Hug the Monkey

Welcoming an Older Adopted Child

I came across Adopting the Older Child, a terrific blog from Robin Hayes, a psychologist and the mother of three children, two of whom were adopted at around four years old.

In a post on helping new siblings learn to get along, she outlines steps in a program to make sure that they have time to get used to each other and accept each other, without beginning to re-enact abuse or trauma.

For example, as the kids get used to each other, she advises:

Over time, build on success. Slowly extend the allotted time for play. When they can play successfully for about 20 minutes one-on-one, add one 10 minute session where all the children play together, supervised by an engaged, involved parent.  Again, keep it positive and end on a happy note.

In the past, adoptive parents were often not given much information about attachment and behavior issues that children might suffer from, let alone clear directions on how to deal with them.

Robin is a heroine to me for welcoming into her family older, hard-to-place kids. I always thought that if the time came for me to have kids, I would adopt one with medical problems; that as a society, we should only adopt until all the orphanages were empty. (The time to have a family never came for me.) But Robin is doing it.

Neuroscience in the Age of Miracles

It really does seem like science has pulled aside the veil of emotion. And brain scanning can point the way to therapies that can alter the brain's workings to make it healthier. A two-day seminar at Chico State University promises to provide a terrific overview. This is part of the annual "Children in Trauma" Conference, designed for social workers, law enforcement, therapists and others who work with kids. I attended two years ago and it was well worth it.

CSU, Chico to Host 7th Annual Children in Trauma Conference – Neuroscience and the Age of Miracles

California State University, Chico, Continuing Education, in partnership with the Superior Court of California, presents Children in Trauma 2009: Neuroscience and the Age of Miracles. The two-day professional development conference will be held Jan. 16-17, 2009, at the Bell Memorial Union Auditorium on the CSU, Chico campus.

The 7th annual Children in Trauma Conference will provide an intensive two-day practicum focusing on how traumatic stress can alter early child development and how professionals who work with children can recognize this problem and learn how to apply the emerging intervention and treatment protocols.

The conference will feature nationally recognized practitioner Richard Gaskill, Ed.D., Child Trauma Academy Fellow and Clinical Director at Sumner Mental Health Center in Wellington, Kansas.

Gaskill is well respected in the field and has developed many successful programs for children and their parents, including child development classes, parenting classes, child-parent relationship training, attachment enhancement treatment groups, therapeutic alternative schools, therapeutic preschools, after-school programs and juvenile offender programs.

Marriage and family therapists, social workers, psychologists, educators, school and family counselors, attorneys, law enforcement professionals, mediators, child custody evaluators, behavioral health professionals, nurses, physicians, psychoanalysts, emergency responders, children’s advocates and concerned individuals are encouraged to take advantage of this continuing education opportunity.

Participants will gain a greater understanding of difficulties and challenges children who have experienced trauma face and an improved ability to intervene successfully with children and youth adversely affected by severe trauma and post-traumatic stress disorder. In addition to learning from a recognized practitioner, participants will walk away from this conference with an array of professional contacts and practical treatment tools.

Participants may earn 12 hours of BBSE (Provider PCE 799), BRN (Provider 00656), MCEP (Provider CAL123), and MCLE continuing education credit.

In addition to the featured speaker, exhibitors from public service agencies and other resource providers will be on hand to share a wide array of information and discuss their services. Exhibitor space is available.

Early registration fee for the two-day conference is $295 per person (includes continental breakfast, lunch and materials). Group rate discounts are also available.

To enroll or for more information, please call CSU, Chico Continuing Education at 530-898-6105, e-mail rce@csuchico.edu, and visit the Web site http://rce.csuchico.edu/inservice.

Turning Mares into Foster-Mares

Walnut Hills Farm, a horse breeding operation in Kentucky is using oxytocin to connect foals with foster-mothers while their real mothers are being bred elsewhere.

Not only can unbred mares that have previously had at least one foal be persuaded with medication to produce milk, but the procedure also seems to stimulate maternal behavior, greatly simplifying the tricky process of getting a nurse mare to adopt an orphan foal. For an operation like Walnut Hall, which uses nurse mares routinely, it was a revolutionary idea.

It's nice that they are using rescued horses as the foster mothers, "giving them a new lease on life," as the article in TheHorse.com says.

But, hold on a minute, this doesn't mean that we can necessarily improve the attachment of moms and babies with oxytocin. It's more complicated than that. After all, in hospital births, women are routinely given a large amount of pitocin, an oxytocin analog. And if anything, it seems to inhibit the natural attachment process.

See The Mother/Baby Attachment Gap for more on this.

For Orphans, There's a Critical Period for Nurturing

In the United States and some other countries, there's awareness that babies in orphanages need to have a primary caregiver -- someone they can bond with. If they don't, they will likely grow up with many psychological and cognitive problems. Babies need loving touch for proper brain development and to develop the oxytocin response that will teach them to bond with others.

