Navigating puberty, identity, and race among transnationally, transracially adopted Korean American adolescents.

This exploratory study examined the relation between pubertal timing and dimensions of ethnic-racial identity among adopted Korean Americans raised transracially in White families. The study also examined whether internalized racism moderated the association between pubertal timing and ethnic-racial identity. Adopted Korean American adolescents (N = 202; 108 females; ages 13-19 years) completed measures of pubertal development, ethnic-racial identity, and internalized racism in 2007. There was no significant main effect of pubertal timing for either male or female adolescents. Internalized racism moderated the relation between pubertal timing and ethnic-racial identity clarity (B = -.16, p = .015) among male adolescents. Specifically, earlier pubertal timing was significantly associated with lower ethnic-racial identity clarity for male adolescents with higher levels of internalized racism.

Racial disparities in pregnancy options counseling and referral in the US South.

OBJECTIVE: The objective of this study is to examine racial variation in receipt of counseling and referral for pregnancy options (abortion, adoption, and parenting) following pregnancy confirmation. Equitable offering of such information is a professional and ethical obligation and an opportunity to prevent racial disparities in maternal and child health. DATA SOURCE: Primary data from patients at southern United States publicly funded family planning clinics, October 2018-June 2019. STUDY DESIGN: Patients at 14 clinics completed a survey about their experiences with pregnancy options counseling and referral following a positive pregnancy test. The primary predictor variable was patients' self-reported racial identity. Outcomes included discussion of pregnancy options, referral for those options, and for support services. DATA COLLECTION: Data from eligible patients with non-missing information for key variables (n = 313) were analyzed using descriptive statistics, χ2 tests, and multivariable logistic regression. PRINCIPAL FINDINGS: Patients were largely Black (58%), uninsured (64%), and 18-29 years of age (80%). Intention to continue pregnancy and receipt of prenatal care referral did not differ significantly among Black as compared to non-Black patients. However, Black patients had a higher likelihood of wanting an abortion or adoption referral and not receiving one (abortion: marginal effect [ME] = 7.68%, p = 0.037; adjusted ME [aME] = 9.02%, p = 0.015; adoption: ME = 7.06%, p = 0.031; aME = 8.42%, p = 0.011). Black patients intending to end their pregnancies had a lower probability of receiving an abortion referral than non-Black patients (ME = -22.37%, p = 0.004; aME = -19.69%, p = 0.023). In the fully adjusted model, Black patients also had a higher probability of wanting access to care resources (including transportation, childcare, and financial support) and not receiving them (aME = 5.38%, p = 0.019). CONCLUSIONS: Clinical interactions surrounding pregnancy confirmation provide critical opportunities to discuss options, coordinate care, and mitigate risk, yet are susceptible to systemic bias. These findings add to limited evidence around pregnancy counseling and referral disparities. Ongoing assessment of pregnancy counseling and referral disparities can provide insight into organizational strengths or the potential to increase structural equity.

Making the Ethnic Embryo: Enacting Race in US Embryo Adoption.

How are frozen embryos donated for procreation racialized as "ethnic" subjects and what are the political implications of these enactments? Based on ethnographic research within an embryo adoption program in the United States, I examine the practices through which staff and participants produce "ethnicity" in embryos and trace its multiple permutations. Strategies used to stabilize race in embryos also disturb, fracture, and confound the bases for designating race. Analyzing race-making practices in embryo adoption reveals the interplay between practical challenges in assisted family-making practices and their wider political implications for reproductive politics.

Depth in Cultural Socialization in Families with Children Adopted from China.

Parents raising children adopted from a different racial/ethnic group usually engage in cultural socialization-providing activities in adoptees' birth culture-hoping to instill pride and help adoptees develop a positive identity. Adoptive parents engage in a wide variety of socialization activities, yet adult adoptees have reported not having deep enough exposure from their parents. The present study explored the depth of cultural socialization in transracial adoptive families. Informed by Pinderhughes' Ethnic-Racial Socialization model, this study developed a continuum examining the depth in cultural socialization with three indicators: (1) the depth of cultural activities, (2) parents' motivation for cultural socialization, and (3) parental cultural attitudes. Qualitative analyses of 41 White parents raising children adopted from China found that parents' motivation and acknowledgement of cultural differences reflected deep appreciation of adoptees' birth culture, however, activities they provided were not as deep. Activities that facilitated close relationships with people who shared adoptees' background in a natural context appeared to provide the deepest cultural connection. Despite limitations, the study demonstrated that the depth continuum was able to capture variations and nuances in cultural socialization. Suggestions for future research and recommendation for practice were also included.

