We have been referred a 5th child that we just found out has HbH disease ( a kind of Thalassemia intermediate). The orphanage in Taiwan says that the parents are denying being carriers and are being genetically tested and that the other 3 children of the birthparents do not have the condition. Is this a life threatening ailment or a chronic medical condition that may be medically managed?

This article describes the effects of chronic maltreatment, such as can occur in an orphanage, on a child's psychological development, brain development, and later relationships. There are clear links between maltreatment and later psychological, emotional, behavioral, and interpersonal disorders. The basis for this linkage is the impact that maltreatment has on brain development. Daniel Siegel, medical director of the Infant and Preschool Service at the University of California, L.A., has found important links between interpersonal experiences and neurobiological development

The new article of Dr. Boris Gindis spells out what and why should be done by the parents of internationally adopted children in regards to their child’s behavior issues at school. The author explains the importance of being well informed about the current laws (IDEA 2004) and the benefits of having a professional on your side when resolving contentious situations related to behavior of your child at school.

This article was inspired by a telephone consultation with a prospective parent concerned about a 3 year old child from South America, who she was considering for adoption. A pediatrician evaluated the child and gave him a “clean bill of health” but was doubtful about his speech: the child was not talking at all and instead pointed at things as a means of expressing himself. The child had a hearing test which came back fine.

The current research involves collecting data from the parents of post-institutionalized children for the purpose of determining the specific resources these children will need during their years in school. While many Eastern European adoptees may glide smoothly through the educational system without needing any additional help, it's clear from data collected at ongoing support networks that a great many of them will need some kind of assistance over and above ESL services during their school careers.

Children sometimes have their own view on living with a parent, but at what point does their view begin to carry weight...

The term “institutional autism” has recently become a subject of discussion on adoptive parents’ lists and in the online publications of adoption professionals. No wonder: the diagnosis continues to cause a lot of confusion and ill-suited remedial efforts.

Oppositional and defiant behavior is a very difficult family problem. A defiant child can take all the fun out of family life and relationships. But there are effective ways to manage and eliminate this problem. This article describes such an approach.

There is a crisis of epidemic proportion within the International Adoption Community. It has the potential to compromise the health and well-being of many adoptive families. Known as Post Adoptive Depression or PAD, it affects over 65 percent of adopting mothers according to a recent survey by the Eastern European Adoption Coalition (EEAC), yet goes unacknowledged or unrecognized by agencies, social workers, and most of the medical community.

I once received a phone call from a distraught parent, “My fourteen-year-old son lies non-stop about everything. It’s so bad that if he keeps this up, we’ve threatened to send him to boot camp!” As well as lying, the child had been skipping class and wrestling practice; I gave the parent’s three suggestions to follow for the next two weeks:

Why is it that so many adopted children are diagnosed with ADHD? Debbie, an adoptive parent and counsellor, explains how trauma related to adoption can affect the brain in a way which causese hyperactivity. She outlines briefly some useful parenting strategies for these hyperaroused children.

If adoption is on your mind, you should think through your strategies on native language issues of your future child well in advance. Indeed, the preservation of the first language is a "hot" topic for many adoptive parents who often have to choose between their hopes and dreams and the reality of parenting a traumatized post-institutional child. The article points out at some aspects of development of your internationally adopted child, which you should consider deciding on the child’s native language preservation.

On arrival to the US with their newly adopted child or later on, when certain problems require parents to go to professionals for a developmental evaluation of the child, many parents are faced with the dilemma: who is the right professional for the evaluation of an internationally adopted child and what can different specialists offer?
Dr. Gindis explains the difference between neuropsychological or psycho-educational assessments of an internationally adopted child and helps you understand which professional you should look for.

The number of women in the workforce is larger than at any time in our history. Increasingly women are focusing on their careers and putting off child-bearing until their thirties and forties. For many women whose biological clock is ticking, increasing the odds of becoming pregnant has become a top priority.

Dr. Gindis speaks about the specifics of Post Traumatic Stress Disorder (PTSD) in internationally adopted children.

