As an adoptive parent, or as a professional working with post-institutionalized internationally adopted children, it is important to be thinking about the impact of the world in which that child lived prior to being adopted. The child may have lived with a foster care family rather than in an orphanage. In others, the child will have known only one or several institutions. In those institutions, the child may have been unable to have met her needs for food, attention, touch, and comfort when in pain. Over time, she may have learned not to look for those needs to be met and may have come to distrust the adults in his or her world. Also, the child may have experienced neglect, poor nutrition, lack of stimulation, and potential for attachment, inconsistent caregivers, and various forms of traumatic experiences including physical abuse, sexual abuse, and witnessing of violence toward others (including other children). Parents need to understand a childs orphanage life in order to understand what makes their child think and behave the way she does. It is very hard to help a child join a family without being fully aware of her history. In general, what might a childs life have been in an orphanage? Even the best institutions have the following:

• uneducated or minimally trained caregivers

• rotating caregivers on shifts

• abrupt transfers to different orphanages or sections of an orphanage

• loss of peers as those children are adopted or transferred

• limited language interaction with adults

• regimented daily activities: eating, sleeping, toileting at the same time each day

• lack of spontaneous activities

• absence of personal possessions

• limited activities to develop motor skillsno use of markers, pencils, equipment

• exposure to toxins, including lead

Children in many orphanages are frequently nutritionally deprived and often have low muscle tone. Playground equipment may be non-existent or, if present, may be in disrepair. Children may be over-responsive when put in high-stimulus situations. Speech acquisition, because of minimal exposure and subsequent minimal usage of words, may be extremely delayed and it may take a long time to develop appropriate articulation and grammar. At an orphanage, children do what everyone else does, eat when everyone else eats, go to school when they are told, and even use the restroom on a schedule.

What this means is that orphanage children are never encouraged to make (good) decisions and no one talks to them about choice makingkey essentials to personal success and active coping. At first sight, the child may appear to be overly mature and too good or well trained, ready at age four, for example, to learn how to work with and care for younger children. They may know how to dress themselves, go to the bathroom totally independently, sweep floors with a large broom, and sit quietly without any argument for long periods of time. Older siblings in a sibling group may also be parentified, having been taught to take care of younger brothers and sisters.

In reality, their often traumatic experiences within the institution have taught and conditioned these children to be hypervigilant (on constant high-alert) and to take on expected roles without recognition of their own individual desires or needs. Their emotions and feelings are never considered in decision-making or in complying with institutional life. Asking these children how they feel leads to a blank or questioning expression, rather than to words such as happy, sad, scared that a normal three-year old understands, uses, and applies to herself. Internationally adopted children, whether from an institutional or deprivational environment, quite possibly have not had the positive human contact necessary for social and emotional communication post-adoption.

Helpful Factors in Adoption Transition

There are pre-institutional and institutional factors that help children adjust to their adopted families (Hopkins-Best, 1997). These factors are helpful for a parent to reflect on, as the transition at the time of adoption may impact a childs adjustment into the family:

• Children who have had few moves during their pre-adoptive years fare better, unless they have been seriously abused and/or neglected in any placement. Those who have had a secure attachment to a caregiver are more likely to attach to new parents.

• Giving the child an opportunity to see her caregiver/foster parent figure before leaving the institution or giving her the chance to go back to see her caregiver to say good-bye, allows the child to transition with the blessings (and often tears of joy) of that caretaker.

• Toddlers who have had a chance to transition to the adoptive family with preparation, gradual visitation, and even overnights, do better than those who suddenly are placed with a familynever to return to the orphanage again, not able to say good-bye to friends and caretakers.

• Some children are just inherently more resilient than others. Resilience is a relational trait. An adoptive parent can consciously help instill a healthy resilience within an adopted child.

Your Role as a Parent

A major task of parenting is to first give a child emotional and physical safety, above all else, and to help a child develop the abilities to meet all of the needs with self, others, and the world. (Rosenbloom & Williams, 1999) All parents want a healthy child, whether that child joins a family through birth or adoption. Its probable that they want a child to:

• be able to attach and be intimate

• become autonomous and independent over time

• feel safe and secure with them

• trust them

• develop self esteem

• develop a conscience

You need to remember that the child may have experienced neglect, poor nutrition, lack of stimulation or potential for attachment, inconsistent caregivers, and various forms of traumatic experiences including physical abuse, sexual abuse, and witnessing of violence toward others (including other children). It is important to begin to think about what will happen in this childs life as she grows into maturity, and how her early environment has impacted her.

Attachment between a parent and a post-institutionalized child begins with the parent. It is up to the adult to begin the process by creating an empathic, safe, caring, loving environment for a new child. It is up to the adoptive parent to model communication, affection, coping, and emotional modulation.

It is up to him or her to remain in control if and when the child does not. It is also up to the parent to take good care of him-or-herself in order to take good care of the family. Parents provide the love and nurturing and also provide the rules and structure. Treating new children with respect and maintaining a sense of hope will affirm and reaffirm that they have found a forever family. Suggestions for modeling and instilling hope include the following:

• addressing the child in positive language

• setting a sense of order and structure

• setting realistic limits and rules

• providing physical nurturing and attention

• providing emotional nurturing

• having consistency in bedtime, mealtime and other routines

• using eye contact with the child

• praising the childs behavior (you did a good job)

• keeping calm when the child is having a meltdown

• recognizing and stating that a behavior is bad, the child is not

• being the lead on giving affection and encouraging reciprocity from the child

• stopping manipulation of parents (if there are two)by being on the same page

• holding the child accountable to learn and to abide by the rules

• practicing healthy self care by having a life outside the home

• teaching the child to problem solve as soon as language allows; prior to that, keeping language short and simple

• giving the child choices right from the beginning

• developing non-punitive strategies for bad situations

The Negative After-Effects

What does a deprived or neglected institutional background mean for a newly adopted child and his family? The issues below affect many adoptees to many different degrees. Parent awareness and/or professional assistance can help turn-around, or at least modulate, the negative after-effects of institutional living. Not every issue will disappear entirely, but a parents initial high expectations may shift to an enormous appreciation for the courageous work a post-institutional child is willing to do, in order to become family.

