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​​​​​​​​​​​​1.5.1 Medical


1.5.1.1             Possible Medical and Psychological Diagnoses​​​
1.5.1.2             Precluded Medical Conditions for New Zealand Entry
1.5.1.3             Medical Reports
1.5.1.4             Medical Testing on return to New Zealand​​
​ ​
Children that are in need of Intercountry Adoption may be affected by certain medical conditions.  The type and severity of medical conditions are very dependent on each individual case, however in some countries, certain medical conditions are more prevalent than others e.g. Chile.

Particularly for older children, there may be the possibility of a history of past experiences such as physical or sexual abuse, emotional deprivation that may cause long term psychological problems. Applicants need to form an evaluation of this prior to adoption and look for signs after adoption and seek appropriate help.

Children who are deprived of a normal family group in which to grow suffer a very serious handicap.  How well they cope and how they grow depend, partly on their own personality resources but largely upon the substitute environment in which they live.  Children who have been moved repeatedly from one home to another or have lived in large impersonal orphanages are likely to have difficulty in acquiring socially desired standards of behaviour.

There is a direct relationship between the length of time a child is institutionalised and the anticipated consequences in their physical and emotional development. According to some medical experts, children who have spent time in an institution must be considered high-risk placements or possibly children with special needs.

In an article about the risks associated with adopting an institutionalised child Dr Dana Johnson, an American doctor specialising in children adopted intercountry, states that in his opinion the chance of an institutionalised child being completely normal on arrival to the new country is essentially zero.  His reasoning is that children who are in orphanages are likely to have come from destitute backgrounds where there was poor prenatal care, malnutrition, or from situations where parental rights were terminated because of neglect and/or abuse (physical/sexual).  Children with major medical problems or physical handicaps may have been placed in orphanages by their parents due to limited access to corrective treatment and rehabilitation services. Additionally, he states that all institutionalised children fall behind in motor development, speech acquisition and attainment of necessary social skills. Physical growth is impaired (children lose one month of linear growth for every three moths in the orphanage) with weight gain and head growth depressed. Congregate living conditions foster the spread of multiple infectious agents such as intestinal parasites, hepatitis B, middle ear infections.

Many studies (refer below) of intercountry adopted children have shown that the majority of adoptive parents have coped well and the adopted children have adapted very well in their new families and new environments (far better of course than if they had remained in an orphanage). 

Despite these assurances each individual adoption has its own circumstances and can depend on:
  • The child's background and reason for being in the orphanage (e.g. born prematurely, poor pre-natal care, exposure to alcohol whilst inside and outside the womb).

  • The part of the world the child is from and current environment.

  • The economic situation (generally the lower the standard of living of a country the higher the likelihood of insufficient funds allocated to children's medical and nutritional needs. There may also be a lack of immunisations).

  • The level of or lack of stimulation whilst in the orphanage.

  • The lack of consistent caregivers.

  • Living conditions that are conducive to the spread of infectious diseases.

Given this back drop applicants need to make an informed decision in adopting a particular child as a decision to adopt a child is a life long commitment involving a willingness and the capability of parenting a child that may have a known medical condition at the time of adoption or the medical condition was undiagnosed and may become apparent in later years.  Expert advice should be sought where necessary.  Applicants need to be aware that there is no guarantee that the child will be free of serious present or future health and developmental problems, even with a high level of care and nurture in the new home. It is also impossible to determine whether any child will or will not attain learning levels, behavioural levels, attachment levels that are considered 'normal'.

A 2006 IMMF study [ Antonio Ferrandis, Spain] where adoptions from several countries were studied, found that in the last eight years that the intercountry adoption failure rate was 10 percent.  In most cases the failure occurred with teenagers coming into adolescence and involved behavioural problems, school failures, violent episodes and a difficult relationship with parents.  Many parents could not control the situation that had been developing through time with the end result being that the child was returned to an institution.  Some of the factors that were evident in the adoption failures were: disruptive behaviours such as aggressiveness and sexual precocity, difficulties emotionally and in bonding especially with the mother, inappropriate idealised expectations of the adoptive parents of the reality of the damage of institutionalisation of some older adopted children, conflicts between the child and the rest of the family's children [if any].

The consequences of these unsuccessful adoptions are that for children that are returned to care , only 60 percent can adjust to a second family [ Hoopes 1997, Steinhauer 1991 and others]

Applicants need to adopt children that they are capable of parenting. If applicants arrive this far in their adoption journey and honestly have doubts about their ability to parent a particular child for whatever reason, they should feel assured that it is common to have these doubts.  It is perfectly acceptable to step back and give themselves more time for careful consideration before proceeding.

It has been important to outline the risks, but as mentioned above, many research studies show similar findings to Mr Cliff Picton, Associate Dean of International Social Work, La Trobe University, Melbourne who has conducted a long term research project with more than 60 Australian families who between them have adopted over 100 Filipino children.  He has stated that clear outcomes of the research have indicated the following:
  • The widely held view that adoptions automatically lead to a set of difficulties that in turn lead to negative outcomes is not supported by his research.

  • International adoption does have some risks, but the fact that some adoptions have difficulties and fail is no indictment on the whole process of adoption.

  • There is a large body of research that shows that psychological outcomes for adoptees are no different from non-adoptive outcomes.

  • His interviews with more than 60 families showed that Filipino adoptees were overwhelmingly well adjusted, happy, confident, and understood their place in the adoptive families and in Australian society.