Los padres que crían a niños adoptados de grupos étnicos o raciales diferentes generalmente se interesan por la socialización cultural y ofrecen actividades de la cultura de origen del adoptado con la esperanza de inculcarle orgullo y ayudarlo a desarrollar una identidad positiva. Los padres adoptivos participan en una amplia variedad de actividades de socialización (p. ej.: Quiroz, 2012), sin embargo, los adoptados adultos han informado no recibir una exposición suficientemente profunda de parte de sus padres (p. ej.: Day et al., 2015). El presente estudio analizó la profundidad de la socialización cultural en familias adoptivas interraciales. Basándose en el "Modelo de Socialización Étnico-Racial" de 2010 de Pinderhughes, este estudio desarrolló un continuo analizando la profundidad de la socialización cultural con tres indicadores: (1) la profundidad de las actividades culturales (2) la motivación de los padres para la socialización cultural y (3) las actitudes culturales de los padres. Los análisis cualitativos de 41 padres blancos que criaban a niños adoptados de China descubrieron que la motivación de los padres y el reconocimiento de las diferencias culturales reflejaban una profunda valoración de la cultura natal de los adoptados, sin embargo, las actividades que ofrecieron no fueron igual de profundas. Aparentemente, las actividades que facilitaron las relaciones cercanas con personas que compartían el origen de los adoptados en un contexto natural ofrecieron la conexión cultural más profunda. A pesar de las limitaciones, el estudio demostró que el continuo de la profundidad pudo captar las variaciones y los matices de la socialización cultural. También se incluyeron sugerencias para futuras investigaciones y recomendaciones para la práctica.

The Familial and the Familiar: Locating Relatedness in Colombian Donor Conception.

In this article, I explore how women undergoing in vitro fertilization with familial or anonymous egg donors located relatedness with a donor-conceived child through familial and social identities. Recognizing gametes as substances that contain biological and sociocultural/behavioral traits shaped women's narratives around interconnected notions of the familial and familiar, or the social understanding of biological and social inheritance, and knowledge of the genetic materials involved. Women's narratives of relatedness reflect their relationships with family and society and their desire to reproduce these relationships in their child(ren), a process that reproduces prevailing Colombian social values and notions of ideal citizens.

Alcohol and drug use among internationally adopted adolescents: Results from a Norwegian population-based study.

Internationally adopted adolescents are at increased risk for mental health problems. However, little is known about problematic alcohol and drug use, which are important indicators of maladjustment. The aim of this study was to examine the level of problematic alcohol and drug use in internationally adopted adolescents compared to their nonadopted peers. The study is based on data from the youth@hordaland-survey, which was conducted in Hordaland County, Norway, in the spring of 2012. All adolescents born from 1993 to 1995 residing in Hordaland at the time of the study were invited to participate. Information on adoption was obtained from the Central Adoption Registry and linked to self-report data from the youth@hordaland-survey. Among 10,200 participants, 45 were identified as internationally adopted. No significant differences were found between international adoptees and their peers regarding whether or not they had tried alcohol or illicit drugs or their patterns of drinking behavior. However, adopted adolescents had a higher mean score on a measure of problematic alcohol and drug use compared to their nonadopted peers. The difference was attenuated and no longer significant when adjusting for measures of depression and attention-deficit/hyperactivity disorder. Results from a structural equation model indicated a full mediation effect of mental health problems on the association between adoption status and problematic alcohol and drug use. Our findings indicate that internationally adopted adolescents experience more problematic alcohol and drug use than their nonadopted peers, and the difference can largely be explained by mental health problems. (PsycINFO Database Record

On Reproductive Work in Spain: Transnational Adoption, Egg Donation, Surrogacy.

Spain's plummeting fertility since the late twentieth century may seem to reflect a waning desire for children. Nevertheless, reproductive disappointments resulting from gender inequalities cause many Spanish women to postpone motherhood and experience age-related fertility problems. For them, creating a family often becomes possible only through the reproductive labor of other women. Our analysis of transnational adoption, egg donation, and surrogacy in Spain shows how anonymity and altruism play out in these three strategies, with implications for the valuation of women's reproductive work and relationships among reproductive providers, intermediaries, recipients, and the resulting children.

