Common Special Needs in International Adoption

What are the special needs common to international adoption. What special needs do we see from specific countries. We speak with Dr. Kimara Gustafson, an associate professor of pediatrics at the University of Minnesota and a pediatrician at their Adoption Medicine Clinic. She also has her Masters in Public Health.

Transcript

spk_0:   0:07
Welcome everyone to Creating a Family Talk about adoption and foster care. Today we're gonna be talking about common special needs in international adoption with Dr Kamara Gustafsson. She is an assistant professor in the Department of Pediatrics at the University of Minnesota. She has her masters of public health that she also has an appointment at the University of Minnesota Adoption Medicine Clinic. Dr. Gustafson, welcome to creating a family. Thank you so much for talking with us today about a topic that we get a whole lot of questions. One.

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* Note that this is an automatic transcription, please forgive the errors.

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spk_1:   0:40
Yeah, of course. Thank you for having me.

spk_0:   0:43
We're gonna start by talking about not only what the common special needs, but also just briefly, What are they? And how involved is post adoption care, be it Three surgeries are through therapy or through parenting challenges, because I think that's what parents need to think about when they when they're checking off the list of all the things that they're willing to accept or they have a referral of a specific child that has a condition. It seems to me that they need to be thinking about how that how the impact will affect the child, how it will affect their family. How what type of of therapies and surgeries are, even if that would be required. So I've got a list of common special needs. So we're gonna just go down the special needs and you tell us just generally what it is, and then what's involved with it, how people will say, Well, how big of a special needed years. I always objected that, cause I'm not really sure that that's the way that we measure. Ah need. But you can. We can talk about how involved the cure would be. Uh, all right, So let's start with terrible policy. What exactly is cerebral palsy?

spk_1:   1:57
Yes. So cerebral palsy is usually thought to be more of kind of what we call a motor disorder. So it impacts kind of the way that your muscles move and kind of the amount of tone like how tight or how loose your tone is. It's usually thought to be due to a, um, insult to the brain sometime kind of around the birth process or made me shortly before kind of during the birth process on git can, uh, very in terms of severity or kind of degrees. So we think that it can on Lee involve kind of the legs it can do all you know, the arms and the legs or get involved just like one side of the bodies of the right side of the left side. And, uh, just like with most of the conditions that probably won't touch base on there's ah kind of a spectrum. And so there were people who could have kind of a mild case of several all the, um, and when we see that, typically rethink that kind of cognitively, there's less likely that there is any impact. So that person kind of from ah cognisant point should be expected to be on the same trajectory but would have more kind of physical. Um, limitations are potentially need more kind of therapy geared towards their physical needs. But if they have more motor involvement than there is more likely to be also a cognitive involvement as well. So that's kind of something that potentially families would want to consider. The other thing, too, is that sometimes CP, um can be under kind of ah, not I don't want to stay hidden, but it's like, uh, for a younger child if they don't have a MME. A definitive diagnosis that the child has CP. Sometimes it'll be under what we call hypoxic ischemic encephalopathy, or h I eat. Um and that is, um ah, condition that we think of where the baby right around the time of birds. It could be for birth trauma that they have kind of a lack of oxygen kind of transient lee, but can impact them. So that's something that, not uncommonly well see where family will send us a referral that has a diagnosis already of H I v E. And then we go on to say that, uh, kind of signs and symptoms are pointing in deduction that this child has now developed cp likely as ah um sick. Well, I from that HIV.

spk_0:   4:21
Okay. And it isn't terrible policy also more common in premature birth.

spk_1:   4:27
It can be yeah, again, because the premature infants they're bringing in a little bit more kind of sensitive or, um, just underdeveloped. And so cp can be an insult of any source. So either like lack of oxygen or there was kind of a transient stroke or Klatt, and versus the HIV is usually refers to just lack of oxygen. So, yes, if there is ah, premature infant or an infant, that was growth restricted in some way that they're going to be a higher risk that their brain will kind of incur that insult that lead to CP

spk_0:   5:05
character. Okay, How involved is the post adoption care for cerebral palsy?

spk_1:   5:13
Yeah. So again, it's on the spectrum. So for mild cases, it would likely just be a matter of ongoing physical therapy, maybe some occupational therapy, and then depending on kind of there ah, muscle restriction or kind of muscle condition, they might need help from orthopedics. Not so much from a circle surgical standpoint, but for splints, sir. Kind of casting to help with positioning of the limb, Um, to the extreme. And then those are the kids that we see, that they might be wheelchair bound, so that might be limiting in terms of kind of mobility and could have impacts for the family in terms of like, the layout of the house. Um, and what kind of know where The family recently asked. You know what's the best minivan for wheelchair. And I was like, I feel kind of dumb. It should know the answer, so I just I just You know, I e kind of sent out that question to, you know, the group of parents. It was like the head will church with its investment, you know? And so those are things that you know, the family was realizing that we need to get your car. Um but it can be all the way to where they need to see someone. You know, a physician multiple times a year, maybe to get certain, um, medications that help with kind of muscle relaxants or treatments on. And then again on the severe end, because it is C P is caused by an insult to the brain. Definitely not everyone. The CP has seizures, but they're higher risk procedure. So we do see Children that have C p and have kind of, ah, concurrent seizure disorder. So then that would be kind of an added specialist that they need to follow and added medication and such.

spk_0:   6:57
All right. Excellent. Now heart issues again, everything we're saying is on a spectrum of severity. But in general, what are some of the more typical hard issues? You see, an international adoption.

spk_1:   7:11
Yeah. So very typical. We'll see what we call a P D A or paying duct. iStar cheerio says some things we see a people on and these air both can, um, kind of parts of the heart. Anatomy that are open went before an infant is born and then short should close shortly after an infant is born as a transition from the blood supply from the biological mom to breathing on their own on dso again. Like if a baby was born premature, sometimes the p d a won't close the way that we expected to or that p f l p fo doesn't close. And so if it persists, then um, it's usually kind of diagnosed as a small um asd And, uh,

spk_0:   7:59
what does SD stand for?

spk_1:   8:00
Yeah, atrial septal defect. Gotcha. Um and so so Those are probably the most common that we see. And oftentimes those may not need any kind of intervention. Or if they do, it would be kind of more of a minor surgery and potentially even as simple as, um and you know, any surgery doesn't sound simple, but something like they could go to AA a cardiac cath lab, as opposed to kind of open heart surgery. Okay, um then kind of moving down the spectrum so you could have larger STDs, um, and then VSD, which is Ah ventricular septal defect. Which kind of the lower part of the heart. So And then once we get past that, then it tends to get a little bit more complicated and so similarly kind of the follow up and kind of potential treatments can be a little bit more involved when we start to get away from kind of the those top floor.

spk_0:   8:56
So with those four, they require general either nothing that child will be hit with the hole in the heart would be healing on its own, or it would require surgery. And the surgery, it sounds like could very between something relatively simple to full blown Ah, surgery on the heart itself.

