Consideration in service delivery to special populations Flashcards
INTRODUCTION
Internationally adopted children
Decreasing numbers of IAC in the U.S
# adopted is about ¼ of what it was
https://travel.state.gov/content/adoptionsabroad/en/about-us/statistics.html 2017
Majority of adoptees in 2015 were 1-12 years old
Some top countries children adopted from:
- China
- Ethiopia
- Haiti
- South Korea
Hwa-Froelich :
US families adopt ch from abroad 4-16x more than other countries.
Most studies: South Korea & Romania
South Korea: Positive Outcomes
Romania: Negative outcomes
BECOMING AN “ORPHAN
In home countries of IAC, usually found in orphanages
Some have parents who are dead
In many cases, however, parents put their children into orphanages cannot afford to feed them
Also, in some cases, parents are NOT MARRIED; great DISGRACE in some countries, so the child is placed in an orphanage
Kathleen Morris (Practical strategies for therapists working with SI/SPD Disorders)
Volunteered: Russian, Romanian, Bulgarian orphanages
She has also worked for 17 years as the founder and director of two SI clinics
I went to her workshop
According to Kathleen Morris:
Russian cities-mother abandon ch on street
Walking along holding hands; mother says, “look there!” drops ch hand, runs away.
Orphange workers go out in the PM to look inside manholes-ch hiding from cold.
(Morris)
Smell in orphanage is so bad that some visitors throw up when they enter. In some Bulgarian orphanages, schedule: 1.Breakfast 2.Sit on bench 3.Lunch 4.Sit on bench 5.Dinner 6.Go to bed-stay there
Former student Marilyn Stansfield, (worked in Romanian orphanage)
Orphanage workers stole supplies-diapers, wheelchair parts, bottles, soap, combs, toilet paper
Sometimes told not to change a wet diaper or use shampoo during bath.
Workers took orphans’ food.
Marilyn also volunteered at a Romanian hospital for abandoned babies…
8 beds-room
Only human contact=diaper change
Not held or cuddled
All meals; blanket/pillow propped next to heads, bottle placed on blankets
Marilyn tried to feed a newbie from a bottle…
Wouldn’t eat-stared at Marilyn
Nurse: baby unfamiliar w/ being held while feeding
Too much sensory input-be held and eat simultaneously
ACCULTURATION ISSUES
Frequently, IAC are ABRUPTLY TAKEN OUT of their familiar surroundings and placed into totally new environments
This is especially hard on OLDER IAC
They may miss the FAMILIARITY of surroundings they have known all their lives
Used to INTERACTING with other CHILDREN, not adults
GENERAL CONSIDERATIONS
Possible post-traumatic stress syndrome
Consequent need for psychological services, emotional support
Adoptive PARENTS may need these services also–feel OVERWHELMED
Other potential areas of concern include
Malnourishment-decrease brain development general health
Decrease dental care
Decrease gross, fine motor skills
Behavioral issues
Physical abuse-neglect
Decrease emotional bonding opportunities
Potential alcoholism in birth mothers (esp. Eastern European)
Hwa-Froelich—major parent concerns
HIV infection # one
Latent TB
Immunization status
Short stature
SPEECH AND LANGUAGE CONSIDERATIONS**
Articulatory-phonological skills may be negatively impacted by LOW ORAL MUSCLE TONE
Some IAC refuse to even chew, let alone speak
Again, dental/orthodontic needs may have been neglected
We will remember the definition of “language
A system of symbols that represents concepts formed by exposure and experience
With very limited exposure and experience, some IAC may have very LIMITED CONCEPTUAL FOUNDATIONS
A challenge for many IAC
Decrease cognitive-linguistic stimulation in L1
Rapid L1 LOSS.
WEAK conceptual FOUNDATION upon which to build L2
IAC may have
Post-institutional Autistic Syndrome
—experienced such abuse and neglect that they exhibit autistic-like behaviors—e.g., rocking, hair-pulling
Ellesef (Adoption and pragmatic problems. ADVANCE for SLPs, December issue)
5-10 years post-adoption, some c tested high on standardized tests of lang.
But signif. Pragmatic deficits
Pragmatic deficits interfered w/ academic performance and social interactions inside and outside school.
So we know from research that
The YOUNGER IAC are at the age of adoption, the better their chances for developing language normally
Those who show initial delays may still have them later; we always need to TEST when the children are NEWLY ADOPTED and follow up
CONCLUSION
SLPs are becoming increasingly involved in providing services to IAC, especially on multidisciplinary teams
Remember, parents need support too!
Anecdotal evidence: pediatricians may tell adoptive parents “wait and see”
Increasingly, this is being viewed as UNACCEPTABLE; currently, most experts recommend that adoptive parents just ASSUME that children will need ADDITIONAL services and stimulation in ALL AREAS of development
When children are evaluated:
- Parent report is usually highly reliable and valid
- Macarthur Communicative Development Inventory is popular
- Use PRELINGUISTIC measures of joint attention, symbolic play, object permanence, PRESPEECH vocalization
