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Birth Parents in International Adoption

Sat, 02 Jun 2007 09:01:19 GMT

Right from the beginning, I want to admit two important facts that have been part of my belief system for a very long time:

I've never wanted to find my own birth family. I was domestically adopted at birth in the USA, and I have had very minor interest regarding my birth family. Nor have I had any identity issues that would lead me on a search for a 'missing piece' of myself.
Twelve years ago, my husband and I chose international adoption for the specific reason that "birthparents will not be part of the picture." I had no intention of sharing my child with some unknown family. I wanted things to be straight forward and absent of anyone or anything that complicated my or my future child's life.�

Being adopted myself has afforded many benefits to parenting adopted children that I had not anticipated. I understand their basic curiosities about their origins. I feel no insecurity when they talk about their birth parents, because I know that at their ages I also wondered if I was really a princess who had been mistakenly 'lost', and wondered if my first family thought of me on my birthday. My advantage also allows me to anticipate questions they might be hesitant to ask and bring those inquiries into our daily lives and conversations.

Although I have a lack of desire to search for my own birth family, I have made it abundantly and frequently clear that this is simply my own point of view. That there are many adoptees who have a strong desire to know more and understand the details surrounding their birth/adoption/life-story.

What I did not expect or anticipate, however, is how my own five children who came to our family through adoption would feel freedoms of expression and emotion that I never had. My open attitude has allowed our girls, who came to us at all ages (and are now ages 8-17 years), to explore and claim their rights to know and understand their heritage. They want whatever answers are available, and feel it is their absolute right to know every moment of their own history, as is the right of a child born into a family.

As a parent, these issues aren't a smooth or easy road to walk. My daughter from Korea will have the option to search for her birth family and a very good chance to find them. My four daughters from China have extremely limited options. Going back to their orphanages they might receive information about where they were found, or a copy of a note left by a birthparent when they were abandoned. While we as parents cherish these little details, stepping back we must realize how tiny and insignificant they will be to our teenage and adult children. They offer no real answers, only more confusion and questions. These little scraps of information do not answer the essential questions my daughters and thousands of other adoptees are asking:

Who are my birthparents?
Why, specific to me, (and not in general i.e.: poverty, single parenthood, government policies) was I abandoned/placed for adoption?
Do I have birth-siblings?
Did my birth family want me?
What do my birthparents look like?
What would my life be like if they had kept me?
Did they love me?
Do they ever think of me?
Do they miss me?

I can re-assure my children over and over again, but I also now understand this: Knowing what I know now, my attitude has completely changed. If I could choose, I would have some type of contact with the birthparents of my children. I would try to bridge any social or cultural gaps between us and I would absolutely welcome them into our lives.

Not as co-parents..no. That would not be impossible. But as the birth-parents, the first parents of the beautiful children I love with every piece of my heart and soul.

When my children were younger, it was easy to tell them, and have them accept, that they would meet their birth parents in heaven. They were at peace with this idea and I felt I was doing a good job. Now that I have 2 pre-teens and 2 teenagers, I know this assurance is simply not enough. Regardless of whether or not the answers can be found for all of their questions, the issues MUST be explored.

Less than a week ago, I returned from a birth-land trip with my daughter, Jennifer WuQin, who was adopted at age nine-years from China. She has now graduated from high school and we took this trip as her graduation gift. Her primary goal? Contact the orphanage and see her file and gain any and all photos of herself as a child before we adopted her. Through the hard work of Lotus Travel, she was able to visit her orphanage and many caretakers, but her requests for more information were denied.

Did we feel cheated or disappointed? YES. We did. While I fully respect the adoption process of this country, I also feel that there was a file, sitting just a few floors above us in the orphanage, that probably contained very minor information. But those tiny details would have given her some hope that she could someday find the answers to the puzzle of her life.

My daughter Jennifer is the most amazing person. I love her more than could ever be described. Will this incident truly affect her life? I think not. But this trip helped me understand even better what I now know to be true: International adoptees are organizing themselves and demanding information that is equivalent to our open-adoption system in the USA. Nothing any adoptive parent attempts to do will deter this. These young people want answers and will not stop at the first closed door. My daughter fully intends to find another road to the answers she seeks.

As adoptive parents we have only three choices:

Tell our children their birthparents loved them but could not parent them due to circumstances in their lives (yes, this may be very true).