spk_1:   9:17
Yeah, and sometimes it depends on so definitely depends on the size of the defect. But also we kind of put it in the context of it could depend on the age of the child. So if a child is younger, then like within is dear VSD, we would maybe potentially give them a chance to see if that, um, condition is kind of self resolving. When we get kind of to an older age, usually when they're can agreed, school and older a likelihood that it's gonna quotable. Fix itself decreases. So then, that is one where, um, again, depending on kind of the size, the family would we would recommend that the family talk to a cardiologists about Is this something that can just be followed? Or does it You really need to be addressed. And, um and oftentimes we look to see Ah, you know other. We can get a little bit of a sense from kind of some of the medical information that's available pre adoption, kind of that pre medical review Looking to see, you know, how is the child doing overall? Are they growing? Are they developing? Um, is the heart is struggling? It will definitely, um, have impacts in terms of growth and development. And so sometimes we can pick up kind of this little hints to see, um, the likelihood of a child needing more kind of ah support and therapy versus less.

spk_0:   10:46
So a child with a heart issue do they have either surgical, whether it's surgically repaired or if it heals on its own for the ones that you've mentioned, the four more common heart issues this a child have a normal life expectancy and a normal life. In other words, can they can they partake of the activities of of of a normal childhood? And will they live as long as of the Children?

spk_1:   11:10
Yeah, so there's a great question, and it really depends on the kind of, um, congenital heart defect that they have, Um, and then depends on whether or not it's been addressed or partially addressed in their productive country. At what age? Um and, um, kind of how well was the, you know, surgery or intervention? Um, how successful was it? Um, And then those factors, you know, we can see ones that even if they have a major defect and it was addressed, you know, very early on in kind of the early infancy, period. And they've been doing well that they may not have life expectancy all the way, you know, to the full life. But it would be well into adulthood, but ah, but then we can see other ones where if it's not repaired and what I'm thinking of is that we often things will break the heart into, um in the two categories one being, ah, hypoxic, meaning that their body is unable to get enough oxygen to their whole body or kind of non hypoxic. And so, if they're in the hypoxic category, we know that the longer that they go with kind of sub optimal levels of oxygen, um, that can have an impact on just the way that they're organs are functioning and then specifically how their brain is functioning and growing. So those people would more likely have kind of a cognitive in impact with the heart condition and then, more likely would be thought to have kind of a shortened life expectancy. And maybe, you know, depending on the severity again may not be even into adulthood.

spk_0:   12:53
Okay, and and with all the special needs we are talking about, keep in mind that you would obviously be needing both pre pre acceptance of a referral. Um, and even perhaps, if, as your checking off the list of what you're willing to accept, um, you need to converse with a adoption medicine clinic or your pediatrician but in particular an adoption medicine clinic to help you understand more specifics and especially that is the case after you have a referral because you have a child and you have the records from that child. So, yeah, I think that to a clinic into it to a doctor who can help you evaluate the specifics for this child,

spk_1:   13:36
right? I totally agree. And we find him. So we do over 30,000 pre adoption review is kind of since the inception of the clinic about 30 years ago, and with the high number of pre adoption reviews that we do, we found that, um, part of the reason that families like it is that kind of there, um, comfort level and, um kind of the expectations that they have pre adoption, you know, pre kind of needing their child are just, um, kind of significantly improved in terms of what to expect and what the kind of the first couple weeks or months will be. And then even down the road, in terms of years and kind of decades after versus where, we also will see families and clinic that have maybe not had that pre adoption review. Um, and we may, I think, are a little bit more kind of deer in headlights in terms of who? Gosh, there's all these specialists. I need to see the one thing I want to kind of mention that you touched on which I think is a great that when one kind of the way that I started to from families is when you're thinking of the list of, you know, kind of what are conditions that you feel comfortable, Um, both in your home. But I think logistically thinking about where you live. And so what are your resource is You know, if you are in the middle of nowhere and that kind of the closest regional hospital is hours away, then maybe a kid with a heart condition is not a great fit for you. Because, you know, the closest pediatric cardiologists could be in the next date versus if you live in the metro area and you have access to a kind of a whole wealth than, um then that's not as much of a concern s. Oh, that's something that I told families, because depending on families that they have other Children, you know? Do you know I know that we have three boys and they know that having hits, it's all about being in the car and just struggling small bodies around all over the place. But, um, you know, So now do you want to add in other doctors? Visits, therapy visits, you know, And if you're any visit, requires at least you know, an hour drive, that's gonna be a significant amount of your time. That's

spk_0:   15:51
such a good point.

spk_1:   15:52
Yeah,

spk_0:   15:53
I think that's a really good point to think through the logistics of what the special need may require. If it's a very involved heart condition and you have to go to a specialty hospital, that Ah hospital that specializes in and pediatric cardiology and that's going to require have a state travel. How can you handle that help from your job standpoint from a family standpoint, So all of those are just are so important. So thank you for raising them. All right. Two cleft lip cleft palate. That used to be a fairly common one that we saw coming from China in particular. But other countries as well explain what club flipping cleft palate is and what the, uh, typical care regime would be to repair it.

spk_1:   16:40
Yeah, So, um, we still see it. I'm not too infrequently. I'm so cleft. Lip and palate is a condition where kind of the body as it's forming before birth. And if the face starts on the outside and kind of comes together and so that for some reason it doesn't fully come together and they'll lift area, Um, we're kind of right under the nose. And then the palette is that kind of hard part on the top of the roof of the mouth and so doesn't kind of fully close there. Well, um, we often times from China. Uh, it's both cleft lip and cleft palate on DSO, um, and from other countries as well, depending on the country that the lip is often times repaired. Some things it's not. Recover it well, so they would need kind of like a plastic surgeon all over kind of revision. But the palette is left unrepaired, and so that's something that, definitely for their families they would need to address. After a child comes home, a hat can have implications in terms of how well a child it's feeding, and that speech related just because it can't quite form the salads or be able to use their tongue in the way that we would hope. And then also, we always want to make sure that they get their hearing tested because they can have because of and then the defect in that mid face area. It can extend you that they have chronic your infections or potential fluid in the here's that's causing hearing difficulty. Um, and then, uh, sometimes we get Children that are young enough that we don't quite know what the impact, if, if any, it will have on their G's. But definitely that would be a child that would need to establish with pediatric dentistry and then orbit Onyx down the road

spk_0:   18:29
because it could be, I can also be the absence of teeth. So at at a minimum, a number, usually a number of surgeries and then and then and then dental north of Donncha.

spk_1:   18:40
Yeah, and oftentimes, especially in larger kind of metro areas, there's what we call kind of a comprehensive cleft lip palette. Clinic is usually run through that your nose and throat service. And so that's one where we kind of they pull together like the, um, kind of that your nose and throat surgeons and hands of plastic surgery or, um, Earl Facial Mexico surgery. Then you have a speech and language therapist, the hearing specialists and then dentistry.

spk_0:   19:10
Yeah, that's so knowing that there is, Ah, a cleft palate clinic called Flipping or Cliff Clinic would be helpful moving to developmental special needs. Let's start with down syndrome.

spk_1:   19:23
Yeah, one more point. I wanted to just make about the cleft condition. Is that about 25 to 30% of kids with clips it can't. The cleft ing itself can be associate with a syndrome. So sometimes it's just kind of, ah, physical kind of anatomical condition that's you would require repair, but cognitively and a developmentally. We don't expect them to be any kind of different than their kind of non cleft ID peers. But there is that kind of 25 to 30% of kids that, um, it might be part of a larger syndrome, And some of the symptoms can be associated with, you know, kind of cognitive delays or developmental delays. And so again, that's something where it families say, Yes, we're okay with cleft lip cleft palate. The you might be surprised if they get a referral, you know? But then they said, No, we don't want all these syndrome thing might be a surprise that they get a referral that seems a little bit more complicated than just a simple uplifting.

