Healing the Hearts of Adopted Children by Lysa Parker M.S., CFLE Adopting children is most often an incredibly rewarding experience for many parents. For some, however, there can be enormous challenges for which many are not prepared. Adoptive parents, while thoroughly scrutinized by adoption agencies, may be given little information about their adopted child, in terms of family or childcare history or specific parenting skills they need to know that will help them develop a close loving relationship. Adopted children come from a variety of situations from open adoptions to being abused or neglected and living in institutions. Only in the past few years have post-adoption resources become more available for adoptive families. Adoption and post-adoption agencies are becoming more aware of the need to inform parents of a child's prior history and the potential for cognitive, behavior and emotional problems. What is attachment and why is it important? “Attachment” is a term that refers to a psychological and biological event-meaning that babies are born with a natural drive to form an affectional bond initially between a mother and her baby or whoever is the primary caregiver. This in turn allows the child to form multiple attachments to other caring adults throughout the lifespan. For biological children, the process of attachment can begin in utero when the mother begins to feel affection for her developing baby and looks forward to the baby's birth. For other mothers, including adoptive mothers, this process can begin after the baby's birth and is a process that takes time through daily care and playful interactions. Babies initiate attachment by making their needs known through crying, clinging and sucking with the expectation of keeping their mother close. Smiling, cooing and laughter are other ways in which babies endear themselves to their mothers and fathers with the expectation that their parents will respond back to them in a similar way. Developing a secure attachment relationship with older adopted children can sometimes be difficult and may take longer since it requires that the parent and child first develop a relationship of trust. This is why it is extremely important for one parent to be the primary caregiver for their adopted child during the first few years until this trust is firmly established. Developing a secure attachment with one person, mother or father is critically important for teaching a child affection, empathy and compassion toward others and sets the foundation of trust that will carry over into adulthood, affecting all future adult relationships. When adopted children don't attach Unfortunately, for a number of parents, their experiences with their adopted children have been devastating due to the lack of critical information and/or training in working with children from abusive, neglectful home or institutional environments. These early experiences have resulted in what is commonly diagnosed as an “attachment disorder”. Some of the first heartbreaking examples of attachment disordered children that garnered worldwide attention were the children adopted from Romania and other Eastern Bloc countries.
Copyright 2007 by Lysa Parker
1
When the Soviet empire crumbled in the early 1990's, suddenly thousands of children, who had been languishing in orphanages, became available for adoption. Since 1991, adoption of Eastern Bloc children continued to increase to a staggering 3,700 in one year alone. Doctors found that nearly two-thirds of these children adjusted well, some with only minor problems such as developmental delays or learning problems. One third, however, displayed major problems such as an inability to form a close emotional attachment to their parents, destructive behaviors with a host of emotional and learning problems. These children took everyone by surprise. There were no appropriate resources, therapies or financial assistance for these children and their families. Many parents gave the children back because they were totally unprepared to cope with the severity of the problems, which proved to be catastrophic for both the parents and the children. (2) These situations have opened our eyes and minds to the tragic consequences when young children's psychological and emotional needs are not nurtured, creating this failure of attachment.
What is Reactive Attachment Disorder and its causes? Reactive Attachment Disorder (RAD) is usually the result of a disruption of or trauma to the attachment process such as a history of physical or sexual abuse, neglect and/or frequent change in caregivers within the first three to five years of a child's life. Sometimes other factors can contribute to the break in attachment:
Separation of a child and attachment figure due to adoption Death of a parent Hospitalization of a child or caregiver Frequent moves/multiple changes in caregiver Emotionally unavailable caregiver due to immaturity or mental or physical illness Abuse and/or neglect of the child Inconsolable chronic pain Parental drug use/alcohol abuse Birth/adoption of subsequent siblings
Younger children removed from their parent(s) are at great risk for developing attachment disorders as they and their siblings are frequently placed in a multitude of foster homes before they are considered for adoption which is the beginning of a downhill spiral.
