Approximately 20,000 children are adopted from foreign countries each year. Of these children, approximately 46% are adopted before they are 12 months old and 43% are adopted between 1 and 4 years of age. The development of children adopted from abroad before or by 2 years of age is the focus of this article. Given the impoverished language input and social interactions associated with institutional care and the disruption in communication and social-emotional development, children adopted from abroad may demonstrate different or delayed developmental trajectories than do children living with their biological parents in monolingual or multilingual homes. The dual purposes of this article are (1) to describe current developmental evidence on the speech, social, language, and symbolic behavior development for infants and toddlers adopted from abroad and (2) to recommend clinical practices for referral and assessment based on this evidence. This descriptive information is intended to inform parents and professionals seeking to make appropriate decisions about when and whether to seek speech-language assessment or intervention services for children adopted internationally. A case study is provided to illustrate the complexities of these decisions.