Emotion identification from facial expressions in children adopted internationally.

AJSLP

Research Article

Emotion Identification From Facial Expressions in Children Adopted Internationally Deborah A. Hwa-Froelich,a Hisako Matsuo,a and Jenna C. Beckerb

Purpose: Children adopted internationally who are exposed to institutional care receive less social interaction than children reared in families. These children spend their preadoptive life with individuals from their birth country and are adopted into families who may look and interact differently. The presumed patterns of limited social stimulation and transition from ethnically similar to ethnically and culturally different social interactions may affect these children’s ability to accurately identify emotions from facial expressions. Method: Thirty-five 4-year-old children adopted from Asia and Eastern Europe by U.S. families were compared with 33 nonadopted peers on the Diagnostic Analysis of Nonverbal Accuracy, Version 2 (DANVA2) Faces subtests. Correlation and regression analyses were

completed with preadoption (adoption age, foster care exposure), postadoption environment (postadoption care duration, number of siblings, socioeconomic status), and individual (chronological age, gender, language competence) variables to determine related and predictive variables. Results: The nonadopted group demonstrated better emotion identification than children internationally adopted, but no region-of-origin differences were found. English language performance was correlated with and predicted 20% of the variance in emotion identification of facial expressions on the DANVA2. Conclusion: Children adopted internationally who have stronger language ability tend to be more accurate in identifying emotions from facial expressions.

A

see Hwa-Froelich, 2012b). Children adopted from abroad generally experience little face-to-face interaction with caring adults before adoption, and these limited face-to-face interactions are with adults from the infant’s birth country (Johnson, 2000; Leiden Conference on the Development and Care of Children Without Permanent Parents, 2012; Miller, 2005). It is unclear whether difficulties interpreting facial expressions are related to adverse early care (such as limited face-to-face interactions, differences in interpreting culturally diverse facial expressions) or postadoption exposure to different kinds of family social interactions, such as increased face-to-face interactions with parents and siblings (Brody, 2004; Downey & Condron, 2004; Dunn, Brown, Slomkousky, Tesla, & Youngblade, 1991). The purpose of this study was to compare children adopted internationally with children who were not adopted in their ability to identify emotions from pictures. Additionally, we analyzed the relationships of pre- and postadoption experience and individual variables (gender, chronological age and language ability) with emotion identification performance to determine which variables predicted emotion identification performance.

ccurate interpretation of facial expressions is important for inferring the emotional states of others and for developing social understanding during communicative interactions (Carpendale & Lewis, 2006; Chiat & Roy, 2008). This skill is dependent on receiving consistent face-to-face interactions during caregiving and begins to develop as early as age 30 weeks (7 months; Caron, Caron, & Myers, 1982). If, however, infants do not receive these types of social interactions, do they develop the ability to interpret emotions from facial expressions? There is emerging evidence that children exposed to institutional rearing demonstrate difficulty identifying emotions from facial expressions (Camras, Perlman, Wismer Fries, & Pollak, 2006; Wismer Fries & Pollak, 2004) and have poorer social competence than their peers (for a review,

a

Saint Louis University, St. Louis, MO Frisco Independent School District, Frisco, TX Correspondence to Deborah A. Hwa-Froelich: [email protected]

b

Editor: Krista Wilkinson Associate Editor: Cynthia Cress Received January 15, 2014 Revision received May 2, 2014 Accepted June 17, 2014 DOI: 10.1044/2014_AJSLP-14-0009

Disclosure: Deborah A. Hwa-Froelich is the author of Supporting Development in Internationally Adopted Children (published by Paul H. Brookes, 2012) and receives royalties from sales associated with this book.

American Journal of Speech-Language Pathology • Vol. 23 • 641–654 • November 2014 • © American Speech-Language-Hearing Association

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Emotion Identification of Facial Expressions Infants depend on and expect to receive consistent, positive, face-to-face nonverbal and verbal social communication from their caregivers (Lewis, 1997). It is from these interactions that children learn how to discriminate and interpret emotions from facial expressions. At about age 30 weeks, infants were able to discriminate between happy and surprised facial expressions (Caron et al., 1982), and by age 1 year, infants continued or stopped crawling toward their parent on the basis of their parents’ facial expressions of joy or fear (Sorce, Emde, Campos, & Klinnert, 1985). Between ages 3 and 6 years, children were able to label emotions of facial expressions from photographs (Bullock & Russell, 1984; Herba & Phillips, 2004; Weimer, Sallquist, & Bolnick, 2012). For example, preschool-age children tend to focus on facial expressions to interpret emotions (Herba & Phillips, 2004), and they are 87%–89% accurate in identifying pictures of happy, sad, and mad facial expressions and approximately 64% accurate in identifying facial expressions showing fear (Weimer et al., 2012). Children residing in institutions do not receive the same amount or quality of social interaction as children raised by their biological families and are delayed in their ability to reference emotions from facial expressions (Camras et al., 2006; Leiden Conference on the Development and Care of Children Without Permanent Parents, 2012; Wismer et al., 2004). Developmental delays in interpretation of this type of nonverbal communication may result in social communication problems, specifically in referencing and understanding emotions (Nowicki & Mitchell, 1998). Children with language delay and learning disorders demonstrate poorer emotion identification than children who are typically developing. Longitudinal studies of children with a history of language impairment (LI) have found relationships between (a) reading, expressive language performance, and pragmatic language performance and (b) behavioral, emotional, and social problems in children between the ages of 7 and 16 years (St. Clair, Pickles, Durkin, & ContiRamsden, 2011). Children between 5 and 12 years old who had nonverbal and verbal learning problems or LI had more difficulty identifying emotions from pictures of facial expressions than a group of typically developing children (Dimitrovsky, Spector, Levy-Shiff, & Vakil, 1998; Spackman, Fujiki, Brinton, Nelson, & Allen, 2005). In addition, 7- to 10-year-old children with LI differed from their typically developing peers in making decisions as to when to hide or display their emotional response (Brinton, Spackman, Fujiki, & Ricks, 2007). Thus, children with language or learning problems have difficulty interpreting emotions from facial expressions that may affect their social communication and social competence. Emotion identification ability is also related to social interactions with siblings. Several studies have reported improved social communication and social competence in children who live and interact with more siblings (Downey & Condron, 2004; Hughes, Lecce, & Wilson, 2007). For example, Downey and Condron (2004) found that children

