Purpose: Language and speech are difficult to assess in newly arrived internationally adopted children. The purpose of this study was to determine if assessments completed when toddlers were first adopted could predict language outcomes at age 2. Local norms were used to develop early intervention guidelines that were evaluated against age 2 outcomes. Patterns of language emergence were also analyzed. Method: Twenty-seven children between 11 and 23 months of age adopted from Eastern Europe were followed from adoption through the 1st year home. Results from initial assessments using the Communication and Symbolic Behavior Scales--Developmental Profile (CSBS-DP; A. Wetherby & B. Prizant, 2002) and MacArthur Communicative Development Inventory--Words and Gestures (MCDI-WG; L. Fenson et al., 1993) were compared against speech and language outcomes 1 year later when the children were 2 years of age. Results: By age 2, receptive language and articulation were developing well; expressive language was still emerging. Initial assessment using the CSBS-DP Behavior Sample and MCDI-WG Words Understood Developmental Quotient predicted age 2 language outcomes. Early intervention guidelines based on these 2 measures had strong positive and negative likelihood ratios (LR) when using age 2 outcomes as the criteria (LR+ = 21.00; LR- = 0.00). Six of the 27 children (22%) had slow language development in comparison to their peers. Conclusion: Newly adopted children with delays on prelinguistic and vocabulary comprehension measures were highly likely to have slow language development at age 2. Initial assessments of these abilities should be used to make early intervention decisions.