occupational therapy and the adopted child megan bresnahan, otr/l university of minnesota amplatz...
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Occupational Therapy and the Adopted Child
Megan Bresnahan, OTR/LUniversity of Minnesota Amplatz Children’s Hospital
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What is the International Adoption Clinic?
• Pre-adoption review• Post-adoption visit• Ongoing support
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Trends
• Changes are seen in the countries that we see children from
• More restrictions• Hague Adoption Convention
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Trends
• Support for institutions• Nutrition• Access to medical care• Substance use/abuse• Foster care vs institutional care• Foods• Promotion of adoptions within country
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China
• Mostly orphanage care and some models moving more to a foster care model
• 2005: 7903• 2011: 2587
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Russia
• Orphanage Care• 2004: 5862• 2011: 962
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Ethiopia
• Increased scrutiny• Orphanage care• 2004: 284• 2010: 2511• 2011: 1732
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Guatemala
• US is not currently processing adoptions from Guatemala
• 2007: 4726
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India
• Orphanage care• 2004: 406• 2011: 226
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South Korea
• Foster Care• Some orphanage care for older
children and children with special needs
• 2004: 1713• 2011: 736
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Columbia
• Typically orphanage care• 2006: 344• 2011: 216
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Haiti
• Orphanage care• 2004: 355• 2009: 330• 2011: 33
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Marshall Islands
• Relatively new• Child is typically with birth family
until adoption• 2009: 22• 2010: 19
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Factors Affecting Development
• Genetic Background• Pre-natal care• Birth History• Age at time of Adoption• Country of origin• Cultural Issues• Living environment prior to adoption: foster home vs.
institution including orphanage or hospital vs. time with birth family
• Length of time in orphanage care and number of placements/transitions
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Factors Affecting Development cont.
• Quality of care in institution (caregiver to child ratio, etc.)• Malnutrition• Eating and Sleep Disturbances• Abuse (physical, sexual or emotional)• Trauma• Medical/health problems• Lack of developmental stimulation• Language delays• Sensory deprivation• Attachment disorders• Separation and loss issues• Substance Exposure
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Startling Numbers
• A general guideline is that for each 3 months in an institution a child will lose approximately 1 month of development
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Other factors to consider
• Families adopting more than one child at a time
• Parents with limited parenting experience
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Speech and Language Considerations
• Model language; avoid correcting as it may inhibit the child from trying to speak
• Avoid television• Many behaviors associated with attachment
disorders and ADHD are also seen in children who are just learning English or who have speech and language delays
• Children learn conversational English first, after several years language skills for academic learning
• Encourage imaginary play
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Cognitive and Learning Considerations
• Lack of early stimulation may have long term effects on learning
• Memory problems may be present• Initially, consider placing a child in
developmentally appropriate setting rather than age appropriate
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Social, Emotional and Attachments Disorder Considerations
• Children need to adjust to their new family and all of the changes that they are experiencing
• Initially, the primary caregivers should be the main people to provide for the child’s basic needs
• Maximize the amount of time that the parents are with the child
• Consistency and routines are helpful• Minimize the number of settings that the child is in• Children may functional at higher levels in other
areas of development than in emotional development
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Interventions
• School based therapy services• Medically based therapy services• Psychology• Neuropsych testing• Other specialists• When to start?
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Attachment in OT
• Utilize routine and structure in the session
• Family Involvement• Parent permission• Indiscriminate friendliness• “High Fives”
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Henry
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Sensory Processing Concerns
• Sensory deprivation, lack of sensory experiences may have effects on sensory system
• This may cause the child to have a difficult time processing sensory input in a new environment
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Sensory Deprivation
• If a child lived in an institution, she or he may have missed sensory experience
• The child may not have been held, rocked, talked to or sung to
• In a crowded orphanage, a small child might spend large portions of the day in a crib with little to do and not placed in a variety of positions
• There may have been little chance to feel different textures, see different sights, hear different sounds or taste a variety of foods
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Sensory Deprivation
• A child may not have been played with or given the chance to run, jump, climb or play with toys
• All of these activities provide sensory information to the brain, which interprets and organizes it
• Without exposure to these activities, the brain does not learn how to appropriately use the information
• Then when a child has new sensory experience, he or she may be over- or under-sensitive to the experience
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Treatment
• Very individual for each child
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Research
• 2005 study at the U of MN studied 222 kids from Eastern Europe; 12% with full or partial FASD
• New FASD study• Growth Endocrine Study• Nutrition and International
Adoption Study
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Organizations working to improve Orphan care
• SPOON foundation (http://spoonfoundation.org)
• Half The Sky (www.halfthesky.org)• Orphans at Play (www.OAP.com)• Mission to Promote Adoption in Korea (
www.mpak.com)• The Red Thread Promise• Worldwide Orphans Foundation
(www.wwo.org)
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Case Study: Nick
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Case Study: Jesse and Maya