Alone No More: Recognizing Post-Adoption Depression

Before we traveled to China the second time, we were prepared for countless “what ifs,” including our new daughter’s potential attachment struggles, sibling rivalry, adjustment challenges, developmental delays and a range of physical problems. Despite our endless preparations, I still made assumptions, perhaps the most dangerous being that I would not have issues adjusting to my much-anticipated second child. I had glanced through articles and browsed Internet group postings about parental adjustment issues including Post-Adoption Depression Syndrome, or PADS, but I never thought I would experience some of its challenges.

What is PADS?

June Bond coined the term PADS in a ground-breaking 1995 article discussing occurrences of parents, often mothers but sometimes fathers, suffering from an adoption-induced depression that shared symptoms of the better known and more commonly researched Post-Partum Depression Syndrome, or PPDS. The best definitions use PPDS as a starting point and provide a range of severity from “baby blues” to clinical PADS. As parents we may and should expect to feel some level of post-arrival anxiety, confusion, disappointment and minor depression. Karen Foli and John Thompson in “The Post-Adoption Blues” provide the following definition:

“[Post-adoption depression is] a mood disorder that occurs post-placement or post-adoption of a child. Post-adoption depression can be classified as mild, moderate or severe . . . The onset of depression can occur days or years after the child joins the family. Prevalence is unknown. Duration is greater than 3-to- 12 months. Post-adoption depression can be episodic, with remissions and reoc- currences. More research is needed to fully describe this mood disorder.”

What is clear from the current research is this: post-placement and post-adoption depression is a continuum from minor and temporary adjustment challenges to more severe, long-term and recurring responses. Wherever we may be on this continuum, we must first build awareness not only that depression can happen, but also that it is normal and natural. We are not bad parents because we are struggling with the enormous change, responsibilities and challenges we now have in addition to our beautiful child.

Clinical depression is a common disorder, affecting 19 million Americans or 6.6 percent of the population each year, according to the National Mental Health Society Web site. Various studies and surveys indicate that 16 percent to 25 percent of the population will suffer from a major depressive episode in life. Recently, while I was reading a popular women’s journal, I noted not one but four advertisements for anti-depression drugs and two articles discussing depression. Depression is real and can have negative and extreme consequences in our lives, impacting our children, spouse, work and friendships.

Preparing for the Possibility

Adoption placing agencies and social workers are now discussing PADS with soon-to-be parents as well as offering follow-up counseling and seminars covering a range of topics, including PADS. This awareness and the related service offerings are a sign that the community is recognizing the validity of PADS. Still, many parents have not yet heard about PADS and may not until they are faced with its struggles first-hand.

If you are soon to become a parent through adoption — either for the first-time or again — you can prepare now for the possibility that you or your spouse could struggle with post-adoption depression, from mild to severe. Preparation can minimize the possibility or severity of PADS, as well as provide you with a framework to fall back on when you are not functioning at an optimal level.

First, recognize that you may struggle with some form of PADS after the adoption. This step is perhaps the hardest. We may want to continue in a denial state if we do suffer from PADS. We have dreamed about this child for so long; we have gone through paperwork and red tape processes; we have imagined in full technicolor what our life with this child will be like. If we encounter problems, we may want to ignore them or explain them away instead of evaluate if we have an issue that requires us to seek help. We may know we are struggling with some sort of depression, but feel ashamed and frustrated. We feel we are failing miserably at this parenting thing which everyone else seems to pull off without a problem.

You can improve your understanding of PADS and other post-adoption issues that may occur by reading published materials and attending any seminars offered by your agency, social worker or local support groups. In addition, you can plan now for built-in protection and support structures. You might also consider protective parenting measures, caregivers or babysitters for children and professional help resources. I struggled with feelings of loneliness and failure during my depression. In my research and discussion with other parents, I found loneliness to be a common theme for parents with PADS. You can protect yourself by educating family and friends on PADS in advance.

Validating the Issues

If you find yourself struggling after placement of your child, you may wonder how you will know if you need to seek professional help. The following exercises may help you determine if you need professional services.

Journaling

Journaling is a simple act that has amazing diagnostic and therapeutic attributes. Set aside some time each day, often the beginning or end of the day is best, and write. Write about the day, your emotions, your thoughts, your physical state, your appetite and more. Just write. You may write a little or pages and pages of what is mostly nonsense to you. Do not self-edit as you write. Do not be afraid that others will see what you are writing and judge you. The point of this journaling is to get on paper a reflection of your life right now. Then, each day read what you wrote the day before. One day removed, you may “see” some of your challenges, why you feel the way you do, what situations cause you anxiety, fear, grief, anger or other emotions. Through journaling, you may be able to recognize areas where you can “self-help” and modify your life and actions. You may realize you are struggling with depression and need to seek help from others. Journaling will also help you with the more quantitative assessment provided in the next exercise.

Quantitative Assessments

Today, no recognized and tested diagnostic tools exist for PADS specifically. Most authorities rely on one or more general or post-partum depression tools when discussing PADS assessment. The PostPartum Depression Screening Scale by Beck and Gable is one of the more current and recognized tools. A clinician with experience to interpret findings and provide assistance administers these assessments.

