Newsletter #156 for Internationally Adopting Parents
November 22, 2011
PAL Center Inc.

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Tatyana Elleseff MA CCC-SLP
Orofacial Observations of Internationally Adopted Children: Recommendations for Parents and Non-Medical Adoption Professionals

Portions of this article were originally published in November 17, 2011 Issue of Advance Magazine for Speech Language Pathologists & Audiologists, Online Newsletter, under the title: "Orofacial Assessments: Pediatric Case Studies Illustrate Their Importance".

Several months ago, I've administered speech-language testing to a 3-8 year old boy, adopted from Russia at the age of 3-0. During the course of my assessment I noticed his atypical facial features. He had a very small head, inward set eyes, and widely set ears. At that time, even though this boy had already seen a number of other adoption professionals (including a neurologist, an occupational therapist and another speech language pathologist), I felt that it was very important to record my findings and refer the parent for a second opinion with a pediatrician specializing in working with internationally adopted children. My rationale for seeking a second opinion for this child was further reinforced by a number of additional red flags, which included his significantly decreased play skills, severely impaired language ability, as well as significant social emotional and behavioral manifestations characterized by excessive impulsivity, distractibility, hyperactivity, decreased self-regulation, rapid over-stimulation, as well as anger outbursts and tantrums when others refused to follow his agenda and attempted to set limits on his behavior.

Subsequent, second opinion consultations for this child resulted in a diagnosis of Fetal Alcohol Spectrum Disorder, a term which describes the range of physical, mental, behavioral, and learning disabilities that can occur in children whose prenatal history is remarkable for excessive maternal alcohol consumption.

I use this case to illustrate a point. At the time of adoption this child presented with significant unrecognized deficits, which continued to persist unrecognized and unaddressed post adoption. While I acknowledge that oftentimes little could be done done before a child is adopted, I also want to emphasize that this child could have been receiving relevant and necessary services for 8 months post adoption, but didn't because his deficits were missed!

The above case is not an isolated occurrence by any means. As a speech language pathologist who works exclusively with various at-risk pediatric populations (including internationally adopted children), I have numerous clinical examples I can share with you. In the past I have encountered undiagnosed feeding and swallowing issues, submucous clefts, vocal webs, Cerebral Palsy, Wilson's Syndrome, a number of undiagnosed Fetal Alcohol Spectrum Disorder cases, and even several cases of severe infections due to excessive tooth decay and poor oral hygiene. I can go on for a while but I do believe that I have sufficiently demonstrated my point.

Fact is that oftentimes internationally adopted children arrive to US with a host of undetected disorders and deficits. Lack of detection is further increased in children adopted from economically developing countries or from hard to access insular regional orphanages, where they may fail to receive consistent and appropriate medical care, or where overcrowded conditions coupled with staff shortages may cause for deficits to be missed or unrecognized.

Consequently, oftentimes it is the parent(s) who are the first individuals to observe something different or unusual regarding their child's facial features, oral structures, or any other appearance anomalies.

While many parents, of course, are not professionally trained in recognizing physical signs and symptoms of serious disorders, it is important to note that detection of unusual features is not as difficult as it sounds.

Read entire article

Boris Gindis Ph.D
Children with FAS - A Psychological Profile
Based on research and my own clinical experience, children with this condition are presented in significant numbers among international adoptees, particularly in those from Eastern Europe. FASD is found in population born in the US as well, but the IA children may experience additional and very specific difficulties.

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