Mike Noah

Prospective adoptive families frequently ask how well adopted children adjust. The myriad of adoption stories families hear by word of mouth, on the Internet, or in other media run the range from wonderful to nightmarish. Anyone who is considering adoption wants to know that they are doing the right thing and that adopted children are doing well in their new families.

Rainbow House International Survey Results
A number of studies done over the last decade have addressed this issue. According to a 1998 Rainbow House International survey of 206 Russian and Eastern European adopted children, 73 percent were developmentally delayed at arrival. But after an average of 24 months in their homes, only 39 percent were reported to have delays. The largest ongoing delay reported was speech and language (32 percent). Of the 21 attachment-resistive characteristics listed in this survey, 63 percent of adoptees were reported as having none of the characteristics, 91 percent had four or fewer, and 98 percent had six or fewer, showing that a majority had attached quite well to their adoptive families.

Cradle of Hope Survey Results
Cradle of Hope and 18 other U.S. adoption agencies mailed surveys to 2,159 families and received back 1,246 (a 57 percent return rate). The results, also reported in 1998, showed that 95 percent of families had experienced an overall positive adjustment. Ninety percent of the children younger than three and 72 percent older than three were reported to have very good attachment to their families. Approximately two years after placement, 95 percent exhibited no or only mild delays in motor skills, and 88 percent exhibited no or only mild delays in emotional maturity.

Surprising Resilience in Most Cases
The adverse effects of institutionalization on children's global development--physically, emotionally, medically, and psychologically--have been well documented. Developmental delays and attachment difficulties are highlighted in the above studies. Yet the only finding more remarkable than the damage caused by institutional neglect, say researchers now charting Romanian adoptees, is the ability of many children to overcome the setbacks once neglect ends. Case Western Reserve University professor of social work Victor Groza has been following more than 300 Romanian adoptees since 1992 and has found that 80 percent have already made up quite well for lost time. After the first year, says Groza, 20 percent had adapted so well it was all but impossible to distinguish them from typical children their age. An additional 60 percent showed subtle problems such as slower eye-hand coordination. In the 20 percent who fared worst, Groza found more long-lasting cognitive behavioral and emotional problems.

Lessons To Be Learned from Difficult Placements
I became interested in looking at children who continue to exhibit classic institutionalization signs and behaviors one to two years after placement, and what factors contribute to their being successful placements nonetheless. In preparation for two days of training for our Holt-Romania social workers, I examined post-placement reports of ten families whose children still exhibit after-effects of institutionalization. I reviewed these reports for difficulties still present, family coping strategies, and strengths and positive qualities the children possessed. Listed below are some of the lessons from this review that might be helpful to other adoptive parents.

1. Seek Appropriate Resources
All the families sought resources and treatments for their children; some needed only speech therapy or assistance with English, while others sought much more help. The important lesson is that every adoptive family must be willing to seek out whatever resources and treatments their children need in a timely manner. Do not wait until a child arrives to do this. Be proactive and learn beforehand what community resources are available. The most common assistance families obtain for children from institutional settings are speech and occupational therapy. Also locate physicians, counselors, and psychologists who are familiar with international adoption and institutionalization issues. One's direct service agency and other adoptive parents should also be able to help.

2. Stay Committed
All the families showed commitment to assisting their child however they could, even if progress was slow. It was evident that each child's most important resource was his or her family. A commitment to the child's wellbeing may be the single most important factor in a successful adoption.

3. Have the Right Attitude
Developing the right attitude ahead of time is essential. It is important for adoptive parents to enter adoption with realistic expectations and a basic understanding of issues related to their child's institutionalization and abandonment. The parents' commitment should begin even before a child is referred. It is a natural tendency for prospective parents to create fantasies of what their future children will be like. It is better, however, for them to love and accept their future children for who they really are.

4. Have Hope
I noticed an undercurrent of hope throughout almost all these cases. As long as families could see that their children were making progress, even if in some cases it was in very small increments, families appeared hopeful that progress would continue and they and their children would be okay in the end. Armed with hope, families were able "to see the light at the end of the tunnel," whether it was near or far away.

5. Maintain Optimism, Flexibility, Patience, and a Sense of Humor
These qualities are mentioned together because the presence of one generally means the presence of one or more of the others as well. Two or more of these qualities, particularly flexibility and patience, were present with most of the ten families reviewed. A study involving a questionnaire returned by a large number of families who adopted from Romania revealed that 90 percent had a positive view of their adoption. Being satisfied with their adoptions, however, did not mean the adoptions were problem-free. Being flexible and patient with the adoption process, not only prior to a child's arrival home, but also throughout the adjustment periods, and seeking out resources needed at different stages certainly contributes to an optimistic outlook. A consistent sense of humor helps foster optimism and a healthy perspective.

6. Pray for Bonding
In all cases reviewed, families appeared to be the most optimistic and hopeful about their adoptions when their children showed attachment (love, affection, trust, faith) to them. This was the most important overriding factor. As long as their children showed affection, or at least exhibited gradual progress toward that end, it seemed to be easier to deal with other problems or delays. In these ten cases, those children with the strongest attachments had previously formed an attachment with a caretaker, social worker, or foster parent, or had lived for a significant period of time during their early years with their birth family.

7. Be Informed
Before deciding on a child referral it is important for adopting parents to be as informed as possible. Even if information is scarce, it always helps to consult a pediatrician or other specialist before making a final decision. The Internet also can provide a wealth of medical information on adoption. I strongly recommend that the medical professional consulted be familiar with the special needs and concerns of internationally adopted children. Many families are now sending their referred child's information to one of the two dozen or so North American clinics specializing in international adoption medicine for consultation and feedback prior to making a decision. These clinics generally are run by physicians who have traveled extensively and have in-depth knowledge about common medical and institutionalization issues regarding children being adopted from other countries. The feedback they can provide could be invaluable.

Mike Noah, MSW, is director of social services for Romania and Latin America for Holt International Children's Services, Eugene, OR.

Edited excerpt reprinted with permission from Hi Families 43 (January/February 2001), 12-14. The full text of the Cradle of Hope "Survey Findings" may be downloaded from the following Web site: www.cradlehope.org/surv.html.

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© 2001 East-West Church and Ministry Report
ISSN 1069-5664