International Adoption of Children Surviving the Haitian Earthquake.

OBJECTIVE: To evaluate resilience and frequency of behavioral symptoms in Haitian children internationally adopted before and after the earthquake of January 12, 2010. METHODS: We conducted a retrospective quantitative study in 40 Haitian children. Families were also asked to participate in a qualitative study (individual interview at 18-24 months after the earthquake) and to complete State-Trait Anxiety Inventory (STAI) and STAI for children (STAI-C) questionnaires. RESULTS: Demographic and clinical characteristics were similar in the group who experienced the earthquake (n=22) and in the group who did not (n=18). The families of 30 adoptees were interviewed. There was no statistical difference between the two groups for the STAI (P=0.53) and STAI-C (P=0.75) or for the frequency of behavioral problems. Plenary adoption was pronounced for 84.6% and 33.3% of the children adopted in the pre- and post-earthquake group, respectively (P=0.02). Children rarely talked about the experience of the earthquake, which, by contrast, was a stressful experience for the adoptive families. CONCLUSIONS: Haitian children adopted after the earthquake did not express more stress or behavioral problems than those adopted before it. However, the possibility of a resurgence of mental disorders after age 10 should be borne in mind. (Disaster Med Public Health Preparedness. 2018;12:450-454).

Infertility, Adoption, and Family Formation in Indonesia.

When combined, primary and secondary infertility affects up to 21 percent of Indonesian couples. Based on ethnographic fieldwork with married heterosexual couples, I explore how intra-family adoption represents a culturally and religiously acceptable pathway to family formation for couples without access to assisted reproductive technologies. I examine how kinship is central to the negotiation of adoption, and to maintaining ethnic and religious continuity within adoptive families. I reveal how adoption can enable infertile women and birth mothers to achieve or escape the dominant expectations of heteronormativity, and discuss intra-family adoption by infertile couples in relation to reproductive stratification and leveling.

American Indian and White Adoptees: Are There Mental Health Differences?

Adult adoptees are at increased risk for mental health problems compared to nonadoptees. However, little is known about subsets of adoptees that may be more or less vulnerable to mental health problems. The purpose of this study was to explore the presence of mental health problems of American Indian (AI) persons compared to White persons who were separated from their birth families during childhood by foster care and/or adoption. Family systems theory guided the study. AI adoptees reported higher percentages of problems than White adoptees on all mental health problems measures (e.g., substance abuse, mental health, self-injury, and suicide). Data analysis included a series of chi-square statistics and logistic regression models. AI adoptees were more likely to report mental health problems, including alcohol addiction, alcohol recovery, drug recovery, self-assessed eating disorder, eating disorder diagnosis, self-harm, and suicidal ideation than were whites.

Growth status of Korean orphans raised in the affluent West: anthropometric trend, multivariate determinants, and descriptive comparison with their North and South Korean peers.

ABSTRACT: This paper investigates the trend in height among adult Korean orphans who were adopted in early life into affluent Western nations. Final heights of 148 females were analyzed based on a Korean government survey conducted in 2008. Height of the orphans was descriptively compared against final heights of South and North Koreans. Furthermore, statistical determinants of orphan height were investigated in multivariate regressions. Mean height of Korean orphans was 160.44 cm (SD 5.89), which was higher than that of South Koreans at 158.83 cm (SD 5.01). Both Korean orphans and South Koreans were taller than North Koreans at 155.30 cm (SD 4.94). However, height of Korean orphans stagnated at around 160-161 cm while those of North and South Koreans improved over time. In the regression analysis, the socioeconomic status of the adoptive family was statistically significant in all models, while dummies for the adoptive nations and age at adoption were insignificant. This study shows that the mean final height of women experiencing extreme environmental improvements in early-life is capped at 160-161 cm, tentatively suggesting that social stress factors in the host nation or early-life factors in the birth nation might have offset some of the environmental enrichment effects achieved through intercountry adoption.

Timing of menarche in girls adopted from China: a cohort study.