spk_0:   20:23
So they be aware that cleft lip and cleft palate can come, can be associate ID with syndromes that also, in fact, development and and brain development and intelligence and other things such as that.

spk_1:   20:38
Yeah, and that's when we're especially for the collecting. Those families, I think historically, you know, like when we used to see more cliffs from South Korea and those it was usually have associated with just the kind of an atomic. So if you're speaking to parents that have older kids, I had a clock Luke Capella they their experience might be Well, we just came home. We had a couple surgeries, and otherwise Now they're great and they're in high school and they're gonna go to college next year. Yeah, yada And so. But we know that there can be just a higher risk of syndrome related versus kind of the general population. And so that is one that specifically if a family is going in with the expectation that it's just a physical abnormality. I say you want to make sure that you're reading that pre adoption review very closely are kind of the the medical information closely. So you're not surprised that you're bringing home a child that you think is just an atomic, but it could be part of something more

spk_0:   21:36
good. Okay, excellent. Now let's talk about Down Syndrome the way we all know that Down Syndrome is a genetic defect. But what are some other things that parents are? When people are adopting a child, they are anticipating developmental delays. Obviously, yum are developmental impairments, not just delays. What are some other things they should anticipate when accepting a referral of a child with down's?

spk_1:   22:03
Yeah, So you're right. I think that when we have families that, um, we have a pre medical review for Down Syndrome. They are already very well versed in terms of from kind of the genetic and developmental standpoint of the condition. This thing to know that it can be associated with other issues, So we always recommend that they be evaluated just to kind of rule it out. They're associated with heart defects of digestive systems. What kind of intestinal and stomach issues. Ear infections, hearing issues, eye disease, including cataracts and, ah, higher rates of having difficulty with nearsighted. Or first, I did notice obstructive sleep apnea. There's a very small percentage, but increased versus the general population of certain types of leukemia. And then I thyroid dysfunction. Um, and so this is when that if it hasn't been done in the productive country, we definitely would want to check. Um, and usually the some of it has been evaluated. So oftentimes we'll see where they have had a heart evaluation or Annette valuation of their hearing. Um, And then there's ah kind of preventive care guidelines for Children and, um, young adults and adults that have down syndrome that they would need to continue to follow it, So that would be something they would partner with their primary care provider. And again, there's, you know, a very wide spectrum in turns of the, you know, kind of cognitive attainment for Children with down syndrome. So some they might be more severely cognitively impacted versus others. It's mild, Um, and but, um, unfortunately, can't always predict, you know, with a young child kind of which, which end of the spectrum that they will end on.

spk_0:   23:55
Yeah, I'm glad you pointed that out because there is such a wide variety of degrees of impairment. And how do you How do you know that the child is older than you have a better feel. But if the child is younger, you really you have to assume that you just you don't know and no amount of, of, of posted of post referral review with a specialist is going to be able to answer that question.

spk_1:   24:21
Yeah, and that this one is one that Aye, aye, definitely have some kind of empathy for the family because, you know, we know that just in general when we get a child, if we're able to bring a child home when they're younger, kind of the potential for intervention and support, um has a better potential impact in terms of, um, their future, a kind of adults attainment. But then at the same time, like he said, that if we have a child that's very young, we don't quite know, you know what they're kind of inherent trajectory will be. So it's a little bit of ah, kind of unfortunately, that they're kind of stuck doing both sides, but definitely the earlier that we know when we can intervene. We always think it's kind of better potential,

spk_0:   25:09
plus removing a child earlier from a institutionalized setting, which we know is not good for Children, regardless, so it cuts both ways. Let me remind everyone that this show is brought to you and underwritten by the support of the jockey being family foundation. Post adoption support programs are vital to helping to preserve families. However, the availability of these programs is not always communicated clearly during the adoption process, and legal professionals and judges are essential to encouraging the use of these surgery of the service's. And we know that families do better when the service is our provided as permissible by law and it's not, You know, that depends on where you're your aunt, that judges in court clerks and adoption agencies can order backpacks through the jockey being family website on. These backpacks are flee and they can be shipped to the courthouse for adoption day. It could be handed out by the judge or the clerk or whatever, and of course, the agencies can also get these, uh they're They're high quality backpacks. That child's initials. But most important inside they have post adoption service is have resource is post adoption. Resource is for families to get more information. You can go to their website jockey being family dot com. All right, Um, how often do we do? You see autism as a diagnosis on a child that's been referred?

spk_1:   26:38
Ah, it's a great question. We don't I don't know if I've ever seen a child that's come with the diagnosis about to them.

spk_0:   26:45
Yeah, I haven't either. So it's interesting. And why is that?

spk_1:   26:48
Well, so I don't necessarily know, You know, the the developmental kind of availability. Sorry. Availability of developmental specialists in these countries is pretty Whoa, you know, And so you know, oftentimes, if we're asking that the child be formally screened by a developmental specialist in many places, you know, like in China specifically or in India, it's very unlikely this gonna happen. Um and so I think that's part of it. Um, And then again, part of it is that Ah, as you had mentioned or kind of alluded to that, we know that there might be some kind of maladaptive behaviors that are developed just from institutionalized care. So we have seen Children that would meet criteria for autism, you know, based on the kind of the way we diagnose. But it's more due to the interest institutionalized care than kind of that they have underlying autism. Uh, but that being said, we have also seen Children that you it's suspicious or has become clear kind of, oh, pertained that air. Very likely autistic, Um, and

spk_0:   27:57
the absence of an autism diagnosis in your referral and your medical paperwork that you get with a child is not necessarily reflective of much because we're not going to their seldom. It's seldom diagnosed abroad,

spk_1:   28:11
so that's where sometimes that it it is not something that that's where I feel like it helps to have kind of, ah, expert review of the track because you can look to see even that the younger ages developmentally, if there's some kind of red flags or things that air kind of picking your level of suspicion in terms of autism and then often hims if we do here are kind of see things that might be a little bit of a concern. I will always try to request video, um, and say, you know, can we have video of the child moving about interacting with other Children, interacting with their caregivers? Um, to get a kind of a sense of, um, you know, those more subtle sign that might not come up on the review And and then, you know, we always, if possible, will ask, you know, can we make sure that we're screening them for any hearing issues? Because, you know, if they can't hear, then maybe that's the reason why they're not interact, acting and such. But I would say that, um, most of the Children that we catch that are kind of the high likelihood of being autistic. It's a family that has started to follow along. Are, you know, is in the pre kind of match period of maybe has even gotten as far as it accepted the referral. And then in that waiting period before they're bringing the child home, they're getting updates, and they're getting videos. And as a child grows were saying, Well, this is pretty consistent behavior or, you know, the behavior is becoming more concerning because as they age, we would expect them to do more months older. That's usually in my experience how we have some times have come to the diagnosis.

spk_0:   29:51
Okay? And how can you tell whether a developmental delay is something that is caused by the pre adoption living environment? And how much of that is going to help that? How much of that is going the child with good loving care and in good support in a home the child will outgrow?

