SUPPORTING ADOPTIVE FAMILIES TO MINIMIZE TRAUMA IN YOUNG ADOPTED CHILDREN

Susan O’Quinn, Infant Development Consultant & Social Worker~ Peel Infant Development, Canadian Clinic for Adopted Children, Trillium Health Centre

 

IMPrint, Volume 41, Winter 2004-2005 pp10-13

Newsletter of the Infant Mental Health Promotion Project

 

Families created through adoption require particular supports to assist both child and family in the significant adjustment to their new situation. Trauma and loss are commonly experienced by families who unite through adoption (Newton-Verrier 1993). Children who enter an adoptive family after experiencing multiple caregivers, neglect or abuse can have difficulty forming relation­ships with others (Larrieu 2002). In the past, society believed that children were resilient or malleable and did not hold memories. We now recognize that children’s early experiences, memories and interpretations of their experiences form the template or foundation for future learning (Gaensbauer 2004).

 

In the first years of life, children develop a view of the world through their experiences with their primary caregiver. When they are adequately nurtured, children are more likely to develop secure relationships with their caregivers and develop a view of the world as a positive place where others can be trusted to meet their needs. Children entering adoptive families following neglect, abuse, loss and/or trauma are at risk of viewing the world nega­tively and believing that they cannot rely on others and must rely only on themselves (Albus & Dozier 1999). The early months and years in their permanent families are critical to helping children reduce the impact of past issues and form healthy relationships in their new family.

 

The trauma associated with adoption

 

Trauma results when a significantly distressing event outside the usual range of human experience overwhelms defenses and causes lasting emotional harm. Traumatic experiences may be pervasive and chronic, such as war or incest, or time limited, such as a natural disaster or neighbourhood shooting (Giller 2003). According to Perry (1994), deprivation of critical nurturing experi­ences during early childhood, maybe the least understood area of child maltreatment. Complicating the impact of early trauma is the finding that the brain’s most rapid development is in the first few years of life. During these early years the brain actively responds to experience to organize new neural pathways, and this makes young children highly vulnerable to neglect and /or stressful experience (Perry et al. 1995). Chronic early trauma during the formation of personality can shape the perceptions and beliefs that form the template through which children view their world. Research indicates that trauma can cause changes in the brain’s development and impair emotional regulation skills (Reynold 2003).

 

When children enter their permanent families after experiences of foster care, sometimes with multiple caregivers, orphanage life or international relocation, it is essential that parents and their support team understand loss and trauma. Difficulties associated with unresolved loss and trauma can affect the entire family system and are associated with high levels of family dysfunction (Gilbert

2003). Most adoptions inherently involve loss (Cohen 1994). For the young child or infant, any significant change involves multiple losses: loss of familiar sights, sounds, smells, routines, diets, language, and importantly, loss of attachment figures. Such loss or change can be traumatic and result in difficulties that can be observed in a child’s behaviour and/or changes in functioning.

 

The following are examples of common behaviours that reflect a child’s loss, grief and trauma:

 

•     After arriving in new family environment, a child spends most of her time “blanking out” and “staring off in space.” These episodes are followed by extreme distress.

•     A child’s fear of future loss is so great, that he is unable to leave his parents’ sight. The child is experienced by the family as “clingy.”

•     After living with her family in Canada for one year following a year in a foster home in her birth country of China, a two-year old decides that all Chinese women are bad.

•     A child’s behaviour and development regresses when his adoptive parent goes on business trip.

•     A 3-year-old child with exceptional memory is unable to cope (i.e. cries and screams) when there are changes in the layout of a familiar store (i.e. bread in different area of store).

 

Transition planning to minimize trauma

 

Transition plans developed by adults and previous caregivers assist children to move successfully from one environment to another. Effective, individually-designed transition plans are essential to minimize a child’s experience of trauma from a significant life change (Steele & Sheppard 2003).

 

The overall principle guiding transition planning is to minimize the child’s experience of change during the transfer process. Regardless of the quality of the child’s previous environment, maintaining as many similarities as possible early on helps the child feel safer, and regardless of the child’s age, preparation for an anticipated move is essential to successful transition.

 

                1. Prepare the child using photos

     •Picture albums can help define the steps involved in a move so that these can be clearly connected for young children who may not be able to predict what adults take for granted (e.g. show a picture of the car that will drive them to the next home). Pictures can be helpful even for very young children. Infants begin to recognize and distinguish photographs of human faces between 6 and 9 months (Bower 2001).

•If a child’s native language is not that of the adoptive parents, pictures can be translated into an age-appropriate story that explains the move. Current caregivers can share a story withthe child as he waits for the new parents. The new parents can then read the same book in the new family’s language to connect the old and the new. The current family can offer photos of the expected people, places and familiar areas (house, bedroom, bathing area, kitchen and so forth) and the new family can offer photos of the previous environment to keep connected to the old.

