Children who have experienced physical and social deprivation or trauma often exhibit delays and disruptions in their performance of normal life tasks and activities (occupations). In addition, the circumstances of institutionalization often force the child to develop atypical adaptive responses and behaviors (i.e., gaze aversion, fear, and lack of attachment with adults; attention getting through aggression; antagonism or withdrawal when relating to peers). I do not refer to these behaviors as maladaptive because in many of these horrible contexts, the children must react in these ways in order to survive. This is frequently the circumstance of the IA child. It may be helpful to consult with an experienced OT before the child enters the family in order to anticipate and to understand behaviors that may be problematic. If the delays or disruptions are extreme and/or do not begin to improve within the first month or two after adoption, professional support might be indicated. Occupational therapy can be helpful in assisting the family in understanding the child's behaviors, measuring the child's functional performance, determining the needs and supports for improving the child's behavior, and planning meaningful intervention strategies with the family and the child. It can also contribute to developing meaningful social and educational programs in schools and day cares. The following is a non inclusive checklist of behaviors that might indicate need for a referral to an occupational therapist. They have been organized within three performance areas of occupation (1) Developmental Activities; (2) Play Activities; (3) Activities of Daily Living.