spk_1:   30:13
Yeah, that's usually what we ask is we say, you know, how does this trial compare to the other Children in the institution? Um, and because often things, the caregivers in the institution, even if they don't necessarily say, Oh, yeah, so you know, we know that this child has autism. They kind of have a sense of. There's something about this kid that's a little different then the other kids. And so you know, if everyone's kind of got a mild delay or, you know, the behaviors are, um, kind of mildly mellowed, active because of the setting, you know, for the most part, those kids we think have the potential to kind of rebound and recover with the right intervention right support, but the ones that are artistic generally, they'll even be a little bit more pronounced. Um, and to the point where the orphanage caregivers ls that you know, that's the one that is a little bit trickier to deal with or definitely kind of stands out compared to the other two or three year olds overseeing.

spk_0:   31:11
Okay, Excellent. Now hepatitis B and C. Um, how common is that? And what is the prognosis?

spk_1:   31:21
Yeah, so we haven't actually seen a lot of hepatitis. I would say the main country that I've seen it in recently would be, um he, um And, uh and some of it was just that we didn't have Ah, pre adoption, um, lab findings so that I think that there wasn't there wasn't really production screening available to the family. Um, I would say that previously we used to think that hepatitis was a more serious condition and definitely, you know, domestically, if a child is born here, we always tryingto back to need them shortly after birth with hepatitis B, or we screen all pregnant women for hepatitis E because the most common kind of means of transmission for a child is ah through pregnancy and during 100 the birth process Um, but, uh, I will say that both hepatitis B and C are now, I think, in the gastroenterology world starting to be considered more likely, a chronic condition. So not necessarily life limiting in the sense that they're not going to make it to adulthood. But they'd have more complications as an older adults. Hepatitis C. There's, ah, recent medication, um, regimen that has been approved. E think in the adult side. And so they're hoping it's gonna trickle down. So that pediatric side, but is essentially thought to be curable. So now it's considered not necessarily a chronic condition, but something that has the potential to be cured. And then I think the thought is that the they might be able to translate that over to hepatitis. Okay, So what? I've been telling families, um, is that, um, those I'm not as concerned about it. We would definitely want that child to follow along with a pediatric gastroenterologist, um, and that their risk of, um, liver dysfunction, especially as an older adult, um and then they have ah increased risk of certain takes a liver cancers so again would need to follow closely. Um, but historically, that was to be more of an issue and that they will likelihood it would be that they would need potentially liver transplant. We're not seeing that as much because we're able. We have more medications and treatments to better treat it. And then the other thing until families is that you know, this treatment for hepatitis C has really come down in the last 10 to 15 years. And so if the child is very young and incoming with hepatitis B or C as, ah young infant or young child potential that, you know, 10 15 years from now, we discover something even better is there. And so it's kind of in my Hey hierarchy of things to consider that one is is pretty low and in my mind, one that I think could be relatively, well, easily managed.

spk_0:   34:13
Okay, what about a Tri V? Now there's been so many advances, but have we overplayed those in the media T where it's no longer a threat to ah person's life? So what do we know about HIV?

spk_1:   34:25
Yeah, so similarly, HIV is now thought to be kind of a chronic condition and again for HIV and hepatitis B and C. These are ones that can be transmitted most commonly through, you know, um, and bodily fluids. So blood and, um, other bodily fluids. But what I also tell families is the risk to the immediate family is is pretty low, especially if the conditions are under good control and under good medical management. So something that sometimes families will ask me. Well, we have other Children in the house. Is that something we should be worried about? Or what are the implications for my child at school or kind of after school activities? There should be no restrictions from that employment, and there's no really increased risk for the parents. Are you know any siblings, potential siblings? But you're getting back to HIV. It's something that we now think of. It's kind of a chronic condition again. They would need to follow with kind of, ah, immunologist or infectious disease specialist, and we need thio potentially take medication like long. But I think of it similar toe diabetes or, um, certain, um, kind of more benign and kidney conditions is not something that should really kind of short in their life. Um, the implications sometimes that family think about is that you know what happens when they get to adulthood and they think about partnering on potentially having their own Children. So that is something that new needs to be considered. Um, but I think that definitely the infectious disease. An immunologist they work with, Um commonly, they say that had something that oven hymns. They start having that conversation with the child early on. And there are ways in which they can, you know, have, ah, full life as an adult without feeling like you have any restrictions.

spk_0:   36:14
Okay, let's talk about some of the more common orthopedic issues from the ones that come to mind. Our club, foot and limb and indigent differences. Our deficiencies, um are those how common or club foot and limb ish is?

spk_1:   36:32
Yeah, so we don't see it as commonly anymore, but we still do see eight some. So those are really thought to be, um, just a, uh, kind of anatomical abnormality so often pains it has to do with positioning of the child in the womb prior to delivery that sometimes that if their position in a certain way, or if there's not, maybe quite enough, can er in the attic fluid that the foot is not allowed to grow in the way that we would hope on DSO. That's something that so can be sometimes treated just with, like casting and helping the foot to kind of re position once that external pressure is gone after the child's born. Similarly, for like, limo or digit issues. That's typically caused by a condition called amniotic band syndrome, where the amniotic fluid actually creates a kind of a band in the room, and we'll such that it makes it so that the fingers of the hand can't roll. Um, and so it's usually more of kind of cosmetic. A lot of times, it's a pretty amazing when these kids come there, um, kind of very well used with that limb. And so you would be kind of amazing Thio for, for me, dizzy and brothers to see like how well they use it, even if they're missing most of their fingers or, you know, they're even their whole hands, they've been able to compensate. Well, so and then Now it is with the kind of the way that we're advancing in terms of prosthesis. There's a lot of kind of options for families um, in terms of different processes that the child can use to help to compensate if need be. But some of the Children don't even really need a prosthesis. It would be more like cosmetic they wanted.

spk_0:   38:22
But again, something that family should consider the logistics of if their child is does have, even if it's just for cosmetic reasons that they would want to be able to have access and get to the because the prosthetics take both training as well as fitting and things like that. All right, all right, let's talk about Alban. Is, um um that, um How common is that? And and what is the what is the treatment and what else accompanies eyes? It just cosmetic. Are there other conditions that could they also are associated with with albinism?

spk_1:   39:00
Yeah, so I wouldn't say that it's extremely common, but I have seen a couple three reviews over the last couple years. Um, so it's a condition usually caused by a genetic that leads to a kind of the lack of, or a decrease amount of pigment in the different parts of the bodies of the skin, the hair and the eyes, and depending on which country they're coming from, It can be more immediately obvious or not, you know. So I have seen some some Children that air coming from kind of the African countries where we expect that they're gonna have more melon in or coloration than there. There's, um, skin. And so it's a more immediately obvious. Where's I have seen some Children coming from China, where you know the skin and that baseline is paler. And so, um, if you don't look closely kind of the hair, maybe it looks blonder as opposed it white. Um, this is not, like, immediately obvious that that they have is Alban is, um, to kind of the undreamed I. The most common thing that are associated with it that would definitely need to be evaluated would be that there's a high rate of visual impairment because of the color, like the pigmentation and the way that that works in the eye. Um, and so it could be anywhere from mild, where they just need glasses to severe where they're essentially legally blind. Um, and so that's something for families to consider because definitely, you know, if you have a child that's legally blind, that's gonna be only two kind of greater implications in terms of, like, short term and long term. Um, and the resource is that they will need and then practically the other thing that needs to be considered just that their skin, because of the lack of pigmentation, is much, much more sensitive to sun exposure. So they families would need to be very vigilant about kind of skin care, and that child would need to be followed by dermatology. Um, kind of on a regular basis doesn't need to be super frequent, but no, we need to establish with pediatric dermatology kind of early on. And then the last thing would be again, um, social implications. So that one's a little bit kind of more nebulous and kind of hard to say. But, um, you know, this is the child that is already gonna have some and of the social concepts in terms of being internationally adopted and likely not looking like their family. But then, if they're looking to kind of find kind of their political group, and let's say that the child is adapted from, you know, Congo and their group is very dark skin at Baseline, that now, Elsa. And they're kind of even, You know, the odd duck out within that group too. So those are just things to kind of think about for the family. Um, then, like I said, it's more nebulous. So I can't kind of say that every child that has albinism is gonna you have issues with their social concept and whatnot, But

