“Adopted children must learn the important developmental skills of connecting their feelings with their thoughts and actions.” (Dee A. Paddock, MA, MTS, NCC)

Fear, anger, loss and grief. Most of us would prefer to not have to deal with adoption fall-out. It is emotional, messy, complicated stuff that most of us were not raised to handle. 

But somewhere between the ages of four and ten, our adopted children begin to realize that in gaining an adoptive family, they have suffered some very significant losses.

Suddenly, they need help interpreting both their positive and negative emotions and they need acceptance for what they’re feeling on all levels. They look to us for help, and if we can’t, or if we come up short, they proceed on a long, lonely journey all by themselves.

Adoption fall-out is an opportunity that parents should grab with both hands! It is a chance for you to stretch yourself as a mom or dad, and a chance to keep your child fully in your life. Typically, fall-out first begins in the car, on the schoolyard or at bedtime. It may start with a single question. It can enter your life with a child’s amazing and bewildering breakdown, or creep in silently with a child’s sullen look and angry silence. It is often attributed to “ages & stages", and it may go underground…but it doesn’t go away.

Once we parents realize what we’re dealing with, how do we ever equip ourselves with the tools to help? How do we teach our internationally adopted children to cope with the sources of adoption fall-out, and how do we give them what they need to grow? How do we help our children, mostly pre-verbal when adopted, express the feelings of anger, sadness or confusion over the life choices that were made for them—emotions that they may carry but can’t explain?

Teaching our children to understand their emotions and allowing them to express their feelings about the beginning of their lives is a powerful first step toward fall-out containment. Many of our internationally adopted children come to us with very little history, and a very big need to know the "facts" of how and why they began with one set of parents and ended up with another. They crave a structure of knowledge that will help them navigate the enormously complex feelings that accompany abandonment. They need hands-on context to aid them in keeping their self-esteem while dealing with feelings of unworthiness, and the ultimate core question: why didn’t my birthparents keep me?

The Seven Core Issues in Adoption can provide parents with the insight and information needed to create a toolbox that will enable them understand the feelings of an adopted child. Deborah N. Silverstein, LCSW, and Sharon Kaplan Roszia, MS, have identified universal adoption issues that trigger emotions that are experienced, to some degree, by every single adoptee:

1) Loss

2) Rejection 

3) Guilt and Shame

4) Grief

5) Identity

6) Intimacy

7) Mastery / Control

These seven issues are the basis for an adoptee’s thoughts, feelings and reactions. They are a parent’s key to understanding a child’s perceptions of herself and her view of her biological and adoptive families. The seven issues are inter-related and overlap, and they decisively affect most every aspect of an adopted child’s life.

Rather than being viewed as a pile of negative emotional baggage, the seven core issues can be utilized by an adoptive parent to guide a child to self-awareness, strength and resiliency. Some of the seven issues have a panacea-- "prescriptions" that a parent can apply to help a child grow and heal, while others simply demand acceptance. One of the hardest things for any parent is to see a child in pain and not be able to make the pain go away, or fix what is wrong. Especially in adoption, a parent’s role must sometimes be the "facilitator", instead of the "fixer" that we’d really like it to be. The facilitator role is an important one however, and it is essential to an adopted child and her family circle.

Psychologist Doris Landry has created a set of four prescriptive tools for parents to use to help them steer their children through the seven issues, and to alleviate some of the alienation and confusion categorized by Silverstein and Kaplan Roszia. Children who are dealing with core issues may be helped with one or more of the following:

• Education

• Understanding

• Ongoing Awareness 

• Acceptance

A parent’s job entails guidance and support; it requires a mom or dad to allow and encourage a child to feel every emotion deeply, while using the education, understanding, awareness, and acceptance tools that give a child permission to move forward. For an adoptee stuck in a core issue, the world is a scary, insecure place. Mom or Dad might not be able to fix the world, or a child’s losses, but according to therapist Dee Paddock, parents have an important role. A parent…

"…can model doggedness, mastery, moral courage, love and hope. Our adopted children can grow into adults who are optimists, who believe it is possible to transcend sorrow and fear, and that things do change."

LOSS
Through abandonment and adoption, our internationally adopted children lost their birthparents and biological siblings, and their extended family of aunts, uncles and grandparents. Our children lost their birth country, birth culture, racial identity and language. Some of our daughters and sons lost orphanage caretakers that they cared about; others lost foster families that they had loved and lived with since birth.

