Developmental delays are extremely common in children adopted internationally. The majority of children have been raised in orphanages or a hybrid of orphanage and foster care. Institutional care in general does not provide children with the nurturing and stimulation that is crucial to support appropriate development in childhood. Infants living in institutions may spend excessive amounts of time isolated in cribs and little time being stimulated by caregivers. They have little opportunity to be held, rocked and moved around so they don't learn how to move well. The environment may also be lacking in age appropriate play objects. Furthermore, they lack the back and forth social engagement and modeling of play that young children typically engage in with their parents. They do not get adequate social and verbal play opportunities with adults, which are important for developing social and communication skills. As a result, the majority of children adopted internationally have speech delays.

Internationally adopted children coming from a foster care setting typically demonstrate fewer developmental delays, depending on the quality of the foster home. However, trauma of separating from the foster family can also impact the developmental skills that the child demonstrates after adoption.

Post-adoption, most children will show significant catch up gains in their development. It is important that their specific developmental needs are diagnosed accurately so that targeted therapies can be put into place. Children seen in the CHOP International Adoption Health Program will have developmental testing at their initial post adoption visit and are referred for appropriate therapies. At subsequent visits, repeat developmental testing is done to assess their progress and determine any changes needed in therapies.