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with one or two siblings had better social skills than children who had no siblings or children who lived with three or more siblings. They also reported a negative birth order effect when there were more than three younger siblings. Dunn et al. (1991) also reported a birth order effect. They collected several language and emotion understanding measures from fifty 33- to 40-month-old second-born children. Children who scored higher on identification of emotions from facial expressions and puppet scenarios about emotions demonstrated more advanced expressive language, had mothers who expressed longer utterances, and lived with fathers with higher occupational status. These parent characteristics are typically associated with higher education and income backgrounds (Huttenlocher, Vasilyeva, Cymerman, & Levine, 2002). Additionally, the younger children had higher scores in emotion identification when they observed their mothers interacting frequently with an older sibling. Variance in identification of emotions was predicted by children’s discourse about causality and feelings and child–sibling cooperation. Children’s mean length of utterance, mother’s mean length of utterance, and socioeconomic status (SES) also predicted identification of emotions but to a lesser degree (Dunn et al., 1991). In other words, children’s discourse about feelings and their positive sibling interactions were influenced by increased exposure to complex maternal language and observation of parent interactions with siblings. These variables positively influenced not only the children’s language development but also their emotion recognition skills. Children who are internationally adopted who have delayed language development because of the disruption in language acquisition from their birth language to their adopted language (for a review, see Hwa-Froelich, 2012a) may not be exposed to positive peer interactions before adoption or observe caregiver interactions with older siblings after adoption. Other variables that may influence emotion identification include gender, chronological age, and ethnic or cultural background. McClure (2000) found a female and age advantage in a meta-analysis of 104 studies measuring emotion identification from photographs. Studies with infants, children, and adolescents as old as age 18 years were included. The female advantage was found regardless of the measures administered (including the Diagnostic Analysis of Nonverbal Accuracy, Version 2, or DANVA2; Nowicki & Duke, 1994), the age reflected in the face stimuli, and the gender of the investigators. Older children were better at identifying emotions than younger children. There is some controversy as to whether there are cultural differences in identifying emotions from pictures. Ekman et al. (1987) presented 18 black-and-white photographs of five Caucasian men and four Caucasian women displaying six different emotions (happy, surprise, sad, afraid, disgust, anger) to adults from 10 different countries. They reported strong agreement for emotion identification across all participants. In contrast, in a meta-analysis of 31 studies measuring emotion identification in adults from both Western and non-Western countries, Russell (1994) reported cultural differences in identification of disgust, anger, and fear but

American Journal of Speech-Language Pathology • Vol. 23 • 641–654 • November 2014

not of happy, sad, or surprise. Russell argued that these differences may be related to participants’ educational level, amount of exposure to Westerners, rural or urban residence, and differences in emotional knowledge. Elfenbein and Ambady (2002) conducted a meta-analysis of 97 studies and found that identification of emotions was affected by cultural similarity. Although individuals from different countries were able to identify emotions from photographs at a level greater than chance, when individuals identified emotions from photographs of culturally similar people, they had an advantage. However, in spite of this cultural advantage, it seems that adults are able to identify emotions from culturally diverse photographs.

Children Internationally Adopted Before adoption, children are often exposed to institutional care, but the duration and quality of this care may differ. The quality of care in orphanages (high child to caregiver ratios, high staff turnover, little staff training) is often of poorer quality than care by foster or biological families (Johnson, 2000; Leiden Conference on the Development and Care of Children Without Permanent Parents, 2012; Miller, 2005; Nelson, 2007; Tizard & Joseph, 1970; Windsor et al., 2011). Age of adoption represents a variable for duration of adverse care and has been associated with poorer developmental outcomes (Rutter & O’Connor, 2004; Van IJzendoorn & Juffer, 2006). Institutional care has been associated with poorer physical health, reduced neurological development, and developmental delays. These delays include smaller head circumferences and weight– height ratios (Ladage & Harris, 2012), as well as different right hemisphere development and neural activity affecting behavior, nonverbal communication, and social processing (for a review, see Hwa-Froelich, 2012b). Early negative experiences appear to negatively influence brain development, structure, and function. The affected neurological areas (frontal, central, parietal, temporal, and occipital regions) are associated with processing social information (for a review, see Moulson, Fox, Zeanah, & Nelson, 2009), which may negatively influence processing and interpreting facial expressions. Although adverse early care may result in developmental delays in emotion identification of facial expressions, variables in the children’s lives after adoption may also affect this skill. Children are adopted at different ages and begin living with families who do or do not have other children living at home. Many of these families either adopt additional children or have older biological children who also interact with the child and parents. More children in the home may provide more exposure to and observation of social interactions, thereby affecting the development of children’s understanding and identification of emotions of facial expressions (Brody, 2004; Downey & Condron, 2004; Dunn et al., 1991). Thus, postadoption variables in the home environment affecting emotion identification development may include (a) duration of postadoption care, including exposure to the adopted language

and social interactions; (b) the family’s SES level; and (c) number of siblings in the family. Some research has documented that children who are internationally adopted perform within the average range on standardized language measures and from parentreport measures (Glennen, 2007; Hwa-Froelich & Matsuo, 2008, 2010; Scott, Roberts, & Glennen, 2011). Other research has provided evidence that they have weaker verbal and nonverbal language performance in comparison with nonadopted peers matched on age, gender, and socioeconomic level (N. J. Cohen, Lojkasek, Zadeh, Pugliese, & Kiefer, 2008; Gauthier & Genesee, 2011). What these findings indicate is that although some children adopted internationally perform in the average range compared with test sample norms, when compared with a group of children from the same socioeconomic background, some tend to catch up during the preschool years but perform less well than this particular peer group over time. For example, Gauthier and Genesee (2011) compared the language performance of 24 children adopted from China between ages 7 and 24 months with that of a nonadopted group of 25 French-speaking children matched on age, gender, and SES. They measured the children between the ages of 19 and 46.5 months and then again 12–18 months later between the ages of 56.5 and 72 months. Initially, the Chinese children’s receptive language performance was not significantly different from that of the control group, but their expressive language performance was significantly lower. Approximately a year later at school age, the Chinese children’s receptive and expressive language scores were significantly lower than those of the control group. Nonverbal intelligence, general health, adoption age, and amount of French language exposure were not related to language performance; however, the age at which they said their first French word was negatively correlated with language performance. Gauthier and Genesee concluded that early postadoption language learning ability may predict later language performance. Children who are adopted internationally display a different pattern of language acquisition. The initial rapid acquisition of language appears to be a result of increased nurturance and stimulation (Windsor et al., 2011). This initial catch-up may slow down over time, which is likely to place these children at risk of language delay (Rutter, 2005; Scott et al., 2011). However, children adopted from abroad may be similar to children with expressive language impairment or children identified as late talkers, who also demonstrate socioemotional problems associated with expressive language delay (Irwin, Carter, & Briggs-Gowan, 2002). Late talkers continue to demonstrate similar patterns of weaker language performance over time, including pragmatic language (Bonifacio et al., 2007; Girolametto, Wiigs, Smyth, Weitzman, & Pearce, 2001). It is also possible that when children adopted internationally are compared with a larger sample of children representing a range of SES levels as represented by standardized test norms, they perform within average range. However, children adopted internationally are more often adopted into families

