This content was originally published by Creating a Family, the national adoption and foster care education and support nonprofit. Understanding Risk Factors in International Adoption – Creating a Family
Through careful consideration, you’ve come to the path of international adoption to create your family. But you still have so many questions you are grappling with about what you still need to learn and how to prepare. We wholeheartedly endorse learning as much as possible about the country program you are pursuing, the typical medical needs of the kids from this country, and the other considerations integral to the process. However, the most important thing you can do while pursuing international adoption is to set realistic expectations about the risk factors you will encounter. Holding realistic expectations about these risk factors and the international adoption process will equip you to stay open, flexible, and adaptable to better meet your child’s needs.
Understanding Risk Factors in International Adoption
As you gain a deeper understanding of the risk factors in international adoption, holding realistic expectations can help you navigate the steps to bringing a child home. Reasonable expectations can aid you in setting a mindset that can flex and respond thoughtfully to the inevitable changes and unexpected bumps in the road. The following considerations can help you set realistic expectations to sustain you when facing the unknown or many unanswered questions.
In most cases of international adoption, information about a birth mother’s life and pregnancy is limited or outright unavailable. In many instances, birth parents are unknown or unidentified altogether. However, understanding the context of a child’s pregnancy can significantly contribute to that child’s overall well-being. Understanding the sending country’s systems and resources for prenatal care and maternal nutrition can help you understand the impacts on unborn children. Learning about the mother’s stress levels, behavioral health history, and family medical history – when possible – can also help you understand the impacts on the child.
1. Consider prenatal conditions.
The most significant impact on the child can be a pregnant mother’s use of alcohol and drugs. Alcohol causes the most significant effects on a child’s developing brain and often results in lifelong deficits and challenges. The consequences of prenatal alcohol exposure can range from subtle to severe and frequently don’t appear until the child gets to school age.
You can begin educating yourself on the impacts of prenatal substance exposure early in your adoption process. While some countries see more prenatal substance exposure – or children in care born with the effects of exposure – the information is vital to preparing well and setting realistic expectations of what may be ahead for you if you adopt a child with possible exposure.
Here are a few of our recommended resources to help you start learning:
- Check out our newly revamped resource page: Raising a Child with Prenatal Exposure.
- Download our free guide: Understanding Prenatal Exposure to Alcohol and Drugs.
- Take this free course from CreatingaFamilyEd.org through our partnership with Jockey Being Family®.
- Register for one of the CreatingaFamily.org parent training workshops on raising kids with prenatal exposure.
- Check out FASDUnited.org – their website includes this state directory of clinics, services, and supports for kids impacted by prenatal alcohol exposure.
2. Consider behavioral health disorders.
It can be scary to step into the unknown of behavioral health disorders, including attachment challenges. When you educate yourself about the instances of known behavioral health diagnoses associated with international adoption generally and a specific country’s program, if possible, you can equip yourself with reasonable expectations.
Genetic links
Depression, bipolar disorder, and schizophrenia all have vital genetic components. While the risks for these disorders are passed on through the birth parents’ genes, the child’s environment also has a major impact on whether those genes are expressed.
Attention Deficit hyperactivity disorder (ADHD) also has a highly hereditary component and is the single most common disorder seen in adopted children. Most children exposed to alcohol in utero will have ADHD. Again, the child’s environment can affect the expression of ADHD.
Attachment challenges
It’s essential also to understand attachment challenges as behavioral health issues. Children who have experienced significant loss and institutional care also frequently experience some attachment struggles. Early childhood neglect is even worse than abuse and can affect not only a child’s attachment but also their speech and language, motor development, and growth.
These attachment challenges exist in a wide range of severity. Diagnoses may include Reactive Attachment Disorder (RAD), where a child struggles to bond or connect with anyone, or Disinhibited Social Engagement Disorder, where a child may attempt to bond with anyone, including strangers. However, a child’s mistrust of caregivers can complicate trusting their new parents. While it won’t necessarily rise to a diagnosable disorder, it can impact behaviors, create challenges in adapting to a new home, and affect the siblings in the house, too.
The recent CreatingaFamily.org podcast, 7 Core Issues in Adoption & Foster Care, can help you understand the roots of these behavioral health challenges and how parents can prepare and support a child through the issues they encounter. When you choose to adopt internationally, it’s crucial to set an expectation of ongoing attention to attachment and behavioral health. You must also be prepared to set habits early for nourishing self-care and a robust support network.
CreatingaFamily.org’s Adoption Comparison Charts
3. Consider medical conditions.
The changing face of international adoption includes shifts in the types and instances of the various medical conditions expected in the children placed in US homes. For example, Hepatitis B, which can cause serious lifelong problems, has decreased in prevalence worldwide thanks to the widespread availability of vaccines. Hepatitis C is also decreasing in prevalence, and although it can also cause long-term effects, effective treatment is available with early diagnosis. HIV has also become increasingly infrequent in international adoption, as has congenital syphilis, except for children adopted from Haiti.
Birth defects
In some countries, cleft lip and/or palate are more common than in others. The prognosis for these kids is good when adoptive parents take their child to a clinic specializing in cleft lip and palate. Accessing the therapeutic services (speech, OT, PT, for example) needed to help the child heal will also be beneficial.
Access to prenatal care
Another medical consideration is the absence of prenatal care for expectant mothers. In pregnant women who don’t have access to prenatal care, the incidence of prematurity is two to three times higher than it would be in the United States. Many countries have stigmas and cultural norms that may prevent a woman from seeking prenatal care, especially if she is single. Because of the extreme poverty and malnutrition among many mothers in countries like India, it’s common for these babies to have a very low birth weight.
Consult an international adoption clinic.
There are many other medical concerns for adoptive parents to consider when pursuing international adoption. These include congenital heart issues, missing limbs or digits, albinism, dwarfism, and tuberculosis. Consulting with a specialist in international adoption medicine will equip you with potential medical problems specific to the country from which you plan to adopt.
These organizations offer directories to find an adoption medicine clinic:
It’s also helpful to consider children’s hospitals for international adoption medicine, especially those connected to universities.
When considering international adoption, prospective parents should prepare for additional learning. Many of the kids with medical needs who come to US families will need multiple medical appointments, surgeries, and ongoing treatment. While some of the needs are straightforward and manageable, there are still many instances where undisclosed or unknown needs become apparent. They then may require additional testing, research, and care. Setting reasonable expectations about medical needs requires flexibility, education, and a strong support network of professionals and allies for your family.
Realistic Expectations and an Open Heart
Most of us understand that no matter how we form our family, there are no guarantees about a child’s health. The most important thing we can do while working through the international adoption process is to form and maintain realistic expectations. Getting a handle on what support we may need, finding the services and resources our child may need, and rallying a supportive friends and family network are all crucial elements to crafting reasonable expectations. Talking with other experienced adoptive or special needs parents can also help create realistic expectations.
Frequently, the most challenging issues for adoptive parents in the long run are the emotional ones, not the medical ones. Maintaining an open heart of compassion will help you guide this child toward a healthy self. And your open heart will be substantially supported when you surround yourself with others who get it. CreatingaFamily.org has an active online Facebook community and online post-adoptive parent groups where you can connect with other parents and caregivers for learning and support. Consider joining us today!
If you are interested in further understanding the need for permanency for kids all over the world, check out these resources:
