Reprinted (with little change) by kind permission of the Latin American Parent Association)

The guidelines follow, but first you must know that it is very important to speak by telephone or in person to several families who have traveled recently to the same country that you will be visiting, and have used the same source, if possible, because they will have the most up-to-date information on customs and other practical matters.

**DON'T**

*be impatient;
*be inconsiderate, loud, noisy or argumentative;
*overdo on alcohol;
*put yourself on a time schedule and/or set deadlines that your hosts either cannot meet or will have no inclination to try to meet;
*try to "buy" your way for faster service;
*seek or expect to find your culture in the foreign country;
*form a clique with other North Americans and shut out others;
*be afraid to socialize with your hosts;
*make demands and expect everyone to cater to you;
*indulge in political conversation with people in your host country (unless you know them very well, and maybe not even then);
*expect a foreign bureaucracy to work any more efficiently or swiftly than one of ours;
*complain about or criticize different customs and attitudes found in the host country;
*argue if you are told to return tomorrow by the orphanage or passport office, etc.;
*be afraid to ask questions, but phrase them carefully;
*expect sterile conditions, but remember your child made it this far, and will survive even if conditions are not up to your standards of cleanliness or newness;
*take offense if you are treated rudely or brusquely; the best way to handle such situations here or there is to rise above them, stay calm, and not respond in kind.
(Reprinted (with little change) by kind permission of the Latin American Parent Association)

**DO**

*read up on your host country before you travel (check with your local library for reference and travel books);
*be patient with the process and courteous at all times;
*be considerate and aware that you are in a different culture;
*remember that you are a visitor and guest in their country and behave accordingly;
*if possible, stay with local people who have been recommended and who may know the adoption procedures;
*listen to the advice of your guide or host;
*show an interest in the host country's customs and culture and try to adapt to those customs;
*go sightseeing if possible (and take plenty of photographs);
*bring small gifts (flowers, candy) for guides, administrators, etc.;
*dress appropriately for different occasions (meetings with involved officials, sightseeing, etc.);
*dress your child nicely when meeting social workers or other special persons involved with your adoption;
*be flexible about the length of your stay;
*remember, when there is a setback, that with patience and persistence, it will pass and you will go home with your child;
*make apologies for mistakes you may make;
*learn some of the country's language before you travel, and use it: your efforts will be appreciated;
*bring your country's language dictionary with you, and try to learn more of the language while you are there;
*remember that others will adopt through your source after you. Try to leave the country with a favorable impression so as not to make things more difficult for those following you.

September 1, 2006  
By: Brenda McCreight

Recently, an adoptive father asked me for suggestions on how he could develop a trust based relationship with his seven year old daughter, adopted internationally from an orphanage two years previously. 

"It's quite a problem," he said earnestly," because no matter how hard I try, she holds herself back. She has to triple check everything and she's continuously asking me the same questions over and over." 

"What kind of questions?" 

He thought a moment, "Routine things, like will my wife pick her up after school. I can tell you, my wife picks her up every day, has the whole two years. And when she goes to bed at night, she asks ten times if she asks once, if I'll check on her after she's asleep. And even after all this time, she still hoards food under her pillow and steals little things from my wife." 

"I'm curious, why do you think she should trust you?" I asked. 

He stared at me as if I had suddenly sprouted horns (ask my teens, they'll tell you I don't need to grow any. I already have a set hidden under my bangs). 

"Well, she should trust me because I'm her father and I've shown her I'm a good one&..." he hesitated. "I mean, we're her parents forever now, and we tell her that all the time. We're doing everything we can, but if she could just trust us, it would be way easier to get along." 

"Okay," I replied, "let me put it another way - what will change if she trusts you?" 

"I thought I just answered that question," his voice was calm, even though his face was getting a bit flushed and his eyes were narrowing. I wondered if that's how he looked to his daughter the ninth time she asked him to check on her. "We'd be more like a real family, the affection would be more natural, she'd be able to give me a spontaneous hug once in a while, she'd stop stealing and hoarding." 

He was on a roll now, but I interrupted. "Does she hug you at all?" I asked. 

"Well, yes, but my wife or I always have to initiate it. Look, I just want some suggestions for building trust!" He really was a patient man; I could tell that by the way he knotted his hands at his sides instead of yelling at me. 

To make a long story short enough to fit the allotted space - what I finally explained to this caring dad was that his daughter would not trust him for a long, long time, probably not until she was well into adulthood. Why should she? Her earliest and most formative years were focused on learning how to survive alone, with no one trust but herself. Then, all of a sudden, she lands in a place so different that it might as well be another planet. And in this foreign place she is given to nice, but very strange, people who proclaim themselves as her mommy and daddy (and expect her to fully understand what those terms mean to them), and who want from her all kinds of things she had never imagined existed. For example, they want her to act like a part of the family before she can understand what a family is. They want to play with her before she learns what toys are for. They want her to keep her bedroom clean before she knows what the little room behind the door is (a closet, actually). They want to cuddle her for no reason whatsoever, and&.they want her to pretend that her past never happened, that nothing ever changes, that good things never disappear without warning or reason, and that all she learned about surviving is never, ever going to be needed again. 

I can tell you, as I told that well meaning dad, this is way too much for one little girl to learn in two short years. My advice to him was to back off. Stick with the cuddles, keep playing with her, and helping her, and teaching her, but let her keep her defenses while she learns the survival rules of this new life. I also had to tell him that they were never going to be a "real family" in the way he meant it - that is - one which existed without a history of loss and abandonment, and without a child whose well developed sense of being alone was so strong it chewed up trust like a black hole eats stars. 

I also told him that they can still be a "real" adoptive family. They can give her birthday parties, they can teach her how to make friends, they can coach her soccer team and take her to dancing lessons, they can cuddle her at night while they read to her, they can brag about her accomplishments to friends, and when enough years have passed that they have had the time it takes to fill her with stars, they will have earned her trust. Because that is how it happens - parents don't build trust with their children, they earn it by caring, by giving affection, by honesty, by being reliable, by providing safe discipline, and most of all, by simply being there for a long, long, time

By LINDSEY TANNER
AP Medical Writer 
Wed May 25,11:26 AM ET

CHICAGO - The scenario is increasingly common — eager parents adopt children born in hardship an ocean away, hoping to create a cohesive family against seemingly daunting odds.

And yet, children adopted from abroad seem to adjust remarkably well, according to a new study that challenges the widely held notion that these youngsters are badly damaged emotionally and prone to disruptive behavior.

The analysis of more than 50 years of international data found youngsters adopted from abroad are only slightly more likely than nonadopted children to have behavioral problems such as aggressiveness and anxiety. And they actually seem to have fewer problems than children adopted within their own countries.

"The first years of life should not be considered as inevitable destiny. On the contrary, most children grab the new chance offered to them," said researchers Femmie Juffer and Marinus H. van IJzendoorn of Leiden University in the Netherlands.

The results are generally reassuring for international adoption — a growing trend involving more than 40,000 children a year moving among more than 100 countries, the researchers said.

"Our findings may help them fight the stereotype that is often associated with international adoption," the researchers said.

The study appears in Wednesday's Journal of the American Medical Association.

The authors pooled results from 137 studies on adoptions by parents living in the United States, Canada, Europe, Australia, New Zealand and Israel.

The analysis involved studies on adoption between 1950 and 2005, involving more than 30,000 adoptees and more than 100,000 nonadopted children.

During that time, adoption has evolved from being a "shameful secret" to being celebrated and often very visible, especially with the relatively recent phenomenon of white parents adopting Chinese children, according to a JAMA editorial by Dr. Laurie C. Miller of Tufts-New England Medical Center. In the United States alone, parents have adopted more than 230,000 children from other countries since 1989, she said.

Miller said sensationalized stories about severely disturbed children adopted from abroad have been widespread in the media, which may have skewed perceptions of these children.

In the study, behavior problems were relatively uncommon in all groups studied, but adopted children in general had more of them than nonadopted youngsters, regardless of where the adoption took place. That is not surprising, since both groups often suffer deprivation and come from broken families.

Internationally adopted children had a 20 percent higher chance of being disruptive than nonadopted children, and a 10 percent higher chance of being anxious or withdrawn. They also were twice as likely as nonadopted children to receive mental health services — results that the authors said were much better than expected given these children's often troubled early start in life.

The results might reflect the parents who adopt foreign children, said Dr. Gregory Plemmons of Vanderbilt University's clinic for international adoptees. These parents often are high-achieving and financially well-off, and tend to seek out services like counseling for their children, Plemmons said.

Children adopted within their own countries had an 36 percent higher chance of being anxious or withdrawn than the international adoptees did, and a 50 percent higher chance of being aggressive or disruptive, the study found.

These children were four times more likely than nonadopted children and twice as likely as internationally adopted children to receive mental health services. Also, domestically adopted youngsters had a 60 percent higher chance of having behavior problems than nonadopted children.

Plemmons theorized that children adopted domestically might suffer from the instability of living with different foster families before getting adopted.

Language learning and development
August 01,2006 / Jason Mosheim

While children adopted from abroad typically are grouped together in the category of "international adoptees," they exhibit many differences. With older children, even those adopted at age 2 or slightly older, learning a new language is not always an ESL skill.

Environmental, emotional and medical factors can impact language development in children raised in institutions. Children have very few opportunities to make choices or express their needs. Their clothes are laid out for them, and they don't get to ask to go to the bathroom or request their favorite foods.

"They eat what's given to them, and they do what's on the schedule. That's how they're used to living," said Susan Hough, PhD, CCC -SLP, of Washington Hospital Children's Therapy Center in McMurray , PA.

Over the past decade she has evaluated thousands of international adoptees. Infants may spend many hours in cribs, and children abruptly are switched to a new room when they get older.

Once they are adopted, however, the tables turn, she said. "Suddenly, they've got these parents who want to give them everything and anything all at once. It's pretty overwhelming."

Caregivers at orphanage are responsible for large numbers of children, leaving little time for individual attention and interaction. A high caregiver-to-child ratio—the average is 15:1—makes it difficult to interact, noted Dr. Hough. Eastern European orphanages typically are described as "eerily quiet" because children quickly learn that crying will not get them what they want.

Medical issues such as otitis media, poor nutrition, low birth weight, deficient immunizations, and undetected vision and hearing problems also can affect development.

It's important to give recently adopted children a chance to spend time adapting to their family and new home. Even after a phase of seemingly rapid new language acquisition and smooth adjustment to the home, children may begin to show significant learning problems, which can persist long after the period needed to address bilingual and adjustment issues.

"If language difficulties were related solely to differences in length of exposure to English, it would be merely a matter of allowing extra time for children to 'catch up' developmentally," said Dr. Hough. "This is often not the case."

Early testing within one or two years of adoption may not be adequate because subtle learning problems may not appear until the child reaches school age. However, early testing can give speech-language pathologists a chance to understand the issues they'll be dealing with down the road.

"A therapist who understands some of the orphanage factors and what the expectations are can evaluate these children. Then, if there is a problem, they'll know the areas that really need help. It's great if you can establish a baseline," she said.

If a parent suspects a young toddler is struggling, Dr. Hough will conduct an evaluation. Children under 3 generally have limited expressive vocabularies in their native language. In fact, international adoptees lose their native expressive language quickly, often within the first three to six months after adoption. Conversely, comprehension skills appear to be retained for a longer period of time.

"There is little motivation to continue to use native language with little or no assistance from the adoptive parents," she said. A period of silence often occurs during this time of transition.

Clinicians should keep a few points in mind when assessing a child adopted internationally:

• children lose one month of development for every three months they spend in an orphanage , according to research by Dana Johnson, MD, PhD, of the University of Minnesota International Adoption Clinic, and (***RK Editor Emphasis, see below)
• children over age 2 who were adopted before 18 months of age can be evaluated with standardized language assessment norms, while those adopted after that age should not be assessed against standardized norms until two years after adoption, according to Sharon Glennon, PhD, director of the Speech-Language Pathology program at Towson University .

"Dynamic assessments, which look at the child's ability to learn something new, should be considered in this case," said Dr. Hough.

Examples include non-word repetition tasks and natural language samples. Using spontaneous conversation during the assessment also will help clinicians reach an understanding of a child's capabilities.

Speech-language pathologists should examine adoptees when they first arrive at school to make sure they're on target and set up a screening or referral system in second or third grade to make sure they have the ability to deal with the more abstract aspects of language.

