Developmental delays are sometimes noted on preadoption referrals. There are many reasons for delays in infants and children. Important risk factors can complicate developmental delays such as institutional care, early deprivation, possible prenatal exposures and other medical issues.

Clinicians use 5 categories to assess childhood development: gross/fine motor, speech/language, cognition, social/personal, and activities of daily living (ADL’s). In infancy, the major focus is on the child’s motor skills. Early childhood starts to look more at motor and social communication such as play skills and eye contact. Older children are expected to demonstrate language, learning and living skills. 12- 16% of children in the USA are noted to have some form of developmental delay.1 Global developmental delay is defined as significant delays in 2+ categories and 1-2% of children have global delays.2

The question that we ask on preadoption referral is whether we feel that the delays are due to the postnatal (after they are born) high risk environment of the child or whether there is an organic issue or problem with the child that may cause permanent delays. The younger the child, the more difficult it is to answer this. If a child is 6 mo old and not sitting yet, it may be just due to early deprivation or lack of opportunity and many children catch up easily. However it may be a brain problem that may prevent normal development and require special services.

Some countries will send formal testing if the child is noted to have development that is not the same as the other children in their care center. China typically sends a Developmental Quotient (DQ) test if they are specifying that the child has delays and this is a rough estimate of IQ. However in young children, early developmental scores are not great at predicting outcomes unless they show extremely low functioning. As an example, if you have a child with DQ in the 30’s (average score would be 100), this is an extremely low test and does indicate concern for their future ability to function in the normal range.

In summary, if children are listed as having developmental delays, it depends on the type of delay listed and whether there are multiple areas of impairments. Age is a factor as well to see what other skills the child is able to perform well, to assess for cognitive risks. Developmental delays should also be assessed during the pre and post adoption process by a medical professional who is familiar with typical delays in order to determine what services may be needed to help the child reach their full potential.

Summary

• Seen occasionally in the preadoption information
• Mild delays may be due to preadoption environment but is difficult to rule out permanent issues in younger children. Will require consideration of catchup or therapeutic services.
• Moderate and severe delays may require special services in the home and school and lifelong assistance

References

1. Boyle CA, Decoufle P, Yeargin-Allsopp M. Prevalence and health impact of developmental disabilities in US children. Pediatrics. 1994;93(3):399-403.

2. Shevell M, Ashwal S, Donley D, et al. Practice parameter: Evaluation of the child with global developmental delay Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Neurology. 2003;60(3):367-380.

This article was generously shared by Dr. Judith Eckerle of the University of Minnesota, Adoption Medicine Clinic. Child referrals are becoming increasingly complex, and adoption medicine professionals are identifying many more children with special needs from all countries that participate in intercountry adoption, as well as from the United States. To help families prepare for these changes, Dr. Eckerle and other medical specialists are writing a book: Health Topics For Preadoptive Families.