Development, International Adoption Clinic at the University of Minnesota

EXAMINATION AND CLOSE MONITORING IS IMPORTANT
Developmental examinations should be included in the medical visits your child receives soon after her/his arrival home, and should be followed especially closely for the first 24 months post-adoption. Many factors affect development, including the child's genetic background, quality of care prior to adoption, medical and nutritional health, and anxiety and emotional status.

The developmental examination is almost always abnormal in institutionalized children beyond early infancy. Even children reared in foster homes can show delays. Gross motor delays are frequently abnormal in Korean and Guatemalan adoptees due to the practice of foster mothers carrying children, thereby preventing the development of strength and gross motor skills on the same timetable as infants raised in North American homes. In many cases where the developmental evaluation indicates abnormalities, the child needs time to adapt to his or her new environment before any intervention occurs.

Initial developmental screening should be designed, therefore, to identify factors that may interfere with a child's ability to develop to his or her full potential. This is not the time to assess intelligence or do standardized testing. A joint medical and neurodevelopmental assessment is usually most beneficial. Findings that are neurological, such as muscle tone abnormalities, may require earlier referral for more extensive evaluation and intervention. However, if no specific neurological or other risk factors are identified on this first evaluation, it is best to reassess the child after she/he has transitioned to the new home.

GENERAL DEVELOPMENT GUIDELINES
This is a general development guideline by age. Because development and milestones in relation to age can vary and overlap--and all internationally adopted children have different degrees of delay from which they can recover--these points should be used as a general reference tool for observation and not an absolute checklist.

Age of the Child

3-6 mo.
9-12 mo.
18 mo.-2 yrs
3-4 yrs
5 yrs

3-6 Months

• Turning his/her head to follow movement
• Looking at you and watching or curious about your face
• Smiling
• Cooing or gurgling
• Startling at loud noises
• Moving arms and legs easily
• Raising his/her head when lying on his/her tummy
• Teething
• Crying or being uncomfortable when hungry
• Rolling over
• Holding his/her head up without support
• Reaching for and holding objects
• Mouthing objects or trying to put objects into his/her mouth
• Turning head toward or reacting to sounds
• Babbling or squealing
• Laughing out loud

9-12 Months

• Crawling
• Responding to his/her own name
• Identifying caregivers from strangers
• Saying things like "mama" or "dada"
• Imitating sounds
• Looking without squinting
• Standing with support
• Hitting two objects together
• Playing "peek-a-boo"
• Waving "bye-bye"
• Showing affection
• Reaching for toys
• Walking with one hand held
• Finger feeding him/herself

18 Months - 2 Years

• Attempting to put on shoes
• Feeding him/herself with a spoon
• Liking to help
• Letting his/her needs be known
• Pointing to objects when named
• Walking without help
• Picking up small objects (such as Cheerios)
• Building a tower with blocks
• Listening to short stories
• Turning pages of a book
• Copying another child's play
• Jumping, running, walking up and down stairs with help
• Using two-word sentences
• Often doing the opposite of what is asked

3-4 Years

• Toilet training during the day--usually dry through the night
• Talking and being understood
• Using three-word sentences
• Differentiating between boys and girls
• Pedaling a trike and/or kicking a ball
• Imitating drawing a straight line
• Stringing large objects
• Naming several body parts
• Asking questions
• Playing make-believe
• Dressing him/herself (except for fasteners)
• Putting together a 7- to 12-piece puzzle and identifying colors
• Drawing a face
• Balancing on one foot

5 Years

• Playing organized games
• Following three-step directions
• Cutting with scissors (or using a comparable tool)
• Copying familiar shapes
• Drawing a person with several body parts
• Catching a bounced ball
• Counting to 10
• Understanding the meaning of many words