Hwa-Froelich et al.: Identifying Emotions and International Adoption

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from higher than average SES levels by parents who have higher levels of education (Hellerstedt et al., 2008). Thus, when comparing children internationally adopted with children from a similar SES background, children in the control group may represent a positively skewed sample in cognitive and linguistic abilities. Children adopted internationally may have difficulty with social communication skills. In a study with children adopted from Eastern Europe, parents reported that their children had difficulty with nonverbal communication skills (Glennen & Bright, 2005). Parents of forty-six 6- to 9-year-old children adopted from Eastern Europe before age 3 completed a standardized checklist measuring their children’s general and social communication skills. Glennen and Bright (2005) reported that the children scored below mean scores on three subtests related to social communication or pragmatic language, including the nonverbal communication subtest, which consisted of items such as demonstrating poor eye contact or problems interpreting conversational overtures. Children adopted from abroad who have poorer language learning ability, poor nonverbal communication skills, or both may have difficulty interpreting emotions in facial expressions (Dunn et al., 1991). There is emerging evidence that children who are internationally adopted have more difficulty interpreting facial expressions than their nonadopted peers. Wismer Fries and Pollak (2004) studied eighteen 4- to 5-year-old children adopted from Eastern Europe between ages 7 and 42 months and assessed between 10 and 48 months after adoption. These children were compared with a nonadopted group matched on age and SES. Wismer Fries and Pollak did not compare the language abilities of the adopted children with those of the control group but reported that the language scores of the adopted children fell within normal range according to test norms. Children were asked to match facial expressions to verbal labels and then match facial expressions to a character’s feeling (happiness, anger, sadness, or fear) in story situations. The control group performed better than the adopted group on both tasks. Thus, when age and SES were controlled, the children adopted from Eastern Europe had significantly poorer emotion identification than nonadopted children. However, the adoption age range was large, amount of time with the children’s adoptive family was highly variable, and language ability was not controlled, which are factors that may have influenced the results. Emotion identification abilities for children internationally adopted may be related to adoption and chronological age. The Wismer Fries and Pollak (2004) study was replicated using an additional group of 23 children adopted from China who were compared with the original group of 18 children adopted from Eastern Europe and 43 nonadopted children between ages 4 and 5.5 years (Camras et al., 2006). Fifteen (65%) of the Chinese children had experienced foster care, although the duration of foster care was unknown for some of the children. Camras et al. (2006) found that the children adopted from China performed better than the Eastern European group and

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as well as the control group. Adoption age and chronological age predicted performance, but foster care experience and mother’s education level were not predictive of performance. Some aspects of this study may have influenced these findings. Groups were not compared on language ability, the adoptive parents of the Chinese group had more education than parents who adopted children from Eastern Europe, the Chinese children were adopted at younger ages and were 5 months older than the Eastern European children, and gender differences were not analyzed. Thus, the better performance of the Chinese adoptees may have been influenced by these differences. The Chinese children may also have had better language skills. Studies with nonadopted children have indicated that children with better language skills, mothers with better language skills, children living in a family with a higher SES background, older children, and females demonstrate more advanced emotion identification skills (Brody, 2004; Dunn et al., 1991; McClure, 2000; Nowicki & Mitchell, 1998). Additionally, the number of siblings was not measured, which may also affect emotion understanding (Downey & Condron, 2004; Dunn et al., 1991). Together, one or a combination of these aspects may have influenced Camras et al.’s (2006) results. To summarize, children exposed to institutional care are at risk of delays in emotion identification after adoption. It is unclear whether differences in identification of emotions are due to the lack of consistent social interactions with caring adults or to the initial exposure to facial expressions that are ethnically and culturally diverse from those of their adoptive family. It is also unclear what variables may be related or predictive of emotion identification of facial expressions. Variables affecting the performance of children adopted from abroad may include age of adoption, foster care exposure, duration of postadoption family care, number of siblings to observe or interact with after adoption, SES, chronological age, gender, or weaker language competence. We hypothesize that children who are adopted internationally will differ in their emotion identification performance from U.S. children who are not adopted. If exposure to ethnically and culturally similar caregivers influences emotion identification, children adopted from Asia and Eastern Europe will differ in emotion identification performance when compared with a group of U.S. nonadopted children. To understand the influence of the variables associated with adoption, we investigated the relationship among preadoption variables (adoption age, foster care exposure), postadoption variables in the home environment (duration of postadoption care, number of siblings, SES), and individual variables (chronological age, gender, and English language performance). The research questions for this study were as follows: 1.

Do children who are internationally adopted identify emotions from facial expressions differently than children who have not been adopted:

2.

Do children adopted from Asia, children adopted from Eastern Europe, and U.S. children who are not


adopted differ in their ability to identify emotions from facial expressions: 3.

Does identification of emotions from facial expression performance correlate with preadoption, postadoption home environment, or individual variables?

4.

Which preadoption, postadoption home environment, or individual variables predict emotion identification performance?

Method Participants This was a nonrandomized controlled study that was part of a larger project approved by the university institutional review board. Adopted and nonadopted children were recruited from Illinois, Kansas, and Missouri. A total of 68 children were included (25 boys, 43 girls) between ages 48 and 59 months (M = 52.529, SD = 3.107). Adopted group. At the time of recruitment, Guatemala had closed their adoption process, and few parents were adopting from Africa. Therefore, recruitment focused on children adopted from Asian and Eastern European countries. Although most of the Asian children were adopted from China, and most of the Eastern European children were adopted from Russia, these two subgroups (Asian and Eastern European) were formed because there are cultural similarities in preadoptive care among the Asian countries and Eastern European countries (Johnson, 2000; Miller, 2005) and linguistic similarities among the Asian birth languages and Eastern European birth languages (Hwa-Froelich & Matsuo, 2010). The adopted group consisted of 35 children (11 boys, 24 girls) with an age range of 48 to 59 months (M = 52.314, SD = 3.075). Twenty children were adopted from Asian countries, and 15 children were adopted from Eastern Europe. The adopted children (a) only listened to and spoke English after adoption (adoptive parents were monolingual English speakers) and (b) were adopted from an Asian or Eastern European country before age 2 years. Thirty-four had language skills in the average range (85–127), and one girl received a score of 84 on the Clinical Evaluation of Language Fundamentals, Preschool Version, Second Edition (CELF–P2; Wiig, Secord, & Semel, 2004). This child was not receiving speech or language services at the time of the study. The parents reported that their children had normal hearing and no known learning problems. All the parents reported their race as Caucasian. The Asian group included 20 children (3 boys, 17 girls) whose ages ranged from 48 to 59 months (M = 52.177, SD = 2.506). From parent report, 14 (70%) of the children had received some foster care before adoption. Four of the parents were uncertain about the amount of time the children had spent in foster care. For the remaining children, their parents reported that their children had spent all of their preadoptive life in an institution. Information about the quality of institutional care was limited or unavailable. The children were adopted between ages 4 and 21 months (M = 11.625, SD = 4.469). Therefore, the children were