Dr. Linda Busch, clinical psychologist and expert in adoption and attachment, tells the story of how she and her husband came to adopt an 8 year old girl from Russia. Dr. Busch believes that most older adopted children are not attachment disordered, but simply need the same time and attention to attach as children raised with their biological parents. Dr. Busch combines self-reflection with her expertise as a psychologist to tell her beautiful story of older child adoption, and offers help and encouragement to adoptive parents struggling with attachment concerns.

We just received a referral for a 14 month-old Russian girl. I am concerned about her head measurements (microcephaly?) as they are consistently below the 3rd percentile on the CDC charts. Is it easier to make measurement mistakes erring to the small side than to the large side. Perhaps I am making too much of this; but I have read several articles stressing the significance of this condition when it exceeds 2 Standard Deviations (3rd percentile). I have also read that this is not the type of thing that nutritional improvements, etc. will have much effect on after

This article summarizes the results of a follow-up study demonstrating the effectiveness of Dyadic Developmental Psychotherapy for treating children with disorders of attachment. The complete study can be found in the December issue of Child and Adolescent Social Work Journal, which is a peer-reviwed professional journal. In addition, the complete article can be gotten from the author.

We have been referred a 5th child that we just found out has HbH disease (a kind of Thalassemia intermediate). The orphanage in Taiwan says that the Hemoglobinopties are disorders of blood cell structure and they may occur in many different ethnic groups, such as African, Asian, Mediterranean or Middle Eastern decent.

In each bilingual individual there is a dynamic relationship between competencies of two languages, therefore, cognitive skills and conceptual knowledge that a given child possesses may be more functional in one language than in the other. The cornerstone of an assessment of bilingual students should be the determination of their total language proficiency. Does the Bilingual Verbal Ability Test (BVAT) do it well? The article was initially published in "Communiqué" (National Association of School Psychologists), 27.

Reactive Attachment Disorder Checklist

The attachment issues of internationally adopted children remain a very controversial problem for parents and professionals alike. Dr. Boris Gindis looks at Attachment Disorder from different perspectives, briefly analyzing examples from his own decade–long psychological practice and outlining his views on Attachment Disorder.

Research regarding children of intercountry adoption is limited, and most children of intercountry adoption have complex histories that may place them at risk for difficulty or failure in the classroom. Although the performances of some children from orphanage environments approximate those of chronological-age peers 2 to 4 years postadoption, duration of deprivation is consistently related, both historically and currently, to the cognitive delays and behavioral difficulties displayed by many postinstitutionalized children. Research regarding children of intercountry adoption is reviewed, and recommendations for future research are offered. [Journal of Special Education, 39(3)]

Through direct and mediated learning major cognitive skills and processes are formed and put in action. Deprived of such experiences, children may have problems moving to more advanced levels of learning. When a child misses certain stages of normal cognitive development and never learns generic concepts necessary for successful schooling, the educational matter this child is taught simply does not have any structural support upon which to be understood, remembered, and used.
In this article Dr. Gindis re-visits the origins of CCD in international adoptees and points out at the utmost importance of early intervention, discussing some available remedial methodologies.

"Artificial Twinning" is a term used in domestic adoptions to describe the process of adopting two children at the same time who are less that nine months apart in age and biologically unrelated. Most domestic adoption and social welfare agencies prohibit the practice because it is so stressful to adopting parents and counter productive for the children. The only way to complete the adoption of "artificial twins" successfully is to work without official approval.

This article describes the subtle signs of attachment difficulties. Many of these subtle concerns can be found in young children adopted from overseas. It is important for parents to be sensitive to the subtle effects of institutional care so that they can appropriately help their children. This article includes some parent annecdotes and specific ideas for parents to use.

My 20 mo old son is reportedly toilet trained. Is it possible? Should I put him diapers or underwear? I heard a lot about children being traumatized during toilet training in orphanage. How can I help my child to overcome this trauma?

In order to understand what to do with the newly adopted child, who was partially trained or abused during the toilet training process, we first have to determine what exactly is early toilet training and what is the difference in perception of toilet training in Russia and in the United States.

We were just referred a 7 month old boy that was born at 35-36 weeks. The medical report we received says that the neurologist diagnosed him as having "perinatal lesion of central nervous system." In June and August, the notation "early recovery period" was on the report. In October, the notation was "late recovery period."
Is "perinatal lesion of CNS" something that you frequently see? How concerned should we be? Perinatal Encephalopathy - is it something, or is it nothing?

