Can you first tell us what you do? (i.e.: describe what the clinic’s aims are, what your role is).
I began in the spring of 1986 as the co-founder of the International Adoption Clinic at the University of Minnesota and spent the next 20 years providing preadoption review services as well as post-adoption clinical screening for recently arrived international adoptees. My interest in the short- and long-term effects of early childhood institutionalization/deprivation developed in the early 1990’s concurrent with the arrival of post-institutionalized children from Romania. My first visit to a Romanian orphanage in 1993 was a life-changing experience that focused my attention on the importance of contingent caregiving in normal child development. Since then I have spent more and more time in research defining institutional factors that predispose children to physical and developmental delays as well as strategies to avoid such problems. Much of my attention has been directed towards educating governmental officials worldwide about the detrimental effects of early childhood institutionalization and the importance of providing permanent family care for all children.
What brought you into the field of adoption research?
My third child, Gabriel, was adopted from India in 1985. My futile attempt to find information in the pediatric literature on the health needs of international adoptees convinced me that this was a potential area of research.
What is the most pressing issue in your specialized area of medicine and adoption that you see today?
- Appropriate preparation of adoptive families.
- Long-term mental health support for adoptive families.
- Lack of appropriate evidence-based intervention programs for problems encountered in post-institutionalized children.
- Better medical and mental health care for children within the foster care system.
- Elimination of institutions in favor of competent foster care or, preferably, permanent adoption placement.
What changes/trends have you seen in the intersection of medicine and adoption over the last 10 years?
I’ve seen a much greater willingness of adoption professionals to work together to prepare parents and provide optimal post-adoption care for children. I’ve also seen some progress in understanding the need, and willingness to develop domestic foster care and adoption programs in countries that once relied exclusively on institutional care.
How can the field of medicine better help the adoption population and their families?
Over the past two decades we have come to appreciate, in much greater detail, the range of problems associated with early deprivation. However, we have only rudimentary knowledge of the causative factors. Medicine and psychology, working together, are now on the threshold of being able to better describe and understand the underlying pathophysiology.
What is one of the findings that was most surprising to you in your time as a researcher/investigator?
As a parent and a pediatrician, I intuitively know and have been trained to recognize the important role that a competent family plays in insuring normal child development. The most surprising finding is the magnitude of how important a family environment is. Yes, medical issues are important but much more time should be spent by childcare professionals (adoption medicine professionals included) insuring that a family is functional and that a child’s developmental needs are being met.
What are your thoughts on the progression/evolution of medical care in international institutional or foster care settings since you began your work?
When we began the clinic, we were told by one of the agencies in our area that we’d starve as all the kids they placed were in good health and would do well in their adoptive families. We now know there are specific health and developmental risks in all adopted children. The American Academy of Pediatrics has developed care guidelines for children in foster care and screening guidelines for international adoptees as well as establishing a Section within the organization on Adoption and Foster Care.
Perhaps the two most gratifying development are:
- Development of a robust literature on medical issues in adoption
- Intersection of the research interests of pediatricians and developmental psychologists on the effects of early deprivation on child well being.
What is one question about adoption that you are asked most frequently, and how do you respond?
Let me give you three:
From which country should I adopt?
It’s not the country; it’s the preadoption environment and experience of a child that determines the future. Both domestic and international adoptees share the same risk factors. Only by carefully examining the prenatal and postnatal history can you begin to understand the potential needs on an individual child and determine whether you are prepared to meet those needs. The choice of country should be determine more by eligibility requirements, willingness to adopt transracially and cost than by perceived child outcomes.
Will my child recover from her/his delays?
I’m very optimistic about the outcome of adoptees. Marked improvement is the norm and adoptive families have the motivation and resources to provide the needed care. However, we must be cognizant that some issues may persist and be willing to regularly evaluate a child’s progress and provide needed intervention.
Where can I find competent mental health care?
Unfortunately, I often don’t have a good answer for this question. Child psychologists, neuropsychologists and psychiatrists are in short supply nationally and few have experience and knowledge of the problems encountered in adopted children.
What are the most pressing issues facing the United States in regards to the intersection of medicine and adoption, and ensuring that children adopted privately or through foster care are well cared for and whose special medical needs are addressed?
Parents who adopt internationally are highly educated, highly motivated and almost always have good health insurance that covers not only physical issues but mental health care as well. They are also willing to advocate for their kids within school systems and are not reluctant to seek mental health care. Despite these strengths, preadoption preparation is spotty and often incomplete leading to an imbalance between expectations and reality.
Most children in foster care are poorly served by the system in terms of medical care and parents adopting from foster care have not yet embraced pre-adoption medical review to help plan for the needs of their child. The same is true for those who adopt privately. I find this tragic as almost all adopted children share the same range of risk factors, e.g. impoverished origin, prenatal chemical exposure, parental history of mental illness, early deprivation, physical/sexual abuse etc.
Over the next decade I hope there will be more integration of social work and medicine as we all attempt to better prepare all adoptive parents for the challenges ahead. Setting appropriate expectations if the key for successful placement and we can only accomplish this by having professionals work together.