exposed to their adoptive family and the English language between ages 32 and 49 months (M = 39.925, SD = 4.438). The children were largely adopted from China (n = 16) with four children adopted from Korea (n =3) and Vietnam (n = 1). The children’s CELF–P2 core language scores ranged between 84 and 121 (M = 103.0, SD = 9.531). The Eastern European group had 15 children (8 boys, 7 girls) with ages ranging from 48 to 59 months (M = 52.533, SD = 3.226). According to parent report, three (20%) of the children had received some foster care before adoption, and the remaining children had spent their preadoptive life in an institution. However, specific information about the quality of foster care or institutional care was unavailable. The children were adopted between ages 6 and 24 months (M = 13.20, SD = 5.467). Thus, the children had been exposed to their adoptive family and the English language between ages 28 and 50 months (M = 39.733, SD = 7.076). Eleven children were adopted from Russia, and four children were adopted from Kazakhstan. The children’s CELF–P2 core language scores ranged between 92 and 127 (M = 104.067, SD = 9.028). The Asian and Eastern European groups were compared on adoption age, chronological age, and core language scores using an independent-samples t test. No significant differences were found for adoption age, t(33) = 0.938, p = .35; chronological age, t(33) = 0.36, p = .721; or core language performance, t(33) = 0.335, p = .74. However, group differences were found for foster care. The Asian group had more children who were exposed to foster care with a large effect than did the Eastern European groups, c2(3) = 11.667, p = .009, V = 0.577. The increased availability of foster care in Asian countries has been documented in the literature (Miller, 2005). Group means and standard deviations (Asian, Eastern European, adopted, and nonadopted) for preadoption, postadoption home environment, and individual variables as well as for CELF–P2 core language are given in Tables 1 and 2, respectively. Nonadopted group. The nonadopted comparison group of 33 children (15 boys, 18 girls) had an age range of 48 to 59 months (M = 52.758, SD = 3.172). On the basis of parent report, four of the children were of mixed race; three had one Asian and one Caucasian parent, one child had a Latina mother and an African American father, and a fifth child was African American. All remaining children were Caucasian with Caucasian parents. The nonadopted group had CELF–P2 core language scores that ranged between 88 and 133 (M = 112.242, SD = 8.689). For the nonadopted age- and SES-matched group, the parents reported that their children were typically developing, monolingual speakers of English and were not adopted, nor had they received foster care. The first author observed that all the children expressed general American English dialect. The parents reported that the children had normal hearing and no known learning problems. Group characteristics are described in Tables 1 and 2. Group comparisons. Asian, Eastern European, and nonadopted groups were compared by SES status and parent education levels using a chi-square test. Parents were


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Table 1. Descriptive statistics for preadoption, postadoption family, and individual variables by group. Variable

Asian

Eastern European

Adopted

Nonadopted

Individual n Male Female No. exposed to foster care Age, months M (SD) Range Adopted age, months M (SD) Range Postadoption care, monthsa M (SD) Range SES level, M (SD) Education level, M (SD) Siblings, M (SD) Younger Older Total

20 3 17 14

15 8 7 3

35 11 24 17

33 15 18 NA

52.177 (2.506) 48–59

52.533 (3.226) 48–59

52.314 (3.075) 48–59

52.758 (3.172) 48–59

11.625 (4.469) 4–21

13.20 (5.467) 6–24

12.300 (4.908) 4–24

NA NA

39.925 (4.438) 32–49

39.733 (7.076) 28–50

39.843 (5.624) 28–50

52.758 (3.172) 48–59

2.600 (0.883) 3.950 (0.686)

Family 2.530 (1.060) 4.333 (0.673)

2.570 (0.948) 4.114 (0.698)

2.360 (1.141) 4.061 (0.998)

0.300 (0.470) 0.450 (0.605) 0.750 (0.716)

0.667 (0.617) 0.533 (0.834) 1.200 (0.862)

.0457 (0.561) 0.457 (0.702) 0.943 (0.802)

0.576 (0.614) 0.788 (0.82) 1.364 (0.859)

Note. SES level: 1 = < $50,000, 2 = $51,000–$100,000, 3 = $101,000–$150,000, 4 = > $150,000; education levels: 1 = high school diploma, 2 = technical training, 3 = some college, 4 = BA or BS, 5 = postgraduate education. NA = not applicable; SES = socioeconomic status. a

English exposure is equivalent to duration of postadoption care.

asked their general income level, which was rank ordered as (a) less than $50,000 per year, (b) between $51,000 and $100,000, (c) between $101,000 and $150,000, or (d) more than $150,000. Parents also reported their education levels, which were rank ordered as (a) high school degree, (b) technical school education, (c) some college education, (d) college degree, or (e) postgraduate degree. An average for parent education was computed by adding education levels of two parents and doubling the education level of single parents, then dividing the sum by two. No significant associations were found between the groups for income, c2(2) = 5.827, p = .667, or average parent education, c2(2) = 10.564, p = .393. A one-way ANOVA was used to compare the three groups for differences in postadoption home environment variables (number of younger, older, and all siblings).

Number of siblings living in each family ranged from none to three for the Asian and Eastern European groups and none to four for the nonadopted group. The range for younger siblings was none to one for the Asian group and none to two for the Eastern European group and the nonadopted group. The range for older siblings was none to three for all three groups. Among the Asian, Eastern European, and nonadopted groups, there were no significant differences found for number of younger siblings, F(2, 65) = 2.094, p = .131, or older siblings F(2, 645) = 1.370, p = .261. Significant differences were found between groups for the total number of siblings, F(2, 65) = 2.372, p = .035. A Bonferroni post hoc analysis found that the Asian group was significantly different, with a large effect for the nonadopted group p = .031, d = 1.083, but that the Eastern European group was not significantly different, p = 1.0.

Table 2. CELF–P2 core language means, standard deviations, and score range by group. CELF–P2 Core language M (SD) Range Expressive language M (SD) Range Receptive language M (SD) Range

Asian 103.000 (9.531) 84–121

Eastern European 104.067 (9.028) 92–127

Adopted

Nonadopted

103.457 (9.198) 84–127

112.242 (8.689) 88–133

101.050 (9.122) 86–119

99.933 (11.781) 81–123

100.571 (10.196) 81–123

113.606 (9.168) 87–128

105.750 (11.392) 86–125

104.533 (13. 054) 81–121

105.229 (11.961) 81–125

109.667 (10.670) 85–131

Note. CELF–P2 = Clinical Evaluation of Language Fundamentals, Preschool Version, Second Edition.