Persistent diarrhea is extremely common in PI children and can be caused by many factors. Very often several factors are present at the same time. Frequently persistent diarrhea is just an uncomfortable condition, but sometimes it can be a sign of a serious health problem. In most of the cases, it is a combination of different factors, which is determining the necessity and urgency of actions. Children with persistent diarrhea are more prone to have gastro-intestinal tract complications during or after any stressful situations (emotional, infectious and so on)

Peer pressure is one thing that all teens have in common. You can't escape it. It is everywhere. Whether it is pressure to conform to a group norm or pressure to act, peer pressure is something everybody has to deal with at some time in his or her life.

What is school readiness and why every parent of an internationally adopted child should be concerned with it at all? Dr. Boris Gindis explains why the answer to this question may have many consequences for the child and for the family.
This article was initially published in: The Family Focus, FRUA newsletter, Summer 2004

The cultural aspect of international adoption.
In this article theoretical conceptualizations of Vygotsky and Feuerstein serve as a major paradigm for the analysis of cultural issues of international adoptees. Native language attrition and dynamics of English language acquisition are considered in the context of transculturality. The specificity of cumulative cognitive deficit (CCD) in international adoptees is linked to prolonged institutionalization, lack of cultural mediation in early childhood, and profound native language loss. The issue of remediation is examined with an emphasis on cognitive education in the context of acculturation.

I have heard that Attention Deficit/Hyperactivity Disorder (ADHD) is more common among adoptive children than the general population. Is this true? And, if so, why?

The parenting key to solving conflict with an angry kid is to understand what they really want and give it to them. And what an angry child really wants may surprise you. Read on to discover how you can start getting the respect you deserve even from an angry kid.

After the initial amazing advancements with the English language learning, some internationally adopted children experience problems at school, the progress slows down, and they actually fall behind the school requirements. Some of these children may even show significant difficulty in their academic work, which, in turn, brings behavioral and emotional problems. Dr Gindis speaks about the characteristics of Cumulative Cognitive Deficit that some of these children may experience.
This is the abstract of the article “Detecting and remediating the Cumulative Cognitive Deficit in school age internationally adopted post-institutionalized children,” initially published in: POST, Issue #27.

Many adoptive families struggle for years to create the peaceful family of which they had dreamed. Regrettably, one of the main barriers preventing such family harmony is one of the least understood when it comes to understanding the plight of the adopted child. That barrier is trauma.

These activities are entertaining for a whole family and promote cognitive abilities of a newly adopted child. They also set the stage for developing mutual attachment in the family through shared fun and play. The descriptions of activities offer general ideas, and the parents should feel free to make necessary adjustments. It’s important to understand that a child adopted from an overseas orphanage can, for example, be seven years old according to the birth certificate, but developmentally (emotionally and cognitively) is very likely two or three years younger. Thus, the suggested sets of activities differ mostly by the goal parents may have in mind, rather then by child’s age.

The language issue in international adoptees

A significant number of internationally adopted children may have learning problems in school and require a lot of remediation and other services at school. These services are regulated by the law, called IDEA, which was recently modified. Dr. Boris Gindis explains what the infamous “Discrepancy Formula” that used to be a part of your child’s evaluation for Learning Disability classification is, and how inappropriate its application is in regards to internationally adopted children.

I have heard the term "institutional autism" as being a complication of living in an institution or orphanage. Autism sounds like a very scary word and I am nervous about this condition. Could you explain this diagnosis and what are the expected outcomes for these children?

When a newly arrived post-institutionalized child receives a diagnosis of Failure To Thrive, what does that really mean to his new parents and family? In older adoptees, a diagnosis like this can be devastating. Whereas most very young children with this diagnosis "grow out of it" quickly with good food and parental devotion, the damage done to an older child requires much more intensive therapy to overcome. This is the story of one child who came to America at age five years and received a diagnosis of Failure To Thrive. You will follow the progression of therapies from developmental pediatrician to Occupational Therapist to Psychologist and finally to school support.