spk_0:   42:03
we have No, But that's it. That's it. That's the parents need to consider that. What are some other common causes of vision impairment? Ah, and how common are they in international adoption?

spk_1:   42:16
Yeah, so we can see a some congenital glaucoma or cataracts. Sometimes it's due to, um, kind of infectious disease around the time that the child is before they're born. Um, but, um, I don't see ah Thanh of vision issues. Usually, if they do have ah, kind of a known vision issue, it's potentially associated with another syndrome. So, like Down syndrome, Amore, Alban is, um um we haven't seen a lot of kids where they are coming. Um, with just kind of the vision come at the only issue. What

spk_0:   42:55
about hearing

spk_1:   42:57
Oso hearing is is pretty common, eh? So we know that Children, especially Children. They're living in an institutional studying, um are higher risk for kind of undiagnosed your infections? Just, you know, that if you think about kids in day care, they're always sick. Um, and, um And so if they have kind of recurrent or chronic ear infections that aren't diagnosed with their high risk, that that might cause some damage either kind of temporary or permanent in terms of the hearing, um, so when there's a spin so we often handle see speech delay like a kind of a mild speech delay with these kids. And again, we're trying to piece out Is it because of, you know, lack of opportunity and institutionalized cares because they just get here? Um, so not infrequently. We'll ask if we can get kind of a formal hearing tests just to rule out hearing is an issue. Um, if it is a matter that they have, um, just kind of a physical blockage. So, like extra fluid or whatnot that usually is easily corrected, they can get your tubes or other, you know, kind of procedures to help with that, Um, but then, um, goes all the way to the spectrum that they have kind of a nerve dysfunction for their hearing. And so what I'm thinking, Ah, Mark most commonly is that there's a infection called C M V that can cause the, um, kind of higher risk for pregnant women for adults. Or, you know, someone who's pregnant. CMB usually feels like you have a really bad cold, but unfortunately can have greater implications for the unborn child and the most common cause. They're kind of most common implication would be, um, hearing loss or kind of hearing

spk_0:   44:37
acumen Scotch. And you may or may not know about betting again, depending on the age of the child. You may or may not know of the of a hearing loss, although there's usually evidence in the in the file that would indicate

spk_1:   44:52
yeah, So the most common kind of, um, hint of hearing loss is that they have a speech delay because if you can't hear, then you can't. And if you're the sounds that you need, thio be ableto reproduce, um, and so speeches, even in younger in Finn's, we know it can be translated to that. They don't babble a lot where they don't turn to sound, um, or they don't kind of, um, try the interact so again, going back to the artisans. That's why we also for Children, that there's a concern that they're not appropriately interacting with their surroundings. We always want to make sure to check their hearing, because it could be something as simple as that. They can't hear number that they have autism.

spk_0:   45:35
Okay, so from the standpoint of treatment, if you have a child, it depends on the cause of the hearing loss. If it's a matter of fluid in the areas you point out, that's relatively easy, um, tubes in the year and your medication or whatever. But if it is caused by nerve damage, then you need to be prepared that your child I will have a permanent hearing loss. And that would involve things like, um, special education, learning sign language and and all that goes with that.

spk_1:   46:05
Yeah, And for some of the kids we have seen, they have been fortunate that been able to get cochlear implants, you know, even in their country pre adoptive. So there are treatments that can be done toe kind of augment, you know, hearing aids, or even to the end of the section of having a implant. Thio provide another means to, um, to restore their hearing. But family should know that there are certain types of hearing impairment that are not able to be fully corrected or correctable. It also, um, I know that with cochlear implants, I think kind of sometimes the population things old like, even if you can hear there's a way to fix it and that Carly is the case for the majority. But there's always gonna be that minority that might not be able to hear.

spk_0:   46:50
And cochlear implants aren't like it restores your hearing to what the what the average person here is. It certainly improves, or it can improve. But it's not. It's not the same. Is normal hearing.

spk_1:   47:01
Yeah, it might not be. And then the other thing, too, would be again. You know, we think about when was the intervention made it what it is just a child. So if there could have pre verbal or polis operable, that could have implications on there speech? No. You know, if what's difficult is sometimes you know this these a lot of these kids are coming right in that, you know, perfect window when we're expecting that their language to really blossom. And so if we kind of are starting to make interventions a little bit after that, then there's gonna be a lot of catch up in terms of trying to get their speech back on track.

spk_0:   47:34
Okay, let me remind people again, we've talked about jockey being family, but I also wanted to talk about our partners. And these are agencies that believe in our mission of providing unbiased, accurate information and wanting it and both pre and post adoption. One such agency is Spence Chapin. They already license and accredited nonprofit adoption agency in the New York City metro area on they've been offering adoption service is for more than 100 years, and they are known for their host. Adoption service is, and they cover the entire tri at birth parents, adoptive parents and a draw and adoptees. And they really have a stellar program for post adoption regardless of your role in the triangle. And that is Spence Chapin. All right, so let's talk about Euro genital issues. What does that include? And how common are they?

spk_1:   48:34
Yeah, so it's a great question. I think the most common one that we see can be, um, break into two categories. One would be that we see something called a pervert a nus meaning that the, um kind of the out lit for the large intestine. So you know, the way that the person has a bowel movement it is is closed, and so we need to be open. And then the other kind of category would be that, um their genitalia does not appear kind of the way that we would expect based on their chromosomes. So if you know, if chromosomally we think that they're a girl or more often what it is is that we say that they have X y so that there, boy chromosomally But the genitalia is a little confusing. In terms of that, we don't see kind of the Penis and the testicles the way that we would expect. Um and so those are kind of the two main categories when we go down kind of the imperfectly heinous category. So that is, um, something that can be associated with the condition called back to roll, which stands for the tea bowl. Anal cardiac trick. Osaka Jill, renal and limb. Um, and this is what we call an association. So it's not a syndrome, so we don't know. It's not like a genetic cause that causes all of these things. But for kind of a reason that we don't fully always know that child has, um all these different kind of abnormalities in different parts of their body. Um and so the with the child has a factory role, then we target the interventions and treatments. Two of the different Agam Allah's they have cognitively. Those Children shouldn't necessarily have any kind of restriction in terms of, um, cognitive development and and gross. The one thing is for the improvement in its depending on kind of the severity of that. Those Children that I always kind of morn family may not ever be able to be continent like in terms of being toilet trained. So, of course, could have implications for, you know, if you have someone who is cognitively, you know, kind of some the match to their peers, but still having to wear diapers that has kind of there, um, implications for older Children and adults, for sure. Um, and then when we look kind of down the line in terms of ambiguous genitalia. So that followed into kind of what we think of disorder of sexual differentiation. Um, when this is getting a little bit too into the details. But all of us physically as like a unborn infant, start out looking more like a female and then for the boys. Their body starts producing testosterone before they're born. And it's the testosterone that causes some of the kind of organs to emerge so that when they're born, they look more of physically like, Ah, a boy as we would expect. And so for our kids that have this d S. D, the disorder, sexual differentiation, something has happened to the pathway that, um, includes testosterone. So it's not produced. And so that just never happens. Eso oftentimes those are the kids that at least the file that I've seen it has been picked up so they'll have chromosome will studies that have been made available to the family to say this child has chromosomes. They're X y, but they look more kind of what we call, um physically like female in terms of in their day per area.