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Thus, children adopted from Asia tended to live with fewer siblings than the other two groups. Although we did not collect information on the ethnicity of the adopted group’s siblings, on the basis of general observation, these children either had nonadopted, biological Caucasian siblings or siblings adopted from the same region. Only one Asian child had younger siblings adopted from an African background who were adopted after we collected data for this study. Ethnicity of the siblings for the nonadopted group was the same as their ethnicity, for example, the children with one Asian and one Caucasian parent had Asian and Caucasian siblings. The two African and African Latino children were only children. Chi-square and one-way ANOVA analyses were used to compare all three groups on individual variables of chronological age, gender, and CELF–P2 core language scores. The Asian group had more girls than the Eastern European and nonadopted groups, with a moderate effect, c2(2) = 6.748, p = .034, V = .315. The percentages of boys in the Eastern European group (53%) and the nonadopted group (46%) were not significantly different. No significant differences were found among groups for chronological age, F(2, 65) = 0.233, p = .793. However, CELF–P2 core language scores were significantly different with a large effect, F(2, 65) = 8.125, p = .001, h = .199. A post hoc Bonferroni analysis indicated that the nonadopted group had significantly higher core language scores with a large effect than the Asian group, p = .002, d = 1.013, and the Eastern European group, p = .015, d = 0.923. Language differences were expected and supported in the literature for children adopted from abroad (Gauthier & Genesee, 2011; Glennen, 2007). Because all but one of the children scored 85 or higher on the CELF–P2, however, they were considered to be without language impairment. One girl who was included in the sample received a CELF–P2 core language score of 84 and may have had language delay or impairment, but she was not receiving special education services at the time of the study.

Materials The CELF–P2 (Wiig et al., 2004) was administered as a standardized measure of receptive, expressive, and core language performance. The test was designed for children between ages 3 and 6 years, and its authors report a sensitivity of .85 and a specificity of .82 with “the criterion of having a language disorder is defined as a Core Language score of 85 or less” (Wiig et al., 2004, p. 141). The core language standard score consists of three subtests (receptive language sentence structure, expressive language word structure, and expressive vocabulary) and was used as a measure of language ability. The DANVA2 Adult and Child faces subtests (Nowicki & Duke, 1994) were administered as a measure of emotion identification. The faces section has 48 genderbalanced color photos of 24 adults and 24 children. One fourth of the photographs (six adults and six children)

included male and female members of African American, Asian, and Middle Eastern ethnic groups. The remaining photographs (18 adults and 18 children) were of Caucasian faces. All photographs portrayed one of the four target emotions: happy, sad, angry, or frightened. Scores for the subtests consist of the total number of errors participants make. The manual provides means and standard deviations by age group but does not provide cut-off scores that would indicate a level of impairment. Thus, the DANVA2 is a research tool, not a diagnostic one. To create the photographic stimuli, adult men and women and boys and girls between ages 6 and 12 years were asked to read a vignette that was designed to elicit one of the four emotions (happy, sad, angry, or fear). Photographs were taken when the person exhibited the emotion for the vignette. The photographs were shown to 54 college students, 43 high school students, 34 seventh-grade students, and 54 third-grade students. When at least 80% of the students agreed on the emotion displayed by the photograph, it was selected to be part of the 48 stimuli. As a research tool, the DANVA2 was strongly correlated with Matsumoto and Ekman’s (1988) Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces test. In addition, Nowicki and Mitchell (1998) and Nowicki and Duke (1994) reported strong correlations with preschool children’s DANVA2 scores and their preschool teachers’ ratings of social competence and 6- to 10-year-old children’s DANVA2 scores with personal and social adjustment and academic achievement. The DANVA2 has also been administered to preschool children with traumatic brain injury (Thustos et al., 2011). Nowicki and Duke reported that internal consistency for the DANVA2 ranges from .69 to .81, and Goonan (1995) reported a coefficient alpha of .71 for 4-year-old children. Test–retest reliability ranges from .66 to .88.

Procedure Recruitment notices for the study were shared with local and national adoption agencies, local early childhood centers, and pediatric offices. Parents who were interested in participating in the study contacted the first author. Each child was assigned a number code so that adoption status was known only to the first author. Research assistants collected the data and were unaware of the adoption status of each child. However, once the research assistants were able to see the ethnic difference between the child and one of the parents, they may have assumed the child’s adoption status. Before testing, parents were asked to complete an institutional review board–approved consent form; once consent was procured, the graduate assistant administered measures. Contingent on where the parents felt the child would perform best, all sessions occurred at a university speech–language–hearing clinic or at the families’ homes with one of the parents present. The parent remained in the testing room with the child for the duration of the assessment.


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The data for this study were collected as part of a larger research study. CELF–P2 administration was between 20 and 30 min in duration, and the DANVA2 faces subtest was approximately 10–15 min long. Children were offered breaks if they demonstrated fatigue or requested a break. The DANVA2 faces subtest consists of 48 trials and was administered by showing each participant the adult photographs followed by the child photographs. The DANVA2 directions include the emotional labels of happy, sad, angry, or frightened. These labels were changed to simpler, less formal language (happy, sad, mad, or scared) because these terms have been documented to be highly familiar to preschool-age children (Herba & Phillips, 2004). The following directions were read to each child before presenting the adult photographs and reread before presenting the child photographs: I am going to show you some people’s faces and I want you to tell me how they feel. I want you to tell me if they are happy, sad, mad, or scared. Let’s start with adult faces. Is this a happy, sad, mad, or scared face? Following the DANVA2 directions, each photograph was shown to the child for approximately 3 s, and children were asked to judge whether the pictured person was showing the emotion happy, sad, mad, or scared. Although printed emotion labels can be provided to help subjects recall the labels, none of the children were able to read. Thus, verbal reminders of the four emotions were presented often. For the first five photographs, the emotion labels were verbalized before presenting the photograph to remind the child of the labels. Verbal reminders were given for every other photograph for the next five photographs. Over the remaining 14 photographs, verbal reminders were given before every third or fourth photograph or if the child hesitated and seemed to have forgotten the labels. These procedures were repeated for the child faces subtest. Intrarater and interrater reliability measures were completed for the score sheets for all measures. Research assistants checked the total number of errors on the DANVA2 score sheets and total number of correct responses on the CELF–P2 test forms and converted them to standard scores. All research assistants rescored 10% of their previous assessments to ensure intrarater reliability over time. They also rescored 20% of the other assistants’ previous assessments to ensure interrater reliability. Intrarater reliability of scoring ranged from 75% to 100% with an average of 97% agreement. Interrater reliability ranged from 75% to 100% agreement with an average of 95% agreement.