Classroom teachers need to be aware of warning signs and bring them to the attention of the clinician. When appropriate, speech-language pathologists can place students in social skills groups or facilitate interactions with other children.

It's crucial to note that children adopted from orphanages are not learning English as a second language ( ESL ). The term "abrupt language switch" is applied to these children because they must abruptly halt their current language development and immediately start learning a new language.

"They start out monolingual, are switched over abruptly and without warning, and then become monolingual again," Dr. Hough explained. "Many times people try to treat them as if they're ESL , but the pattern for language acquisition is very different."

ESL students have families that support them in their first language by interpreting and teaching them new words. This typically is not the case for parents of international adoptees. However, the parents are very much tuned in to their child's needs.

"They will do anything and everything you ask them to do for their child," she said. "They will research; they're the ones who walk in the door with articles in hand."

Speech-language pathologists should use parents as a resource and involve them in therapy. They are particularly helpful in carry-over.

The fact that the parents succeeded in adopting a child from a foreign country speaks to their "remarkable persistence and resilience," Dr. Hough said. However, a problem can occur if they have high expectations that the child is not able to meet. "You have to help them understand that that's OK."

Traditionally, the ratio of boys to girls with speech or language disorders is 3:1, according to Dr. Hough. However, a recent study on Eastern European adoptees found that both genders had their fair share of problems.

"The boys were supposed to be worse than the girls, but girls were as equally delayed as the boys," she said.

The girls had more delays in their use of expressive language, while the boys had more problems with reading. Overall, receptive language skills were not as impaired, and they did well with learning basic vocabulary.

These findings suggest that the difficulties for most of the children are part of a more general linguistic deficit that seems to follow the pattern of children with specific language impairment ( SLI ) rather than delayed language or auditory processing deficits.

"The diagnosis of SLI for these children is possible because they showed a deficit in language acquisition even though their nonverbal intelligence was within or above normal range," said Dr. Hough.

She found that children who were adopted at a later age had more difficulties in reading. Older children have to catch up with language a lot faster and already have some established language.

"I'm much more concerned about them than I am about the younger ones," she said.

In the early years following adoption, language progress varies considerably, researchers have found. Approximately one-third of children show significant delays that require intervention. It is unclear whether these difficulties are delays or true language deficits.

"Given a history of institutionalization and the abrupt switch in language environment, these children should be considered at risk, carefully monitored, and provided therapeutic services as necessary," Dr. Hough stated.

Reprinted with Permission of Advance for Science, By Jason Mosheim

 

 

April 01,2004 
By:  Rebecca M. Thomas
Imagine. You are a young child--one, five, eight years old--or maybe older. One day, someone comes to you in your foster home or your orphanage and says: "Very soon you're going to be leaving the world you know here with us forever. You are going to live with people you don't know. They will be your new family. No one you know will go with you. You may not recognize many things in your new home or neighborhood, but you'll get used to them. Soon, you'll be happy there in your new life."

For most children who are adopted, this transition from a known way of life--however good or bad it may be--to an unknown world represents a major life change as well as a significant life "loss." Yet, even though such transition may be difficult at first, most adoption stories have very happy endings!

Children of all ages placed for adoption do make a remarkable adjustment in being with their new family in a fairly short period of time. And their new families embrace them with great love, care and sensitivity to their needs. During this transitional time, which can last from just a few days or weeks to a few months or even years, each person in the family begins to bond and form a loving attachment with the new child.

Attachment is a core issue in adoption. Because without successful attachment, life is often difficult, stressful, empty or lonely for the child.

7 CORE ISSUES IN ADOPTION:

LOSS

Fears ultimate abandonment

Loss of biological, genetic, and cultural history

Issues of holding on and letting go

REJECTION

Placement for adoption as a personal rejection

Can only be “chosen” if first rejected

Issues of self-esteem

Anticipates rejection

Misperceives situations

GUILT / SHAME

Feels deserving of misfortune

Ashamed of being different

May take defensive stance Anger

GRIEF

Grief overlooked in childhood or blocked by adult leading to depression and acting out

May grieve lack of “fit” in adoptive family

IDENTITY

Deficits in information about birth parents, birthplace, etc. may impede integration of identity

May seek identity in early pregnancies or extreme behaviors in order to create a sense of belonging

INTIMACY & RELATIONSHIPS

Fears getting close and risking reenactment of earlier losses

Concerns over possible incest (e.g. with an unrecognized sibling)

Bonding issues may lower capacity for intimacy

CONTROL / GAINS

Adoption alters life course

Aware of not being a party to initial adoption decisions, in which adults made life-altering choices

Haphazard nature of adoption removes cause-and-effect continuum

As an adoptive parent, you want to bring a child into your home and make that child a part of your family forever. If you're like most adoptive parents, you don't make a distinction between an adopted child and a biological child. You simply want your adopted child to behave as if he or she had always been your child.