 

             2.  Assist the transition using objects

•    Some children already have favorite items that can assist them when they move. Some children may not. Parents may want to introduce themselves ahead of time by bringing or send­ing a few items along with a photo to help the child become familiar with her anticipated caregivers.

•    Items that support nurturing and interdependence within the parent-child relationship are recommended over those that encourage a child’s independence, for example, a blanket or stuffed doll rather than blocks or balls.

 

3.  Consider all the senses

·     Infants and young children learn and explore the world using their senses of taste, touch, smell, hearing and sight. When building a transition plan, parents should try to consider all of these senses. It is important not to over-stimulate a child with new sensory experiences, but instead to use previous experi­ences and preferences to inform the transition.

·     Based on this principle, parents might tape familiar sounds and songs of the previous environment and learn a child’s favorite songs and games. Parents might use the same detergents previously used or not wash blankets and sheets initially to maintain a sense of familiarity.

·     Many parents anticipate with excitement decorating the new baby or child’s room. To minimize trauma, caution is needed. Decorations that support the transition are recommended over those that might overwhelm a child. For example, a child used to an all white environment might be overwhelmed by a move into a colourful room with many objects.

•    Parents should gather information about a child’s preferences for textures in food, clothing and so forth.

·     To avoid over-stimulating a child, parents should be cautious when planning new activities. For example, large crowds, amusement fairs and similar environments might be over­whelming for a child who is not used to such a bombardment of sensory experiences.

•    Parents may want to familiarize themselves to their child using fragrances, clothing detergent, or household scents. As an example, parents might place a blanket in their own bed to gather their scent and then send this or bring it to their child.

 

4.  Gather information regarding a child’s previous daily routine and preferences

•    It is essential that new caregivers gather extensive information regarding a child’s daily routine, preferred activities, feeding ritu­als and preferences, sleep schedules, methods of calming, times when most likely to get upset, things most liked and so forth.

·     Parents should use a child’s previous schedule to inform new routines. Where possible, every effort should be made to maintain a child’s previous routine. Gradually, the family can redefine their routine and structure.

·     A child’s favorite foods initially will enhance the parent-child feeding routine.

·     Information related to favourite people, preferred nurturing activities and so forth is also critical. For example, asking a caregiver to document memories of the child will enhance the new parents’ understanding of their child as well as assist them in helping the child cope with loss and grief.

 

      5.Prepare and allow expression of feelings

      • The transition from one caregiver to another is a significant event for everyone and a time of many emotions. This transi­tion should not be curtailed because of adult fear of expression of feelings. Parents should prepare themselves for the chal­lenges that are likely. While it may be a period of excitement for the adoptive parent, it is also a time for the child and previous caregivers to separate. That relationship can be honoured by accepting the feelings involved.

      •Recording this transition on video or in wilting may be helpful when the child is older. Encouraging the previous caregiver to support the transfer can be helpful, for example inviting the previous caregiver to help decorate the child’s new room, placing the child’s old sheets on the new bed, and so forth can be supportive to the child.

      •It is important to honour a child’s relationship with previous caregivers or special people. Photos of previous caregivers may be useful to help the child remember. A parent’s own experience of loss and grief will influence the ability to help their child with this loss.

 

6.  Initial goals should be relationship based, not object directed.

•     In the early weeks and months with a child, the focus should be on building a repertoire of positive interactions between parent and child, for example through interactional body-based games where the parent is the “toy” rather than offering toys. For some children, inanimate objects may feel safer, but the child may then connect more to the object than the person.

•     Goals should be to build communication between the parent and child without using words. It is a time to observe children, read their cues, respond appropriately, and offer warmth through touch, song and movement. If child is already using words, learning the child’s words will be important to inform interactions.

 

7.   Transition time considerations

•     Parents should allow a pace appropriate for the child based on previous caregiver feedback. If the child already displays difficulty with new situations and changes, the transition period will take longer and may involve a gradual process of meeting and visitation prior to child relocating. Wherever possible, a process of establishing familiarity and comfort with the new family should occur before uprooting a child.

•    A child’s response at the time of a traumatic experience can predict adjustment needs later (Cook et al. 2003). A strong predictor of posttraumatic stress disorder is a child’s use of complex defense strategies such as disassociation to cope during the traumatic experience. Parental strategies that decrease the child’s stress during the transfer process may serve as a protective factor by minimizing the child’s experi­ence of trauma (Cook et a!. 2003). If a child “blanks out” (disassociates) when upset, parents can try to keep the child in the “here and now” and to ground the child by reminding him or here where s/he is and what is happening.

 

The role of extended family and friends

 

Extended friends and families can be of great help to a new family in their adjustment. Preparing a family’s support network ahead of time for the child’s arrival and helping them to understand the special considerations that may be necessary for supporting the growing parent-child relationship can be useful.