Copyright 2007 by Lysa Parker
2
The Symptoms of RAD
Lack of eye contact Indiscriminately affectionate with strangers Not affectionate on Parents' terms (not cuddly) Destructive to self, others and material things (accident prone) Cruelty to animals Lying about the obvious (crazy lying) Stealing No impulse controls (frequently acts hyperactive) Learning Lags Lack of conscience Abnormal eating patterns such as hoarding food or gorging on sugary foods Poor peer relationships Preoccupation with fire Persistent nonsense questions & chatter Inappropriately demanding & clingy Abnormal speech patterns Based on the DSM IV
Copyright 2007 by Lysa Parker
3
Adoptive parents need to know as much about the child's early history as possible in order to meet the child on their emotional or developmental level rather than the chronological age of the child. If a child who was removed from his parents due to abuse or neglect is adopted, the adoptive parents should be aware that traditional parenting is not the best approach to use even if it may have worked for their biological children. There are special considerations involved with parenting traumatized children. For instance, these children have learned to respond to threatening situations and most remain in a low-level state of alarm. This affects their behavioral, physiological, emotional and cognitive functioning. Often these children appear to be younger than their years. They should be allowed to talk about their trauma but on their terms. Listen to them, without overreacting, then provide comfort and support. Traumatized children thrive on consistent, predictable patterns each day. Help the child understand the pattern and when new or different activities occur, tell the child well beforehand to help them mentally adjust. They need to know that their caretaker is in control. A household that is disorganized and chaotic will produce anxiety and will probably be disastrous for everyone. (10) A nurturing, affectionate home environment can be therapeutic to the traumatized child if used appropriately and in the right context. It's important to remember that physical touch will have different meanings to victims of physical or sexual abuse. Allowing the child to initiate affection first, like hugs or kisses, will in time help to reestablish a relationship of trust. Maintaining open communication by explaining who, what, why and where of daily situations, will help the child make sense of the world. (10) Traumatized children need boundaries too. In the case of dealing with an abused or neglected child it's important to understand that they may be emotionally and socially delayed. Have realistic expectations of the child that are based on the emotional age not necessarily the chronological age. Be consistent yet flexible with your boundaries. This demonstrates reason, fairness and understanding to the child. Positive rewards may be helpful however, physical punishment is never appropriate. Allowing children choices gives them a sense of control and gives them decision-making power. It would be wise, however, to limit their choices to two or three at most. Parents have the added responsibility of being aware of their child's limitations and protecting them from situations that may be too stimulating, upsetting or traumatizing. For example, if the parent observes that a particular activity or situation increases the child's stress and anxiety, then avoiding these can prevent major "melt-downs" and reduce the possibility of re-traumatizing the child. (10, 11) It's not uncommon for the traumatized child to exhibit symptoms such as sleep problems, impulsivity, and anxiety for years after the event(s). Parents are advised to be tolerant and comfort them when possible since these symptoms will come and go over time. (10, 11)
Copyright 2007 by Lysa Parker
4
When parents need professional help Psychologists are now much more aware of the behaviors of the attachment disordered child, For the last fifteen years some therapists have tried, largely unsuccessfully, to implement experimental therapies such as “rage reduction” or other coercive forms of holding therapy that were found to do more harm than good. This has unfortunately created a negative perception of all attachment related therapies making it more difficult for families to find the help they need. One organization called ATTACh was formed in 1990 to bring together adoptive parents, educators and therapists who work with children with attachment disorders. ATTACh recently went through it’s own metamorphosis when the board of directors made the decision to break ties with all therapists who practice or endorse “rage reduction” therapy and other forms of therapies considered to be coercive or abusive (read their position paper on coercive therapies at www.attach.org/position.htm ). One of several catalysts to this change was a report written by The American Professional Society on the Abuse of Children (APSAC) and published in the journal Child Maltreatment (February 2006) titled “Report of the Taskforce on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems”. After reviewing current therapies and citing the abuses, the report condemned the use of coercive therapies and offered recommendations (http://www.attach.org/apsac.htm) to help parents and professionals discern those therapies that are more humane and effective. Nurturing attachment in the adopted infant It's generally agreed that children fair better when adopted in infancy. When possible, open adoptions can work very well. In many instances it allows the adoptive parents to become involved during the birth mother's pregnancy and birth or shortly thereafter. These early interactions help the parents bond with their baby more quickly, though it can be emotionally very risky if the birthmother changes her mind. Regardless of whether parents have the luxury of an open adoption or they adopt internationally, there are ways to nurture attachment, and in some cases, re-attachment with their child. A style of parenting called Attachment Parenting* helps adoptive parents and adopted children establish a strong bond fairly easily. Attachment Parenting encourages parents to respond sensitively to their infant combined with close physical contact. Parents can accomplish this by simply responding to an infant's cries or cues and meeting the infant's needs, whatever they may be. All babies benefit from being held by their mothers and fathers-most enjoy being held a lot! Soft carriers and bedsharing (or sleeping in close proximity) are a great ways to meet this need for closeness and keep the baby physically close and happy. In fact, many adoption agencies are encouraging parents to use soft carriers as well as co-sleeping with their newly adopted babies. Attachment Parenting is also being used by foster parents, who foster newborns just prior to being adopted, with great success. (12) In her book, Launching a Baby's Adoption, Patricia Johnston writes, "promoting attachment…lends itself to a whole style of parenting which fits right in with my strong view…that adoptions must be baby-centered. Parents promote intimacy by responding to the baby's cues rather than imposing their own will upon Baby.