Historically, ESL was designed for students from new immigrant families. At present, ESL is a mandatory, federally funded program for every non-English speaking child who enters the public school system. The teaching methodology of ESL programs is for children from families where another language is spoken. Moreover, the acceptance into the program assumes this premise. However, from the time of adoption internationally adopted children live in monolingual (English only) families, not in the families where "other-than-English" language is used. Indeed, we have a unique and paradoxical situation when students, who are legally eligible for ESL, have the English language as their home language!

Children of different ages adopted internationally are often ”at risk” educationally. Deprived of essential learning experiences in orphanages, they are indeed disadvantaged and may have cognitive and language problems moving to more advanced levels of learning after adoption. The answer to this problem in many cases is an early, well-planned, focused, and systematic cognitive and language remediation at school, in the community, and at home. Dr. Gindis gives an overview of the SmartStart program that attempts to enhance every day family activities and make them more cognitively and developmentally effective for a child.

In the series of articles Dr. Gindis explains what happens with the language of adoptees from foreign countries when they arrive to the US and begin their life in American families. Dr. Gindis explains why language metamorphosis in internationally adopted children are often the reason for so many school issues, specific to these children only and what parents need to know to help their children to overcome these problems. This is part 4 of the series.

The initial adjustment period is incredibly demanding and difficult for all members of any adoptive family, not just the child who will most likely be acting like a much younger one, will be visibly stressed out and over-aroused with everything new that is happening in his/her life. It is a cultural shock in many cases, and even families who are eager to embrace the child’s native culture and would try to learn the language, eat the food and fill the house with the ethnic nick-knacks very quickly realize that it is not enough: culture goes so much deeper than that.

I have heard that many internationally adopted children are at risk for Reactive Attachment Disorder. What is this disorder and what are some of the signs that parents should look for?

What is post-traumatic stress and how does it manifest in the young institutionalized child?

The initial mutual adjustment of an adopted child and the adopting family is an extremely important and stressful period in the life of every participant. What to expect? Is there a way to prepare for it emotionally and physically? It is only reasonable to expect the child to have behavior problems determined by the complexity of the situation.

The world of childhood is quite different from our adult world. It is not simply a smaller version of it. It is a different world, and you have to learn to understand it. You have to learn to "read" child's behavior. Every parent needs these skills, but parents adopting internationally may need them more then others, since you will not have the advantage of understanding your child's native language.

Does anyone have advice on what to look for in a Pediatrician to care for my Internationally adopted child, and what questions should one ask of him during the “Get to know you interview”?

ADHD in post-orphanage children is a matter of great practical significance and is an emotionally charged issue for adoptive parents. I have to point out that the core of ADHD - impulsivity, restlessness, and inattentiveness - may be symptoms of many other disorders, or just one of the characteristics of post-orphanage behavior, or social adjustment.

This article describes how attachment develops and difficulties that children can expeience when all does not go as it should.

This article describes an evidence-based approach to treating children with disorders of attachment. The basic approach has proven effective and the results of a follow-up study using this method can be found in a professional peer-reviewed journal. The approach is sensitive and responsive to the child's needs and encourages an attuned relatiionship.

Cognitive and academic issues

The shy/withdrawn adolescent may have major conflicts and issues but nobody knows. In fact, sometimes parents are not able to detect the internal storm or struggle in the shy or withdrawn, largely due to an external calm.

Brain-based learning strategies for helping hyperactive kids. Teacher resources and parenting tips to help control ADD when kids stop taking stimulant drugs. A likely scenario given the recent publicity about heart-related problems linked to Ritalin.

Assessing behaviour in school-age children is more than simply identifying a few problems and if you don't get it right, you can make matters worse. This article defines a good assessment process...

What is in the best interest of a child? Is the focus on racially matching a child with her adoptive family more important than providing a stable, loving and nuturing home?

In January of 2007 Americans will be able to see a Russian movie of 2005 “Italianetz,” a controversial film that touched upon many people involved in international adoption, the movie that stirred various, predominantly positive emotions among Russians and abroad. The author of this review, B. Gindis Ph.D., looks at the movie from the perspective of a child psychologist working with the internationally adopted children from Russia for more than a decade.