BACKGROUND: Girls adopted internationally from some states have been found to have high rates of early puberty, including early menarche. Explanations for the link between international adoption and early puberty include post-adoption catch-up growth triggering puberty, and under-recorded age. METHODS: We compared menarcheal age in a cohort of 814 girls adopted from China into North America against menarcheal ages in girls in China. Adoptive parents provided survey data on their daughters' weight in 2005 and on menarcheal status and age at menarche in 2011. RESULTS: Estimated median age at menarche for adopted Chinese girls is 12.37 years (95% CI: 11.84-13.00 years). Estimated prevalence of menarcheal age ≤10.00 years for adopted girls is 3%. These findings are similar to published findings on non-adopted Chinese girls. The distribution of menarche of adopted girls and non-adopted girls at the estimated incidence rates P3-P97 are also similar. Among the 609 girls whose parents reported on their weight shortly after adoption, 148 (24.3%) were -2SD or more below the median weight in the WHO weight-for-age tables. The proportion of these girls who had attained menarche was not statistically different from other girls. CONCLUSIONS: For girls adopted from China, the age of menarche, the percentage of girls attaining menarche <10 years and the distribution of menarcheal age are all similar to Chinese girls growing up in China.

International Adoptees With Cleft Lip and/or Palate: Lessons Learned From a Growing Population.

BACKGROUND: International adoptees with cleft lip and palate (CLP) are a growing population in the United States. They represent a clinical challenge, presenting at various ages and stages of cleft repair. METHODS: A retrospective review of patients seen at the CLP Program at the Children's Hospital of Philadelphia (CHOP) between 1998 and 2012 with a history of international adoption was performed. Demographics, surgical histories, and long-term speech outcomes were reviewed. RESULTS: Seventy-four female and 77 male patients were evaluated. Patients were adopted at an average age of 2.3 years (range, 0.4-8.6 years); 80.8% (n = 122) of patients were adopted from China. The rate of international cleft adoption increased by approximately 1.5 patients per year (r = 0.7739, P < 0.001); 13.2% (n = 19) of all subjects with cleft palates had oronasal fistulas (ONFs) that required repair. The ONF rates for primary palatoplasties at CHOP were significantly lower compared to both preadoption repairs (P = 0.002) and postadoption repairs at outside hospitals (P = 0.01); 14.8% (n = 21) of all patients had secondary surgeries for velopharyngeal incompetence (VPI). Rates of secondary surgery for VPI were also significantly lower for primary palatoplasties at CHOP compared to both preadoption repairs (P = 0.0018) and postadoption repairs at outside hospitals (P = 0.0033). CONCLUSIONS: International adoptees with CLP are a growing population and are clinically challenging with high ONF rates and high secondary surgery rates for VPI. We recommend expedited repair of unoperated cleft palates in adoptees older than 18 months. Adopted patients with CLP should be rigorously evaluated for the need for speech therapy and secondary surgeries to correct for VPI.

Ethnic socialization, perceived discrimination, and psychological adjustment among transracially adopted and nonadopted ethnic minority adults.

Little is known on how transracial adoptees (TRA) navigate issues of race and ethnicity. Using Shared Fate Theory as a framework, this study was interested in the moderating role of adoption status among a group of ethnic minority adults in explaining the relationship between ethnic socialization, perceived discrimination, and mental health outcomes. Nonadopted (NA; n = 83) and TRA (n = 87) ethnic minorities responded to measures on ethnic socialization, perceived discrimination, and psychological outcomes administered online. TRA and NA ethnic minorities reported similar levels of ethnic socialization, perceived discrimination, and psychological outcomes (depression and self-esteem). Perceived discrimination was significantly associated with depression for both TRA and NA ethnic minorities. Ordinal Least Squares (OLS) regressions that were run for a moderated moderational analysis suggest that the protective role of ethnic socialization depended on adoption status. Among the different forms of ethnic socialization, cultural socialization and preparation for bias significantly buffered against the effects of perceived discrimination, but the effects were more pronounced for TRA than for NA ethnic minorities. Because NA and TRA ethnic minorities were similarly affected by discrimination, it suggests that being a TRA does not confer any additional risk when experiencing discrimination. Additionally, the study found that ethnic socialization may continue to serve a protective role against the effects of discrimination into adulthood for TRA, but less so for NA ethnic minorities. These results have policy implications regarding the role of parental ethnicity in adoption decisions as well as the importance of educating adopted parents about ethnic socialization for ethnic minority children. (PsycINFO Database Record

Confirmatory evidence for a multidimensional model of racial-ethnic socialization for transracially adoptive families.