Copyright 2007 by Lysa Parker
5
The pediatrician and author, William Sears, M.D., actually calls this style ‘attachment parenting’ **.” How does this style of parenting promote attachment? When infants know their cries will be answered in a loving and sensitive manner and they experience physical closeness, certain physiological mechanisms are triggered that enhance the attachment process and the baby’s developing brain. (8) In contrast, if a baby’s cries are responded to inconsistently or ignored then a cascade of stress chemicals are hormones are released, triggering the “fright, flight or freeze” responses in the child’s brain that can create serious long term effects. Over time this can cause children to learn to shut down emotionally and satisfy their needs in inappropriate ways. If you don’t consistently comfort and calm a child who is experiencing an amygdala alarm trigger in his brain, it can lead to enduring changes in his brain. These include serious disruptions to the fine chemical balances in his frontal lobes and to stress response systems in his body and his brain. When any of the alarm systems-rage, fear, or separation distress- are triggered in a child’s lower brain, he will be in a state of emotional pain and intense bodily arousal, unless an adult helps him to calm down. This is because once one of the alarm systems has been triggered, neurochemical and hormonal forces will be activated, which overwhelm the mind and body like wildfire. (14)
* It’s important to note that in the APSAC report it was found that some of these coercive types of therapies were erroneously being referred to by therapists as “attachment parenting”. Thankfully a distinction was made within the report that it did not intend to refer to the style of “attachment parenting” that promoted parent-child bonding. **Dr. Sears and his wife Martha coined the term “Attachment Parenting” nearly thirty years ago.
The Eight Principles of Attachment Parenting 1. Prepare for Pregnancy, Birth and Parenting 2. Feed with Love and Respect 3. Respond with Sensitivity 4. Use Nurturing Touch 5. Engage in Nighttime Parenting 6. Provide Consistent, Loving Care 7. Practice Positive Discipline 8. Strive for Balance in Your Personal and Family Life © 2007 Reprinted with permission by Attachment Parenting International www.attachmentparenting.org
Copyright 2007 by Lysa Parker
6
The importance of close physical contact in forming attachments Researchers have found that skin-to-skin closeness has incredible physiological benefits while separation can have equal detrimental affects. "Kangaroo care" a term which simply means the parent holds the infant skin -to-skin, has been studied for over a decade and found to have substantial benefits for the baby and mother. Susan Ludington of UCLA found that a mother's temperature fluctuates to maintain her baby's thermo neutral range. In other words, when the baby's temperature goes down the mother's temperature rises. "When her baby reaches the thermo neutral range, the mother's temperature returns to baseline." A case study was done on a critically ill preterm infant who was going to be adopted. Though the infant was mechanically ventilated, the hospital offered the parents "kangaroo care". The authors observed that the infant thrived and that the experience was "profoundly beneficial" for the infant. (6) When studying one of our closest relatives, monkeys, the primate researchers found that "Separation is so traumatic for the infant monkey that their whole system rebels: They experience loss of body temperature, release of stress hormones (cortisol), cardiac arrhythmias, increased heart rate, agitation, sleep disturbances, and immunological compromises. And although hormones stabilize when they are reunited with their mothers, there are long-term effects-for instance in sleep and immunological efficiency." We know human infants experience similar effects. (6) What does the future hold for adoptive families? While a smaller percentage of adopted children will be diagnosed with RAD, others may exhibit milder versions of attachment disorders or insecure attachment. Some experts believe that the majority of attachment problems in children are caused by parental ignorance about child development rather than abuse. This has resulted in an estimated 1 in 3 people with avoidant, ambivalent or resistant attachment. (11) Whatever the causes, adoptive families need the appropriate information, training and support in raising children with attachment difficulties. In 1997, the Federal government passed the Adoption and Safe Families Act that authorized funds to be made available for post-adoption services. The President's Adoption 2002 Initiative made available approximately 20 million dollars that have been allocated for adoption agencies to use as bonuses for families of "special needs" children to help them to pay for therapeutic and other necessary services. (1) While it may appear that adopting children can be risky, the good news is that the preliminary finding of a new comprehensive study being conducted at the University of Minnesota indicates that there is minimal difference in psychological functioning between children raised in adoptive families and those in biological families. (5) Adoption can be successful and adopted children can form strong emotional attachments when parents and children are given appropriate information, resources and support. The painful lessons of the past have finally broken through the walls of ignorance, shedding new light and giving renewed hope to adoptive parents who have opened their hearts and homes to thousands of children in need.