Adoptive parents often become impatient with the attachment process because it does takes time for the bonds to form. Sometimes longer than they like! But the wait, the effort and the love you put into developing an attachment with your adopted child are worth it in the long run!

What is attachment all about? In this feature piece, we'll take a look at key components of this important aspect of adoption. Here, you'll read about:

1) What is bonding? What is attachment?

2) Why is attachment important?

3) How can I tell if my child is forming a healthy attachment to me?

4) Are there signals that attachment is not going well?

5) What are some ways I can foster good attachment?

6) What books or information can I read to better understand adoption and attachment?

7) Where are the online resources related to attachment issues?

The terms bonding and attachment often are used interchangeably when people talk about the developing relationship between adoptive parents and their children. Actually, the two words refer to different aspects of that relationship. The distinction between the concepts is especially important for adoptive families.

"Essentially, you can have a bond with someone, or something, you don't even know," explains Marilyn Durbin, LCSW, a therapist specializing in adoption issues. "For instance, unborn children and their biological mothers have a bond, even though the two of them haven't met.

But adoptive parents don't have the opportunity to bond with their child in the same way that biological parents do. The attachment starts once you meet your child and the relationship actually begins. The distinction is important because in adoption there is no pre-bond--an important step in parenting. "You might bond with a photograph of an unknown child, but once you meet the child, says Durbin, "That's when the attachment begins."

So, what most people are talking about when they refer to bonding with their adopted child is really developing an attachment with their son or daughter. Because attachment is about building a relationship, you will find that attachment is truly an ongoing process that grows and changes over time.

Each family and child will have their own "timeline" for forming an attachment, depending on various factors. A child's age, genetic and environmental background, culture, mental and physical health status--as well as the parents' capability and willingness to allow attachments to form in their own way, at their own pace--all play important roles in forming attachments.

"There's reason to believe that a child's experience of his parents is an especially potent sculptor of the parts of the brain involved in emotion, personality and behavior. Some studies indicate that the strength of a child's bonding with his caregivers may increase his ability to learn and to cope with stress."

From "Babies, Bonds and Brains," by Karen Wright

Discover magazine, October 1997

------------------------------------------------------------------------

What is normal attachment behavior as newly adopted children transition into their forever families?

All families, both adoptive and biological, go through different stages in the attachment process as the children and parents come to know one another. In adoptive families, the way attachment "plays out" often relates to the age of the child at the time he or she enters their "forever" family.

Newly adopted children of all ages, including infants, go through a grieving process. They have experienced a major break with a known way of life, even if that life may not have been good. This kind of break is experienced as a psychological loss. It will take time for your child to heal the wound from that loss and to adjust to a new life with you.

To determine whether your child is forming appropriate attachments, new adoptive parents can start by determining if their child is at the normal stage of development for his/her age.

"There is a whole spectrum of behaviors you'll see in newly adopted children as they begin forming attachments to their new parents," explains Durbin. At first, parents may see what's often call the "honeymoon phase," where the child is on her best behavior, following all the "rules" and making little or no fuss about anything. This phase eventually ends.

Once the honeymoon phase passes, parents can expect a newly adopted child to test the limits of the relationship. The bottom line? The child--regardless of his or her age--wants to find out if the parents are really, truly going to hang in there no matter what.

"The issue here is about trust," says Durbin. "Through behavior mostly, the child will be asking, 'Will this person (my new parent) really take care of me?' So early on, newly adopted kids usually set up situations to reject the relationship. This is normal for any kid coming into a permanent family situation."

In some cases, children test their new parents through fits of anger and rage, tantrums, lying, fighting or breaking even the simplest rules of the family. Other signs of trying to reject attachment might include problems with eating or sleeping, whining, clinging or regressing in toilet habits.