Children who have lost their birthparents, foster parents or primary orphanage caretakers have had the rug whipped out from underneath them one too many times. They come to expect fear and loss as a normal consequence of loving and living; they know it can happen at any time and without warning, because it’s happened to them before. Internationally adopted children can suffer from intense separation anxiety, and may have difficulty with transitions and separations of even the innocuous kind. Camp, sleepovers, moving, or attending a new school are small hiccups that can re-awaken conscious, or unconscious loss issues. A parent’s death, divorce, or hospitalization are severe trials that need to be recognized as major earthquakes for a child with a previous loss trauma.

Birthmother loss is especially poignant for an adoptee. A birthmother’s rejection cuts deeply, sharply and permanently. If a child was adopted as an infant, the birthmother is the person the child ‘remembers’ on an unconscious, primal level, and is symbolic of the “loss soup” that contains the overwhelming longing an adoptee may feel for her previous life. As a parent you can give your child permission to love two mothers, one who gave her life and one who will take care of her, make good choices for her and love her forever. You can also give your child permission to feel anger at the choices a birthparent made for her. Abandonment may have been the birthmom’s only choice, but even if a child understands this intellectually, it still hurts and the hurt needs to be expressed. Your child may even need permission to express feeling angry with you – for not being there when she was a baby and needed you, or for ‘stealing’ her away from her birthmother and country. Some children get temporarily caught in birthmother loss and need concrete ways of processing:

• Include the birthmother in normal conversation with your child. 

• Celebrate adoption day, your child’s birthday or Mother’s Day with a birthmother honoring ceremony the day before the holiday (“Mother’s Day Eve”). Help your child make the day of her own symbolic design, using letter writing, picture drawing, cake-baking, candle-lighting or moon-wishes.

Reinforcing a place for two “real” moms within one family is a unifying gesture, and one that affirms the reality of a child’s love and loss, past and present. It's important to remember that focusing on adoption loss does not equate with fixating on unhappiness.

There is no tool to ‘cure’ loss, and there is no closure. A parent’s understanding of a child’s loss won’t make the loss go away, but it will forge an empathic parent-child liaison based on honesty and trust. Acknowledging loss is an important first step in acceptance and moving forward for our children, and we have to stop ourselves from trying to amend their reality by painting an entirely rosy picture of their early lives—a rosy picture that may not entirely jibe with what they are feeling inside. Our children don’t need us to make life pretty; to grow, they need to be taught to examine their feelings and be able to decide if loss is unfairly over-influencing an emotional reaction. Adoption loss can’t be eradicated, but a child can learn to recognize it, own it, channel it and control it.

LOSS SOUP: "When my daughter from China was four years old, we went into the trenches together to address her adoption issues. I agonized over how to address the loss in her life. Who was she mourning? What was causing her pain? It seemed like she was fiercely grieving an actual person; did her dimly remembered foster mother figure more prominently in her “sads” than her lost birth mom? Which loss should I focus on when talking to her about her past? The therapist told me it didn't matter; that my daughter's multiple losses were dumped into one pot, and that I needed to address them not as separate incidents or separate people, but as one FEELING.

Loss Soup. My daughter and I went for the loss ‘feeling’, knowing we couldn't banish it, but both of us learning to live with it. I include myself here, because although it was my daughter's story and her pain, I also had to learn the skills that would help her-- and help ME put aside my stoic upbringing and be the mom she needed. It is heartbreaking to watch a child in any kind of physical or emotional pain, but it is strengthening to work through the pain together. Adoption loss doesn't go away, but it can become a dimension of joyful living, rather than a sad view of life." (Jean MacLeod)

REJECTION
A child’s feelings of rejection are directly related to abandonment. Children without a way to express their confusion, fear, sadness and anger over their perceived rejection by their birthmother, may act out with inappropriate tantrums or behaviors (or act in, with depression, boredom and withdrawal). A child may be extra controlling, or exhibit intense anxiety about loss or separation. Adopted children may feel shame ("I must be bad / unlovable for my birthmother to have given me away") and live with poor self-esteem. Adoption is a lifelong process; understanding the ongoing need for communication and learning the words to use may feel simplistic, but it is part of the prescription:

Does your child have words to identify and regularly express the four basic emotions that people are born pre-wired for?

