Pre-placement screening in international adoption.
BACKGROUND
The number of child adoptions from abroad is increasing, but the adverse living conditions of these children prior to the adoption raise questions on their medical and neurodevelopmental status, particularly since there are no guidelines for pre- or post-adoption medical evaluation.


OBJECTIVE
To describe the condition of a cohort of young children who were candidates for adoption in East European orphanages and foster homes, and to determine those attributes associated with a family's decision to adopt or refuse a particular child.


METHODS
Eighty-two young children, median age 11 months, were evaluated by Israeli pediatricians in Eastern Europe between 3 weeks and 6 months prior to their adoption. The evaluation consisted of comprehensive medical and neurodevelopmental testing on site using a battery of standardized assessment tools, and observation of free play and social interactive behaviors recorded on videotape. Laboratory tests included complete blood count, chemistries, serology screening, and metabolic and genetic testing.


RESULTS
The children were growth-retarded. Medical problems were classified as resolved (pneumonia and diarrhea) in 32.8%; or ongoing, such as hepatitis B and C, failure to thrive, organomegaly, and visual and hearing disorders, in 14.8%. Neuromotor status was grossly abnormal in 13.4%. Twenty-two percent of the children were rejected for adoption by families in Israel. Factors associated with the adoption decision were performance skills on developmental testing (P = 0.0001), present medical status (P = 0.002), and weight (P = 0.016).


CONCLUSIONS
Pre-placement comprehensive screening of children eligible for foreign adoption, which includes developmental screening, helps to identify a wide variety of strengths and impairments in a child's background before the adoption procedure is finalized. A family's decision to adopt or not was associated with the child's performance on Bayley Scales, weight, and current medical status, but not with language delays, serious past medical history or suspect family background.
Diamond
Gary W
GW
Child Development Center, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. diamondg@zahav.net.il
Senecky
Yehuda
Y
Schurr
Daniel
D
Zuckerman
Jay
J
Inbar
Dov
D
Eidelman
Arthur
A
Cohen
Herbert J
HJ
D000300:Adoption / Q000208:ethnology*; D017677:Age Distribution; D002652:Child Behavior; D002674:Child, Institutionalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D005581:Foster Home Care / Q000706:statistics & numerical data; D006130:Growth Disorders / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D007806:Language Disorders / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D009468:Neuromuscular Diseases / Q000453:epidemiology; D019372:Orphanages / Q000706:statistics & numerical data; D015995:Prevalence; D012044:Regression Analysis; D013647:Task Performance and Analysis