BEHAVIORAL AND MENTAL DISORDERS
MENTAL AND BEHAVIORAL DISORDERS AT ADOPTION
In the orphanage
The autism spectrum disorders are a heterogeneous group of conditions that share the characteristics of lack of eye contact, aloofness, failure to orient to name, failure to use gestures to point or show, lack of interactive play, lack of interest in peers, and language delays. Many of these characteristics are common in institutionalized children. Malnutrition, prenatal exposure, and prematurity contribute further complications. Social factors may also play a role. For example, gestures and interactive play may not have been required or encouraged in the orphanage environment. Children may have been forbidden to point or ask for things, forbidden to explore, and never engaged or taught peek-a-boo or pretend play. Some children may have sensory dysfunction that interferes with enjoyment of physical experiences.
Parents traveling to collect their child sometimes observe autistic-like behaviors. Care must be taken to distinguish these from the normal adaptive behaviors of a child removed from a familiar environment and placed in the care of well-meaning but frightening strangers. Withdrawal, lack of interactive communication, and lack of eye contact are typical responses of a child in the first hours or days after placement. Lack of response to the child's name sometimes results from (unintentional) mispronunciation by the parents, unfamiliarity with the new name, or an undiagnosed hearing problem.
Many parents describe their child as "shut down", or "completely passive and withdrawn" during the first hours and days after placement. Observation over time is perhaps the best means to differentiate these adjustment behaviors from the more serious conditions "acquired institutional autism" and "true autism".
Some children continue to display autistic-like behaviors for a considerable period of time after adoption. These children have significant impairment of social and communication skills, but in contrast to typical autism, this "quasi-autism" (or acquired institutional autism) tends to improve to some extent by age 6 years. Furthermore, although some children have severe mental impairment at arrival, many have dramatic improvement in IQ in the first several years after adoption. In contrast to typical autism, these children usually have (or achieve) a normal head circumference, and unlike the male preponderance in typical autism, boys and girls are affected equally.
From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.