Mad, Sad, Scared and Happy

Some children really have no idea why they are feeling the way they do inside-- no one has helped them make the connection between their lives/losses in their birth country and their current feelings. They do not understand what is triggering their reactions, and over-reactions. They honestly do not know why they are feeling angry, why they are taking it out on their mom or dad, and why they carry so much inexpressible emotion. Once they become aware their relief is often immense, and they can begin to work on coping mechanisms.

Does your child have your permission and encouragement to express her feelings? 

"I wish I still had my birthmother" is hard for a child to say if she believes her mom would be sad or angry in hearing the truth about what she thinks or how she feels. If a mother takes it personally, it is far too risky for a kid to be honest ("my mom will leave me if I tell her this"). Our children's #1 fear is of abandonment, and they will suffer in silence if that's what it takes to avoid causing the unthinkable to happen again.

GUILT and SHAME
Guilt and shame are by-products of rejection. They are a child’s paralyzing, toxic reaction to the belief that something must be intrinsically wrong with them, or that they must have done something really bad, to have caused their own abandonment. Shame is secret and silent. Adults understand that birthparents have grown-up reasons to relinquish a child, but children view the act personally as a reflection of themselves, and are deeply ashamed of not being ‘good enough’ for a mother to keep. The prescription for shame is to blast it out in the open and help children understand that their ‘rejection’ and abandonment was not about them:

"Detect it, Expose it, Dump it!”

Shame and guilt can only exist in dark, untouched secret places. Bringing the reasons for a child’s self-incriminating feelings out into the light and exposing self-held secrets to the truth will begin to eliminate shame, rejection and guilt’s internalized triple grip.

GRIEF
A pro-active parent can help their child explore the past, live fully in the present and develop the resilience necessary for the future. Therapeutic parenting is a term that describes the extra level of pro-active parenting that is required to help a child discover and recover from their childhood trauma. Children exhibit expressions of grief according to their experience and their temperament, and they may present grief in very different ways. Some children display sadness by fighting, some are unable to play, and some children demonstrate little expression and no excitement about life in general. Others are excessively nervous or shy, and worry more than is normal.

A therapeutic parent uses all four tools (understanding, awareness, education, acceptance) to help a child with grief. A parent can gain valuable insight into a child’s feelings by introducing sensitive or painful topics, by really listening, and by being watchfully aware of a child’s activities. The content of a child’s imaginative play is a window into what they are feeling, and by observing without interfering, a parent may be able to decipher if a child is trapped in the grieving process. Without skills to become "un-stuck", a child will repetitively play out his or her issues. A useful twist on ‘misery loves company’: a therapeutic parent using the four tools can relieve a child’s burden by sharing play and conversation, and by examining and validating the child’s emotions. Part of the miracle of therapeutic practice is that simply talking about an inner issue like grief can take the issue outward, re-shape it, and change a child’s perceptions about it.

MASTERY AND CONTROL

"The adoptee often feels as though he/she has had no control over the events of his/her life. Decisions surrounding relinquishment, choice of adoptive family, and information to be shared with them were all made by other people. The adoptee feels helpless and frustrated that life seems to be a series of uncontrollable events. As a result, the adoptee’s need to be in control of "something" often becomes a problem." (Judy Bemig and Betsy Keefer)

Paradoxically, post-institutional (PI) adoptees suffer from a lack of control over the early-life decisions made for them, and also suffer from demanding too much of the unnatural kind of control, at too early an age. Ideally, children learn autonomy in steps, and learn control over their world under the watchful eye of their mothers. A healthy bio infant/toddler trusts that his or her world is a safe place to investigate and master (control). An abandoned, PI child skips over the trust, to desperately trying to control his or her environment in order to survive. A child that is having difficulty dealing with the seven core issues is unable to let herself believe that "father or mother knows best" and will engage in continual power struggles with her parents, and anyone else in authority. These children must control friends, play-dates, conversations and parental attention. Some children will feel pushed to hoard food, tell lies, or even steal, in order to demonstrate complete control over their own world. A child lives through an orphanage experience by taking care of herself; to later trust an adult to take care of her feels dangerously life-threatening.

