Additional Details About the Study

Data collected
Growth of the human body is dependant on countless aspects of a child’s environment and history. When determining the risk (the likelihood) of a child experiencing difficulties in growth, we must consider as many factors (aspects of a child’s life) as possible. If an aspect of a child’s life is suspected or found to have a negative impact it is called a risk factor.

Research has already shown that the quality and quantity of nutrition isn’t the only risk factor that determines a child’s growth pattern, but the extent to which other risk factors (stress, social interaction, heredity, drug or alcohol exposure, etc.) may contribute is unknown. This knowledge is the basis for our current study, and we know that any attempt to investigate the cause of growth difficulties must take into consideration as many of these risk factors as possible.

We have been collecting a wide variety of information including each child’s:

• Age at the time of adoption
  
  
• Quality of pre-adoptive environment

Because the Eastern European countries require parents to travel to the country for several weeks, adoptive parents are able to see first-hand the conditions of their child’s environment. Based on these observations, we asked parents to rate the quality of their child’s pre- adoptive environment on a 5-point scale (extremely well, well, adequately, poorly, very poorly).

• Current health status
  
  The number of known medical issues (minor, ongoing, or major) present from the time of adoption to the six-month follow-up assessment is recorded.
  
  Parents have graciously given us access to their child’s medical records including both the pre-adoption medical history given to them by the institution or adoption agency and the medical records compiled after their arrival into the United States. With this access, we are able to gather information from a variety of health professionals who have treated each child including ophthalmologists, audiologists, and endocrinologists.
  
  
• Risk that they were prenatally exposed to alcohol (based on history and facial feature analysis)
  
  We ask parents to report their child’s history of prenatal alcohol exposure based on the information that they have received through records, speaking with caregivers at the institution, and other sources.
  
  Our medical team and research staff analyze each child’s facial features to assess whether or not the child has facial features consistent with those found in children with a known history of prenatal alcohol exposure. In order to determine the presence or absence of these features, the medical team utilizes the traditional method of physically measuring various aspects of the face and drawing on experience, while the research staff utilizes the FAS Facial Photographic Analysis Software (FAS Diagnostic and Prevention Network, University of Washington) to analyze a digital photo of each child.
  
  
• Physical growth measures (including birth measures if available)
  Height/length, weight, head circumference
  
  
• Stress sensitive system secretion

Cortisol, a stress hormone, can be found in saliva. Under normal conditions, the concentration of this hormone in the saliva is highest in the morning right after awaking, decreases throughout the day, and is lowest in the evening just before sleep. Incidences of stress during the day should result in a spike in cortisol concentration. Preliminary research has shown that chronic stress, like that experienced by children living in institutions, may alter these rhythmic changes resulting in decreased cortisol concentration in the morning and increased concentration at night. Also, a stressful event results in only a small rise of cortisol concentration. Although this information is not used in diagnostic medicine, researchers associate the degree of rhythm disturbance with the child’s stress level.

For research, the child’s stress response to a stressful situation and normal daily rhythm is investigated for each session. To determine a child’s normal daily rhythm, we ask parents to collect their child’s saliva at home (after waking and prior to sleeping) on two days when the child has been in the US for one month and again on two days when the child has been in the country for 6 months. The child’s response (production of cortisol) to a stressful situation is investigated by collecting saliva before and after the blood draw which occurs during the medical visit at the initial and follow-up sessions.

• Growth hormone secretion/sensitivity
  
  There is good reason to believe that the stress system which produces cortisol may inhibit the functions of the growth hormone system. If this is the case, increased To investigate how well the growth hormone system is working this secretion and sensitivity is represented by the level of two specific growth factors, Insulin-like growth factor I (IGF-I) and Insulin-like growth factor binding protein 3 (IGFBP-3).