1. Hwa-Froelich, Deborah A. PhD, CCC-SLP

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A mother is like a mountain spring that nourishes the tree at the root. But one who nourishes another's child, is like a water that rises into a cloud and goes a long distance to water a tree in the desert. - The Talmud


Parents who adopt children from abroad travel great distances to adopt children living in institutions and/or foster care and provide postadoptive care, nourishment, and stimulation. For many, this postadoption care is enough and these children thrive and adapt well into their new lives. Others, however, do not. What variables determine whether children adopted from abroad have positive or negative outcomes? Are some children more adaptable or resilient than others? The purpose of this issue is to provide information related to risk, adversity, adaptation, and resilience in internationally adopted children. Evidence-based clinical guidelines for assessment and referral practices will also be discussed.


Resilience has been defined more as a process than as a characteristic in that the process of resilience is affected by life experiences and the individual's interpretation of these life experiences across time (Rutter, 2000; Rutter et al., 2000). Obviously, persons exposed to less risk and adversity in both frequency and duration have fewer problems and have a greater chance for success. On the other hand, children who have experienced more than one stressor are at greater risk of poor outcomes. For those children experiencing multiple stressors, some children appear more resilient than others and achieve positive outcomes in spite of their negative experiences. What characteristics do these successful children have in common? What can be learned from resilient children to help practitioners provide intervention promoting resilience and recovery from adverse experiences?


Children adopted from different countries present a different developmental picture. After facing adversity and adaptation to institutional environments early in life, enduring disruption in relationship development beginning with limited social contact then increased social interaction with their adopted family, and experiencing disrupted communication development in one language to immersion in an adopted language, these children demonstrate a different developmental trajectory than monolingual and bilingual language learners living with their biological families. Determining which children have communication, social-emotional, or learning problems and making appropriate referrals for interdisciplinary services become challenging for practicing clinicians. Resilience is strongly correlated with average or higher cognitive ability, self-esteem, self-efficacy, and competence in solving and planning for potential problems (Rutter, 2000; Rutter et al., 2000). In addition, having emotional ties with caregiver substitutes and an external support system that positively reinforces competence and provides a sense of confidence are protective factors for resilience (Rutter, 2000; Rutter et al., 2000). In this issue, the authors present different frameworks of risk, adaptation, and resilience in internationally adopted children. For example, maternal prenatal care and health, as well as postpartum infant nutrition and healthcare, are essential for children's physical growth and development. Head circumference, in particular, is strongly correlated with cognitive development (Rutter, O'Connor, & the English and Romanian Adoptees Study Team, 2004). Dr. Jennifer Ladage presents a comprehensive review of the literature on maternal and prenatal variables and postpartum nutrition, physical growth, and health variables that may impact communication development of children adopted from several different countries.


The attachment between child and caring adults and attunement of the family are related to children's nonverbal and social communication and emotion regulation development, leading to the development of self-regulation, self-esteem, and self-efficacy. Children living in institutions often do not receive the quality and quantity of social or communicative attention an infant receives growing up in a family. Caregiver-infant ratios are typically high where the primary goal of caregivers is to efficiently care for large numbers of children (Johnson, 2000; Miller, 2005). Thus, social interactions are rarely directed to children individually nor do these interactions occur frequently or for long durations. Thus, children adopted from institutional care are at risk for social and emotional delays and adaptive behaviors resembling autistic-like behaviors, inattention, overactivity, and differences in attachment development (Kreppner, O'Connor, & Rutter, 2001; O'Connor, Bredenkamp, Rutter, & the English and Romanian Adoptees Study Team, 1999; Rutter et al., 2007a, 2007b). These behaviors may adversely affect the relationship development between the adopted child and the parent(s) as well as the development of appropriate nonverbal, verbal, and social communication needed for academic and social success. Dr. Samantha Wilson addresses the role of early relationship development between the child and the caregiver(s) on social, emotional, and communication development and discusses the need for speech-language pathologists and other early interventionists to refer to appropriate mental health professionals. She also describes early intervention approaches to facilitate the parent-child relationship.