Open ourselves to the reality that our children absolutely will be able to find their birthparents (it's a reality: genetic testing in the next 20 years will match our kids to their birthparents through-out the world) and support our children.
Vainly try to brainwash our children into believing that their birthparents do not matter and/or are bad people.

I know that last option does not go down well. But the truth is, I receive articles all the time that are warm and loving in the telling of the adoption story, but mention the birthparents as alcoholic, street-people, unmarried mothers of many, etc..facts? Maybe. But honestly..these are human conditions that yes, may have led to the placement of the child in an orphanage, but do the fully describe the parent/human that is your child's link to life before adoption? And is this the primary information you want your child to believe? The honest truth that I have seen played out again and again in adoptees is this:

When parents emphasize that a birthparent had specific problems, the child will often work very hard to have those exact same problems. It's part of forming identity. The best option for an adoptive parent is to love their child fully, while also supporting their child's journey of identity, culture/racial issues and knowledge of self. This helps a child seek out the positive and the truth, and at the same time view the adoptive parent as a truly supportive, loving parent who is not threatened or fear-filled. Because the truth is, adoptive parents need to accept that we are the parents of our children, and we do not lose that identity or our children's love simply because they wish to explore their history, culture or origins.

I've spent the bulk of this article dispelling the 2^nd fact I presented in the beginning. It would be dishonest to end it here. I have made the decision to carefully wade into finding my original family. My birth-family.

I was adopted in 1968, and my parents (my adoptive parents/real parents, who raised me) were pretty forward-thinking. They truly raised me to have a great respect for the choice my birth-mother made. And yet, there is this tinge of guilt, this shame I feel for wanting to do this. I know my parents do not understand, and do not truly support this search, though they are trying to appear supportive.so I continue to put off papers I could file or roads I could take, because of the guilt I feel.

I admit this now because it is the honest thing to do. Five months ago, just after my 39^th birthday, I suffered a minor heart attack. 16 years ago, I had my first run-in with skin cancer. For these reasons, I would like to have some type of contact that would allow me to have access to my birth family's medical records. And I have met a brick wall. Even today, in the USA, my records are impossible to 'unseal'. They exist, but I cannot reach them. I might as well be back in China two weeks ago, with my daughter asking for records that are there, but being denied access. And that needs to change.

As an adoptee I want only this single message to get through to adoptive parents:

We love you. You are our parents. If you fill us with guilt because of your insecurities or fears, it does not stop our needs or longing, but only makes us deny or hate ourselves for wanting some simple facts or knowledge. And eventually our anger turns inward to ourselves, our outwards to you. Love us enough to be secure and know we love you also, as we can love no one else.

As and adoptive mom I want my children to know this:

I am fallible. I won't always hear your need, or know your longing, but I am trying. I am secure in your love for me and I want you to explore every avenue for your life.

I'm not afraid anymore. Is that strange to say at my age? Probably as strange as saying that I am glad I had a heart attack. It freed me from any guilt that I may have had. I love my parents and accept them as well. But I also know and do not fear that I losing their love. I have to follow my own path.

By loving my parents and my children, I have become a bridge. An adoptee and an adoptive mom. I need to find my answers and I respect that my children also need to find their own answers, in their own time. My desire is for everyone to get past the fear and embrace what I tell my children daily:

Love is the only thing in life that multiplies the more you give it away.

A Child's Guide to Adoption

Mon, 11 Jun 2007 12:50:52 GMT

How is a family created? Most people think that a family is made when a couple gives birth to children. That's true, many times families are formed in this way.�But there are also other ways families are formed. In the old television show The Brady Bunch, the mother and father get remarried, combining their two families into one. Another way to create a family is by adoption. In legal terms, once a child is adopted, the adult who adopted him is his parent.

Why do people want to adopt children?

There are probably as many reasons for wanting to adopt kids as there are children waiting to be adopted. Some couples are not able to have children for medical reasons but still want to raise a family. Some single adults, although they don't have a partner or want to get married, desperately want to be a parent. Other kids' parents might remarry and their new stepparent might adopt them. Whatever way a parent and child come together, whether it's through birth, marriage, or adoption - a new family is born.

What's Adoption and How Does It Work?

The process of adopting a kid can be pretty long and involved. Some single adults and couples have to wait for years to adopt a baby. People wanting to adopt go through extensive background checks including, in some states, having their fingerprints sent to the Federal Bureau of Investigation (FBI).

