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Occupational Therapy and the Adopted Child. Megan Bresnahan , OTR/L University of Minnesota Amplatz Children’s Hospital. What is the International Adoption Clinic?. Pre-adoption review Post-adoption visit Ongoing support. Trends.
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Occupational Therapy and the Adopted Child Megan Bresnahan, OTR/L University of Minnesota Amplatz Children’s Hospital
What is the International Adoption Clinic? • Pre-adoption review • Post-adoption visit • Ongoing support
Trends • Changes are seen in the countries that we see children from • More restrictions • Hague Adoption Convention
Trends • Support for institutions • Nutrition • Access to medical care • Substance use/abuse • Foster care vs institutional care • Foods • Promotion of adoptions within country
China • Mostly orphanage careand some models moving more to a foster care model • 2005: 7903 • 2011: 2587
Russia • Orphanage Care • 2004: 5862 • 2011: 962
Ethiopia • Increased scrutiny • Orphanage care • 2004: 284 • 2010: 2511 • 2011: 1732
Guatemala • US is not currently processing adoptions from Guatemala • 2007: 4726
India • Orphanage care • 2004: 406 • 2011: 226
South Korea • Foster Care • Some orphanage care for older children and children with special needs • 2004: 1713 • 2011: 736
Columbia • Typically orphanage care • 2006: 344 • 2011: 216
Haiti • Orphanage care • 2004: 355 • 2009: 330 • 2011: 33
Marshall Islands • Relatively new • Child is typically with birth family until adoption • 2009: 22 • 2010: 19
Factors Affecting Development • 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
Factors Affecting Development cont. • Quality of care in institution (caregiver to child ratio, etc.) • Malnutrition • Eating and Sleep Disturbances • Abuse (physical, sexual or emotional) • Trauma • Medical/health problems • Lack of developmental stimulation • Language delays • Sensory deprivation • Attachment disorders • Separation and loss issues • Substance Exposure
Startling Numbers • A general guideline is that for each 3 months in an institution a child will lose approximately 1 month of development
Other factors to consider • Families adopting more than one child at a time • Parents with limited parenting experience
Speech and Language Considerations • Model language; avoid correcting as it may inhibit the child from trying to speak • Avoid television • 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
Cognitive and Learning Considerations • Lack of early stimulation may have long term effects on learning • Memory problems may be present • Initially, consider placing a child in developmentally appropriate setting rather than age appropriate
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 • Consistency and routines are 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
Interventions • School based therapy services • Medically based therapy services • Psychology • Neuropsych testing • Other specialists • When to start?
Attachment in OT • Utilize routine and structure in the session • Family Involvement • Parent permission • Indiscriminate friendliness • “High Fives”
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
Sensory Deprivation • If a child lived in an institution, she or he may have missed sensory experience • The child may not have been held, rocked, talked to or sung to • In a crowded orphanage, a small child might spend large portions of the day in a crib with little to do and not placed in a variety of positions • There may have been little chance to feel different textures, see different sights, hear different sounds or taste a variety of foods
Sensory Deprivation • A child may not have been played with or given the chance to run, jump, climb or play with toys • All of these activities provide sensory information to the brain, which interprets and organizes it • Without exposure to these activities, the brain does not learn how to appropriately use the information • Then when a child has new sensory experience, he or she may be over- or under-sensitive to the experience
Treatment • Very individual for each child
Research • 2005 study at the U of MN studied 222 kids from Eastern Europe; 12% with full or partial FASD • New FASD study • Growth Endocrine Study • Nutrition and International Adoption Study
Organizations working to improve Orphan care • SPOON foundation (http://spoonfoundation.org) • Half The Sky (www.halfthesky.org) • Orphans at Play (www.OAP.com) • Mission to Promote Adoption in Korea (www.mpak.com) • The Red Thread Promise • Worldwide Orphans Foundation (www.wwo.org)
