Evidence suggests that the main reason a mother would leave her child in an orphanage is maternal alcohol abuse during pregnancy¹. Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used to describe a number of conditions that arise due to prenatal alcohol exposure. FASD includes four diagnoses: Fetal Alcohol Syndrome (FAS), partial Fetal Alcohol Syndrome (pFAS), Alcohol-Related Neurodevelopmental Disability (ARND), and Alcohol-Related Birth Defects (ARBD). Fetal Alcohol Syndrome (FAS) is the leading preventable cause of intellectual disabilities in children. According to a recent meta-analysis by Lange et al. (2013), the prevalence of FAS is highest among children adopted from Russia and those residing in orphanages worldwide (Lange et al. 2013). However, the overall prevalence of prenatal exposure to alcohol is unknown. In many cases, children adopted internationally have inadequate pregnancy and birth history documentation. Therefore, in countries with high prevalence of prenatal alcohol use, children are assumed to have been exposed to alcohol prenatally. Children with FASD are more likely to be removed from their homes and placed in foster care or an orphanage (Lange et al. 2013). Fetal Alcohol Syndrome (FAS) is characterized by documented or presumed pre-natal alcohol exposure during pregnancy with specific facial dysmorphisms, growth retardation, and central nervous system impairment (e.g., developmental delay, seizures, or behavior problems) in the child.

Partial FAS (pFAS) is characterized by a presence (or assumed presence) of alcohol exposure prenatally, and some but not all of the specific characteristics of FAS. ARND is characterized by known or presumed maternal alcohol use during pregnancy with neurodevelopmental disabilities in the child (e.g., developmental delay, seizures, or behavior disorders) without the characteristic facial features and growth retardation. Finally, ARBD is characterized by the presence or assumption of alcohol exposure prenatally with end-organ damage, such as congenital heart lesion or renal anomaly, without dysmorphic facies or growth retardation (CDC 2012; Lange et al. 2013; Miller et al. 2007). When children have an FASD, they are at increased risk of having developmental disabilities, such as intellectual disability, behaviors disorders, such as attention deficit hyperactivity disorder, and significant medical concerns such as seizure disorder.

Children with developmental disabilities and special healthcare needs require significant developmental interventions and behavior supports when they are preparing to enter school. The child should undergo a medical and developmental evaluation by a Developmental Pediatrician, Child Neurologist, and/or Pediatric Adoption Specialist. If the child is less than 3 years of age, the child should be evaluated by Early Intervention (EI), a federal program designed for children at risk of developmental delays from birth until 36 months of age. Early Intervention is Part C of the Individuals with Disabilities Education Act (IDEA) that was added to the IDEA in 1986. Early Intervention services can include developmental education, speech and language therapy, occupational therapy and physical therapy provided in-home or at the child’s daycare setting .

As the child approaches his 3rd birthday, the Early Intervention team will help the family transition the child into the local public school Special Education Services for Preschoolers with Disabilities. The Special Education Services for Preschoolers with Disabilities is Part B of the IDEA and is designed for children ages 3–5 years old. According to the IDEA, every child has the right to a free and appropriate public education (FAPE). By law no child can be denied an education based upon their physical, mental or behavioral disability. Therefore, once EI services have concluded, the goal is that the child will transition into the local public school and will continue to receive the services he received from EI. If the child did not receive EI services, then the parents can initiate the enrollment process through their local public school. The child will undergo a comprehensive special education evaluation to determine which school-based services the child should receive. This evaluation may include cognitive testing, speech and language evaluation, measures of adaptive functioning and behavior assessment. Once the special education team has completed the evaluation and determined the child’s eligibility category(ies) (such as Speech and Language Impairment, Intellectual Disability, Visual Impairment, Other Health Impairment, Autism, etc.), the special team meets with the child’s parents to discuss their plan of action and the elements of the child’s Individual Education Plan (IEP). The IEP is a set of services and educational goals and objectives the child will receive within the school setting. The IEP will contain measurements of progress to determine whether the child is making adequate progress toward meeting those goals. Within the preschool setting, the child will need interventions that address specific developmental needs (such as speech and language therapy, specialized curriculum) and behavioral needs (such as social skills training or a behavior support plan). Children adopted via intercountry adoption may have more difficulty adjusting to the school setting, depending upon their level of attachment and age at which they were adopted.