People who want to adopt kids also meet with social workers or representatives from an adoption agency who ask questions like why they want to adopt, their attitudes toward children, and how they resolve family disagreements. This process is needed so that kids are placed in good homes where they can grow up happy and loved.

Why Do Kids Need to Be Adopted?

Of course, the financial side is only part of adoption, a very small part.�Babies and kids are a huge responsibility and not everyone is equipped to handle being a parent, or ready to parent when a child is born to them. If you've ever taken care of a puppy, you know that taking care of a pet can be very demanding, and they require lots of attention. Taking care of a baby is probably a hundred times more work! But this is only one of many reasons why there are so many kids waiting to be adopted.

In many cases, a young or single woman who gives birth to a baby can't handle that responsibility so she makes an adoption plan for her baby. Other times, especially in the case of adoptions from other countries, there is war, sickness, or poverty, and a parent may believe that the baby would be better off in another country. Sometimes a child's parents may pass away and he needs to go to someone else who can take care of him.

If You Were Adopted

Kids who were adopted are no different than other kids. But if you were adopted, you may have a little more on your mind than your friends. Sometimes, learning you were adopted may make it hard for you to pay attention in school. Many kids who were adopted wonder about their birth parents and why they didn't keep them. Sometimes they feel abandoned even if they love their parents and are happy in their home. They may also wonder where they came from and what nationalities they are. These feelings are normal and should be talked about with a parent or another adult who you trust so you can put your mind at ease.

Some kids do not find out they were adopted until they are older - sometimes not until they are adults themselves. Their parents might have put off telling them until they thought they would be able to better understand or because they feared what their reaction would be. Finding out later that they were adopted can be more of an adjustment for an older child or adult. That's why experts say it's best to explain to a child that he or she was adopted when they are around age 3 or 4, when they are first putting sentences together and can understand complex things.

If Your Brother or Sister Was Adopted

If your parents�gave birth to�you, you may have heard others refer to you as your parent's 'real child'.� How does that make you feel? Does that make your adopted brother or sister fake? Of course not! Being adopted doesn't make a sibling any less real or part of the family. There is no question that there are differences between you and your brother or sister. But there would be differences between you if you were both born into your family as well. No two people are alike. Think how boring that would be!

The facts are, your brother or sister - adopted or not - is going to be a part of your life for a very long time and you will rely on each other even more as you get older. Talk to your adopted brother or sister about his or her concerns. You might be able to help him or her sort out his or her feelings about being adopted or encourage him or her to talk to a parent or another trusted adult. You might even suggest that you talk about the situation as a family.

If Someone You Know Was Adopted

If you find out that someone you know, maybe a good friend, was adopted, there is no reason to treat them any differently. Your friend is still the same person they were the day before. If your friend wants or needs to talk about their situation, listen. Your friend will probably feel better just talking about his or her feelings, and by being a good listener, you've been a good friend. Knowing how your friend feels about their situation will allow you to stand up to anyone who tries to make fun of them for being different.

Adoption can be hard to understand, especially for those who may not have an adopted sibling, cousin or friend. Part of growing up is learning that families are formed in many ways, and accepting and embracing the differences that make each of us unique.

Thoughts on Attachment

Tue, 12 Jun 2007 15:58:09 GMT

Most of what I read in the popular literature makes attachment sound like a rope that runs between a child and a parent. Either your child is holding the rope and is "attached" or he/she has dropped the rope and has attachment problems. Needless to say, this is a simplistic image. The fact is, attachment is a complex relationship between parent and child and there are a wide range of variations and problems. Both parent and child contribute to the health of this special relationship.

I think of attachment as many woven strands between parent and child. These strands grow gradually and continually throughout the relationship. Both parent and child have to work at creating the weaving. When the weaving progresses smoothly, and the relationship is mainly cooperative, we call the attachment "secure". Secure attachment provides the child with a safe base (a parent) who helps the child maintain physical and emotional balance as the child moves away from the parent-base to explore the world and become an individual person. Reconnecting with the parent is a way for the child to regain equilibrium and to process experiences.

Before a parent can be a "secure base", infants have to know how to locate and signal or call the parent. When a parent initially anticipates and then responds to the signals, infants learn to communicate and trust that adult. There are a multitude of ways that this intimacy helps a child maintain physical and emotional balance. If the tasks of development (trust, social relationships, mastery of skills, identity) are the high wire act, then attachment is the combination of the ladders, guywires, balance pole, and of course, the ever-present safety net.