spk_0:   52:12
So what would be the treatment there? Because if the child is chrome is ona lea male, but physically female. Howto parents approach that because at this point, you don't want to predetermine And especially because you don't know how the child is going to identify that age. I mean

spk_1:   52:30
right, that's Oh, yeah, that is that you actually just provided the answer is historically we used to be a little bit too aggressive and say, Well, they look, you know, quote unquote female, so we should start doing everything um, Thio makes them kind of can complete that quote unquote transition. Now, we know from our experience that that is not the kind of the correct pathway. And listen, set, Um, it has a young child there. You know, we will always try to help to you recommend that they established with endocrinology to figure out kind of what was the cause. That their bodies not producing the testosterone. Um, and make sure that there's not other things involved in terms of other, like growth hormone deficiency or endocrine formal deficiencies that need to be addressed in the immediate period. Um, but the assuming that those things are okay for young Children, there's not necessarily any specific intervention that needs to be done. It's more kind of allowing the child time Thio have start to a develop their own gender identity and then as we get closer to puberty, and then that would be when we would think about maybe offering more kind of hormonal supplements. Um, and either, you know, if, um, I knew it if they wanted to kind of their appearance to be more masculine or feminine, Um so, like, if the if the child says, Well, I am chromosomally X y, but I identify more as a female. So then when we start to hit puberty, we have to figure out how do we help their body to not produce testosterone? If that pathway has reestablished or on the flip side, you know, how do we, um, provide them with disaster on if they identify, Mara is wanting to be a male. So it's again. It's, um, you know, easy for me to say it's not easy for the family is necessarily, But, um, it would be something that, for sure, families would need to be comfortable with that. We kind of that ambiguity, Um and you know, letting kind of their child guide in terms of how they develop. And then there are, you know, surgeries and treatments that can be done down the road. But they're they're usually deferred. Um, and, uh, the other thing, too, would be depending on the state. Some states, you know, now have kind of an option, too, to do, like 1/3 gender or kind of non gender, non binary. But I'm not 100% verse and you, all of the 50 states, there might be some state that still will ask the family to assign a gender. Um and so then potentially, you know, down the road, they would they would need thio and change that if the child more close identifies with the other.

spk_0:   55:31
And one thing that think families would have to know is that they're going to have to be prepared to help advocate for this child because they don't fit a norm. And, um and that's gonna require parental interference and help along the way until the child is old enoughto old enough Tonto to decide on their own and also to take over advocating for themselves. The good news, though, is that now parents don't have to make the decision until their child is able to start guiding them is toe how they feel that they are, how they're identifying and so that actually makes it easier from a parental point of view is that the child is You're not having to make these decisions until the child is old enough to start giving you input.

spk_1:   56:15
Yeah, right. So it's again in kind of a double edged sword. So the parents have to be comfortable with kind of the short term ambiguity. But long term life, they don't feel like they have to carry the whole wheat of that decision where we know now that part of that, obviously you know, should be with the child that they should be ableto have imports in terms of, um, how they self identify.

spk_0:   56:38
And I will say, having talked to parents who have gone through this, um, Children do generally self identified, they they let you know what they the gender that they think they are. And, uh, it's not. It's not always ambiguous to them.

spk_1:   56:53
Yeah, yeah,

spk_0:   56:54
All right now, one that that Ah, we cannot leave this conversation without talking about because it's such an important one. And that is the impact of trauma because the reality is any child who has been well, especially those Children who have been right, spend any time at all and institutional settings have experienced some form of of trauma. So how, ah, what type of impact should parents be prepared for? And let's tie into that the age of the child adoption.

spk_1:   57:26
Yeah, so I think that similarly to kind of what we're talking about with the, um, MBA Houston Taylor, we have come a great ways in terms of our understanding of trauma and trauma based care on the potential impacts on Children. So, um, when ah, Children were adopted and and I should probably mention this the beginning. So I personal connection to international adoption that I was adopted from Korea as an infant and I came home when I was less than a year old. And at the time, you know my parents, I think the kind of understanding from the agency was that Oh, if they come home as a baby, you know, we can just nurture them. Um, and we can kind of over supersede nature in a way, um, and they'll be fine. Um, in their pre verbal and so they don't have any memory of kind of that pre adoption period. Now we know that that's not necessarily the case. And we've had, um, you know, kind of studies that show that on this is usually more the on the domestic side, but with a domestic adoption. When a child is placed even right at births with an adoptive family, we know that a child does have a sense of their prenatal environment. So they kind of their potentially hearing sounds, you know, like the people talk about, you know, baby Mozart, and you can expose and of the unborn child to the songs. And they can hear the biological mother's voice. So depending on what that environment is like, if the prenatal environment was very stressful, um, or there was, um, abuse going on to the, um, to the pregnant woman, you know, that could have an impact on the infant on then. Just even kind of that separation of having or the kind of the transition of having been used to one environment and then always them being placed in the new environment with new sounds and not having any kind of, um, no one's known environmental input can be difficult for some for some Children and then definitely kind of. The longer that I think a child is in either a foster care or institutionalized care. And one of their sense of permanency is not kind of fully established. There is a higher risk of, um, kind of ongoing from our difficulties with attachment and being able to send those bonds going. Words We have, ah, psychologist through our clinic who, um, she's kind of the world renowned expert Dr Maria Cristina in terms of toxic stress and, um, trauma based care for you looking at these kids of our international adoption. And we know that's from her extensive research that Children, when they're very young, that have kind of their weight of buffer, toxic stress would be through typically their parents or their caregiver. Um, for when kids get to be older, so kind of that preteen teen there go to is not necessarily going to be their parents. So that's something that adoptive families need to consider when they're thinking about adopting older Children. Um, that, ideally, that that child will still be able to form a bond with someone, but it night might not be with the parents in the something. It might be another kind of, um, close caregiver, a close adult or even appear in their posted active environment.

spk_0:   1:1:05
Another thing that I think it's important for parents who are adopting Children who have been institutionalized, consider is the possibility of sexual abuse. And quite often we don't. There is nothing in the records, Um, although sometimes there might be. So how common do you believe that is our health? How aware should parents be who are adopting Children who have been institutionalized?

