1. Occupational Therapy and the Adopted Child Megan Bresnahan, OTR/L University of Minnesota Amplatz Children’s Hospital

2. What is the International Adoption Clinic? Pre-adoption review Post-adoption visit Ongoing support

3. Trends Changes are seen in the countries that we see children from More restrictions Hague Adoption Convention

4. Trends Support for institutions Nutrition Access to medical care Substance use/abuse Foster care vs institutional care Foods Promotion of adoptions within country

5. China Mostly orphanage care and some models moving more to a foster care model 2005: 7903 2011: 2587

6. Russia Orphanage Care 2004: 5862 2011: 962

7. Ethiopia Increased scrutiny Orphanage care 2004: 284 2010: 2511 2011: 1732

8. Guatemala US is not currently processing adoptions from Guatemala 2007: 4726

9. India Orphanage care 2004: 406 2011: 226

10. South Korea Foster Care Some orphanage care for older children and children with special needs 2004: 1713 2011: 736

11. Columbia Typically orphanage care 2006: 344 2011: 216

12. Haiti Orphanage care 2004: 355 2009: 330 2011: 33

13. Marshall Islands Relatively new Child is typically with birth family until adoption 2009: 22 2010: 19

14. Factors Affecting Development Genetic Background Pre-natal care Birth History Age at time of Adoption Country of origin Cultural Issues Living environment prior to adoption: foster home vs. institution including orphanage or hospital vs. time with birth family Length of time in orphanage care and number of placements/transitions

15. Factors Affecting Development cont. Quality of care in institution (caregiver to child ratio, etc.) Malnutrition Eating and Sleep Disturbances Abuse (physical, sexual or emotional) Trauma Medical/health problems Lack of developmental stimulation Language delays Sensory deprivation Attachment disorders Separation and loss issues Substance Exposure

16. Startling Numbers A general guideline is that for each 3 months in an institution a child will lose approximately 1 month of development

17. Other factors to consider Families adopting more than one child at a time Parents with limited parenting experience

18. Speech and Language Considerations Model language; avoid correcting as it may inhibit the child from trying to speak Avoid television Many behaviors associated with attachment disorders and ADHD are also seen in children who are just learning English or who have speech and language delays Children learn conversational English first, after several years language skills for academic learning Encourage imaginary play

19. Cognitive and Learning Considerations Lack of early stimulation may have long term effects on learning Memory problems may be present Initially, consider placing a child in developmentally appropriate setting rather than age appropriate

20. Social, Emotional and Attachments Disorder Considerations Children need to adjust to their new family and all of the changes that they are experiencing Initially, the primary caregivers should be the main people to provide for the child’s basic needs Maximize the amount of time that the parents are with the child Consistency and routines are helpful Minimize the number of settings that the child is in Children may functional at higher levels in other areas of development than in emotional development

21. Interventions School based therapy services Medically based therapy services Psychology Neuropsych testing Other specialists When to start?

22. Attachment in OT Utilize routine and structure in the session Family Involvement Parent permission Indiscriminate friendliness “High Fives”

23. Henry

24. Sensory Processing Concerns Sensory deprivation, lack of sensory experiences may have effects on sensory system This may cause the child to have a difficult time processing sensory input in a new environment

25. Sensory Deprivation If a child lived in an institution, she or he may have missed sensory experience The child may not have been held, rocked, talked to or sung to In a crowded orphanage, a small child might spend large portions of the day in a crib with little to do and not placed in a variety of positions There may have been little chance to feel different textures, see different sights, hear different sounds or taste a variety of foods

26. Sensory Deprivation A child may not have been played with or given the chance to run, jump, climb or play with toys All of these activities provide sensory information to the brain, which interprets and organizes it Without exposure to these activities, the brain does not learn how to appropriately use the information Then when a child has new sensory experience, he or she may be over- or under-sensitive to the experience

27. Treatment Very individual for each child

28. Research 2005 study at the U of MN studied 222 kids from Eastern Europe; 12% with full or partial FASD New FASD study Growth Endocrine Study Nutrition and International Adoption Study

29. Organizations working to improve Orphan care SPOON foundation (http://spoonfoundation.org) Half The Sky (www.halfthesky.org) Orphans at Play (www.OAP.com)www.OAP.com Mission to Promote Adoption in Korea (www.mpak.com)www.mpak.com The Red Thread Promise Worldwide Orphans Foundation (www.wwo.org)

30. Case Study: Nick

31. Case Study: Jesse and Maya