In the series of articles Dr. Gindis explains what happens with the language of adoptees from foreign countries when they arrive to the US and begin their life in American families. Dr. Gindis explains why language metamorphosis in internationally adopted children are often the reason for so many school issues, specific to these children only and what parents need to know to help their children to overcome these problems. This is part 1 of the series.

Don't let their good arguments fool you... They haven't a clue!

Temperament is a given. Understanding what is temperament and how it may affect your relationship with your child can help you develop a better relationship with your child and avoid many problems later in life.

In the series of articles Dr. Gindis explains what happens with the language of adoptees from foreign countries when they arrive to the US and begin their life in American families. Dr. Gindis explains why language metamorphosis in internationally adopted children are often the reason for so many school issues, specific to these children only and what parents need to know to help their children to overcome these problems. This is part 3 of the series.

Since the beginning of September 2006 a lot of agencies requested a free evaluation of our new course JSBG2 - Adopting older children internationally: making a decision and coping with post-adoption difficulties. We received positive responses and questions, which are very important in light of upcoming ratification of Hague regulations that will govern the entire adoptive process. We believe it can benefit every prospective parent to familiarize with Hague requirements for their pre-adoption training; the artcle will also give definitive answers about the BGCenter Online School course to the agencies that are looking for the providers of such training.

In the series of articles Dr. Gindis explains what happens with the language of adoptees from foreign countries when they arrive to the US and begin their life in American families. Dr. Gindis explains why language metamorphosis in internationally adopted children are often the reason for so many school issues, specific to these children only and what parents need to know to help their children to overcome these problems. This is part 5 of the series.

What symptoms suggest that an adoptive child has been exposed to a significant traumatic event?

Post-Adoption Depression. Who is likely to experience it and how can it be prevented?

As a society, we spend too much of our energy identifying and punishing the bully that we fail to spend enough time empowering the victims of bullying. We should spend more of our energy on the things that we can control rather than the things we have limited or no control over.

In spite of recent media attention, "scared straight" boot camps are proving to be ineffective.

A psycho-educational assessment of a child in the native language has not yet become a standard procedure for every older internationally adopted child, but its value is difficult to overestimate. Dr. Gindis explains why and when parents should request such evaluation.

Here are a few good reasons why you need to take some time out and make sure that your child has the right kind of sexual information and how it can help your child...

Of course, there are many differences between foster care and adoption, ranging from the trivial to the significant.

The patterns and dynamics of English language acquisition by internationally adopted children

We just received a referral of a 1 year old child to evaluate. The report states that she has "dysplasia of coxofermoral joints". I'm wondering if this is the same as "hip dysplasia" which I understand appears on a lot of referrals.

Urinating while asleep, also called nocturnal enuresis, is common in children. It is messy and worrying, but as it is unintentional, it can only be an indication of a growing body system growing adapted to sleeping without diapers. Nocturnal enuresis in teenagers and adolescents, though, may be worrisome for parents; it can be embarrassing for older children, and is considered a physical manifestation of deeper troubles in a teenager or adolescent.

In my practice as a special education attorney for parents and students for more than twenty-five years, I have seen certain issues and frustrations expressed repeatedly. I have written a series of short articles to discuss some of the mistakes people make in the special education process that often cause or exacerbate those issues and frustrations. The articles focus in turn on mistakes commonly made by parents; school districts; independent evaluators; and, finally, advocates for parents and students.

In the series of articles Dr. Gindis explains what happens with the language of adoptees from foreign countries when they arrive to the US and begin their life in American families. Dr. Gindis explains why language metamorphosis in internationally adopted children are often the reason for so many school issues, specific to these children only and what parents need to know to help their children to overcome these problems. This is part 2 of the series.

During the process of adoption from the Former Soviet Unions (FSU), families are forced to ascertain the health and developmental status of their potential child based on medical reports provided by orphanages, evaluation by the in-country medical professionals (when available), and on the family’s personal experience during the visit(s) with the child in the orphanage. Proper use of the documents, typically present in any orphanage file, can make the process of adoption more informed and somewhat less stressful. Besides the medical and educational value of such documents, there is a potential present and future sentimental value of this paperwork to the adoptive family and adopted child.

