Adopting children is an incredibly rewarding experience for many parents whether or not they have biological children of their own. Yet, adoptive parents, while thoroughly scrutinized by adopting agencies, are often given little information about their adopted child, in terms of family history or specific parenting skills that will help their adopted children develop strong emotional attachments. Only recently have post-adoption resources become available for adoptive families. Though these resources are few nationwide, 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 attachment problems.

What is attachment and why is it important?

Attachment is a term that refers to a psychological and biological event- it is the affectional bond that develops between a primary caregiver, usually the mother, and her infant. The process of attachment often begins in utero when the mother feels affection for her developing baby and looks forward to the baby's birth. For other mothers it may begin after their baby's birth and is a process that takes time through a series of daily caring interactions. Developing a secure attachment to a primary caregiver is extremely important as the child's mental representations of intimate relationships and the foundation trust often carry over into adulthood, affecting future adult relationships. "Studies of attachment have revealed that the patterning or organization of attachment relationships during infancy is associated with characteristic processes of emotional regulation, social relatedness, access to autobiographical memory and the development of self reflection and narrative." (13) For the past forty years, 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. (15)

When adopted children don't attach

Unfortunately, for a large number of adoptive 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 environments resulting in attachment disorders. Some of the first heartbreaking examples of attachment disordered children to garner worldwide attention were the children adopted from Romania and other East Bloc countries. 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, proving to be catastrophic for 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 met, creating this failure of attachment. Psychologists are much more aware of the behaviors of the attachment disordered child, frequently called Reactive Attachment Disorder.

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 years of a child's life. Sometimes other factors can contribute to the break in attachment as listed in the box below.

• 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

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Younger children removed from their parent(s) are at great risk as they and their siblings are frequently placed in a multitude of foster homes before they are considered for adoption thus creating a downhill spiral.

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

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Based on the DSM IV

It's critically important to know as much about the child's history in order to meet the child on their emotional or developmental level. If parenting a child who was removed from his parents due to abuse or neglect, parents should be aware that traditional parenting is not the best approach to use even if it worked for their biological children. There are special considerations involved with parenting traumatized children. For instance, traumatized 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 beforehand. 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 and will have different meanings to victims of physical or sexual abuse. Allowing the child to initiate affection like hugs or kisses first will, in time, help to reestablish a relationship of trust. Maintaining open communication by explaining the who, what, why and where of daily situations, will help the child make sense of the world. (10)

Traumatized children need boundaries too. Make your expectations very clear and the reasonable consequences if these expectations aren't met. However 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 the consequences. 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 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)

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 the baby very early, 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 to the parents.

A style of parenting called Attachment Parenting helps adoptive parents and adopted children establish a strong bond fairly easily. Attachment Parenting promotes sensitive responsiveness to a baby combined with close physical contact. Parents can accomplish this by simply responding to an infant's cries and meeting the infant's needs, whatever they may be. All babies benefit from being held by their primary caregivers and they enjoy being held a lot! Soft carriers and bed sharing are a great way to meet this need closeness and keep the baby physically close and happy. Attachment Parenting is also being used by foster parents, who foster newborns just prior to being adopted, with great success. (14) 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. The pediatrician and author, William Sears, M.D., actually calls this style "attachment parenting." How does this style of parenting promote attachment? When human infants know their cries will be answered and they experience physical closeness, specific physiological mechanisms are triggered that enhance the attachment process. (8)

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 our closest relative, 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.

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 February 15, 2008 

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 February 15, 2008 fromhttp://www.childtrauma.org/.

11. Perry, B.D. (2001). Bonding and attachment in maltreated children: consequences of emotional neglect in childhood. Retrieved February 15, 2008 from http://www.childtrauma.org.

12. Thomas, N. ((2002). What is Attachment Disorder/Reactive Attachment Disorder (RAD)? Retrieved February 15, 2008.

13. Siegel, D. (1999). The Developing Mind: How relationships and the brain interact to shape who we are.New York, Guilford Press.

14. Sears, W., Sears, M. (2001). The Attachment Parenting Book. New York, Little, Brown and Company.

15. Shaffer, D., Developmental Psychology: Childhood and Adolescence, (Pacific Grove, CA, 1999) 413-414.

Website Resources:

1. www.fairfamilies.org
2. www.adoptionsupport.org
3. www.raisingadoptedchildren.com
4. Adoptive Families Magazine - www.adoptivefamilies.com
5. Nancy Thomas Parenting - www.attachment.org
6. Attachment Parenting International - www.attachmentparenting.org
7. Dr. William Sears at www.askdrsears.com
8. The Child Trauma Academy- www.childtrauma.org
9. National Mental Health Association -mhanational.org
10. Child Welfare Information Gateway (formerly The National Adoption Information Clearinghouse)