Tatyana Elleseff MA CCC-SLP
Orofacial Observations of Internationally
Adopted Children: Recommendations for Parents and Non-Medical Adoption
Portions of this article were originally
published in November 17, 2011 Issue of Advance Magazine for Speech
Language Pathologists & Audiologists, Online Newsletter, under the
title: "Orofacial Assessments: Pediatric Case Studies Illustrate
Several months ago, I've administered speech-language
testing to a 3-8 year old boy, adopted from Russia at the age of 3-0.
During the course of my assessment I noticed his atypical facial features.
He had a very small head, inward set eyes, and widely set ears. At that
time, even though this boy had already seen a number of other adoption
professionals (including a neurologist, an occupational therapist and
another speech language pathologist), I felt that it was very important
to record my findings and refer the parent for a second opinion with
a pediatrician specializing in working with internationally adopted
children. My rationale for seeking a second opinion for this child was
further reinforced by a number of additional red flags, which included
his significantly decreased play skills, severely impaired language
ability, as well as significant social emotional and behavioral manifestations
characterized by excessive impulsivity, distractibility, hyperactivity,
decreased self-regulation, rapid over-stimulation, as well as anger
outbursts and tantrums when others refused to follow his agenda and
attempted to set limits on his behavior.
Subsequent, second opinion consultations for this child
resulted in a diagnosis of Fetal Alcohol Spectrum Disorder, a term which
describes the range of physical, mental, behavioral, and learning disabilities
that can occur in children whose prenatal history is remarkable for
excessive maternal alcohol consumption.
I use this case to illustrate a point. At the time of
adoption this child presented with significant unrecognized deficits,
which continued to persist unrecognized and unaddressed post adoption.
While I acknowledge that oftentimes little could be done done before
a child is adopted, I also want to emphasize that this child could have
been receiving relevant and necessary services for 8 months post adoption,
but didn't because his deficits were missed!
The above case is not an isolated occurrence by any means.
As a speech language pathologist who works exclusively with various
at-risk pediatric populations (including internationally adopted children),
I have numerous clinical examples I can share with you. In the past
I have encountered undiagnosed feeding and swallowing issues, submucous
clefts, vocal webs, Cerebral Palsy, Wilson's Syndrome, a number of undiagnosed
Fetal Alcohol Spectrum Disorder cases, and even several cases of severe
infections due to excessive tooth decay and poor oral hygiene. I can
go on for a while but I do believe that I have sufficiently demonstrated
Fact is that oftentimes internationally adopted children
arrive to US with a host of undetected disorders and deficits. Lack
of detection is further increased in children adopted from economically
developing countries or from hard to access insular regional orphanages,
where they may fail to receive consistent and appropriate medical care,
or where overcrowded conditions coupled with staff shortages may cause
for deficits to be missed or unrecognized.
Consequently, oftentimes it is the parent(s) who are the
first individuals to observe something different or unusual regarding
their child's facial features, oral structures, or any other appearance
While many parents, of course, are not professionally
trained in recognizing physical signs and symptoms of serious disorders,
it is important to note that detection of unusual features is not as
difficult as it sounds.