When interviewing adoptive parents for “Post-Adoption Blues,” the parents reported feelings in six of the seven areas identified by the PPDS scale. As a rough personal assessment, if you are experiencing five or more of these issues five out of seven days of the week for two or more weeks, you may suffer from PADs:

Sleeping or eating disturbances
Anxiety or insecurity
Emotional changes or mood swings
Guilt or shame
Mental confusion
Suicidal thoughts
Loss of self

PADS does not come in a “one size fits all” model. As in all of life, we have unique experiences, stresses, requirements and needs. We may change job situations, struggle with health issues, grieve lost loved ones, juggle older children’s schedules and needs — today almost all of us live lives that are too busy and stressed. While the name post-adoption depression indicates that we suffer perhaps only because of an adoption, this is not necessarily true. My second daughter did not cause my struggles, instead I had my own Molotov cocktail of a high-stress job, the regressive and jealous behavior of my first daughter, the absence of daytime help for most of the first three months and my own dreams about how well I would juggle all this — be super mom, wife and business professional all in one. Ironically, following the attachment advice of providing all care for my daughters exacerbated my circumstances as I desperately tried to deal with the emotional struggles of my first daughter during the adjustment of having a sibling while furtively providing care to my second daughter in a way that would not escalate the situation.

“I thought I was the failure: that I couldn’t mother well. In fact, neither I nor my child was the problem. Each of us was coping with the transition to family as best we could...” Sheena Macrae, editor Adoption Parenting: Creating a Toolbox, Building Connections

I have been privileged to talk with many other parents struggling with PADS. Anna Cooper, who tragically lost hermother on the day of the referral of her daughter, described the first few months after her daughter arrived as being “alone — completely and utterly alone.” She pushed on for months, believing she was at fault. “I felt that I had to be strong and put on a brave face because that’s what mothers did and that any sign of weakness from me, and I would be viewed as an unfit parent not only from society but from my friends and family members as well,” she said.

Seeking Help

The first thing you need to do if you suspect you are struggling with PADS is to talk to your spouse or, if you are single, to a trusted friend or family member. You need to get some of your worry, your nightmares and anxiety out. You also need the other people involved in the day-to-day of your life with you and your children to be aware.

The next thing you need to do is to activate your plan of support. Enlist friends and family to help in whatever way you need. Use creative and active outlets for frustration, anger, fear and all those other black and blue thoughts. Physical activity often has a dra- matic impact on our emotional state: take walks, ride a bike or join a yoga class. Practice as healthy and balanced a diet as possible. Begin journaling or painting to release some of the emotions. Continue to talk to your spouse or a trusted friend. Seek spiritual comfort and solace from your faith. And, do not forget to protect yourself and your children by following common sense parenting methods that allow you to walk away if you cannot respond appropriately to a stressful situation. When pushed to a breaking point give yourself permission to put your child safely in his or her room for a few minutes while you find sanity again.

If you do not have someone you can share with face-to-face or you are interested in a larger support group, consider joining an online group. Other more general adoption online groups may provide support and encouragement while you deal with challenges. One woman I spoke with shared her longings for support, for “someone I could really talk to and not be made to feel bad or depressed.” Connecting with others who have shared your struggles will validate your feelings and remove some of the loneliness.

In talking with families, I have found many who struggled the first three to six months and speak of progressive improvements instead of immediate solutions. If you have recently brought home a child, give yourself and your family time. Remember, your life has become something new you do not recognize. You have to adjust to your new life and that takes time. Your children also must adjust. Give yourself some time while you use these support structures. Healing for me has come in stages — when my first daughter began to sleep without nightmares, when I went back to work full-time and gained some time away — I achieve some balance, but little recognition. Then, when I could name my feelings and accept them as normal, but something I needed to improve, when our daughters became true sisters in action and deed, when I confessed my struggles to my husband and even now in researching and writing this article, I have reached other points of awareness and health.

Not Love at First Sight?

Finally, if your depression continues, you need to seek professional help. With all other depressions, the recommendation is to first see a physician. Your physician can assess your physical state, determine if you have any other issues that need to be addressed, advise you on counseling services and, if appropriate, provide anti-depressants or other medications that can stabilize a downward spiral. For women, remember hormones and even perimenopause or menopause could also be involved. Next, you may wish to visit a counselor or therapist. You will want a therapist who understands PADS and depression. You can seek recommendations from your doctor, social worker, adoption agency, local support groups, friends and family.

For the Future

What have we accomplished in the last decade? We have at least one book on PADS, journal articles in adoption journals and Web sites, an increasing awareness and active discussion of PADS among adoption agencies, social workers, professionals and parents. I am excited to see the progress in building a community of care where our adoptive families and friends can find validation, support and care. What we do not yet have, but need, in our community for PADS includes:

A clinical definition of PADS.
Professional developed and tested diagnostic tools specifically for PADS.
Public definition — discussions in mainstream parenting magazines and medical journals.
Public validation — we must often explain and educate our family, friends and co-workers.
Therapy resources — lists of counselors for PADS, treatment methods, medication and recommendations made generally available.
More research and studies.

As Cooper shares, PADS is normal. “Because you are experiencing this doesn’t make you a bad parent. It’s quite a normal occurrence and most importantly, there is help available,” she said. “And it’s OK to ask for help; no one is going to view you as an unfit parent if you need help. Adoptive parents do not have to be the ‘super’ parent. They just need to be parents that are super.”

I have learned to take one day at a time and focus on the joys my children bring me. Depression is not resolved overnight, but I now recognize that it is normal and
does not mean I have failed as a wife, mother or woman. I have chosen to talk
with my spouse, close friends and family and have found concern, love and validation, not ridicule or misunderstanding. Finally, I remember it takes time to heal and even after we have returned to “normal,” we will have bad days. With knowledge comes power and with communication comes accountability. I am no longer worried I might drop back into that scary and lonely place.

I now know I am alone no more.

This article was shared by EMK Press, Realistic Expectations The First Year Home. EMK Press publishes a variety of books and helpful resources for families on their journey of parenting.

Alone No More: Recognizing Post-Adoption Depression

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