Attachment Study

Although difficulties in attachment have been recognized in IA children since the 1950s, physicians are still challenged in the early accurate identification and diagnosis of attachment problems in order to implement timely treatment. Institutionalized children, because of poor sanitation, nutrition, medical care and lack of one-on-one caring, commonly have impaired health, development and behavioral problems, which include attachment disorders. Attachment disorders represent a pattern of abnormal behaviors where children who have not received good nurturing are at risk of developing any of the following: poor socialization skills, difficulty controlling emotions, understanding right from wrong, showing abnormal friendliness toward strangers, lying, stealing, and lack of empathy among others. Early identification of children struggling with attachment may allow providers to help the children successfully attach. Our study seeks to describe the presence and severity of attachment symptoms and to describe other factors that may influence the above, such as child personality, control over emotions, length of stay in orphanage and age at adoption.

Immunization Study

Internationally adopted children are frequently not immunized or under immunized. The correlation of immunization history with protective immunity is questionable. Immunization records from internationally adopted children from some areas, especially children from an orphanage, may not accurately reflect protection because of inaccurate or unreliable records, lack of vaccine potency, or other problems. At present, the CDC, the American Academy of Pediatrics' Redbook, and the advisory committee on immunization practices recommend that children repeat all immunizations given over seas, or base immunizations on serologic testing. Our study is designed to provide important information needed to examine the effectiveness of these various approaches to immunization in these children.

Tuberculosis Study

Limited research suggests that rates of TB infection in internationally adopted children are 50 to 150 times that of American-born children. The 2000 Redbook recommends routine tuberculin testing of all internationally adopted children and interpretation independent of BCG vaccination. Since malnutrition is associated with anergy and a common finding in internationally adopted children, we employ anergy testing. Our investigation seeks to determine the prevalence of tuberculin infection in internationally adopted children and to determine the best approach to screen for TB in this group of children.