OBJECTIVES: The purpose of the current study is to test a recently established model of racial-ethnic socialization (Langrehr, 2014) among 2 samples of White transracially adoptive parents and to assess whether the proposed model functions similarly after accounting for adopted child race. METHOD: Based on a modified version of the Racial Bias Preparation Scale (Fisher, Wallace, & Fenton, 2000), confirmatory factor analysis was used to test the 3-factor model (i.e., Prejudice Awareness, Racial-Ethnic Pride, and Egalitarianism) among 172 White transracially adoptive parents with Asian children (Mage = 45.72) and 140 White transracially adoptive parents with Black children (Mage = 42.62). In addition, multigroup invariance testing was used to assess whether the proposed model functioned similarly across the 2 groups of parents. RESULTS: Results indicate that the proposed 3-factor model demonstrated partial measurement invariance such that the subconstruct of Egalitarianism functioned similarly across groups, whereas Racial-Ethnic Pride and Prejudice Awareness were deemed noninvariant. CONCLUSIONS: Findings are intended to help expand the concept of racial-ethnic socialization for transracially adoptive families and address the degree to which current research on racial-ethnic socialization can be applied to different transracially adoptive families. Results are intended to highlight ways that various social-cultural dimensions of family can culminate into different socialization experiences. (PsycINFO Database Record

Discordances Between Serology and Culture for Strongyloides in an Ethiopian Adopted Child With Multiple Parasitic Infections: A Case Report.

RATIONALE: infectious diseases screening of international adoptees is complex because of the concurrence of different pathogens in a child at same time. We describe an international adopted child born at Ethiopia infected by 5 different pathogens (Hymenolepis nana, Giardia intestinalis, Entamoeba histolytica, Strongyloides stercoralis, and Trichuris trichiura), 2 of them S. stercoralis and E. histolytica with a capacity to develop severe clinical complications if not detected promptly with appropriate diagnosis tests.Concerns of the patient: according to the screening protocol a stool sample is always processed for culture addressed to find out protozoan and helminthic pathogens but not specifically for S. stercoralis. Only, when eosinophilia is detected 3 serial stool samples are collected to rule out intestinal parasitic infection including S. stercoralis. INTERVENTIONS: in our case, S. stercoralis would not have been detected if we had followed the protocol because eosinophilia was absent and its specific serology was negative. Fortunately, the initial inclusion of the feces charcoal culture for S. stercoralis allowed us to detect this infection. OUTCOMES: discordances between direct methods such as culture and indirect as serology or antigen test forces us to be very cautious before ruling out S. stercoralis or E. histolytica infection, respectively. Also, if a child from tropical areas has persistent symptoms (such as diarrhea or fever) that have not been treated we have to rule out other infections that have not been detected yet.Main lessons: The introduction of different sequencing tests and the insistence to find out pathogens such as S. stercoralis or E. histolytica was determinant to be able to cure this symptomatic child and to prevent potential severe clinical forms in case of immunosuppression.

Preadoption adversity and long-term clinical-range behavior problems in adopted Chinese girls.

In this study, we report findings on the role of preadoption adversity on long-term clinical-range problems in adopted Chinese girls. Four waves (2005, 2007, 2009 and 2011) of problem behavior data on 1,223 adopted Chinese girls (M = 4.86 years, SD = 2.82 in 2005) were collected from the adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1 (2005), data on the following indicators of preadoption adversity was collected: age at adoption, physical signs/symptoms (e.g., sores) of preadoption adversity, developmental delays at arrival, refusal/avoidance behaviors and crying/clinging behaviors toward adoptive parents during the first 3 weeks of adoption. We found that the percentage of clinical-range internalizing problems was 11.1%, 16.5%, 11.3%, and 16.1% at Wave 1, Wave 2, Wave 3, and Wave 4, respectively; the corresponding percentage of clinical-range externalizing problems was 8.4%, 10.5%, 8.4% and 9.9% respectively; and the corresponding percentage of clinical-range total CBCL problems was 9.3%, 13.0%, 9.8% and 12.6% respectively. Analyses with Mplus showed that controlling for demographic variables, indicators of preadoption adversity, except age at adoption, increased the odds for clinical-range behavior problems. Longitudinal path models revealed that controlling for demographic variables and the children's adjustment status in the previous wave, refusal/avoidance remained significant in predicting clinical-range internalizing, externalizing and total CBCL problems at Wave 2, delays at arrival and signs/symptoms were significant in predicting clinical-range internalizing problems at Wave 3. Overall, adoptees with clinical-range CBCL problems in earlier waves were 9-28 times as likely to show clinical-range CBCL problems in subsequent waves.

