The Situation in Orphanages

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 child’s 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 child’s 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 skills–no 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 making–key 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 inde- pendently, 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 child’s 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 bless- ings (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 family–never to return to the orphan- age 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 first to 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. It’s 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 child’s 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 child’s 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 parent’s 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 child’s 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 child’s 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 child’s 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 child’s PTSD can impact the parent-child relationship, the child’s self-perception, and other areas of the child’s life. The symptoms of PTSD can interfere with or affect a child’s 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 response–some 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 hor- mone 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)

The Positive Outcome

In spite of the possible abuse, deprivation, neglect, and lack of stimulation in the lives of many children who are available for international adoption, most children from orphanages and from the foster care system can and do adjust well to their new lives. Motivated, aware parents are a wonderful source of information, security, support, and love for a new child. “Parents are the one most important educational tool for a child who is being adopted internationally or nationally.” (Kincaid, 1997).

What this means is that, in spite of all the possible negative outcomes that might occur due to institutionalization, there are also positive outcomes to placement and adoption that are within a parent’s power to influence. A child’s ability to recover from trauma is heavily based in innate or learned emotional resilience “an ability to recover from or adjust easily to misfortune or change”.

Creating the ‘Whole Child’–Teaching Resiliency. Parents can help a child successfully combat the effects of his or her pre-adoptive life by using a team approach. Seeking prompt professional help for the specific medical or psychological issues a child exhibits is extremely important, however, parents can also help to create a ‘whole child’ at home. A resilient child with coping skills is equipped to overcome many of the effects of trauma, PTSD and institutionalization. Resiliency is an invisible protective shield; the good news is, it is a trait of internal strength that can be taught by parents, and intrinsically developed.

What are Four Traits of a Resilient Child? A resilient child is socially competent and exhibits empathy, flex- ibility, and caring. These children understand interpersonal give-and-take and have a sense of humor and a coop- erative nature. A resilient child has problem-solving skills and can seek help, plan and look for alternative solu- tions. They use abstract thinking, can look ahead to the future and are able to delay gratification. Autonomy (ability to act and think independently) and self-esteem empower a resilient child with the ability to bounce back with confidence and faith in personal ability to prevail. Resilient children have a sense of purpose and future. They are hopeful, and own a positive view of reality. Their lives have meaning and a spiritual context, and they have a celebratory nature.

Teaching Resiliency. Awareness of the traits that emotionally strengthen a child allows the parent to design daily living activities to teach and reinforce the tasks and skills that build resiliency. To help a child learn problem- solving skills and autonomy, and to develop social competence and a sense of purpose and future, a parent can deliberately include the following into family life:

• Assign the child small tasks; break larger tasks down into manageable segments.

• Establish simple rules that the child can understand easily; do not make them abstract or complex.

• Identify any interests/skills the child has and use them for positive reinforcement. Help the child become open to new experiences.

• Notice when the child responds by laughter or makes a joke, then compliment his abilities and responses; agreeableness is a desirable trait in a child. Try to encourage it.

• Give the child choices among two or three items, situations, or activities that are ‘no loss’ choices (all choices are positive). Then commend the child for choosing, whatever his choice.

• When the child has appropriate language skills, ask the child to identify and name the possible choices, and then choose one.

• Use play to reinforce problem-solving skills.

• Affirm the child’s perception of reality.

• Introduce new activities consistently, again in small doses.

• Help the child find an outside interest or hobby and pursue it.

• Celebrate the child and his or her life in any way possible!

Children who gain coping skills and mastery over their environment are building resiliency. It is a trait that empow- ers a child to deal with childhood trauma, and is key to the healing, therapeutic process. It may take a team of parent, child and professional(s), including a multi-disciplinary approach to bring a post-institutionalized child a posi- tive outcome. Trauma, attachment, sensory, and speech and language work benefit by being addressed simultane- ously as part of one whole: the child. The parent is integral to a child’s positive outcome, and can support the work of professionals by reinforcing the healing process at home.

Helping Children Heal. Parents can make the home, and the parent-child relationship, an emotionally safe place for recovery and re-growth. They can provide comfort and reassurance for their child, set clear boundaries and maintain routines. In addition, a parent can:

• Respect the child’s fears (avoid giving the fears too much credit).

• Avoid new and challenging tasks; use consistency and repetition.

• Monitor and limit exposure to fearful situations.

• Increase child’s physical outlets.

• Give child opportunities to talk about feelings (in limits); listen to and accept the strong feelings of the child.

• Expect regression to a degree.

• Listen for distortions and misunderstandings, and take the opportunity to offer facts.

• Keep anniversary reactions in mind (a child can be affected by abandonment or adoption dates, birthdays, etc).

• Help children focus on images of strength and survival.

A parent who can teach active action-based coping skills, foster resilience, and maintain a healing environment at home can heavily stack the child toward a healthy new beginning. Combatting the effects of an international orphanage takes patience and hard work and may also need specialized professional intervention. Strong parental love, commitment, and determination help children who have the ability to attach and love develop positive relationships.

Mary Beth Williams, PhD, LCSW, CTS specializes in the treatment of trauma-based disorders, including those related to disorganized attachment. Dr. Williams was a school social worker for many years and is familiar with special education related issues, as well. She is the author of many trauma-based workbooks and texts, including Life After Trauma (Second Edition: 2010) with D. Rosenbloom and The PTSD Workbook (2002) with S. Poijula. She is the parent of seven children. Four of her children were adopted, two of them domestically, and two from Kazakhstan.

This article has been reprinted from Adoption Parenting: Creating a Toolbox, Building Connections. EMK Press