Part of the control problem is solved when the parent and the child become aware of what the underlying problem really is (an adoption issue), and what is fueling it (a child’s base fear for survival). Working on changing control patterns takes dedicated, non-punitive action and lots of loving, but firm limit-setting. A parent needs to withdraw the unnatural control and decision-making from the adopted child and work at building a basis of trust and love. The adoptee has to learn to allow the adoptive parent to make good choices and decisions for her, while the parents continually demonstrate trustworthiness. Giving the child the gift of healthy, inner self-control is based in attachment-parenting plus parent control, enforced with kindness and affection. When an adoptee feels safe, and in control of her inner self, some of the need to control the outward universe disappears. Although frustrating, the hard work a parent does with an adopted child on her post-institutional behaviors should be an affirming experience for both; shame is debilitating for a child and anger is self-defeating for the parent.

IDENTITY

“Adoption, for some, precludes a complete or integrated sense of self… Adoptees lacking medical, genetic, religious or historical information are plagued by questions such as: Who are they? Why were they born? Were they in fact merely a mistake, not meant to have been born, an accident?” (Silverstein and Kaplan Roszia)

Helping a child develop an identity that includes the past, the present and the future is integral for a child to feel whole. An adoptee’s realization of the blank space in their family history exacerbates the hollow spot they carry inside, with a profoundly sad result.

Past Identity: Without a foundation to build upon, a structure crumbles. Creating an honest life narrative, or Lifebook, helps provide a sense of history, or life structure, for adopted children. Our internationally adopted sons and daughters come to us encoded with information that we can backtrack, react to and connect with. Everyone has a story, but the facts of an internationally adopted child’s babyhood are not as important as how she feels about her early life, how she interprets pre-adoptive events, and how she views her place in the world. Resilience, a trait that allows a person to view and react to adversity as a challenge rather than as a trauma, plays a large part in how a child defines herself through ‘past identity’. A child who suffered a harsh orphanage experience had a difficult start in life, but can be taught by a parent to be re-defined by her bravery and courageously strong survival skills. A ‘powerless victim’ internal working model can be changed; not by ignoring sad facts, but by embracing them.

“Reframing is at the heart of resilience. You go back to an incident, find the strengths, and build self-esteem from the achievement. It is a way of shifting focus from the cup half empty to the cup half full…” (Hara Estroff Marano)

Resilience may not be an innate trait for some, but it can be learned. Parents play an integral role in modeling behavior and feelings, and by demonstrating their own resilient responses to life. Resilience researcher, Dr. Steve Wolin, believes that the give-and-take, the emotional insight, and the support that are components of a healthy reciprocal relationship, will ultimately generate self-esteem and permanent, integrated strength in an individual building internal reserves.

Present Identity: A child’s identity in the present is to a large degree, familial. It is a huge comfort for a child to feel that she belongs in her adopted family, that she has full membership along with her parents and siblings, and that the membership can never be revoked. A child derives strength from kinship and family claiming behaviors! A parent can emphasize family by celebrating connections, and by dedicating time and importance to building a strong family foundation. Building awareness and mutual a 

• work and play together

• describe and appreciate the special attributes of each family member

• brainstorm family goals

• talk about family unity

• design simple family rituals

• celebrate spiritual or religious beliefs 

• draw or talk about what families do to stay close

• ask each member to list three things that make it difficult to stay close, then problem-solve the difficulties as a family (Landry)

Some adopted teens and adults cite feeling alienated from their adoptive families; it makes sense that time, effort, and priority should be put toward underscoring the fundamental need to be together. A strong family provides a safe base to explore from for a child, and a secure safety net for a teen experimenting with independence.

Future Identity: Family claiming and connection, life narratives, and Lifebooks are tools to help a child learn to integrate her past, understand the present and take charge of her future. Giving a child ownership of her life story and her thoughts and feelings builds a foundation for further construction. Kaplan Roszia and Silverstein warn that a:

"Lack of identity may lead adoptees, particularly in adolescent years, to seek out ways to belong in more extreme fashion than many of their non-adopted peers. Adolescent adoptees are over-represented among those who join sub-cultures, run away, become pregnant, or totally reject their families."

Reinforcing your child’s whole identity, co-creating and re-framing her story while facing the difficult truths together, will strengthen your child’s trust in herself and help give her the resilient fortitude to live with past, present and future shadows.

INTIMACY
For a young child, intimacy is measured in peer friendships and in a child’s relationship with her parents. If a child is grappling with adoption issues, it can interfere with all of her interactions. Grief, shame, loss and rejection may motivate a child to steer clear of any relationship with potential to bring more of the same.