Racial and ethnic socialization as moderators of racial discrimination and school adjustment of adopted and nonadopted Korean American adolescents.

This study investigated the roles of racial and ethnic socialization in the link between racial discrimination and school adjustment among a sample of 233 adopted Korean American adolescents from White adoptive families and 155 nonadopted Korean American adolescents from immigrant Korean families. Adopted Korean American adolescents reported lower levels of racial discrimination, racial socialization, and ethnic socialization than nonadopted Korean American adolescents. However, racial discrimination was negatively related to school belonging and school engagement, and ethnic socialization was positively related to school engagement for both groups. Racial socialization also had a curvilinear relationship with school engagement for both groups. A moderate level of racial socialization predicted positive school engagement, whereas low and high levels of racial socialization predicted negative school engagement. Finally, ethnic socialization moderated the link between racial discrimination and school belonging, which differed between groups. In particular, ethnic socialization exacerbated the relations between racial discrimination and school belonging for adopted Korean American adolescents, whereas ethnic socialization buffered this link for nonadopted Korean American adolescents. The findings illustrate the complex relationship between racial and ethnic socialization, racial discrimination, and school adjustment.

Perceived racial/ethnic discrimination and psychological outcomes among adult international adoptees in Finland: Moderating effects of social support and sense of coherence.

Quantitative literature on international adoptees and racial/ethnic discrimination is lacking despite results in qualitative studies from Europe and the United States that have consistently indicated how racism constantly complicates adoptees' everyday lives. To advance the literature, the present study examined the prevalence of perceived racial/ethnic discrimination among 213 adult international adoptees in Finland (59.6% women and 40.4% men, mean age 24.1 years), and the association between perceived racial/ethnic discrimination and psychological well-being indicators, including psychological distress and sleeping problems. In addition, we examined social support and sense of coherence as moderators of the association between perceived racial/ethnic discrimination and psychological well-being. Our results showed that, on average, adult international adoptees perceived racial/ethnic discrimination occasionally. Hierarchical linear regression analyses indicated a significant association between perceived racial/ethnic discrimination and psychological distress and sleeping problems. Additionally, a significant 2-way interaction of perceived racial/ethnic discrimination and social support indicated that the availability of social support may moderate the association between perceived racial/ethnic discrimination and psychological distress such that adoptees with high levels of social support may be protected from the harmful effects of discrimination. These results highlight the potential significance of social support in reducing the harmful effects of racial/ethnic discrimination on international adoptees. (PsycINFO Database Record

Language development of internationally adopted children: Adverse early experiences outweigh the age of acquisition effect.

UNLABELLED: We compared English language and cognitive skills between internationally adopted children (IA; mean age at adoption=2.24, SD=1.8) and their non-adopted peers from the US reared in biological families (BF) at two time points. We also examined the relationships between outcome measures and age at initial institutionalization, length of institutionalization, and age at adoption. On measures of general language, early literacy, and non-verbal IQ, the IA group performed significantly below their age-peers reared in biological families at both time points, but the group differences disappeared on receptive vocabulary and kindergarten concept knowledge at the second time point. Furthermore, the majority of children reached normative age expectations between 1 and 2 years post-adoption on all standardized measures. Although the age at adoption, age of institutionalization, length of institutionalization, and time in the adoptive family all demonstrated significant correlations with one or more outcome measures, the negative relationship between length of institutionalization and child outcomes remained most robust after controlling for the other variables. Results point to much flexibility and resilience in children's capacity for language acquisition as well as the potential primacy of length of institutionalization in explaining individual variation in IA children's outcomes. LEARNING OUTCOMES: (1) Readers will be able to understand the importance of pre-adoption environment on language and early literacy development in internationally adopted children. (2) Readers will be able to compare the strength of the association between the length of institutionalization and language outcomes with the strength of the association between the latter and the age at adoption. (3) Readers will be able to understand that internationally adopted children are able to reach age expectations on expressive and receptive language measures despite adverse early experiences and a replacement of their first language with an adoptive language.