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Title of Paper: Children adopted from China: a prospective study of their growth and development

Type of Paper: Original Article; Prospective Longitudinal Study

Purpose: To examine the growth and functioning during the first 24 months post-arrival in children adopted from China.

Nutrition-Related Measures:

Participants: 70 infant girls adopted from China and 43 Canadian-born girls of similar age and similar parent educational background to the adopted group. Average age at first assessment was 13. 8 months (range was 8 to 21 months).

Methods: Physical and cognitive development were assessed at four visits: the initial visit was within 6 weeks of arrival, and follow-ups were done at 6 months, 12 months, and 24 months.

Nutrition Results:

Initial

6 month follow-up

12 month follow-up

24 month follow-up

Height

50

50

50

50

Weight

10

25

50

50

OFC

50

50

50

90

Conclusions & Clinical Implications: Girls adopted from China who are adopted around 12 months of age have delayed physical growth and development compared to non-adopted girls living in their adoptive countries. The international adoptees showed catch-up in both growth and development and as a group measuring within the average range by 6 months post-adoption. Catch-up to their non-adopted peers on most developmental measures (including cognitive, motor, and receptive language) was not seen though until 24 months post-adoption. The one exception was expressive language in which catch-up was not observed; international adoptees continued to have impaired expressive language skills compared to the non-adopted group at 24 months post-adoption.

Physical growth was associated with both developmental performance at arrival and with developmental growth over the 24 months. Although there was variation for each developmental measure, better height for age at arrival and larger head circumference at arrival seemed to have the largest associations with better developmental outcomes, including both better initial developmental abilities and greater developmental catch-up. The finding that height to age ratio was associated with developmental functioning emphasizes the importance of nutritional status in cognitive, motor, and language development in international adoptees.

Limitations of the Nutritional Results: The results of this study should be interpreted with caution. As the authors mention, height for age may be affected by risk factors other than nutrition that are experienced by international adoptees prior to adoption. Also, in previous studies older age at adoption has been one of the most consistent predictors of both poorer developmental outcomes and poorer height for age, and in this study, age at adoption was correlated with cognitive and language outcomes. However, when growth measures were used to predict developmental outcomes, age at adoption was not included in the analyses. Therefore, lower height for age may not directly cause poorer developmental outcomes, but height for age could be a marker of the length of deprivation, and it is the length of deprivation that is associated with the developmental outcomes.

Reference: Cohen NJ, Lojkasek M, Zadeh ZY, Pugliese M, Kiefer H. Children adopted from China: a prospective study of their growth and development. Journal of Child Psychology and Psychiatry. 2008; 49 (4): 458-468. http://www.ncbi.nlm.nih.gov/pubmed/18221351


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