While many children who are adopted exhibit little to no developmental concerns or delays, it should be expected that children who are adopted internationally or those who have spent any amount of time in an institutional setting or foster care or been exposed to abuse or neglect and experienced trauma may require assistance, support, or even specialized treatment in order to catch up to their peers. The Kennedy Krieger Institute defines developmental concerns as “delays or abnormal patterns of development in the areas of communication/language, motor skills, problem-solving or social and adaptive behavior. These concerns are usually based on comparison to other children the same age.”

While it would be wonderful to have a road map of what to expect across the board, no such cheat sheet exists and it is imperative for adoptive parents to ask the right questions ahead of time and to be open to and accept these possibilities, get to know their adopted children intimately to better understand their needs, maintain strong relationships with adoption resources and support groups, and take action when needed. The article “Adoption and Stages of Development provides a detailed description of the different stages of childhood development, what can be expected, and how adoptive parents can be both understanding of their child’s behavior and proactive in helping to ensure a child’s development stays on track. 

Developmental Concerns in Private vs. Foster Care vs. International Adoption

There are many roads that lead to adoption and all adoptees who find themselves in the system experience loss and trauma to some degree. For infants, that sense of loss may not be immediately apparent or as significant, but at some point in time, adoptive parents may notice changes in their toddler child, older child, or teen who may suddenly express sadness or fear or curiosity that hadn’t been there just the day before.

While this may not necessarily qualify as a development concern, it should be on all adoptive parent radars to anticipate the fact that at some point in time, little Johnny is going to have questions. As Johnny begins to understand what adoption is and what it means for him, it goes without saying that he may experience any sort of developmental “issues” if you will—from emotional and behavioral regression to problems at school to problems with friends and classmates to communication issues at home. Adoptive parents who have done everything “right,” educated themselves, and knew this might happen may ask, “Why? What did we miss?” The truth is, you missed nothing—Johnny is adopted and human and like every other human on the planet with feelings, he’s expressing this the best way he knows how.

Accepting this truth can be the difference to supporting Johnny through this stage of his development or sending the message that his feelings aren’t valid—or even worse, that they’re wrong, which may push him into a quiet corner where he may stumble through his true feelings in secret rather than seek the support of his adopted parents, family, and friends. 

It is to be expected that children who have spent time in the foster care system have experienced something negative at home to begin with, which is how they wound up in foster care. In the article “Age: Just a Number When It Comes to Trauma,” author Liz Young states, “In order to catch up developmentally, children need trauma-informed, trusting adults to form lasting relationships where they have the safety to practice these essential skills. Children who have survived trauma must have a chance to gain back some of what was lost when trauma invaded their lives and hindered their development.” No matter what their birth family may have contributed to their state of being, children are wired to love their families and so even though they may be in a safer, better environment now, that doesn’t mean they don’t still love, miss, and feel as though they were torn away from their birth family. And as strong a system as foster care tries to be, it is not a perfect system; the children who spend days, months, and even years shuffling through it oftentimes are not receiving the one-on-one sort of attention they should, which can lead to an array of developmental issues. Young goes on to say, “While this may sound and feel very discouraging, hope is not lost for these children.”

Finally, children who have spent time in international orphanages, especially in countries that do not adhere to or have the capability of providing proper care, oftentimes face the possibility of a  variety of developmental concerns. As with private adoption and foster to adopt, many of these issues are treatable and even reversible with a lot of love, work, and patience; however, the changes do not happen overnight and adoptive parents should understand what they are walking into before considering intercountry adoption.

In this article, we’ll talk about some of the common areas of development with which an adopted child may require assistance. It should be noted that adoption itself may not be the reason for a development delay, but rather the result of a child’s overall experience leading up to an adoption and the reality of then living life as an adoptee. While that may sound contradictory and confusing—adoption is not black and white and shouldn’t be approached as such. Rather, adoption is a blend of positives and negatives with the best intentions of a child somewhere in the middle. Most certainly adoptive parents want the best for their children. 

Identity and Self-Esteem

It shouldn’t come as a shock to anyone that many adoptees struggle with identity and in some cases, self-esteem. Questions like, “Why didn’t my mommy want me?” can start early on and should be treated with care. It is normal for an adopted child to want to know who she is. Where she came from? How she got here? Does she have siblings? Why was she adopted? Why did her adoptive parents want her? Do they love her? 

Some children are more open about asking questions, but for those who don’t show an interest, it should not be assumed that they aren’t experiencing feelings or concerns that they are unsure how to express.

The Adoption.com article “5 Ideas to Help Your Teen With Identity Challenges in Adoption offers common-sense ideas that all adoptive parents should consider applying and really, there’s no reason to wait with these solutions until your child is a teenager. Being prepared and being proactive in your child’s life will help you both to be ready for the challenges life will bring. Knowing what to expect and being prepared to deal with issues ahead of the teen years may actually benefit both child and parent as most kids are more apt to listen and be more receptive through their tween years adopted or otherwise.

By ensuring that your child knows who she is and making her feel comfortable in her own skin through open communication, honesty, and a shared learning experience, you are setting her up to succeed rather than to fail later in life when she won’t have your love and support—and answers to help her to wade through the complicated enough teen years. 

