Roadmap for the Future
As the latest adoption buzz continues around the case of Artyom Savelyev, a 7-year-old Russian boy whose adoptive American mother sent him back to his birth country last week, questions arise as to how much medical information prospective parents receive before deciding to move ahead with an adoption.
As part of the international adoption process, federal regulations require American adoption agencies to provide would-be parents with an English-language translation of the child's medical records at least two weeks before the child's placement, or two weeks prior to the date of travel to the country where the adoption will take place.
But the data supplied can be difficult to interpret.
That's where Jane Aronson, M.D., comes in. Parents in the know turn to doctors like Aronson -- a specialist in pre-adoption medical reports, photos and video -- to help them make informed decisions.
"I see pre-adoption referrals as a way for me to help parents understand what they can expect at the time they first become acquainted with the child," Aronson tells ParentDish. "If we educate them about issues, such as fetal alcohol syndrome and low birth weight, then they can use their knowledge to decide if they want to adopt a child that may be at high risk."
While no one knows how much information adoptive mother Torry Ann Hansen knew about her son, Savelyev, the State Department put these rules into place to help ensure that parents receive crucial health information. The records should include a full medical history that discloses any significant illnesses, hospitalizations or special needs. Other information that should be supplied includes growth data, prenatal and birth history, specific information on known health risks in the adoption region or country, dates of medical exams, information on any medical tests performed, current health status and dates on any videos or photos provided of the child.
To help parents navigate the waters of international adoption, the State Department publishes a Guide for Prospective Adoptive Parents, which details many of the requirements involved per the Hague Adoption Convention, an international treaty that protects children, birth parents and prospective adoptive parents.
Aronson's Web site lists medical conditions and development issues that may be found in children adopted from other countries, and describes how a professional can assess a child's condition from video footage. Parents should ask their adoption agency for a good quality video, at least three minutes long, that shows the child in just a diaper. The child's skin and extremities should be completely visible so doctors can look for features and possible deformities, which can be helpful in diagnosing medical conditions, including:
- Fetal alcohol spectrum disorders: A group of conditions that can occur in children whose mother drank alcohol during pregnancy. According to Judith Eckerle King, M.D., a pediatrician in the Division of Global Health at the University of Minnesota specializing in pre-adoptive screenings, major diagnostic criteria are: growth below the 10th percentile, neurological problems, and abnormal facial features -- including a smooth ridge between the nose and upper lip, a thin upper lip, and a short distance between the inner and outer corners of the eyes, giving the eyes a wide-spaced appearance.
-Birthmarks: According to King, though most birthmarks seen on children are not a sign of ill health, some -- such as Cafe au Lait spots -- can be an indicator of a neurocutaneous disorder, depending upon how many there are, what size, and the age of the child.
-Head circumference: Aronson writes that head circumference measurements can be used as an indicator for issues such as malnutrition, poor prenatal care, smoking during pregnancy, prematurity and genetic syndromes.
Aronson adds, however, that not all children who've been exposed to alcohol in the womb exhibit visual markers. Features such as low muscle tone, decreased facial muscle activity, gaze avoidance, and decreased vocalization can be observed in a video, and can aid in diagnosing neurological conditions, developmental age or even the quality of the child's nutrition.
Additionally, some adoption agencies will recommend that a child be independently examined by western-trained doctors based in the child's country. For Justin Herscovici, president of Children of the World, a New York-based agency that facilitates adoptions in Moscow and St. Petersburg, that's standard operating procedure before his clients make a decision to adopt a particular child. These doctors, who are not associated with his agency or the orphanages, conduct physical and developmental examinations as well as blood tests, and then submit a written and verbal report to prospective parents. Bringing that report to an American adoption doctor would be an important next step.
Aronson says that adoption specialists go well beyond the basics. "You can treat a parasite, tuberculosis exposure, bacteria, rickets, that's nothing," she tells ParentDish. "What's really at the heart of this work are the developmental delays and the emotional trauma."
While adopted children typically experience a range of attachment issues, with a rare few developing reactive attachment disorder, the problem can be exacerbated by parents who experience post-adoption "blues" or depression, or even a form of parental attachment disorder. Aronson describes parents who have tried for years to have a baby, wait several more years for an adoptive child, travel a long distance to adopt, and then feel badly when they don't immediately fall in love with the child.
"It's very difficult for them to admit they don't feel good, so they isolate themselves," she says, "and then those bad emotions and feelings are transferred to the child, who already has his own pre-adoption issues, and the combination of the two can equal disaster."
That's one of the reasons Aronson works to learn as much as she can about prospective adoptive parents as well.
"I find out how many children they have at home, if they're single or married, what they plan to do when the baby gets home, about daycare, school; I do the whole thing," Aronson explains. "I try to get to know people so I can really understand what they're prepared and not prepared to do."
In her practice, Aronson advocates that prospective adoptive parents practice what she refers to as "PRE" -- preparation, resources and expectations.
Preparation can include one-on-one sessions or group workshops with the adoption workers, other adoptive parents and experts such as speech and language specialists, physical therapists, physicians and psychologists.
Prior to placement, parents should find out what resources are available to them both locally and nationally, and learn how to access these services before the child arrives. This may include government-sponsored early-intervention programs, financial resources and adoptive family advocacy groups such as Families for Russian and Ukrainian Adoption or Latin America Parents Assocation.
Aronson explains that being honest about their expectations of their child is one of the most crucial and most difficult tasks for adoptive parents, but when families and children are matched appropriately by the agency, expectations become much more realistic.
According to the National Council for Adoption, at least 10 hours of pre-adoption education for parents is mandated by the Hague Convention, though post-adoption follow-up visits are not. According to Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute, U.S. states do require training for parents who adopt from the foster care system, though not for those who adopt privately. And, according to Dr. King, an increasing number of individual adoption service providers are requiring pre-adoptive parent education. However, the lack of parent education can be one of the factors that contributes to adoption disruptions, where placement of the child is terminated, Aronson tells ParentDish.
Parents who are having problems with their children can call on adoption services programs around the country, such as the programs at the Vanderbilt University Medical Center in Nashville, the Children's Hospital & Research Center Oakland in California, and the Cleveland Clinic Children's Hospital.
"There are services available to help families," says Children of the World's Justin Herscovici, who's been doing adoptions in Russia since 1995. "You just have to ask for the help and we will find it."
Related: Adopted Children Need Time to Adjust, Experts Say
Start by teaching him that it is safe to do so.