When a child looses birthmom, has a succession of caregivers, and finally is adopted, I imagine the base feels more like a foundation for a building constructed by several different construction crews. Each crew had it's own set of plans, and poured separate concrete slabs next to and/or on top of each other. To make matters worse, the building that must rest upon this base is grieving for the departed contractors.

To gain a child's trust, an adoptive parent must acknowledge not only the piecemeal foundation but the fact the child may still be waiting for past workers to return. This expectation resurfaces each time a developmental reorganization occurs. No matter how early the separations occurred, the child will be cognizant on some level of the patched together pieces. Without the acknowledgement of these facts by the adoptive parent, the child feels a bit crazy, "Am I imagining something? Why do I feel this way?" The infant or child cannot relax and trust deeply no matter how good or kind or consistent the adoptive parents may be. This unshared piece leads children to become "very busy" or "always happy" as a way to avoid feeling puzzlement, grief and the gap in the present relationship. This is initially a small but real hole in the fabric of attachment. However, as adolescence arrives, the hole widens, precisely because it was previously unaddressed. It offers teens an additional excuse to feel distrust for their parents. When adoptive parents address the issue, the child feels completely "known" by the parent, this is calming and the child can "play" and "feel" more fully.

A child with a patched base history may become demanding, coercive, helpless or threatening in the attachment relationship. Indiscriminant friendliness, or difficulty maintaining emotional or physical balance, difficulties in sensory integration may also occur. When these behaviors prevent the child from accomplishing developmental tasks or interfere with the parent-child relationship the attachment is called "atypical". The weaving has knots or gaps with strands in need of strengthening or repair. Adoptive families may have secure or atypical attachments, just as non-adoptive families do. In early childhood these issues are subtle and resemble difficult phases or temperament. Left unattended, these strands of early childhood difficulties can affect learning, behavior and social relationships.

Reactive attachment disorder (RAD) is quite different than what has been described so far. It occurs when a child has experienced global neglect, that is neglect of every need for many months or years. It is when all or nearly all of the strands that form attachments have been torn to the point the child no longer wants to enter into a genuine, interdependent relationship with an adult. From time to time, nearly all children with complex histories will show behavior that resembles an individual symptom of reactive attachment disorder. These behaviors stem from the time when there was no consistent or responsive caregiver available. Most children and their adoptive parents have the will to repair the strands, and to tolerate the melt-downs that are part of growing up in a family following a difficult early life.

Normally, children become disorganized emotionally and physically before each developmental leap whether it's rolling over, crawling, talking, going to pre-school, learning to read, or preparing for college. Children get cranky and have more than the usual number of a melt-downs. The communication suddenly shifts to baby talk and tantrums. Under the stress of disorganizing, adopted children frequently regress, or revert to survival skills they developed in institutions. These behaviors are typical when a child's brain is reorganizing. (They are also typical when a child is overstimulated, tired, or getting too little attention from a parent to remain in emotional balance.) During periods of reorganization, children need more help from their parent to maintain emotional balance. Since children cannot notify parents of what is happening to them, parents need to anticipate, or at least recognize, these points of disorganization, by learning about child development. A child needs parents to restrict stimulation and demands during this period. It is not the time to start a new music class or increase household chores. T. Berry Brazelton has calls these points of disorganization "touchpoints" because they offer parents and children a powerful opportunity to deepen their attachment.

In looking for guidance, adoptive parents are thrown off track by parenting books and pediatricians who do not take into account our children's early experience with separation and loss. How many parents have had friends, family or pediatricians who say, "throw that bottle away!" just a few months after an infant or toddler has been adopted. These well meaning advisors are forgetting about the importance of sucking for comfort for a child who has recently lost everyone and everything familiar. Throughout an adoptive child's life, sensitive parents must ask themselves if a parenting strategy or technique takes their child's history into account. Many parents worry that a stage will be permanent if they don't immediately eradicate the behavior. Sensitive and authoritative parents can take a step or two back when necessary, while keeping reasonable expectations for the future.