The lack of social interaction may also result in limited early language input for these children. In spite of this adversity, internationally adopted children have demonstrated early postadoption adaptation and resilience in the area of communication development. Drs. Deborah Hwa-Froelich and Sharon Glennen describe early postadoption communication development in infants, toddlers, and pre-school-aged children adopted from abroad. They also provide clinical guidelines for assessment and referral for intervention. Dr. Kathleen Scott provides an analysis of the literature describing later postadoption language outcomes for internationally adopted children when they reach school age.


Clinicians and parents may be uncertain as to when or whether children adopted from abroad need early intervention services. To make evidence-based decisions is dependent on consideration and integration of three areas: (a) research, (b) clinical expertise, and (c) client values (American Speech-Language-Hearing Association, 2006). Drs. Jenny Roberts and Kathleen Scott compare the use of summative and formative measures in research studies with internationally adopted children and offer evidence-based suggestions for best assessment practices with this population.


These perspectives support the need to be knowledgeable and individualized in providing services to a different kind of English language learner. The multiple disciplines of thought represented in this issue describe current medical, psychological, social, and communication developmental theories and paint a complex picture of children exposed to early adverse experiences. Internationally adopted children's postadoption adaptation provides evidence of positive developmental outcomes and evidence of resilience in communication development. This information, as well as the evidence-based clinical strategies, provides early direction for practicing clinicians serving internationally adopted children.


-Deborah A. Hwa-Froelich, PhD, CCC-SLP


Issue Editor Associate Professor Department of Communication Sciences and Disorders Saint Louis University St Louis, Missouri




American Speech-Language-Hearing Association. (2006). Introduction to evidence-based practice. Retrieved February 18, 2007, from[Context Link]


Johnson, D. E. (2000). Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees. In C. A. Nelson (Ed.), The Minnesota symposia on child psychology: The effects of early adversity on neurobiological development (Vol. 31, pp. 113-162). Mahwah, NJ: Erlbaum. [Context Link]


Kreppner, J. M., O'Connor, T. G., & Rutter, M. (2001). Can inattention/overactivity be an institutional deprivation syndrome? Journal of Abnormal Psychology, 29, 513-528. [Context Link]


Miller, L. (2005). Special regional considerations. In L. C. Miller (Ed.), The handbook of international adoption medicine (pp. 45-66). New York: Oxford University Press. [Context Link]


O'Connor, T. G., Bredenkamp, D., Rutter, M., & the English and Romanian Adoptees Study Team. (1999). Attachment disturbances and disorders in children exposed to early sever deprivation. Infant Mental Health Journal, 20(1), 10-29. [Context Link]


Rutter, M. (2000). Resilience reconsidered: Conceptual considerations, empirical findings, and policy implications. In J. P. Shonkoff & S. J. Meisels (Eds.), Handbook of early childhood intervention (2nd ed., pp. 651-682). New York: Cambridge University Press. [Context Link]


Rutter, M., Colvert, E., Kreppner, J., Beckett, C., Castle, J., Groothues, C., et al. (2007a). Early adolescent outcomes for institutionally-deprived and nondeprived adoptees. I: Disinhibited attachment. Journal of Child Psychology and Psychiatry, 48, 17-30. [Context Link]


Rutter, M., Kreppner, J., Croft, C., Murin, M., Colvert, E., Beckett, C., et al. (2007b). Early adolescent outcomes of institutionally deprived and non-deprived adoptees. III: Quasi-autism. Journal of Child Psychology and Psychiatry, 48, 1200-1207. [Context Link]


Rutter, M., O'Connor, T., Beckett, C., Castle, J., Croft, C., Dunn, J., et al. (2000). Recovery and deficit following early deprivation. In P. Selman (Ed.), Intercountry adoption: Developments, trends and perspectives (pp. 107-125). London: British agencies for Adoption & Fostering. [Context Link]


Rutter, M., O'Connor, T. G., & the English and Romanian Adoptees Study Team. (2004). Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees. Developmental Psychology, 40, 81-94. [Context Link]