spk_1:   1:1:31
Yeah. I mean, I would say that if a child is, um, kind of middle grade school and older, Um and they've been institutionalized studying. Um, That, unfortunately, kind of the likelihood is, is pretty high. Um, and so especially if it's an institutionalized setting where there is, ah, wide range of ages, you know, kind of infancy up to some of the orphanages that we see. There's teens that and, you know, and you think that those teams now have been there since they were a baby. So, um, I kind of have all the potential maladaptive behaviors from that experience. Um, so those are the ones that, um I kind of Convergencia. It's, um you kind of have to assume that it's happened and if you're pleasantly surprised that they haven't had the experience in that great, But I would think of operate on that. There's very high likelihood that it has versus the other way around. If it's not like as you mentioned, if it's not noted, that doesn't necessarily mean that it hasn't happened.

spk_0:   1:2:39
I will say we have a number of courses on parenting Children who have been sexually abused. The common assumption of these Children all turn end to abusers themselves is not accurate, and there is a lot that can be done. But it is something that again parents need to realize we require their involvement in therapy and, uh, and work with the child. So it's something that they need to go in. Being prepared to find the therapist that can help their child.

spk_1:   1:3:09
Yeah, definitely. And I think along those lines that, like I was saying that, um, if you're considering or adopting kind of an older like middle aged older child, I think again operating on the assumption that it's very high likelihood that either physical or sexual abuse has occurred, even if it's not noted in the chart and kind of, um, being more proactive in terms of their therapeutic support early on versus if you think, oh, it doesn't have any mention of it. So this isn't an issue. Those air, probably the kids that we see that as they get older and start to kind of, um, cognitively kind of wrap their mind around their pre adoptive experience that struggle potentially struggle more if it hasn't been addressed. Kind of, um, from the get go,

spk_0:   1:4:00
okay. And the last special specialty I want to talk about is prenatal exposure. I don't want to go into a lot of detail because it again we have quite a few courses on every type of prenatal exposure alcohol, drugs and tobacco, marijuana. You name it so but if you could just generally, ah, talk about how common prenatal exposure is, and then now we use that as a Segway into talking about what you, the most common special needs you see from various countries. But first, before we do that, let's talk just briefly about prenatal exposure And how common and the impact

spk_1:   1:4:38
yes, a prenatal exposure is is very common. And, um, it does depend on the country of origin that we see kind of varying degrees. Um, but the one that I wanted definitely highlights a CZ being kind of in my mind, the most important would be alcohol exposure things that oftentimes, because alcohol is so prevalent in our environment and you know, that kind of social drinking is, you know, for the most part, accepted that when people see prenatal exposure and they see, like, cocaine or heroin or methamphetamine, they're like, Oh, my gosh, look at all of these. And if you know, alcohol's on the list or cigarettes were like, Oh, it's not too bad. You know, everyone we know someone who smokes cigarettes or you have a glass of wine here and there from a clinical perspective. In my mind, alcohol is probably the one that I'm most concerned about. So we know that, um, fetal alcohol spectrum disorder is the number one cause for preventable developmental delay or kind of developmental in cognitive impairment. And though that is one that I think again, we're kind of learning more and more as we go. But it's something that I think that family's definitely need to be aware of, um and you know, we'll talk a little bit about this with this specific countries. But just for example, I think when more of the Eastern European countries were open and families were adopting from places like Russia or Romania and we didn't know e think f a s d was not kind of it is widely known at the time. Um, we know that the prevalence of alcohol use among women of childbearing age in those countries is very, very high. So again similar to kind of sexual abuse. When I would see you files from those countries, I would assume that there was alcohol exposure unless told otherwise. But I think that those air where sometimes families buying that if they come home and they're young and they seem to be doing okay, that doesn't necessarily rule out that they won't have problems going on because commonly those types of issues will develop as a child, gets older and into kind of adolescence and then into adulthood, and can have pretty serious implications more soul than, um so some of the other ones that I think families would feel like initially would be more, um, overwhelming. But I think f a S t is by far one of the more common causes that we see that families are struggling with post adoption in our clinic in person.

spk_0:   1:7:12
And another myth that people have is that if a child does not have the the facial features of fetal alcohol exposure, that the child has not been exposed. And that simply isn't the case.

spk_1:   1:7:25
Yeah, correct, Absolutely. So we don't know when the facial features completely develop during that, um, kind of prenatal period. But we know that there can be alcohol exposure that can cause bringing changes, which we and they would be subtle. So it wouldn't necessarily be brain changes that we would see by brain imaging. But brain changes meaning cognitive functioning deficit. Um, that there. And there's no evidence of any facial feature.

spk_0:   1:7:57
All right, So, um, in a, uh, where to start with some prenatal exposure and go through the most prevalent that most of the major placing countries to for international adoption to the U. S. All right. So how common is a prenatal exposure? Alcohol or drugs? And in China,

spk_1:   1:8:20
so China is very very low. I think when we think about prenatal exposure, um, the for alcohol and drugs, the most common countries that we see you would be like Central South America. Um, it kind of depends on for central South America. Some things we see Children that air coming from kind of the native or indigenous um and, ah, population area. And so it's less, I think, um, potentially with some of those some populations, but kind of un unp. I would say that that's one area. Another area would be definitely, um, again Eastern European. So the Bulgaria Ukraine areas was dusty. Hi. Use of alcohol and then other drugs. And then I think sometimes people are surprised. But South Korea now has taken the place of Russia in terms of the number one like kind of the top country that we see for alcohol exposure. Not so much the other drugs, um, but definitely alcohol and some nicotine. And then we're starting to see more production reviews coming through from Southeast Asia. So I'm kind of Thailand and Vietnam. And those, I would say, um also have, um, kind of a higher likelihood of substance or alcohol exposure.

spk_0:   1:9:45
Okay, excellent. What about African countries?

spk_1:   1:9:48
Usually it's low. Sometimes it kind of depends on the country. So historically like Muslim countries, the because of religious adherents, they abstain from alcohol, and so we don't see it as much like historically, Ethiopia. We didn't see any alcohol exposure and then some other country that just the, um, kind of standard of living in terms of cost is solo. So I think that's where we see within China about socially and then the cost of some of these substances is so kind of exorbitant relative to, you know, food and water and shelter. Similarly, like Haiti. Um, and then, ah, country, you know, anything you like, Marshall Islands. Just kind of a small program. But, um, that the just the cost of these substances, you know that they're just trying to figure out how to get food. Um, kind of on a regular basis. So we're not seeing a lot of extra kind of drugs or alcohol.

spk_0:   1:10:49
And what about India?

spk_1:   1:10:51
Oh, a similar that? Yes. So India again, we don't see a lot of drugs or alcohol exposure.

spk_0:   1:10:57
All right, So for China, which is the number one placing country to the U. S. What are the most typical special needs you're seeing?

spk_1:   1:11:07
Yeah, so it's a little bit of a gamut, but I would say that. So I talkto Dr Dana Johnson, who, you know, is, um, the founder of our clinic, one of my mentors. And I kind of think of him as, like the father of international adoption. So

spk_0:   1:11:23
I did, too.