Adoption issues often come up when developmental reorganization occurs. Along with learning to share and wait in line, adopted pre-schoolers want to know "who will take care of me if mommy or daddy dies?" (which non-adopted children almost never ask) As they master times-tables, reading and writing, school aged children want to know if they can be "readopted" to another family, (non-adopted children don't spend time worrying that their parents might give them away or "throw them in the trash.") When adolescents take foreign language classes and advanced chemistry, they threaten to run away to China to find and live with birthparents. All of these are expressions of anxiety about their "secure base", and a wish for reassurance. These demands on parents are more typical of children with complex histories and are not an indication that the attachment or parenting have failed. In fact, they are indications that the attachment is operating as it should, the child is working with the parent to regain equilibrium.

An adopted child may depend more, and for a longer time, on the help of parents. Making sense of adoption on a daily basis is a task that takes time and energy for both child and parent yet it promotes deeper, more meaningful attachment.

My seven year old is learning to read; we sit down to our twenty assigned minutes of homework. "You hate me and I won't read," my child announces. "No I don't hate you," I reassure her. She curls up in a ball, like she used to at four. "I'm a baby." she says. What sort of signal is this? I realize after several weeks of trying various parenting strategies that are "age appropriate" responses that the developmental leap of reading is causing her to reconsider her feelings about adoption. And the reading material is also stimulating questions about separation and loss. The next time we sit down to read, I ask her if the story of the elephant growing up and leaving his mother makes her think about her first parents. She gazes up at me, "I love you mom" she sighs. Now she knows that I know how she feels and our attachment wraps around us like a quilt. The oppositional reading struggles vanish.

�At seven, and probably eight and eighteen, she will sometimes need me to intuit her needs when adoption issues arise. I keep re-learning that if we can connect about her feelings in this area, shortly thereafter she will meet my age appropriate expectations.

The growth of attachment after international adoption takes attention, work, and guidance from a parent. We can rebuild attachment relationships if we are mindful that attachment is not a rigid pattern described in the latest parenting book. Attachment begins with attentiveness, and is an elastic and changing process that fosters growth for parents as well as children.

Can Attachment Problems Turn Into Reactive Attachment Disorder?

Most adopted children have some issues with attachment, which is to say they have a more complicated attachment history that adoptive parents must integrate into the parent-child relationship. These children have occasional to frequent behavior difficulties which are judged atypical as compared to age appropriate behavior of securely attached non-adopted children. A few children who have spent their entire life in an institution or bouncing from one foster home to another, enter adoption with the symptoms of reactive attachment disorder.

Many adoptive parents are worried that somehow mild to moderate attachment difficulties (atypical attachment) will suddenly become RAD. Is this true? From my experience both in observation and reading of cases, I would say there are three reasons for atypical attachment to move towards RAD.

1. Parents deny or minimize or even normalize the atypical signs and symptoms, and therefore those needs of the child remain unaddressed.

2. Parents treat the symptoms as evidence of the child's "badness" or "willfulness" etc. instead of recognizing them as signals and communications. Many of these parents are struggling with their own early history of hurtful parents and feel the child's needs and/or demands are replays of prior abuse. Some parents come to the conclusion their child is "bad" based on philosophical or religious ideas.

3. Parents expect that because their adopted child is "doing well" they can give them the amount of attention and support a non-adopted secure child would receive. Having decided their child is "adjusted", they fail to leave time and space in their lives for the work of attachment. This neglect is felt deeply by the child and incorporated into the adoption and grief and loss issues. Because children with complex histories sometimes delay asking for help, or try to be "extra good" to get attention, the negative feelings are suppressed until some trigger releases them and they overflow.

Black, White and the Cornrow In Between

Thu, 21 Jun 2007 16:19:01 GMT

It was very late and my middle daughter and I were the only ones still awake.� I rose stiffly from the sofa and muscles weary from my labors.� My daughter yawned sleepily, and I kissed her goodnight.

"Go ahead."� I said.� "We are finished.� You can go take a look."�

She smiled, shook her hair back and forth to hear the beads click and clack, and then ran off for a quick look in the mirror before bed.�We had spent most of the previous three hours on her hair.� It is an activity usually reserved for Saturdays, but daily time spent in the pool had taken its toll and a style that started out incredibly cute a few days�before had gone south very quickly.�I knew that if we were going to survive the next few swim lessons, it was time to put her hair in cornrows and beads.

I am white, and new to this skill, so unfortuantely for my girl a process that would take a long time anyway always takes even longer.� So, hours earlier after dinner was finished I�had given�her the summons.

"Come on, Baby," I called.� "It's time to do your hair."