Results Results are described in relation to the research questions. To answer the question of whether children adopted from abroad performed differently than children who were not adopted on identifying emotions from facial

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expressions, we conducted t tests. To answer the second research question of whether there were cultural or ethnic differences in DANVA2 scores, a one-way ANOVA was conducted, comparing the Asian, Eastern European, and U.S. nonadopted groups. For the third research question, we conducted a series of bivariate correlational analyses to explore preadoption, postadoption home environment, and individual variables that may have been related to the total DANVA2 faces error score. Finally, to answer the fourth research question, we conducted a series of regression analyses with backward elimination to test the impact of three sets of independent variables: (a) the adoption condition (adoption age, exposure to foster care), (b) postadoption home environment (duration of postadoptive family care, the number of siblings, and parent’s SES), and (c) children’s individual characteristics (chronological age, gender, and CELF–P2 core score). In general, the statistical analyses resulted in some significant findings. The adopted group DANVA2 faces error score was compared with that of the nonadopted group. A t test found that the nonadopted group’s DANVA2 faces error score (M = 20.061, SD = 6.946) was significantly different, with a moderate effect, than the adopted group’s DANVA2 faces error score (M = 23.714, SD = 5.623, p = .020, d = 0.578). In other words, nonadopted children made fewer errors in identifying emotions from adult and child facial expressions than did the adopted group. Group differences were largely due to emotion identification of children’s faces. Table 3 shows the t-test statistics and effect sizes. To determine whether there were ethnic or cultural differences among the Asian, Eastern European, and U.S. nonadopted groups in interpreting emotions from largely Caucasian adult and child faces (DANVA2 faces total scores), an ANOVA was conducted. ANOVA, rather than the nonparametric version, was used to avoid a Type 2 error of not finding a difference when one truly existed. The between-subjects factor was region of origin (Asian, Eastern European, or United States, nonadopted) and the within-subjects factor was the DANVA faces total error score. The ANOVA showed that there were no differences in DANVA2 faces total error scores, F(2, 65) = 227.353, p = .067, by region of origin. To explore which variables were associated with DANVA2 performance, a series of bivariate correlation analyses were conducted for adopted children and nonadopted children. Variables included preadoption (age of adoption, exposure to foster care), postadoption home environment (duration of postadoption care, total number of siblings, SES), and individual (chronological age, gender, CELF–P2 core score) variables. We used a dichotomous variable for foster care exposure because we wanted to include the four children whose parents were uncertain about the duration of foster care. Because group differences were found for total number of siblings, this variable was entered. There was a negative correlation with moderate effect between the DANVA2 faces total error score and the CELF–P2 core score (r = –.448, p = .007), such that


Table 3. DANVA2 group score means, standard deviations, t-test probability, and effect size. DANVA2 faces subtest Adopted Nonadopted Adult face error score M (SD) Range Child face error score M (SD) Range Total error score M (SD) Range

p

d 0.181a

12.086 (2.537) 7–18

10.758 (3.482) 5–18

.076

11.629 (3.742) 2–19

9.303 (4.180) 1–18

.018* 0.586b

23.741 (5.623) 10–35

20.061 (6.946) 7–34

.020* 0.582b

Note. CELF–P2 = Clinical Evaluation of Language Fundamentals, Preschool Version, 2nd ed.; DANVA2 = Diagnostic Analysis of Nonverbal Abilities, Version 2. a

Small effect size (J. Cohen, 1992). bModerate effect size (J. Cohen, 1992).

with high CELF–P2 core scores were likely to make fewer errors interpreting emotions from facial expressions. In Model 2, when only foster care exposure was controlled, chronological age was marginally significant (B = –0.425, p < .05) with a one-tailed test, and the CELF–P2 core score was statistically significant (B = –0.284, p < .01) with a two-tailed test. Model 2 results indicate that children with higher CELF–P2 core scores were more likely to make fewer errors identifying emotions from facial expressions. When only chronological age was controlled in Model 3, the CELF–P2 core score remained statistically significant (B = –0.266, p < .01). The final model, which was a simple regression analysis, revealed that the CELF–P2 core score was statistically significant (B = –0.274, p < .01) and that the CELF–P2 core score itself accounted for 20.1% of the variation in the DANVA2 faces total error score. In summary, the CELF–P2 core language score is an important predictor of children’s ability to identify emotions from facial expressions.

*p < .05.

Discussion those who scored high on the CELF–P2 core score were likely to make fewer errors in interpreting emotions from adult and child faces. Correlational analyses revealed no statistically significant correlations between the DANVA2 faces total error score and other variables. Correlation coefficients and effect size statistics are presented in Table 4. To determine which variables predicted DANVA2 total faces error scores, we conducted a series of regression analyses with backward deletion for adopted children. These analyses yielded four models with goodness of fit. None of the models indicated multicollinearity of independent variables (tolerance > .9). As shown in Table 5, when gender and foster care exposure were controlled for in Model 1, chronological age was marginally significant (B = –0.501, p < .05) with a one-tailed test. The CELF–P2 core score was significant (B = –0.278, p < .01) with a two-tailed test. In other words, older children and children

From these results, four major findings are discussed. First, children adopted internationally were significantly different from nonadopted children in interpreting emotions from facial expressions. Second, when groups (nonadopted, Asian, and Eastern European) were compared on the basis of region of origin, no significant differences were found among the three groups on identification of emotions from facial expressions. Third, across preadoption, postadoption home environment, and individual variables, the children’s language competence as measured by the CELF–P2 core language score was significantly related to and accounted for a large proportion of children’s nonverbal skills in correct emotion interpretation of facial expressions. To answer the first research question, children who were internationally adopted made more emotion identification errors from facial expressions than children who were not adopted. Children’s facial expressions in particular

Table 4. Pearson correlation matrix for adopted children (N = 35). Variable

1

2

3

4

5

6

7

8

9

1. DANVA2 total face error scores 2. Adoption age, months 3. Foster care exposure 4. Postadoption care, months 5. CA, months 6. Gender 7. CELF–P2 core score 8. Total no. siblings 9. Income levelc

—

.028 —

.029 –.025 —

–.135 –.751**b –.045 —

–.260 .181 –.006 .430**a —

–.090 –.022 .289 –.208 –.255 —

–.448**a –.036 .222 .058 .057 .109 —

.075 .057 –.074 .167 .246 –.049 –.239 —

.236 –.098 .017 –.002 –.255 .019 –.149 .237 —

Note. CA = chronological age; CELF–P2 = Clinical Evaluation of Language Fundamentals, Preschool Version, 2nd ed.; DANVA2 = Diagnostic Analysis of Nonverbal Abilities, Version 2. a Moderate effect size (J. Cohen, 1992). bLarge effect size (J. Cohen, 1992). cIncome level: 1 = < $50,000; 2 = $51,000–$100,000; 3 = $101,000– $150,000; 4 = > $150,000. **p < .01.


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Table 5. Regression analysis with DANVA2 faces error scores as dependent variable.