Copyright 2007 by Lysa Parker
7
The Differences between Secure and Insecure Attachment Relationships Over the past forty years and thousands of studies, attachment researchers have concluded that there are 4 basic categories of attachment; secure, insecure-ambivalent, insecure-avoidant, insecure-disorganized. Attachment researchers still use an instrument called The Strange Situation developed by Dr. Mary Ainsworth to determine these categories during the 1960's. The Strange Situation creates a situation where a baby is separated briefly several times from her mother while in a lab room with a stranger (research assistant). The researchers record how the baby reacts to mother's departure with the stranger, without the stranger and upon reunion with the mother. The behaviors of babies in these different categories are described below: 1) Secure- these infants actively explore, they get upset when their mother leaves, are happy upon reunion and seek physical contact with their mother. Mothers of secure babies are typically loving and responsive to their infant, quick to pick them up when they cried, hold them longer and "with more apparent pleasure." 2) Insecure-ambivalent (anxious/resistant): these infants stays close to their mothers, there is limited exploration, they become very distressed upon separation and ambivalent toward their mother upon reunion but remain near her. Mothers of anxious babies were observed to be "more mean-spirited to merely cool, from chaotic to pleasantly incompetent. Though well meaning, these mothers have difficulty responding to their babies "in a loving, attuned, consistent way." 3) Insecure-avoidant: these infants show little distress when separated, ignore their mother's attempts to interact, are often sociable with strangers or may ignore them as they ignore their mother. These mothers often have an aversion to physical contact themselves and speak sarcastically to their babies. 4) Insecure-disorganized/disoriented: these infants are the most distressed upon separation and are considered the most insecure. They seem confused upon reunion and exhibit behaviors that appear to be a combination of resistant and avoidant. (13)
Copyright 2007 by Lysa Parker
8
References: 1. Barth, R.P.; Miller, J.M. (2000). Building effective post-adoption services: what is the empirical foundation? Family Relations. 49; 447-455. 2. Deane, D. (1997, December 26). Some Americans give up trouble East bloc kids. USA Today, pp. A6, A9. 3. Festinger, T. (2002). After adoption: Dissolution or permanence? Child Welfare. 81; 515-534. 4. Fonagy, P.(2001). The human genome and the representational world: The role of early mother-infant interaction in creating an interpersonal interpretive mechanism. Bulletin of the Menninger Clinic. 65; 427-449. 5. Freivalds, S. (2002 March/April). Nature & Nurture: A new look at how families work. Adoptive Families. 27-30. 6. Heller, S. (1997). The Vital Touch. New York, Henry Hold and Company. 7. Horner, D.R. (2000). A practitioner looks at adoption research. Family Relations. 49;473-478. 8. Johnston, P.I. (1997). Promoting attachment through the senses. Retrieved on October 4, 2002 from http://www.adoptiveparents.com/pages/promoting_attachment.asp. 9. Parker, L. Anderson, G.C. (2002). Kangaroo care for adoptive parents and their critically ill preterm infant. The American Journal of Maternal/Child Nursing. 27;230-232. 10. Perry, B.D. (2002). Principles of working with traumatized children: special considerations for parents, caregivers, and teachers. Retrieved June 18, 2002 from http://www.childtrauma.org/principles_TC.htm. 11. Perry, B.D. (2001). Bonding and attachment in maltreated children: consequences of emotional neglect in childhood. Retrieved June 18, 2002 from http://childtrauma.org/Attach_ca.htm. 12. Sears, W., Sears, M. (2001). The Attachment Parenting Book. New York, Little, Brown and Company. 13. Shaffer, D., Developmental Psychology: Childhood and Adolescence, (Pacific Grove, CA, 1999)pp. 413-414. 14. Sunderland, M., The Science of Parenting (DK Publishers, London 2006) p.29.
Copyright 2007 by Lysa Parker
9
Other website Resources: 1. www.fairfamilies.org 2. www.adoptionsupport.org 3. www.raisingadoptedchildren.com 4. Attachment Parenting International- www.attachmentparenting.org 5 Dr. William Sears at www.askdrsears.com 6. The Child Trauma Academy- www.childtrauma.org 7. National Mental Health Association-http://www.nmha.org 8. The National Adoption Information Clearinghouse- http://www.calib.com/naic/ Lysa Parker has her masters in Human Development and Families Studies and is a Certified Family Life Educator (CFLE) and member of the National Council on Family Relations (NCFR). She is also the co-founder of Attachment Parenting International (API) and Director Emeritus. Lysa is in private practice as a parenting consultant. She can be contacted at www.parentslifeline.com or
[email protected].
Copyright 2007 by Lysa Parker
10