This is the second of a series of short articles I have written to discuss some of the mistakes people make in the special education process. This article focuses on mistakes commonly made by school districts. A general theme ran through the comments I received from attorneys, advocates and parents while I prepared this article: anything a school system does that undermines parents’ trust creates a climate that is costly in dollars, time, peace of mind and the quality and success of services given to the child.

This article outlines twentyone things for parents to do to help ease the transition from orphanage to home.

This article briefly outlines critical questions to ask when selecting a therapist to treat an internationally adopted child.

My referral is a special needs newborn with bilateral clubfoot. What is this condition and is it correctable?

Sensory Integration Disorder is a condition in which incoming sensation and information are processed abnormally and perceived to be other than they actually are or are intentioned. A child may feel pain when very light touch is applied; another may feel nothing unless the pressure is very deep or significant. One child may see all things around him as a threat while another has dangerously little fear of injury. Sensory malfunction can exist in the realm of taste, sight, hearing, touch, or movement. In some cases, an individual's life will be significantly impacted. Since so many newly adopted children from Eastern Europe may have this condition, an evaluation is often indicated.

Don't quit yet! Things may have changed even though you may not realize. Here's how to tell....

Crossing the mid-line is a simple brain-based-learning strategy with dozens of variations that kids and adults can easily do throughout the day. Use these teacher resources and parent tips to help kids improve reading, do homework, and learn new skills. Use them yourself to improve job performance or teaching. Helps everybody focus on the task at hand and get it done.

"We returned with our daughter in late July and our pediatrician has told us to get all her immunization and shots redone because he doesn't trust the Russian records. I guess it's the safe thing to do, although that means 2 needles for the next month for five months. Has anyone else encountered this?"

As with the other aspects of an adoption, there is a great deal of controversy around the question of what medications to bring with you on your trip. There are elaborate packages of antibiotics and other prescription medications that are marketed to adoptive families. The major question is what to treat? with what to treat? and actually – to treat or not to treat at all?

Many new parents worry about their ability to be the best parents that they can be. This is very common and is also completely understandable. You will hear many people say that it is too bad that newborns do not come with an instruction manual. It's too bad they don't, because it sure would have made my life a lot easier, and it could have made life a lot easier for generations of parents and their children alike.

Virtually everyone has heard 2nd or even 3rd hand of an adoption story with a painful or horrible ending for both the child and family. The media grabs onto these rare occurrences and shamelessly focuses on the pain and heartache of all involved. What is the real truth?

Can Fetal Alcohol Syndrome be distinguished by doctors and is there a test that can be performed to help with the diagnosis?

Homework is an area that parents and children often battle over. Effectively managing these battles can mean the difference between a successful and unsuccessful school career for your child. This article summarizes an approach to managing these difficulties.

Well, we know that sitting in front of video games and TV is not health beneficial. Being out doors help's our children to become creative.

What are the Recommended Screening Tests and Evaluations for newly adopted Post Institutionalized child?

Love is the biggest show-and-tell of them all and you need to make it a part of your every day life.

Some of the medical issues encountered in children adopted internationally

Any parent who has attempted to focus on a task while also taking care of children knows how challenging it can be. For many work from home parents that challenge is a part of their every day life.

“I have heard that my son’s orphanage has a problem with scabies and that he is more than likely going to have them.
What is the best way to be proactive about this? Should we treat him and us as soon as we meet (if he has them)? We may be traveling with our older daughter (4.5yrs) so we are worried that she would catch them.”
” My daughter came home from Russia last month with them, and after a delay in diagnosis I did the Nix treatment with her. It seemed to work well and the sores disappeared, but now it's two weeks later and new ones are appearing. A friend told me she'd heard there was a different strain of scabies in Europe that our usual medications might not treat."

Not unlike their married counterparts who pursue adoption, single women often pursue motherhood citing the same need and desire to love and nurture a child of their own.

The problem of how a child comes to know what words refer to what objects or actions is complicated by the fact that a single object or event has many parts and features which can be referred to in a great many ways. The key to helping your child to acquire language as soon as possible is to create persistent frames of references within his immediate environment. To do it you have to be explicit, consistent, and redundant.

Do you have a child that you feel is trying to conquer the world? Does your child insist on having every thing his or her way? Parenting strong-willed children is a challenge that most parents are not prepared for. Here are some parenting tips and advice on dealing with strong-willed children.