Yale International Adoption Clinic

The Yale International Adoption Clinic offers comprehensive services to adopting families, internationally adopted children and the community doctors who care for them.

"Americans seeking to adopt children are turning to Russia, China, Eastern Europe, Southeast Asia and Central and South America," said Carol Weitzman, MD, director of the clinic. "Those interested in adopting children from other countries need to be aware they bring with them unique and complex physical, developmental and emotional issues that have the potential to interfere with their adjustment to their new families.

"Prospective families are not generally provided with a lot of accurate information about these children," said Dr. Weitzman.

This lack of knowledge raises concerns, such as:

• Has the child been exposed to infectious diseases?
• Will the child grow and develop to his or her full potential?
• Will the child readily adapt to a new home?
• What can you do to best prepare for the adoption?

The Yale International Adoption Clinic can help. "We offer a variety of services that prospective parents and pediatricians can access throughout the adoption process," said Michael Cappello, M.D., co-director of the clinic. The Adoption Clinic staff is knowledgeable about the unique medical and social conditions of children from other countries, is skilled in managing infectious diseases and understands the developmental and psychological impact of institutionalization and sensory deprivation.

The goal of the clinic is to assist families every step of the way, from providing guidance and information about pre-adoption records to performing a careful post-adoption assessment of an individual child's medical, developmental and psychosocial well-being.

Pre-adoption Services

• Identifying the special needs/limitations parents are willing to accept.
• Counseling about general risks of international adoptees.
• Evaluating videotapes, photographs and medical histories.
• Preparing adoptive parents for their trip abroad, including how to spot red flags and how to interpret information about the child.
• Providing telephone support for families during their stay abroad.
• Providing pre-adoptive seminars for parents.

"Being able to assess the information given about a child is essential," said Dr. Weitzman. "Even with very limited information, certain issues may present themselves. People tend to assume everything is fixable. Not everything is, and we shepherd people through the worst-case scenarios based on the information we have."

Post-adoption services

The Yale International Adoption Clinic offers comprehensive evaluations of newly adopted children every Monday in the Pediatric Specialty Clinic on the second floor of the Yale-New Haven Children's Hospital.

The evaluation includes:

• Medical examination
• Developmental assessment
• Audiology and physical therapy evaluation
• Growth and nutrition screening
• Psychosocial development assessment
• Screening tests recommended by the American Academy of Pediatrics
• Counseling about potential health and developmental issues

"We find that with time and testing, most medical and developmental issues present themselves. What's often more difficult to determine are emotional problems," said Dr. Weitzman, "which may manifest themselves in tantrums, extreme clinginess, aggression, withdrawal, hyperactivity and/or depression."

Building intimate relationships with caregivers provides children with a framework of how to understand and interact with the world. Children who haven't had that may exhibit many behavioral symptoms that need to be assessed. The clinic staff can help pediatricians caring for children who may need specialized attention, and they can help parents figure out ways to help their child learn coping strategies.

General risks of institutionalized children

Children who have been institutionalized are generally a higher-risk group. Lack of stimulation, inconsistent caregivers and poor nutrition may result in developmental delays in critical areas such as speech acquisition and social skills. Physical growth may be affected. Infections such as intestinal parasites, tuberculosis, hepatitis B, syphilis, measles, chickenpox, etc. are also more common in institutional settings.

Can children recover? They can, but recovery takes time. The longer children are in orphanages, the longer it may take for them to function within a normal range. "Each child is different," said Dr. Weitzman. " Some children are amazingly resilient; others may require more support. One of the most remarkable things about doing this work is watching kids who come out of difficult situations go on to flourish with the loving support of their new families."

If you would like more information about the international adoption clinic or would like to speak with one of the medical directors, please call: Tracy Sotere at 203-737-1623  

Reprinted with permission of Yale-New Haven Children's Hospital/Pediatric Update

Click here for more about Caden's story.

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