Occupational Therapy Services and Developmental Screening in the International Adoption Clinic

1. Occupational Therapy Services and Developmental Screening in the International Adoption Clinic Megan Bresnahan, OTR/L University of Minnesota Amplatz Children’s Hospital

2. Therapy Services Provided in the Adoption Medicine Clinic (IAC) • When you are seen in the Adoption Clinic, you will also have the option to be evaluated by an Occupational Therapist

3. Therapy Services • This therapist will evaluate global development skills (keeping in mind “norms” for children from your child’s country and background), educate you on the findings and make further recommendations for things to do at home or services to consider.

4. Therapy Services • Our Occupational Therapists have experience working with children of all ages with varied experiences and adopted from all countries, including children adopted domestically • Many of our therapists have travelled abroad to work with children in orphanage care.

5. Factors that Affect Development • When assessing your child, there a number of important factors that contribute to their development that we will consider, including: • 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

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

7. Assessments • Screening is based on standardized testing but modified due to child’s differences in experience and language skills. • Functional activities are used to gather information about the child • Parents will be asked about changes in the child since the child joined their family • A general guideline is that for each 3 months in an institution a child will initially be delayed 1 month of development • The session is adapted to the age of the child • We feel that the team assessment is essential, and is one of the strongest elements of our program. This includes the medical evaluation(s), OT and psychological screenings or assessments.

8. Risk Factors for Children 2 years or Younger • These are the findings that we may watch closely, make further recommendations for or recommend interventions: • An identified health or medical problem (CP, FASD, malnutrition, tuberculosis, club feet, impaired vision or hearing, etc) • A small head circumference • Absent or poor eye contact • Self-stimulating behaviors which are not improving (rocking, head banging, etc) • Significantly greater delays than those typically seen for internationally adopted children form similar environments • History of abuse • Excessive irritability or inconsolability

9. Additional Risk Factors for Children Over Two Years of Age • Aggressive, inappropriate or violent behavior • Poor attention span (not related to language) • Decreased language/articulation skills in native language • Indiscriminate friendliness • Poor memory or learning concerns • Attachment issues

10. Interventions that May be Recommended • Home program of daily activities • School based therapy services • Medically based therapy services • Psychology • Neuropsych testing • Other medical specialists

11. Speech and Language Considerations and Recommendations • Model language; avoid correcting as it may inhibit the child from trying to speak • Avoid television • Seek pre-school and play groups with an age mix • 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 • Children frequently have large gaps in their language skills

12. Cognitive and Learning Considerations • Lack of early stimulation may have long term effects • Consider a pre-schools with a focus on child-initiated models of learning • Help school staff to learn about issues related to institutionalization • Initially, consider placing a child in a developmentally appropriate setting rather than age appropriate • Consider neuropsychological testing after 1 year post placement if child is struggling academically and/or there are cognitive concerns.

13. 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 • Consistent, low-key, structured routine is 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

14. Social, Emotional and Attachments Disorder Considerations • Consider early assessment with Pediatric Psychology if there are risk factors in the history such as neglect, abuse, early trauma, adoption at an older age (>2yo) or lengthy institutionalization. This can and should be considered prior to any major noted problems to help the child and family start out on the right path.

15. 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 • This is an issue seen in many children who arrive to their new home. It is also one of the most common issues we address with children who are struggling in school or at home, years after adoption.

16. Sensory Processing Concerns • We will evaluate how your child is responding to sensory experiences in a new environment and make recommendations for school and for your home to help them respond appropriately

17. Summary • The IAC is here to serve families and children with a history of foster care, international or domestic adoption • We see and assess children from a team approach with MD’s, OT, psychology and neuropsychology services that are all integrated and focused on the health of children from foster care and adoption.

18. Contact us at: • Email: iac@umn.edu • Website: http://www.iac.umn.edu/ • General information 612 624 1164 • To schedule a clinic appointment: 612 365 6777 • Other questions: • Stephanie Dahl, RN • sdahl11@umphysicians.umn.edu • Office 612-273-0853