Synopsis: Delays of growth and development proportional to the times of institutionalization of children from the former Soviet Union and Eastern Europe were common.
Source: Albers LH, et al. Health of children adopted from the former Soviet Union and Eastern Europe. JAMA 1997;278:922-924.
The former soviet union has become an important source for adoptions by Americans. A total of 56 children who were adopted from Eastern Europe and the former Soviet Union were evaluated in two international adoption clinics in the United States. Pre-adoptive medical reports from the birth countries were available for 47 of these children (84%). The results of the American evaluations were compared with their medical pre-adoptive records. The pre-adoptive medical records frequently contained multiple neurologic diagnoses (developmental delay, perinatal encephalopathy). Growth delays, which were proportional to time spent in orphanages, were common. Developmental delays were also common.
Although pre-adoptive medical records often included multiple diagnoses suggesting severe neurologic impairment, these diagnoses were not usually confirmed when the children were evaluated in the United States. However, substantial growth and developmental delays were common.
n COMMENT BY LAWRENCE C. KAPLAN, MD
Children born in the former Soviet Union and Eastern Europe are now an important source of international adoptions in the United States. This article illustrates a number of important concerns, not only related to the status of pre-adoptive medical documentation in the area of international adoption, but also to the effect pre-adoption status may have on the health and early childhood development of any child regardless of community or nationality.
Pre-adoptive records of 56 children adopted from Eastern Europe and the former Soviet Union were compared to evaluations they received in two multidisciplinary international adoption clinics using standardized assessments. Despite pre-adoptive reports pointing to many of these children having serious or obscure health conditions (including severe neurologic disease), few actually had such conditions. Furthermore, the majority of maternal histories available for review described abandonment or single motherhood as the reason for availability for adoption. Still, in the majority of children, when assessed comprehensively, there was some degree of developmental or growth delay.
In both fields of child development and international health, it is well-known that otherwise healthy children living in orphanage settings or in the absence of consistent and loving families can experience challenges to general health, growth, and normal rate of attaining developmental skills. Whether these are reversible remains to be fully understood. Pediatricians need to appreciate the enormous effect unusually stressful environments play on the well-being of children and recognize the importance of completely assessing children when pre-adoptive data are limited or questionable. (Dr. Kaplan is Associate Clinical Professor of Pediatrics and Director, Division of Children with Special Health Care Needs, Yale University School of Medicine.)
Children being adopted from the former Soviet Union and eastern European countries:
a. frequently have severe neurological diagnoses that are confirmed by subsequent examinations in the United States.
b. frequently have motor and developmental delays.
c. have delays in growth and development that are attributable to birth defects.
d. can be confidently assumed to be abnormal on the basis of pre-adoptive records.
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