As a result of their preadoptive histories and experiences, internationally adopted children, especially those with a history of institutionalization, can present with a complex profile of developmental and behavioral issues. Although many children demonstrate significant recovery and resilience after joining their adoptive homes, others go on to have mild or sometimes more severe developmental and behavioral issues. This high-risk population requires comprehensive evaluation, monitoring, and interventions by professionals with expertise in child development and knowledge of the impact of institutionalized care to support optimal developmental and behavioral outcomes for children and their families. This article focuses on strategies for evaluation and management of long-term developmental and/or behavioral difficulties exhibited by postinstitutionalized children.