Model Model 1 Foster care exposure CA, months Gender CELF–P2 core score Model 2 Foster care exposure CA, months CELF–P2 core score Model 3 CA, months CELF–P2 core score Model 4 CELF–P2 core score

Unstandardized coefficient B (Standardized coefficient b)

SE

1.942 (0.175) –0.501 (–0.274)† –1.926 (–0.161) –0.278 (–0.454)**

1.816 0.292 1.987 0.097

1.453 (0.131) –0.425 (–0.233)† –0.284 (–0.464)**

1.743 0.281 0.096

–0.430 (–0.235)† –0.266 (–0.435)**

0.279 0.093

–0.274 (–0.448)**

0.095

R2

F(dfs)

f2

.295

3.131 (4, 30)*

0.418a

.272

3.869 (3, 31)*

0.373b

.256

5.508 (2, 32)*

0.344b

.201

8.301 (1, 33)*

0.251c

Note. CA = chronological age; DANVA2 = Diagnostic Analysis of Nonverbal Abilities, Version 2; f 2 = effect size for regression (J. Cohen, 1988). a Large effect size. bMedium effect size. cSmall effect size. *p < .05. **p < .01. †p < .05 (one-tailed).

were more challenging for the adopted group. These findings are supported by literature that has reported differences in neurological structure and function related to social processing, differences in emotion identification compared with a nonadopted control group, and parent-reported problems in nonverbal communication skills (Camras et al., 2006; Glennen & Bright, 2005; Hwa-Froelich, 2012b; Wismer Fries & Pollak, 2004). Wismer Fries and Pollak (2004) and Camras et al. (2006) reported that their sample of children adopted from Eastern Europe and China performed less well in emotion identification than their control group. The finding from this study provides additional evidence that children adopted internationally interpret emotions less well than their nonadopted peers. However, the finding that the adopted group had more difficulty interpreting children’s facial expressions is a unique finding not previously reported in the literature and is in contrast to the meta-analysis by McClure (2000), in which no differences were found for emotion identification between child and adult faces. This finding may be related to exposure to peers because the Asian group had fewer siblings than the other groups. However, no differences were found on the basis of region of origin among DANVA2 scores, and the number of siblings was not a predictive factor in this study. It may be possible that children adopted internationally may be delayed or have more difficulty identifying emotions from children’s facial expressions because they have had less experience with siblings and peers and, given more time, their emotion identification may improve or catch up. If, however, children adopted internationally continue to have problems identifying emotions from children’s facial expression, this weakness may affect their social competence with peers (Glennen & Bright, 2005; Nowicki & Duke, 1994; Nowicki & Mitchell, 1998; St. Clair et al., 2011).

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To answer the second research question, statistically significant region-of-origin group differences in emotion identification were not found. Children who were adopted from Asian and Eastern European countries and nonadopted children interpreted emotions from facial expressions similarly. Our findings confirm those of studies that reported no cultural differences in emotion identification (Ekman et al., 1987; Elfenbein & Ambady, 2002) but differ from those reported by Camras et al. (2006), who reported that although both the Chinese and the Eastern European children performed less well than a noninstitutionalized group, children adopted from China performed almost as well as the noninstitutionalized group. However, in the Camras et al. study, the children adopted from China were adopted at younger ages and measured at older chronological ages compared with their sample of Eastern European children. Thus, the Chinese children had received more exposure to postadoption family care and their adoptive language than the Eastern European children, which may have given the Chinese children an advantage over the Eastern European children. Because the Chinese children received more exposure to improved care and their adoptive language, this may explain why their emotion identification performance was better than that of the Eastern European children and similar to that of the nonadopted children as reported in the Camras et al. study. By controlling for the age of adoption and chronological ages in the present study, the three groups of children—Asian, Eastern European, and nonadopted U.S. children—were not significantly different from each other in interpreting emotions from facial expressions. Additionally, as we hypothesized, if exposure to facial expressions of adults and children from their birth country influenced the children’s emotion identification of Caucasian photographs, then the Asian and Eastern European groups would have performed differently than


the nonadopted group. However, because no group differences were found among the three groups of children, these early ethnically similar face-to-face experiences may not have negatively influenced the children’s ability to interpret largely Caucasian facial expressions. The third research question focused on whether preadoption (adoption age and exposure to foster care), postadoption home environment (duration of postadoption family care, number of siblings, and SES), and individual variables (chronological age, gender, and language ability) would be related to the adopted group’s DANVA2 face error scores. A correlation analysis revealed a significant negative relationship with the CELF–P2 core language score. No other variables were significantly related to DANVA2 face error scores. In other words, interpreting emotions from facial expressions was largely related to oral language competence over preadoption, postadoption home environment, and individual variables other than language competence. Although exposure to foster care was not related to emotion identification performance in either this study or the Camras et al. (2006) study, the lack of significant correlations differed from the correlation analysis in the Camras et al. study. Camras et al. reported significant negative correlations with adoption age and positive correlations with duration of postadoption family care and mother’s education level. As explained earlier, these findings could be explained by group differences in adoption and chronological age, parent education, and the fact that language ability was not compared with or related to emotion identification performance. In the present study, SES, parent educational levels, and adoption age (inversely related to duration of family care) were controlled. It is possible that because the Asian and Eastern European groups did not differ from each other on these variables, adoption age, duration of postadoption family care, and mother’s education level were not significantly correlated with the DANVA2 face error scores. Additionally, because Camras et al. did not compare the language performance of the three groups of children and did not include language scores in their correlation or regression analyses, it is unknown whether their sample’s language competence was related to or predicted emotion interpretation. In the present study, better language ability as measured by the CELF–P2 core language score was significantly related to accuracy in identifying emotions from facial expressions. These findings are similar to those of typically developing children compared with children with weaker, delayed, or impaired language ability (Delaunay-El Allum, Guidetti, Chaix, & Reilly, 2011; Dimitrovsky et al., 1998; Dunn et al., 1991; Spackman et al., 2005). The fourth research question was concerned with determining which variables predicted children’s ability to identify emotions from facial expressions. The regression analysis showed that CELF–P2 core language scores predicted a large proportion of the variance. This finding is also supported by the literature on children with and without language and learning problems (Delaunay-El Allum

