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Pre-placement screening in international adoption
Gary W Diamond1, Yehuda Senecky, Daniel Schurr
1Child Development Center, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. diamondg@zahav.net.il
Insights
Pre-adoption screening of internationally adopted children identified significant medical and neurodevelopmental issues. A child's developmental performance, medical status, and weight influenced adoption decisions, not past history.
Area of Science:
- Pediatric Health
- Developmental Pediatrics
- International Adoption Medicine
Background:
- Increasing rates of international child adoption necessitate understanding the health status of these children.
- Adverse pre-adoption living conditions raise concerns about medical and neurodevelopmental well-being.
- Lack of standardized pre- and post-adoption medical evaluation guidelines poses challenges.
Purpose of the Study:
- To assess the medical and neurodevelopmental condition of young children awaiting international adoption from Eastern Europe.
- To identify factors influencing families' decisions to adopt or decline specific children.
Main Methods:
- Comprehensive medical and neurodevelopmental evaluations were conducted on 82 children (median age 11 months) in Eastern Europe.
- Standardized assessment tools, behavioral observations via videotape, and laboratory tests were utilized.
- Evaluations occurred 3 weeks to 6 months before adoption placement.
Main Results:
- Children exhibited growth retardation; 14.8% had ongoing medical issues like hepatitis, failure to thrive, and sensory disorders.
- Thirteen percent displayed abnormal neuromotor status.
- Families rejected 22% of children, with adoption decisions linked to developmental testing performance, current medical status, and weight.
Conclusions:
- Pre-placement screening effectively identifies medical and developmental strengths and impairments in children eligible for foreign adoption.
- Family adoption decisions were significantly associated with the child's performance on developmental assessments (Bayley Scales), weight, and current medical condition.
- Past medical history and family background did not significantly influence adoption decisions.
Background:
The number of child adoptions from abroad is increasing, but the adverse living conditions of these children prior to the adoption raise questions on their medical and neurodevelopmental status, particularly since there are no guidelines for pre- or post-adoption medical evaluation.
Objectives:
To describe the condition of a cohort of young children who were candidates for adoption in East European orphanages and foster homes, and to determine those attributes associated with a family's decision to adopt or refuse a particular child.
Methods:
Eighty-two young children, median age 11 months, were evaluated by Israeli pediatricians in Eastern Europe between 3 weeks and 6 months prior to their adoption. The evaluation consisted of comprehensive medical and neurodevelopmental testing on site using a battery of standardized assessment tools, and observation of free play and social interactive behaviors recorded on videotape. Laboratory tests included complete blood count, chemistries, serology screening, and metabolic and genetic testing.
Results:
The children were growth-retarded. Medical problems were classified as resolved (pneumonia and diarrhea) in 32.8%; or ongoing, such as hepatitis B and C, failure to thrive, organomegaly, and visual and hearing disorders, in 14.8%. Neuromotor status was grossly abnormal in 13.4%. Twenty-two percent of the children were rejected for adoption by families in Israel. Factors associated with the adoption decision were performance skills on developmental testing (P = 0.0001), present medical status (P = 0.002), and weight (P = 0.016).
Conclusions:
Pre-placement comprehensive screening of children eligible for foreign adoption, which includes developmental screening, helps to identify a wide variety of strengths and impairments in a child's background before the adoption procedure is finalized. A family's decision to adopt or not was associated with the child's performance on Bayley Scales, weight, and current medical status, but not with language delays, serious past medical history or suspect family background.