 

Many adoptive parents find that relatives and friends feel that they (the parents) are ‘going overboard’ when they follow practices that are atypical for families who bear their children biologically but are recommended for adoptive families. The direct involve­ment of extended family is often expected, desired and required in biological families. For children who enter their family after previous caregiving, critical goals are to learn to trust their parents, to seek help and comfort from their parents, to recognize parents as their protectors, and to develop a preference for their parents over other adults (Lawton 2000).

 

In order to reach these goals, parents are often encouraged to practice strategies that support and reinforce their parental roles. For example, avoiding excessive company initially, avoiding over-stimulation (excessive toys, people, environments) and not allowing others to comfort or cuddle their child or complete regu­lar nurturing, grooming or feeding activities. Instead, the child’s primary caregiver(s) is encouraged to complete all nurturing tasks directly. These strategies may seem radical to family and friends who want to develop their own relationships with the child.

 

Suggestions for those who function in a supportive capacity to the family

 

The following suggestions for extended family and friends can help parents build their role as parents and can help their children gain confidence and comfort in their new relationships.

 

•    Respect the position of the parents as the child’s authority and trust that they are making choices necessary for a strong family.

·      Reinforce and support the parental role as nurturer until a preference for parents is observed. For example, instead of cuddling a child, help the child seek comfort from the parent, or assist with instrumental tasks (e.g. running the bath, making the food but allowing the parents to bathe and feed).

•    Assist in teaching desirable social behaviours and rituals. For example, when entering the family home, wait for the child to say “hi” and offer a handshake without expecting cuddles and kisses early on.

•    Maintain the parents’ routines and schedules when caring for a child in the parents’ absence. Consistency is important to ease a child’s experience of change (trauma) by ensuring the predictability needed to help a child feel safe and secure.

•    Positive play-based interactions can gradually build relation­ships between extended family members and the child.

•    Independent overnight or extended visits should be avoided initially until the comfort and readiness of both child and parent have been built.

•    Caution should be exercised regarding traditional time-outs and punishment based practices, particularly when children have a history of loss or trauma. The practices established by the parent(s) should be followed.

•    It is important to recognize that a child’s behaviour lets you know how a child is feeling and tells you about a child’s experi­ences. Some behaviours, while maladaptive in the child’s new environment may have been quite functional and appropriate in the previous environment. Desirable behaviours are best taught through positive interactions.

 

Following these simple suggestions can go a long way to mini­mize the challenges of families created through adoption and support parents and children in their significant adjustment and adaptation.

 

 

References

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Bower 3 (2001). Faces of perception. &ience News 160(1). Reprint:httpj/www.sciencenews.org/articles/2001 0707/bobi 6ref.asp.

Cook A, Blaustein M, Spinazzola J, van der Kolk B (eds.) (2003). Complex trauma in children and adolescents. White paper, National Child Traumatic Stress Network: California. Reprint: http://www.nctsn.                                           org/nctsn_assets/pdfs/edu_materials^tComplexTrauma_All.pdf.

Cohen N (1994). Attachment in adopted infants and toddlers: A devel­opmental perspective. IMPrint 9, 30-3 1.

Gaensbauer TJ (2004). Telling their stories: Representation and reenact­ment of traumaticexperiences occurring in the 1st year of life. Zero to Three, May 2004, 25-31.

Giller E (2003). Understanding trauma. Maryland: The Sidran Institute.Reprint:              httpj/www.sidran.org/whatistrauma. html.

Gilbert KR (2003). Grief in a family context. http­//www.indiana. edu/—.famlygrf/units/ambiguous.html.

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Lawton A (2000). Home based interventions to promote parent-infant attachment in families at psychosocial risk. IMPrint 26, 22-25.

Newton-Verrier N (1993). The primal wound. Baltimore: Gateway Press.

Perry BD (1994). Neurobiological sequelae of childhood trauma: PTSD in children. In MM Marburg, ed., Catecholamine function in posttrau’ matic stress disorder: emerging concepts, Washington DC: American Psychiatric Press.

Perry B, Pollard RA, Blakley It, Baker WL, Vigilante D (1995). Child­hood trauma, the neurobiology of adaptation and use dependent develop­ment of the brain: how “states” become “traits.” Infant Mental Health Journal 16, 271-291.

Reynolds T (2003). Understanding emotion in abused children. Observer16, 10. Reprint: httpz//www.psychologicalscience.org/observer/getarticle.cfm?id=1 398.             

Steele W, Sheppard CH (2003). Moving can be traumatic. Trauma and Loss: Research and Interventions 3(1). Reprint: httpz//www.tlcinstitute.org/Moving.html.

 

 

 

Newsletter of the Infant Mental Health Promotion Project

IMPrint, Volume 41, Winter 2004-2005

pp 10-13