et al., 2011; Dimitrovsky et al., 1998; Dunn et al., 1991; Spackman et al., 2005; St. Clair et al., 2011). Although our adopted sample was not a clinical one, these children’s expressive and core language scores were lower than those of the nonadopted group, and stronger language performance predicted fewer errors in emotion identification of facial expressions. Being able to understand and talk about feelings appears to be an important skill in identifying emotions displayed in facial expressions. Compared with typically developing peers, children who have weaker language performance have more difficulty identifying emotions from facial expressions, which may adversely affect their social communication and competence. Although the DANVA2 is not a clinical diagnostic tool, and poorer performance may not be clinically significant, higher error scores in emotion identification paired with language impairment or in association with parent and teacher report of social communication problems may indicate a social communication disorder with or without language impairment. This study’s group of children adopted internationally had weaker but within-normal-range expressive language scores, except for one child who received a CELF–P2 core language score of 84. Although this profile is supported in the literature (for a review, see Hwa-Froelich, 2012a), reasons for this profile are largely undetermined and include duration of exposure to adverse care (N. J. Cohen et al., 2008; Windsor et al., 2011), attrition of the birth language to begin acquiring an adopted language (Snedeker, Geren, & Shafto, 2007), variability in risk factors (Hwa-Froelich, Matsuo, & Rosenquist, 2013; Scott et al., 2011), or an outcome based on the control group used for comparison (e.g., children who are domestically adopted, a matched SES group, or a test’s population sample; Scott et al., 2011). The fact that this sample of children adopted internationally had weaker expressive language skills than a peer group matched for SES and age may be typical for children adopted by families from a higher SES background. The adopted children may have language abilities comparable to those of children from low- to moderate-SES backgrounds compared with children from higher SES backgrounds. It is also possible that their weaker expressive language skills may predict later language difficulty at school age, similar to children with a history of expressive language delay (Bonifacio et al., 2007; Gauthier & Genesee, 2011; Girolametto et al., 2001; Scott et al., 2011). In any case, all but one of the children internationally adopted performed within the average range on an English standardized language test at age 4 years, which at this age was generally viewed as a sample without language impairment. More research is needed to clarify these possible causes of language delay. Other preadoption (adoption age, exposure to foster care), postadoption home environment (duration with adoptive family, number of siblings, SES), and individual (chronological age, gender) variables did not predict emotion identification performance. Our finding that foster care exposure was not predictive of emotion identification performance confirms a similar finding in the Camras


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et al. (2006) study. They found that the presence of or duration of foster care was not predictive of emotion identification performance. However, our findings that adoption and chronological age, SES, number of siblings, and gender were not predictive differ from those of Camras et al., Dunn et al. (1991), and McClure (2000). Camras et al. found that adoption and chronological age at the time of testing predicted emotion identification performance. As explained previously, this may be because they did not control for adoption age, age at time of testing, or language competence. It is also possible that SES and gender variables were not predictive of performance in the current study because the groups were not significantly different across these variables. However, it is unclear as to why number of siblings was not predictive. It is possible that our small sample size was a limitation. Future research recruiting a larger sample with equivalent groups for different adoption ages, chronological ages, SES level, and number of siblings would help to answer some of these questions.

Clinical Implications The results of this study must be interpreted with caution. The sample size was small, and only one measure of emotion interpretation was used that was not a diagnostic clinical tool. It is possible that the group differences we found may be related to short-term memory weaknesses or the inability to hold the emotion labels in memory long enough to identify the emotions. This possibility needs to be studied in future research studies. However, in combination with the findings from previous studies with children adopted internationally (Camras et al., 2006; Glennen & Bright, 2005; Wismer Fries & Pollak, 2004 ), children who are adopted from abroad may be at risk of having difficulty interpreting emotions from facial expressions, particularly if the child has weaker language performance. The research on language development in children adopted internationally has provided evidence that they are at risk of delayed language development, particularly at school age (N. J. Cohen et al., 2008; Gauthier & Genesee, 2011; Scott et al., 2011). Emerging evidence has indicated that children with LI often have social competence problems. In particular, children with LI have difficulty with accurate emotion identification as well as with knowing when to hide or show emotions (Brinton et al., 2007; Delaunay-El Allum et al., 2011; Dimitrovsky et al., 1998; Spackman et al., 2005; St. Clair et al., 2011). Therefore, it is important to conduct a thorough assessment to determine whether children adopted from abroad have LI, a social communication disorder, or both. Appropriate assessment measures would need to be administered to determine whether a child who is adopted internationally has a language impairment or social communication disorder. It may be that children with poorer verbal language competence may have weaker skills in interpreting emotions from facial expressions, and this weakness may or may not affect their social communication and

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competence. Practitioners are recommended to conduct a thorough and comprehensive assessment considering both verbal language competence and nonverbal communication ability in emotion interpretation. Practitioners may need to interview parents and teachers about social communication behaviors, observe children in social contexts, and collect local sample means on emotion identification protocols of children adopted from abroad to compare with those of children adopted internationally who are suspected of having social communication difficulty (Glennen & Bright, 2005; Hwa-Froelich, 2012a, 2012b; Scott et al., 2011). Comparing the scores of children adopted internationally with the DANVA2 means and standard deviations is a beginning step toward using this tool clinically. This measure, along with parent and teacher reports on a standardized social communication scale such as the Children’s Communication Checklist (Bishop, 2003; Glennen & Bright, 2005) and observations of social communication and competence, may help determine whether a child has a social communication problem. For example, the National Institute of Mental Health recently created and validated a color set of happy, sad, angry, and scared children’s facial expressions for research use (Egger et al., 2011). Although this is another research tool, there may soon be normative data on nonadopted children available for clinical comparisons. More research is needed to explore the development of nonverbal communication skills in children who are adopted internationally. Little research exists that documents the developmental trajectory for nonverbal communication in children adopted from abroad. Additional research focused on other nonverbal behaviors such as interpreting tone of voice and interpretation of emotions during dynamic situations as opposed to static pictures would be helpful in understanding the importance of these skills in social communication competence for children adopted internationally.

Acknowledgments We thank several people who helped with this study: Janel Golden, Kristal Schuette, Jamie Brockmeier, and Kelsey Rosenquist. We also thank all the children and families for their participation in this study. Additionally, the review and suggestions provided by Sara C. Steele, PhD, are most appreciated.

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Dermatologic conditions in internationally adopted children.

Medical evaluation of internationally adopted children.

Compound facial expressions of emotion.

Tuberculin skin testing and T-SPOT.TB in internationally adopted children.

Judgments of subtle facial expressions of emotion.

Outcomes of cleft palatal repair for internationally adopted children.

Outcomes of cleft lip repair for internationally adopted children.

Do internationally adopted children in the Netherlands use more medication than their non-adopted peers?

A longitudinal investigation of children internationally adopted at school age.

Dimensional information-theoretic measurement of facial emotion expressions in schizophrenia.

Communal and agentic behaviour in response to facial emotion expressions.

Posed facial expressions of emotion in schizophrenia and depression.

Facial expressions and interpretation of emotion-arousing situations in deaf and hearing children.

Language and memory abilities of internationally adopted children from China: evidence for early age effects.

Transmission of infectious diseases from internationally adopted children to their adoptive families.

Hepatitis a screening for internationally adopted children from hepatitis A endemic countries.

How Facial Expressions of Emotion Affect Distance Perception.

The not face: A grammaticalization of facial expressions of emotion.

Perceptions of emotion from facial expressions are not culturally universal: evidence from a remote culture.

Facial emotion identification in early-onset psychosis.

Towards emotion detection in educational scenarios from facial expressions and body movements through multimodal approaches.

EMOTION RECOGNITION OF VIRTUAL AGENTS FACIAL EXPRESSIONS: THE EFFECTS OF AGE AND EMOTION INTENSITY.

Internationally adopted children in the early school years: relative strengths and weaknesses in language abilities.

Compound facial expressions of emotion: from basic research to clinical applications.