Autism Spectrum Disorders: International Adoptions
I have been warned that writing about possible problems with international adoptions might upset some in the international adoption community. Yet, I feel compelled to write this article. One, because this information should be available to those making a decision regarding these types of adoptions. Also, because it is a perfect example of how sensory and motor delays can cause autistic type presentations.
I had the pleasure of treating a wonderful young girl that was adopted from China. This was actually my introduction into the world of international adoptions and possible complications. The next few sentences highlight some of the issues I have been informed of. Many times the ratio of caretaker to child in some of these orphanages can be as high as 40 to 1. Many times, these children only have their diapers changed once daily. There is the possibility that their hands may be tied as the hands may be considered dirty. Children may never have been taken out of that crib. In fact, they may just have a drip type tube from which to get sustenance. This I was told described the conditions in one of the better orphanages. I was given a copy of a book relating to a term “the dying rooms .” This is a term relating to some of the horrible conditions in the Chinese orphanages during a certain time period. The phrase “Dying room” can be googled and you will be able to find information regarding a book and a television program relating to the same subject. This particular child had not been out of her crib until she was adopted at 18 months old. Therefore, she could not crawl or walk and certainly could not feed herself. When I saw her she was approximately 12 years old.
In the functional neurology model we look at the motor system as being an important driver to brain function. Naturally then development of the motor system is considered paramount development of brain function. Any Situation in which a child did not scoot on time or crawl on time or misses any of their motor milestones becomes a red flag. Primitive reflexes and lower areas of the brain become inhibited as higher areas of the brain develop. If there are inefficiencies in this process, there tends to be inefficiencies in optimal brain function at the highest levels which is what we see in autism spectrum disorders. Therefore, this child was a perfect model for this concept. The fact that she was never out of the crib until she was 18 months old. She had no motor or movement stimulation. She had very little sensory stimulation whatsoever the first 18 months of her life. It is common to see these children stimming and head banging in their cribs looking for some environmental stimulation from the outside world. As I have often said in my presentations to parents and professionals alike, most people realize that if you affect the brain such as in a stroke, you will affect the body. Most, however, do not realize that it is to the receptors from the environment that drives brain activity. Therefore this child’s very limited environmental stimulation had a high probability of presenting with developmental delays, sensory issues and autistic like symptoms.
This child’s functional neurologic examination was exactly as one would expect. She still had primitive reflexes present. She had sensory integration issues mostly related to touch and sound. She had incoordination and a balance disorder. With the appropriate functional neurological examination I was able to localize her functional lesion. Thanks to great cooperation from a dedicated and loving mother, we were able to implement a treatment program to correct her deficits. What is seen most commonly in regard to the application of hemispheric integration therapy with these children is that the ADHD and sensory type symptoms seem to improve first. I then began to get reports from her mom that her cognitive skills were also improving. This child was home schooled and had tutoring. Fairly quickly I began to get reports from mom stating that her reading level had moved up several grade levels. So once again, we got to see the motor cognitive link in action. I recall being in a functional neurology class and hearing the instructor say that “plants don’t have brains, only things that move have brains!” It was something obvious but that had never occurred to me. And so, this wonderful child was an excellent example as to how motor training can drive brain development. Of course, it was not quite as simple as just motor training. We have to incorporate the sensory stimulation and eventually layer her treatment together with cognitive exercises also so as to allow for multi modal processing. However, with the appropriate examination and monitoring of her treatment program allowed us to quickly adapt the program to her rapidly changing findings mostly on a weekly basis but at times on a daily basis.
In my office, we see many boys, as boys tend to be affected by autism spectrum disorders more than girls. However, we have seen quite a few girls and a disproportionate amount of them have been internationally adopted children. So today I got to kill two birds with one stone. I was able to write about functional neurology and hemispheric integration therapy with regard to autism spectrum disorders and inform prospective parents about a not commonly discussed situation with regard to international adoptions.
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