Speech and Communication

Being able to clearly communicate is important on so many levels—from allowing a child to express himself to supporting the bonding process. While some may focus on the fact that their child is “behind” in speech—garbling sounds or mispronouncing words, the larger more complicated issue isn’t that he is unable to clearly sound out letters and words, but rather that he is unable to express himself and his feelings in a clear manner. This lack of ability can sometimes manifest into what appear to be tantrums, outbursts, and inappropriate behavior as a child becomes frustrated cue to not being able to communicate with those around him. Communication is key to bonding and attachment and the lack thereof can be detrimental to that progress and should not be ignored.

The Adoption.com article “5 Things to Consider with International Adoption and Speech Delays suggests that parents should expect that a child who has spent any amount of time in an orphanage or institution will experience speech delays, at least initially. Similarly, a child who has bounced from place to place in foster care may also exhibit issues with speech and communication.

Early intervention is key. Speak to your child’s pediatrician as early as possible to learn about resources in your community—be it through the county or local school district that you should have access to.

Motor Skills (Gross and Fine)

Children who may not have had one-on-one caregiver attention may exhibit developmental delays with gross motor skills such as rolling over, sitting up, crawling, and walking and fine motor skills such as manipulating toys, bottles and sippy cups, silverware, and crayons and pencils. 

Spending extra time working on these activities with a child and incorporating these skills into playtime and games are paths to helping children to catch up to and reach expected milestones. How Kids Learn: Infant – Age 8 offers a summary of general milestones and suggestions on helping children to stay “on track.” 

In some cases, physical therapy may be required. 

Issues With Eating

It will be important to speak to your child’s caregiver—no matter if it was for a very short time or a long time—to make sure that you have the complete story on their environment, nutritional background, eating habits, and likes and dislikes. You should also make sure to speak to a doctor or nurse if possible to rule out any medical issues or allergies. 

Children who have spent time in orphanages, for example, are often used to a schedule, may have experienced a limited menu, may have been one of many children eating at any given time, or may have gone without. Sometimes these children, when introduced to an adoptive family, and especially in a new country/environment, may refuse food or may go the opposite route and compensate or horde food for fear or uncertainty of not knowing where or when their next meal will come from. The Creatingafamily.org offers an overview of hoarding, overeating, and food obsessions in adopted and foster kids with tips to handling these issues and links to additional help and resources.


So many factors can bleed into a child’s ability to learn. Age and circumstance are huge influencers on a child’s abilities and parents should make sure to learn as much as possible about their child’s previous environment and work closely with faculty and staff as needed.

According to The Institute for Family Studies, “Adoptive parents reported that an 83% majority of their children enjoyed going to school and nearly half—49%—were doing “excellent” or ‘above average’ school work. But when compared to students living with their married biological parents, there were substantially more adopted students who performed poorly on indicators of academic progress and school adjustment. Adopted students were:

          – “twice as likely to have had their parents contacted in the last year due to schoolwork problems;

          – “three times as likely to have had their parents contacted in the last year due to classroom behavior problems;

          – “four times more likely to have repeated a grade;

          – “and three times more likely to have been suspended or expelled from school.

“On the other hand, adopted students were no more likely than other students to be absent often from school (for 11 or more days during the school year).”

IFS goes on to state: “Many adopted children do perform well in school, learning up to their potential and getting along well with other students. Even among those who have difficulties, a majority enjoy going to school and receive counseling and special education services to help them and their parents cope with their health conditions. There is little question that adopted children are better off than they would be in long-term foster or institutional care. At the same time, survey data reveal the complex challenges adopted children face in overcoming the effects of early stress, deprivation, and the loss of the biological family. It is vital that current and potential adoptive parents become aware of the challenges they may face, as well as the eventual benefits that will accrue to them and the child as a result of the love and resources they provide and the struggles they endure.”

Emotional and Behavioral (Playing) and Attachment

Adoption.com’s adoptive parents post-adoption emotional issues forum is just one resource adoptive parents may want to turn to concerning various issues children may experience and tips and solutions on how to best provide support.

Just as with physical development (motor skills), it is equally important for parents to understand and be prepared to transition adopted children, no matter the age, by focusing on bonding and attachment as early as possible. 

Intimate moments like feeding times (bottle-feeding) during infancy to shared family mealtimes, bedtime rituals, spending time as a family reading and playing board games together (video games count too), getting outside to throw a ball or run around the yard, going to the park, working out in the yard, exploring the neighborhood and community—any activities that require talking together, working together, sharing quiet moments—all work toward building trust, which is the foundation to strong emotional and behavioral growth.

Structure and even discipline also play a part in building strong relationships, reinforcing the parent-child relationship, and providing safety and security for a child who very well may have not experienced routine, rules, and expectations in the past. The Adoption.com article “5 Ways to Create a Strong Bond With Your Adopted Child provides several opportunities to cultivate a strong connection to your adopted child, which will have a lifelong impact on everything from their mental to physical development and long-term well-being.


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Sue Kuligowski is a staff storyteller at Adoption.com. The mother of two girls through adoption, she is a proposal coordinator, freelance writer/editor, and an adoption advocate. When she’s not writing or editing, she can be found supervising sometimes successful glow-in-the-dark experiments, chasing down snails in the backyard, and attempting to make sure her girls are eating more vegetables than candy.