spk_1:   1:11:24
Yeah. Hey, has extensive experience in China, and ah, and so what he was saying that kind of families can think of Is that from China? You know that the director of the orphanage and then kind of the minister of adoption they could have the blessed the, um, child's file, you know, as it's making its way to the U. S. And so they don't necessarily kind of pacify all forward unless they feel that the child is adoptable eso. Then, because of that, there's a high number of kind of surgical or slash kind of correctable, um, conditions. So we see a lot of, you know, heart conditions. We see clip, clip, clip, palate. Um, we do see like Alban is amar dwarfism. Um, and then kind of the, you know, ambiguous genitalia. Um and orthopedics. Uh, and then we see a down syndrome is kind of the one that I would say would be kind of more quote unquote. Like the social, um, kind of social concept of down syndrome in China's is, um, not the same as it is here. But we don't necessarily see ones from China that would be kind of fall into the typical category of, like, prenatal exposure or kind of trauma based. So we're not a lot of like sexual abuse, physical abuse or, um, kind of known emotional trauma, even that older Children. Yeah. So it's not noted in the charge, I guess.

spk_0:   1:12:53
Yeah, Yeah, I was going to say, but I think again, given if your child has been institutionalized in Okay, so let's going down the list. India, what do you sing?

spk_1:   1:13:04
So India. It's malnutrition. Um, and, um, and then we are seeing some of, um, development of delays, so it could be kind of like a c p a. Prematurity. Um, related. Um, we're not seeing so much of the kind of the surgical correctable, but some of the ones where it's a little bit ah, big in terms of that, they have assuring last? We don't quite know yet. You know what that is? Or there, Um, having some developmental delay, but we're not quite sure. Is it because of institutionalized impact, or is there some underlying cause? Um, but not quite the same of the kind of quotable syndrome that we would necessarily associate with China.

spk_0:   1:13:49
Okay, what about Columbia?

spk_1:   1:13:51
So Columbia, I would is probably much more on the end of the spectrum in terms of, like, emotional trauma, sexual abuse, physical abuse, um, and then prenatal exposure. Those air, usually older Children and often times come with the siblings That, um And so there was something that happened to maybe one of the Children that, you know, they were removed from the care of their parents.

spk_0:   1:14:12
Okay, what about Ukraine?

spk_1:   1:14:14
So, Ukraine. We see a lot of prenatal exposure in developmental delays. Um, you all the way from you again? Institutional impact all the way to, you know, kind of diagnosable autism. Um, we don't see as much of the kind of conditions that you would see. Like the surgical or kind of quote unquote correctable conscience might ease from China. Of the one thing I will say about Ukraine and sometimes from book area families. Maybe a little bit overwhelmed because those starts sometimes will come and they have just a whole slew of corn unquote diagnoses. Um, but we call them kind of, Ah, the garbage pail diagnoses like they don't they don't actually exist. They don't really mean much. So that's where again, having kind of a medical professional help you, too, and a peace through and say What's what's real and what's that there kind of throwing this on? Because, um, they feel like something's wrong, but they don't quite know what it is yet,

spk_0:   1:15:15
and just the way different medical community's function and diagnosis is just different. And it helps have somebody who's seen a lot of them. All right, what about South Korea?

spk_1:   1:15:27
So South Korea, the number one for sure, would be alcohol exposure? Um, I will say that for other conditions. For the most part, South Korean medical network is probably unpowered, if not better, than what we have available to us in the U. S. Um, so if there are other issues, like if there's a congenital birth marks for, um, heart issues, ah, seizure disorders, they're getting typically exceptional care in South Korea before that. They have medical care before they home. Um, And as I'm sure, many families. No. South Korea is predominantly a foster based, faster care based system. So they're usually with, you know, kind of a more typical like nuclear family with a foster mom and dad and maybe some sibling. So getting a little bit more of that one on one attention than you might be in some of the other countries.

spk_0:   1:16:20
Okay, how about Haiti?

spk_1:   1:16:22
Hey, we still see a lot of infectious disease, and then the impact of, um, kind of chronic or acute on chronic malnourishment. So we're seeing a lot of like, um, some of the parasites, you intestinal parasites. And then, like I said we do. I saw a couple kids recently that had happened because be coming from Haiti.

spk_0:   1:16:44
Okay, um, and then Nigeria, I think. Well, let's say Nigeria and then if you can extrapolated toe other African countries, which you might not be able to I don't know, but

spk_1:   1:16:56
yeah, and we haven't seen a lot. Um, that I am aware, coming from Nigeria, I would say that, um,

spk_0:   1:17:02
let's just talk African countries.

spk_1:   1:17:04
Yeah, again, I think. Probably similar in that It's, um, baby Malnutrition. Um, we have seen some older kids coming from Africa, and so, um, it's a little bit of kind of a hybrid of malnutrition. Plus, um, potentially periods of homelessness, um, some abuse. And then, um, you know, trauma based on you know, how they came to be in an abortion or finish setting.

spk_0:   1:17:31
Okay, excellent. So, in general, the take home message is, um, post referral before, But when you're in the application standpoint, do your research read up on what the special needs because you're gonna be asked to fill out of form. Um, in international adoption is to check off a list of things you were willing to consider. So listen to this. And then then also, you know, do your own research, but then after you have a referral and you have medical records on a specific child, get yourself and that penned the medical records to a doctor who specializes in adoption medicine.

spk_1:   1:18:13
Yeah, I think that that's a key. And I would say that you know, at a minimum, if you can get the records reviewed by a medical professional, but, um, and Obviously, I'm a little biased, but I think, really the, um the best would be to get your records to someone who specializes in adoption medicine. Because we have kind of the benefit of since the With the volume that we see, we were able to kind of spot the trends before they are kind of a non trend. Exactly. So so And then also, we are aware of kind of the questions to ask when you were kind of reading between the lines. So if you're being told that the child is quote unquote normal or development of the contract that then we can help the family and to ask a little bit more pointed questions or elsewhere are pointed assessments and results, um, to peace out. If that sounds early, case or not,

spk_0:   1:19:07
yeah, and your adoption agency should be able to recommend an adoption medical professional. And I would also add that they don't have to be a professional that lives. It is located near you. Every adoption medicine clinic I know of. Except, you know, you can mail our night mail. Listen to me. You can email the ah, scan it, email the chart to them and then do the assessment over the phone. The advantage of choosing a clinic near you is that once a child is home, you can go back to that clinic and have care there as well. But it's not necessary for the post referral evaluation of medical records. So, um yeah, so keep that in mind is your is your moving forward, And I believe there is a list. The, uh um the American. The pediatric association has a list of medical speck of doctors who specializes in adoption medicine.

spk_1:   1:20:08
Yeah, definitely. And then also, we have found some families If you are willing to travel, I know that all of the clinics nationally would be happy to see you so similarly on the post adoption side, if possible. Um, we do see value in seeing adoption medicine specialist for that kind of initial, you know, post adoption visit, which also, right? Yeah, we typically recommend that about 2 to 3 weeks after child has come home. So we have had some families that are, you know, thankfully willing to travel. You know, we've had family that even come internationally like we've had families coming from Germany and South Africa. and South America. And not to add extra visits onto our family's already busy schedule. But oftentimes those visits for the adoption medicine evaluations can be done manually. So not so sometimes families. What kind of tack it on with, you know, a fun trip or whatnot? Didn't country.

spk_0:   1:21:06
Well, Thank you so much. Dr Kamara. Gustafson with the adoption medicine clinic at the University of Minnesota for talking with us today about common special needs. An international adoption. I really appreciate it.

spk_1:   1:21:20
Yeah. Thank you for having me.