“Adoptive parents report that their adopted children seem to hold back a part of themselves in the relationship. Adoptive mothers indicate, for example, that even as an infant, the adoptee was “not cuddly.” Many adoptees as teens state that they have truly never felt close to anyone. Some youngsters declare a lifetime emptiness related to longing for the birthmother they may never have seen.” (Kaplan Roszia & Silverstein)

Working on the intimacy issue requires a great deal of trust, communication and vulnerability from children, and from adults. A parent must be willing to discuss topics that are uncomfortable (infertility, for example) and be willing to participate in painful conversations (a child wishing for her birthparents). It is up to the parent to introduce adoption subjects, and to be willing to accept the notion of a child’s biological family as an intimate part of their own. A parent who is distressed or embarrassed talking about personal issues or who refuses to visit the loss-laden ‘dark’ side of adoption, will not be helpful to their child and will probably not get many shots at parent-child intimacy, either.

Holly van Gulden and Lisa M. Bartels-Rabb, authors of Real Parents, Real Children, suggest using the Pebbles Technique to open a conversation about a sensitive adoption topic.

"Pebbles are one-liners, not conversations, that raise an issue and then are allowed to ripple until a child is ready to pick up on it."

An example might be mentioning your child’s beautiful, black hair and wondering out loud if she got her hair from her birthmother…essentially, throwing out a conversational pebble for the child to catch. If a child chooses not to respond to the pebble, the parent has still communicated a willingness and ability to talk about difficult subject matter, and can toss out another pebble at another time.

Because adopted children are fearful of hurting their adoptive parents, and are unwilling to risk rejection, parents must be the discussion initiators. Parents must model understanding and acceptance, and pro-actively be part of a child’s internal world. An un-addressed intimacy issue can quietly decimate an important relationship, leaving a child alienated and a parent sad and confused. How intimate we are with our young children now, will have direct repercussions on their teen years:

"When an open, accepting environment in which the child can talk about and tackle adoption-related issues is established early on, the child will feel freer to turn to his parents to talk about problems as a teen. If parents deny their child’s feelings or sweep them under the rug, then the family—parents and child alike—will have no system for addressing them when they intensify in adolescence." (van Gulden and Bartels-Rabb)

Adoption fall-out is a blessing in disguise. Our children’s sadness, anger, confusion, and questions are all there for us parents to pick up and run with now, perhaps circumventing some of the bigger outbursts in adolescence. Adoption issues will continue to re-appear at times of transition throughout our children’s lives: entering school, moving, marriage, pregnancy and birth, divorce, medical interventions, deaths of friends and family, mid-life and old-age. How our children handle each challenge depends on their personality and on their preparation. The Seven Core Issues and ‘parenting prescriptions’ give us tools to interpret our children’s thoughts and emotions, and allow us the insight to guide them to self-awareness. We can’t fix the fall-out, but we can help our children with their feelings, and with their healing. We can demonstrate our own resiliency and teach our sons and daughters that their journey of adoption is more than survivable; that it has shaped them in remarkable ways, and with our help, it can also make them strong.

A Note to Parents
Adoption-parenting can be challenging, puzzling and frustrating. Our children are huge joys, but they come with to us with a history and a worldview that we sometimes need to work to connect to. If the seven core issues have raised their head in your household and you are in need of an additional skill set to deal with them, there is help! Attachment or adoption therapists are trained to understand the needs of internationally adopted children, the issues of loss, and the effects of post-institutionalization. 

For parent-recommended therapists, and therapists regiestered with the national organization ATTACh, please visit: ATTACh

REFERENCES
Lifelong Issues in Adoption
By Deborah N. Silverstein, LCSW, and Sharon Kaplan Roszia, MS

Doris Landry, MS, www.adoptionparenting.net 

The Art of Resilience
By Hara Estroff Marano / Psychology Today.com

Orphans and Warriors, The Journey of the Adopted Heart
By Dee Paddock, MA, MTS, NCC

The Resilient Self : How Survivors of Troubled Families Rise Above Adversity
By Steven J. Wolin, MD and Sybil Wolin, Ph.D.

Real Parents. Real Children
By Holly van Gulden and Lisa M. Bartels-Rabb

Copyright 2003 MacLeod, All Rights Reserved