Medical Records. Parents may not get an accurate medical history or may have no medical history or family background; the medical records may be sporadic and spotty. When parents bring a child home, it is important to get a thorough medical examination, including age-appropriate screenings and an assessment of the childs growth and development. In addition, it is important that the child have an assessment of her nutritional status. Contact and meet with a pediatrician familiar with the height and weight charts for the childs birth country (or supply them yourself), to set norms for your child.

Emotional Development. Many children have slow emotional development because they have never been allowed to express emotions (some call this The Silence of the Kids). Many have never learned how to modulate emotions. They may have problems with affect dysregulation (emotional reaction) and be diagnosed as hyperactive or attention deficit disordered. They may have problems putting feelings into words and act out with poor impulse control instead. They may not have the words to describe internal physical or emotional states. They have never even been asked how they feel, let alone know what a sad, mad, or glad feeling is.

Attachment Difficulty. Those children may have an attachment problem and have difficulty with affection and emotional intimacy. On the extreme end of the attachment spectrum, children have Reactive Attachment Disorder, which is a complete inability to connect in a reciprocal fashion. Many post-institutional children have difficulties giving and receiving love (because of their own absence of positive touch and loving,) and do not trust others, primarily due to lack of physical and emotional contact with a primary caregiver. Attachment is reciprocal, is based on love, and takes time to develop. New parents sometimes confuse a Trauma Bond (which is instantaneous and based on terror) with an Attachment Bond when they adopt a child who appears to attach immediately.

Loss and Grief. Many children have a true sense of loss at leaving the orphanage and feel grief when they are separated from that world, no matter how awful it was. Even children adopted as babies and toddlers can internalize sad events of their young lives and exhibit ambiguous loss.

Age. A child adopted at over eighteen months of age, in particular, may have noticeable developmental delays. There is always the possibility that the child has a history of abuse, stored as pre-verbal memories and unable to be recounted. They may even be dissociated or repressed memories.

Sensory Issues. Some children may have problems regulating and filtering sensory input. These children may have problems regulating behavior control, temper control, and adapting to changes.

• The hypersensitive child can be fearful, cautious, negative, and/or defiant. The under-reactive child may be withdrawn, hard to engage, or self-absorbed.

• The motor-disorganized, impulsive child may have an extremely high level of activity and a lack of caution. She may appear to be driven and unable to settle down or organize behavior. She may over or under-react to loud, high, or low-pitched noises, bright lights, touch, foods with certain textures, coordination, touch, pain, odors, temperature, motor planning, attention, and focusing, among others.

• Some children may be inconsolable when hurt or frightened, unreceptive of attention or touch.

• Some may have little or no conception of personal space and property, constantly tripping over their feet, or falling down easily.

• Some may have no skills for conversation or friendship.

Post Traumatic Stress Disorder (PTSD)

Some internationally adopted children may have symptoms of Post-Traumatic Stress Disorder. PTSD is defined in part in the DSM-IV as: Being exposed to a traumatic event where a person experiences, witnesses, or is confronted by event(s) involving actual or threatened death or serious injury, and a response that involves intense fear, helplessness, or horror. Abandonment, institutionalization, loss of a primary caregiver, abuse, neglect and the swift and traumatic life changes in a childs world through the act of international adoption, can contribute to a child developing PTSD. PTSD must be addressed and treated for the child to realize his full emotional and cognitive potential. Not addressed and treated, a childs PTSD can impact the parent-child relationship, the childs self-perception, and other areas of the childs life. The symptoms of PTSD can interfere with or affect a childs attachment to her parents by limiting safety and trust development.

A few of the symptoms of PTSD in young children:

• Hyper-vigilance, anxiety and exaggerated startle responsesome children will be constantly on guard, looking for any danger that might befall them, and fearful of exploring the environment around them.

• Problems concentrating and focusing, and ADHD type behaviors due to increased levels of cortisol (a hormone secreted by the adrenal glands in response to any kind of physical or psychological stress).

• Less ability to give emotionally in a reciprocal fashion.

• Irritability or outbursts of anger.

• Difficulty with falling or staying asleep; including nightmares, night terrors or non-specific distressing dreams.

• Trauma-related fears that may not appear to be related directly to the original trauma (e.g. animals, darkness, and other triggers).

• Increased somatic (body) aches, and problems with stomachaches and headaches.

Love is not enough for some of these children who are at risk. They may have a multi-system developmental disorder that includes PTSD, attachment, and sensory difficulties. They cannot just be loved into normality and may need intervention programs. In time, these children do develop warm relationships, logical thinking and problem solving, and interactive communication (Doolittle, 1995) if they have access to the right types of therapy and highly involved parents. All adoptions of orphanage children should be considered by both prospective parents and adoption officials to be special- needs adoptions that require extra commitments of parents time, energy, acquisition of expertise, and willingness to work with professionals, agencies, and others who have adopted. (Ames 1997)

Read Part 2 of Positive Outcomes to learn how to help your child grow into his or her best present and future life.