In other cases, a child might show what's known as passive-aggressive behavior. "These kids use quiet sabotage," notes Durbin. "They'll do things like get up in the morning, and while everybody else is rushing around preparing for a busy day, the child won't budge, but just sits quietly on the bed, looking sweet. After several days (or weeks or months) of this, parents get angry. And that's the test."

Many adoptive parents can easily become overly anxious about whether an attachment is forming, especially within the first few months after their child comes home. Parents should be cautious about over-stimulating their new children in their attempt to be "good parents," says Lois Melina, in her book, "Raising Adopted Children: A Manual for Adoptive Parents." "Babies may respond to such intensity by withdrawing. The adoptive parent who misinterprets the baby's need for rest as rejection may try even harder to communicate with the baby, prompting even more withdrawal."

What signs can you look for that may represent steps toward forming a healthy attachment? Children of all ages who make good eye contact, who want to be nurtured with touch, hugs, cuddling -- these are signals that the relationship is evolving in a positive way. "I would begin to worry after about six to 12 months if your child hasn't started to show some attachment behavior in terms of coming to you, allowing you to care for them, the anger or tantrums have lessened, and they aren't trying to be controlling," says Durbin.

There is a lot of information and many resources available to help families understand and deal with attachment issues. Be sure to check the "Resources" section at the end for suggestions.

What causes attachment problems? What behaviors signal problems with attachment?

In many cases, adopted children do not have significant problems with forming attachment. They make a fairly smooth transition into becoming a permanent part of their forever families.

So, issues most of these adopted children face are issues common to all children, along with issues related directly to adoption, according to Dr. Gregory Keck and Regina Kupecky, LSW in their book "Adopting the Hurt Child: Hope for Families with Special-Need Kids."

"The types of problems that adoptive families see in their children are most likely the result of breaks in attachment that occur within the first three years. And they are problems that impair, and even cripple, a child's ability to trust and bond--or attach--to other human beings," say Keck and Kupecky.

How can you tell if your adopted child is struggling with attachment issues? They probably will exhibit many, or even all, of the following symptoms:

• Superficially engaging and "charming" behavior

• Indiscriminate affection toward strangers

• Lack of affection with parents on their terms (not cuddly)

• Little eye contact with parents on normal terms

• Persistent nonsense questions and incessant chatter

• Inappropriate demanding and clingy behavior

• Lying about the obvious (crazy lying)

• Stealing

• Destructive behavior to self, to others and to material things (accident prone)

• Abnormal eating patterns

• No impulse controls (frequently acts hyperactive)

• Lags in learning

• Abnormal speech patterns

• Poor peer relationships

• Lack of cause-and-effect thinking

• Lack of conscience

• Cruelty to animals

• Preoccupation with fire

Source: "Adopting the Hurt Child" by Gregory C. Keck Ph.D., and Regina M. Kupecky LSW

There is a lot of information and many resources available to help families understand and deal with attachment issues.

Top Ten Don'ts for Parents of

Unattached Children

1.Don't take the child's behavior personally. Doing this leads you to lose good interaction and decreases the chance of attachment.

2.Don't get into blaming the social workers, the school, your spouse, yourself. Concentrating on blaming takes away energy needed for advocacy for your child and healing for all of you.

3.Don't doubt yourself. The hard work, love, and commitment you have given to the child counts, even if things don't go well all the time.

4.Don't always accept the first diagnosis of your child's problem. This is especially true if you have a gut feeling it's wrong. A second opinion is just as important for a child's psychiatric diagnosis as for a physical diagnosis.

5.Don't give up hope of finding help/resources. There are many helpful organizations out there, "creative funding" to help pay for some therapy.

6.Don't go beyond your limits or take on too much. If you overstress yourself and get physically ill or have a nervous breakdown you won't be able to help anyone, not even yourself.

7.Don't believe that one person, one couple can't do anything to make a difference. "The squeaking wheel gets the grease." If you're persistent and willing to write lots of letters or make many calls (to legislators, the media, etc.) you can shake things up, wake people up.

8. Don't forget to make and cultivate friendships with those who do understand.

9. Don't believe you aren't making a difference in your child's life