Mr Picton's official conclusions of his research state that "Filipino adoptions in the State of Victoria are highly successful".​ 

Dr Dana Johnson, referring to a study of families who had adopted from Romania revealed that 90% had a positive view of their adoption.  Dr Johnson made the following points in summary in an article about children adopted intercountry.
  • Don't expect the child to emerge from an orphanage unscathed.

  • Prepare in advance to rehabilitate the child.

  • Institutionalised children are a high risk group.  Applicants need to make sure that they are prepared to take on the parenting challenges.

  • Optimism is appropriate.  Most families feel positively about their adoption.​

In an article in the Journal of the American Medical Association researchers Femmie Juffer and Marinus H. van IJzendoorn of Leiden University in the Netherlands pooled results from 137 studies on adoptions by parents living in the United States, Canada, Europe, Australia, New Zealand and Israel.  The study disputes the notion that children adopted from other countries tend to be badly damaged emotionally because of the hardships they had to endure. The analysis of more than 50 years of international data found that these youngsters are only slightly more likely than non-adopted children to have behavioural problems such as aggressiveness and anxiety, and they actually seem to have fewer problems than children adopted within their own countries. But with backgrounds that often include abandonment, orphanages and civil strife, foreign adoptees are sometimes thought of as difficult, disruptive children, an image that the study does not support. The researchers stated that before adoption, most international adoptees experience insufficient medical care, malnutrition, maternal separation, and neglect and abuse in orphanages but they found that these children do well and are largely able to catch up with their non-adopted counterparts.



1.5.1.1​ Possible Medical and Psychological Diagnoses

The following is a non-exclusive list of possible medical and psychological diagnoses which are frequently associated with children in intercountry adoptions.  The inclusion of a diagnosis on this list does not necessarily indicate that the condition is present in a particular child, nor does the exclusion of a particular diagnosis indicate that the condition will not be present in any particular child.​

Salmonella

Milk Intolerance

Pneumonia

Developmental Delays

Dental Problems

HIV Positive

Asthma

Foetal Alcohol Syndrome

Hernias

Anaemia

Heart Problems e.g. Murmurs

Ear Problems

Orthopaedic Problems

Mental illness

Tuberculosis

Scabies/Lice

Chronic Infections

Vision Problems

Learning Disabilities

Physical Abuse

Chronic Ear Infection

Feeding/Eating Disorder

Attachment Disorder

Rickets

Diarrhoea

Cleft Palate

Autism

Hepatitis A and B

Parasites

Depression

Hearing Problems

Malnutrition

Sexual Abuse

Genetic Problems

Chronic Sinus Infection

Premature Birth

Dwarfism or stunted growth

Bronchitis

Eczema

Blood disorders




1.5.1.2 Precluded Medical Conditions for New Zealand Entry

The following are medical conditions where New Zealand Immigration will not support the entry into New Zealand of an adopted child:​​
  • Active Pulmonary Tuberculosis (TB)

  • Severe Haemophilia

  • Renal Failure (likely to need renal dialysis)

  • A Physical Incapacity (that requires full-time care)​


​1.5.1.3 Medical Reports

Article 16 (1) (a) of the Hague Convention requires that the Contracting States of the sending country, once satisfied that the child is adoptable, shall prepare a report including information about the child's identity, adoptability, background, social environment, family history, medical history including that of the child's family, and any special needs of the child;​

Medical information provided to the applicants regarding an examination or report of observations of a particular child should include, to the fullest extent possible:
  • Name and credentials of the individual who performed the examination.

  • The date of the examination.

  • Identification of any references, descriptions or observations made by any individual other than the examining physician that are included, clearly identified by source and training of the observer, and with an explanation of whether these are objective or subjective observations.

  • Information about entry into the most recent and all other forms of care, and review of hospitalisations, significant illnesses and other significant events, and the reasons for them, in the course of care.

  • Accurate information about the full range of any tests performed on the child, including tests addressing known risk factors in the child's country of origin.

  • Current health information.

Applicants need to take a sufficient amount of time, taking into account the child's age and best interests, to carefully consider the needs of a child and their ability to meet those needs and to obtain physician review of medical information and other descriptive information, including photographs and/or videotapes where supplied (care should be taken to identify the dates when the photographs were taken). 

If the applicants consider it is necessary an independent medical test/report should be requested (Note: This would incur cost to the applicants).  Factors to consider include the length of time the child has been in the institution and the possibility that some tests or diagnoses have been done incorrectly (some may be overstated, the sophistication of testing methods). Children with chronic medical conditions can appear healthy.  Many illnesses have no symptoms at all, e.g. no jaundice for Hepatitis B, no diarrhoea for parasites.  The medical examination needs to be suitably competent to identify these conditions.​



1.5.1.4 Medical Testing on return to New Zealand

On the adoptive parents return to New Zealand they should take their adopted child to a paediatrician for full testing. According to some experts, even if a child appears 'normal' many problems are not apparent at the time of the arrival home.  The physician should be up to date on what necessary tests should be done for an intercountry adopted child – if not the adoptive parents need to find one who is.  For more detailed information refer to the American Academy of Pediatrics paper "Initial Medical Evaluation of an Adopted Child" and Deborah Borchers article "Post Adoption Checkups".

Conditions which experts recommend that children should be screened as soon as possible after arrival are:
  • Hepatitis B

  • Tuberculosis

  • Malaria

  • Syphilis

  • Anaemia

  • Worms and Giardia

  • Skin Conditions

  • Lactase Deficiency

The physician should also ensure that the child has properly received all immunisations.​