Talk About Their Work
Dr. Gindis Answers
Q. When you do the psychological evaluations,
do you see a difference in results based on the country the children
A. It is a complex issue, as I do see a lot of
disparities from country to country, from age to age, and child to child.
For example, I do see more cases of FASD in the Eastern European kids
and more cases of cognitive impairments and autism in children from
China that were brought to the BGCenter. The numbers are obviously skewed
in relation to the total set of adopted children, as I mostly see those
who have "red flags" in their medical documentation and often
demonstrate atypical for their age behavior. Thus it's easier to generalize
about what is similar and common between all adopted older children
(4+) and sets them apart form children in immigrant families I see too.
Three similarities stand out immediately:
- Repetitive traumatization in their pre-adoption years
leads to chronic emotional problems for a significant number of IA
children. These traumatized children present (at least those I saw)
with an overpowering lack of self-confidence and emotional instability
that stops them in their tracks and which is often masked by inappropriate
behavior, as if they feel that they are so bad and so misunderstood
that there is nothing to lose for them anymore.
- Rapid native language attrition in combination with
slow and inadequate for the requirements of formal education English
language acquisition, create a distinct psychological pattern in these
children's development and behavior, regardless of the age and country
of origin - "another drop" into the traumatic events "bucket".
- Preexisting cognitive and learning delays of various
kinds and depth with a significant potential for an overall cumulative
cognitive deficit in the next few years often cause additional stress
for the former orphanage residents, resulting in their behavior issues.
It seems to me that these 3 major trends among international
adoptees who I see are prevailing and overriding any individual and
country related differences.
When I test these very different and so similar kids,
I can't use different standards in their evaluation - they all will
have to cope with the American educational system and there for must
be all viewed from this perspective: where they are in the continuum.
But their test results always need to be verified from different angles
and explained properly - and this part is very important and easily
misunderstood by professionals and school personnel.
For that matter, my goal in all assessments is to be flexible,
sensible and observant, collect as much additional information as possible
and apply that information to interpretation of the standard tests scores
in the context of known developmental history, cultural and language
differences of a child. At the BGCenter we have developed a specific
methodology of testing internationally adopted children. It is called
"Combined (bilingual - when necessary) developmental, neuropsychological,
and educational assessment". It includes "cross-battery"
technique that allows me to cross-reference the results that point to
multiple possible outcomes. This methodology is used in both "screening"
and "full assessment" procedures applied to all internationally
MA CCC-SLP on the Value of Multidisciplinary Collaboration
As a speech language pathologist who works
with internationally adopted children, I often encounter difficult cases
on which I require multidisciplinary collaboration from other professionals
such as pediatricians, neurologists, psychologists, occupational therapists
and other related specialists. However, over the years of working with
this unique population, I have noted that among adoption professionals
and adoptive parents this practice is not as popular, as I would like
it to be, despite evidence based practice recommendations (Catlett &
Halper, 1992; Ellingson, 2002; Hwa-Froelich, Pettinelli, & Jones,
2006; Tzenalis & Sotiriadou, 2010). Oftentimes, medical professionals
may initially examine a child post adoption, recommend a related service
(e.g., you child needs speech therapy) but will not follow
up with the related service provider regarding the childs progress
or lack of thereof. Of course the same goes the other way, I have also
encountered cases where a related services provider (e.g., OT, ST) had
made clinically relevant observations and did not find it important
to follow up with relevant medical professional/s regarding the findings.
Ive also encountered numerous adoptive parents who did not follow
through on specific recommendations regarding related services provision
(speech or occupational therapy services) or psychiatric/neurological
Consequently, for the purpose of this article I would like to demonstrate
to both adoptive parents and professionals two case examples in which
multidisciplinary and parental collaboration was key to confirming specific
relevant to social and academic functioning diagnoses, which then in
turn supported the provision of relevant services for the children in
question, to help them function appropriately.