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International adoption has become more common in the United States, and there are important challenges that adopted children and families face.

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Over the past five decades, international adoption has become commonplace. In many countries throughout the world, children are reared in orphanages with substandard conditions—without adequate food, clothing, or shelter and with poorly trained caregivers. Such orphanages have been found in a number of countries, including China, Ethiopia, Ukraine, Congo, and Haiti, accounting for over two thirds of internationally adopted children (U.S. Department of State, 2014). Underfunded and understaffed orphanages often provide poor, nonnurturing care for children, increasing the risks for malnutrition, infections, physical handicaps, and growth retardation (The Leiden Conference on the Development and Care of Children Without Permanent Parents, 2012). With high infant-to-caregiver ratios, children available for adoption often spend a significant amount of time deprived of consistent human contact.

Few internationally adopted children enter the United States healthy and at age-appropriate developmental norms. Not surprisingly, the longer the children were institutionalized, the more developmental challenges they face (Jacobs, Miller, & Tirella, 2010). Physical growth stunting is directly associated with the length of institutionalization, but catch-up growth is commonly seen after adoption (Wilson & Weaver, 2009). As with growth, the time spent in an orphanage predicts the degree of developmental delay. Longer institutionalization is associated with delays in development of language, fine motor skills, social skills, attention, and other cognitive skills (Mason & Narad, 2005; Wiik et al., 2011).

Speech and language delays are among the most consistent deficiencies experienced by internationally adopted children, especially those adopted after the age of 1 (Eigsti, Weitzman, Schuh, de Marchena, & Casey, 2011). However, more children reach normative age expectations 1 to 2 years postadoption (Glennen, 2014; Rakhlin et al., 2015). Generally, the younger the child is at adoption, the more quickly he or she will adapt to the new language and close any gaps in language delays (Mason & Narad, 2005). Some research suggests internationally adopted children are prone to long-term deficits in executive function likely due to neurological factors (Merz, Harlé, Noble, & McCall, 2016). The presence of a high-quality parent–child relationship promotes development of language, speech, or academic outcomes, and most children reach age-expected language levels (Glennen, 2014; Harwood, Feng, & Yu, 2013).

As adolescents, all children struggle to come to a sense of identity, to figure out who they are. This struggle may be especially challenging for internationally adopted children who may wonder about their native culture and homeland (Rosnati et al., 2015). Frequently, adolescents may want to discuss and learn more yet inhibit the desire to talk about this with parents (Garber & Grotevant, 2015). Parents who assume a multicultural perspective and provide opportunities for their children to learn about their birth culture support adopted children’s development and promote healthy outcomes (Pinderhughes, Zhang, & Agerbak, 2015). Internationally adopted children seek to understand their birth culture and integrate their birth and adopted cultures into their sense of self (Grotevant, Lo, Fiorenzo, & Dunbar, 2017). A positive sense of ethnic identity is associated with positive outcomes such as self-esteem in international adoptees (Mohanty, 2015). Although there are individual differences in the degree of resilience and in functioning across developmental domains, adopted children overall show great developmental gains and resilience in physical, cognitive, and emotional development (Misca, 2014; Palacios, Román, Moreno, León, & Peñarrubia, 2014; Wilson & Weaver, 2009).