The not-yet-home movie: A medical documentary

The “referral” videos, key elements in the packet of information sent to prospective adoptive parents about a particular child, may be some of the most closely watched films in the world. No aspiring filmmaker could outdo a family-in-waiting when it comes to microscopic, frame-by-frame scrutiny of a referral video—all two or three minutes of it. When my husband and I finally received our referral video from Russia after many months’ wait, we both dropped work for the day and sat down to meet our new daughter. Like most families in this situation, we played and replayed the brief encounter, searching for signs that this small, faraway person might one day feel at home with us. We felt inexplicably relieved when we noticed that the baby in the video not only looked bright and healthy, but also happened to have the same cleft chin sported by my husband, his mother and all their forebears.

The other, equally important audience for the referral video is a physician who knows how to read it as a medical document. Margaret K. Hostetter, M.D., director of the Yale International Adoption Clinic, has seen hundreds of referral videos, both in preplacement evaluations for families that will later come to the Yale clinic with their new child and in consultations for families all across the country who seek an expert opinion. “An informative video, made to show what the baby can do, can be encompassed in two to three minutes,” she says.

Colleague Carol Cohen Weitzman, M.D., describes the range of criteria that are used to assess several important areas of a child’s development. Often children who have been in institutional care will show some evidence of developmental delay on these brief videos. According to Weitzman, the criteria that are assessed include:

Gross motor skills “We assess a child for the normal unfolding of motor milestones as a child develops increasing strength, flexibility of movement and mobility,” says Weitzman. “We look for the presence of unusual or atypical movements, and assess a child for excessive weakness or stiffness.”

Fine motor skills “A child should increasingly develop the ability to manipulate objects and explore their environment with growing precision,” she says. “We assess if this is happening in a predictable way or if there is deviation.”

Language development “Children should make a range of sounds, and the complexity of the sounds should increase with time. Children should show evidence that they are hearing the sounds in their environment and responding to these sounds and words. We assess how children are communicating their needs to others and whether they are invested in communicating with others.”

Cognitive development “As children grow, they should develop an increasingly complex repertoire of problem solving skills—from mouthing and banging objects to testing cause-and-effect “theories.” We assess whether children demonstrate a curiosity to explore, any novel exploration of materials and their ability to imitate others’ actions.”

Social development “Children should be invested in human relationships. We look for evidence of their desire to interact with others and gain satisfaction from a human relationship. This would include assessing children’s ability to make eye contact, to gesture to others and to seek caregivers out for pleasure and comfort in times of distress. Ideally, we would like to assess whether the child is developing discrimination in their relationships.”