The foster care system in the United States is far from perfect -- far, far from perfect. But many nations still have a policy of caring for orphans in institutions, rather than in foster homes. It's partly a question of resources; in an institution, one person can care for many more children.

Researchers from the University of Maryland, led by Nathan Fox, just published the results of a years-long study in Romania in which they compared the development of children in orphanages to those in foster homes.

In one orphanage in the study, the ration of caregiver to children was 1 to 22. If each worker worked an eight-hour shift, she could spend less than 22 minutes a shift on each child. Think about a baby who is changed, fed and touched for no more than one hour each day.

The researchers moved half of the 156 children in the study into foster homes and left the rest in institutions. They could do this ethically because there was no foster care system in Romania at this time -- they had to set one up.

According to the article in Science Daily,

The main findings from the study confirmed earlier results that "children reared in institutions showed greatly diminished intellectual performance relative to children reared in their families of origin." Further, children who were randomly assigned to foster care experienced "significant gains in cognitive function."

They didn't look at attachment, but certainly, the longer the children stayed in the institution, the more attachment problems they had. These are expressed in what we now call reactive attachment disorder, oppositional defiance disorder and post-traumatic stress disorder.  (Institutionalized babies develop PTSD because their bodies instinctively "know" that if they're separated from their mothers, they will die.)

The researchers also found that 24 months was the critical age for children to benefit from placement into a foster home.

But, the sooner the better! And of course, adoption into a permanent home is the best outcome.

Retraining the RAD Brain

I published a story today in the East Bay Express, called When Love Is Not Enough.

The story uses the experiences of two local families who adopted children from overseas to discuss some of the therapies being used to retrain the brains of kids with attachment disorder, PTSD and other abnormalities of brain development.

I didn't get into the oxytocin response too much -- it's too complicated and not the focus of the story. But you can look at the therapies discussed -- attachment therapy, neurofeedback and neurodevelopmental reprogramming -- as ways of building the oxytocin response in the brain.

When Does Attachment Disorder Happen?

In an interview with Babble.com, Jane Aronson, the pediatrician known as the Orphan Doctor, talks about foreign adoption, something she strongly advocates. Aronson is pediatrician to movie star adopters including Angeline Jolie.

In the interview, Aronson points out that adoptions of older foreign children can be very successful when the child was raised by a family, but then lost his parents to AIDS, war or other misfortune. She gives a helpful analysis of adoption services in various countries.

Aronson certainly is highly experienced in overseas adoption, through her organization, Worldwide Orphans Foundation. She makes one strange and really inaccurate remark, however: She claims the science shows that attachment disorder is mostly the result of brain damage or brain chemistry imbalances in the womb.

She told the interviewer,

And attachment likely has more to do with brain damage that occurs during the pregnancy, due to malnourishment, exposure to toxins in the environment, infections during the pregnancy, exposure to alcohol and drugs and smoking. All of that conspires to cause damage to brain structures that are involved in the actual chemistry and physiology of attachment. So when people use this sort of artificial convention of saying, you know, "You gotta get 'em by three, or else they're ruined," I think that's also not taking into consideration that attachment likely has to do with brain chemistry during pregnancy.

While it's accepted that a hostile womb environment -- a mother who takes drugs, who doesn't want the baby, who's being abused -- can make the baby hyper-vigilant and hyper-reactive before he's born, neuroscientists like Bruce Perry who study disordered kids are convinced that not only abuse but also neglect and simple lack of attention after birth can create post-traumatic stress disorder, or PTSD.

In the comments on a blog summary of the interview, most people think Aronson is full of it.

For the perspective of a neuroscientist who studies traumatized children, read this interview with Michael de Bellis of Duke University.

See also RAD Epidemic in Russian Adoptions?

Saving a Troubled Adoption

When I started this blog more than two years ago, the severe behavioral problems that adopted kids and their parents struggle with was really under the radar. Reactive attachment disorder, PTSD and other ills that affect children who were traumatized by, if nothing else, being separated from their mothers, are becoming mainstream concerns, thanks to articles like this one from the Boston Globe.

In "Choices of the Heart," Patricia Wen tells the story of a family that almost relinquished their son when he was 15. Luckily, as a last resort, they found an attachment therapy center that, after months of intensive work, allowed him to heal -- and return to the family.

RAD Becoming Recognized

The horrible stories about the abuse of children with reactive attachment disorder in the foster and adoption system just keep coming.

Therefore, I'm especially happy to read this story from the UK of a woman who's had success in mothering RAD kids.

Sue Clifford began adopting traumatized children in 1991. She intuitively developed parenting styles that help them, in advance of the new understanding neuroscience has provided in the last ten years.

Adopting for Love

Ralph James Savarese's op-ed in yesterday's Los Angeles Times is so inspiring for its depiction of a parent's unyielding love for a child.

