International Adoption and Factors Affecting Bayley's Scores

Background: International adoption continues to be popular in the United States. The adoption clinic at Nationwide Children’s Hospital is a multidisciplinary clinic where each adoptee is evaluated at several time intervals after arrival. From 2014 to 2019, this clinic has taken care of 268 international adoptees. Each adoptee is assessed using a Bayley Scale of Development at the time of adoption and, ideally, 6 months following. Our interest is in determining whether there were certain factors that correlated with Bayley scores to identify when clinical therapy initiation would be most effective.

Methods: This was a retrospective study looking at 28 internationally adopted patients’ Bayley cognitive scores at the initial post-adoption visit and 6-month post-adoption visit. Data was collected via chart review of patients seen at the Nationwide Children’s Hospital adoption clinic from 2014 to 2019. Ages ranged from 4 months to 34 months at the time of adoption. Patients evaluated in this study were those patients with two Bayley scores, both initial and 6 months post adoption. Paired sample t-tests and Pearson correlation coefficients were used to determine factors that were associated with the initial Bayley score, the 6-month post adoption Bayley score, and the change in Bayley scores from the initial to 6-month post-adoption visits.

Results: Of the 28 internationally adopted patients, 23 (82%) had improvement, 4 (14%) had no change, 1 (4%) had a decrease in Bayley scores from initial to 6-month post-adoption. There were several factors that were evaluated including prior neurological diagnosis and prior residence (i.e. orphanage or foster care). There was no statistically significant association between having a prior neurological diagnosis and change in Bayley scores (p=0.31). Patients who had a prior neurological diagnosis did have a statistically significant lower Bayley score at the 6-month post-adoption visit (p = 0.01). Results displayed that adoptees who lived in an orphanage had a higher initial Bayley score, but a smaller improvement in Bayley scores as compared to adoptees who had a prior residence in foster care or lived in an orphanage and went home with a caregiver at night, though not statistically significant (p=0.21 and 0.41).

Conclusion: There is still a lot to be understood about the intricacies of international adoption. One observation was that adoptees in an orphanage setting presented with higher Bayley scores in the immediate pre-adoption period in comparison to those in foster care or returning home with caregivers at night. However, adoptees from foster care settings showed a larger degree of developmental improvement. This data displays higher levels of development obtained in orphanages, and that foster care adoptees had a larger potential for developmental improvement.
Another factor identified, was lower developmental scores in those with neurological diagnoses at both time periods despite early therapeutic interventions.