Savarese is the author of "Reasonable People: A Memoir of Autism and Adoption," coming out today from Other Press. The book tells the story of their son's rebirth after eight years in their care. The six-year-old they adopted had been diagnosed as autistic, abandoned by his mother and abused in foster care.

They had bonded with him when Savarese's wife, an autism expert, had attempted to help the mother. Their love for him was already too strong to let him slip away into a life of trauma.

He writes,

"Despite the stigma attached to "special-needs children," people do adopt these kids. And yet, many more Americans spend gobs of money on fertility treatments or travel to foreign countries to find their perfect little bundles. I'm haunted by something my son wrote after we taught him how to read and type on a computer: "I want you to be proud of me. I dream of that because in foster care I had no one." How many kids lie in bed at night and think something similar?"

His editorial is full of righteous anger at the callous way society looked at his son, and it's full of steady love. This should be a terrific feel-good book for all parents and a must-read for anyone who wants to have a child, biological or adopted, disabled or not.

Book Review: The Connected Child

Karyn Purvis, David Cross and Wendy Lyons Sunshine have written a handbook for parents of at-risk kids that's vitally needed. With the rise in international adoptions and adoptions of kids in foster care has come a mostly unacknowledged crisis. Unprepared and unsupported families are finding themselves unprepared for the task of parenting children with severe emotional problems.

The Connected Child helps parents put some of their therapeutic techniques into practice; more important, it helps them understand their kids in a new way.

Dr. Purvis is the director of Texas Christian University's Institute of Child Development; Dr. Cross is associate director of the institute and a TCU psychology professor. They treat kids with attachment and other behavioral disorders, and they run a summer camp for kids.

The book explains to parents how their assumptions of normal and acceptable behavior may be completely foreign to their children. Not being touched, not having enough to eat, not having toys or stimulation can create a worldview that's totally out of synch with the parents.

That's why setting rules for behavior or other cognitive approaches may not work with these kids. When parents understand that so-called bad behavior comes from fear or self-protection, they can find strategies that address the underlying fear and thereby change behavior.

For example, stealing or hoarding food is common among children from orphanages. They had no choices about when or what they could eat, and often didn't get enough to eat. Instead of demanding that the behavior stop, or that kids hew to mealtimes, the authors offer techniques to maintain a healthy, regular diet while increasing feelings of security about food.

For example, if a child asks for an energy bar a few minutes before mealtime, instead of saying, "No, we'll be eating in ten minutes," they advise giving her the bar and letting her choose whether to keep it in her pocket or by her plate to eat after dinner. Another option is letting the child keep a basket with healthy snacks in her room that she can eat whenever she wants.

Even sending a kid to her room for a time-out can hurt more than it helps, they write. If a child already feels cut off from the family, this isolation seems to reinforce that belief. Instead of dealing out consequences for misbehavior that may seem arbitrary and unrelated to the misdeed, Purvis, Cross and Sunshine illustrate how to help a child understand the real consequences of his behavior. For example, if a kid mistreats a dog, parents are advised to sit down with him and brainstorm the negative consequences of the behavior, such as, "If I hit the dog, it will run away from me." Next, they should make a list of positive consequences that might occur if the dog is treated kindly, such as, "It will like me."

They write,

"Adopted and foster children deserve deep compassion and respect for what they may have endured before they were welcomed into your home. Some of these little ones have survived ordeals that defy the imagination. … the difficult history of these children means that you, as a caretaker, have to work harder to understand and address their unique deficits and make a conscious effort to help them learn the skills they need at home with a caring family."

Parents need to respond to acting out, tantrums and other dysfunctional behavior with love and understanding. Over and over, the book helps parents understand the roots of misbehavior, so that they can respond with love instead of anger.

At-risk kids need to be told directly and simply what's expected of them, according to Purvis and Cross. Parents should identify specific behaviors or values they want to enable, and name them, for example, "asking with respect." If a child asks for something demandingly, the parent says, "Is that asking with respect? Can you ask me with respect?" Throughout, the book provides clear strategies and scripts for handling a wide variety of problems and behaviors.

Finally, The Connected Child includes a chapter called "Healing Yourself to Heal Your Child." Without judgment and with much compassion, the authors point out how much any child, and especially a traumatized child, needs to feel secure and loved by her parents. If a parent hasn't dealt with his or her own grief, anger or emotional dissociation, it will be difficult for that child to heal. If the child does begin to open up, it may actually make her parents uncomfortable.

They offer some advice for such parents, which tends to be on the cognitive side, such as reflecting on their own attachment styles and practicing identifying and articulating their own feelings. Of course, this isn't always so easy, and parents with attachment issues may benefit more from the same kinds of experiential therapy that kids get.

In fact, guiding a child with an attachment disorder toward healing could be exactly the kind of experience that could help a parent heal -- as long as it's done consciously and carefully. The Connected Child is a wonderful guide.

For background on the work of Dr. Purvis and Dr. Cross, see this article from the Texas Christian University magazine.