She scurried off to find toys to entertain herself for the first stretch of taking down the old style and combing through a multitude of tangles while I gathered the tools of the trade: wide tooth comb, rat tail comb, detangler, spray bottle filled with water, and a pair of tiny scissors used to cut the elastics free.

I sat on the sofa with her in front of me in a small chair and got to work.� Soon, three of her siblings gathered there with us and began to play as we settled into one of the comfortable expressions of our family culture "doing hair", just one way this family morphed into a new entity when our girls came home from Haiti.� As a African American friend once told me, "You are now the white mother of a family of color."

Later, after I washed�my daughter's hair and began to�cornrow it, �my children passed the time by watching the BBC's DVD of Prince Caspian by C.S. Lewis, leaving me time to think.��As always, I found the process of styling my black daughter's hair profoundly humbling.

It is not that I am bad at it, I am actually pretty good to be honest.� Each Sunday, I receive the highest praise possible for my efforts from the people who should know:� African American women.� Still, each time I pick up the comb and place my hands on one of my daughters' heads I feel a little nervous.

"What if I don't do a good job?� What if�my baby is�ashamed of her white mother's creation?"

Because I know hair matters.

It matters because it is such a definitive expression of the African race and all their descendants scattered by the diaspora across the globe.� It is both the pride of heritage and�so often the focal point of the pain of discrimination.� It is at once a deep heart's cry to be validated as the unique creation of God but at the same time to not be defined by any one characteristic of one's race.

It matters because as a white family, we had a choice to make when we brought our Haitian daughters home.� Would we strip them of their culture and force them into our white world, or would we lay aside our own and meet them there.� Black, white, Haitian, and American.� Descendants of the oppressed and descendants of the oppressor woven into a family.

And a white mother with a cornrow in her hand.

"I am not my hair.� I am not this skin."� India Arie

What Lies Beneath

Thu, 21 Jun 2007 16:42:41 GMT

Long ago, years before the possibility of adoption even entered my mind, I was in a local shop and as the manager assisted me with my purchase, we began to make small talk.� I was a young mother, so it did not take long for the topic to turn to children.� When I asked him if he had any children, he not only responded affirmatively but shared with me that he and his wife had struggled with infertility and eventually ended up adopting a baby girl.�

�They were white.� She was black.

�"Yeah," he said.� "Her mother is in prison and the father is nowhere to be found.� We applied to adopt and once our paper work was completed, only waited a couple of weeks before they offered us the baby."

�I was taken aback by this watershed of personal information offered to me, a complete stranger, but it was nothing compared to what he would say next.� With no hint of realization of the impropriety or destructiveness of what he was relating to me he said,

�"We just love her to death.� My wife calls the baby her little (racial slur)."

�I was stunned.

�Since that time, I have had the opportunity to receive a vast education concerning both black/ white race relations in the United States and the complexities of transracial adoption.�While this scenario I witnessed so long ago is most certainly extreme, it is also a vivid illustration of�the pitfalls of adopting transracially.

�I consider myself extraordinarily blessed that before my husband and I came anywhere near beginning our adoption journey we first became a part of a church that was begun and led by an African American man to be deliberately diverse and serious about racial reconciliation.� Honestly, when we entered the sanctuary doors, I was perfectly confident that I was racially open-minded and unbiased.� What I found as honest discussion flowed, was that I was largely blind to the deep roots of racism woven into the fabric my life, passed down from generation to generation through my family.� I have since termed it like this:� The song of racism was sung to me over the cradle.

�Since then, I have discovered that I am not alone.� The implications and daily challenges of living as a racial minority in society are lost on most of those who make up the majority, which is why it is imperative that white parents who are adopting transracially go the extra mile to gain the understanding their children will desperately need to navigate the murky racial waters ahead.

�Not too long ago, a dear African American friend of mine and I were discussing these issues and I told her I had come to a conclusion that some might find extreme.

"You know," I said.� "I believe God intended for children to be reared in families, not orphanages, but if the white families raising them do not first honestly explore their own racial attitudes and then deliberately educate themselves about racial issues, it is an injustice to the child."

�"Yes," she agreed somberly.� "Good intentions are not enough."

�So true; and love, although tremendously important, is not enough either.� If minority children are going to thrive in transracial adoptions, they need so much more from their parents.� I have found it takes more patience, humility, and hard work than I once would have thought possible,�but it is achievable.

�And it is no more than every, single child deserves.�

Handling Indiscriminant Friendliness

Thu, 05 Jul 2007 18:31:30 GMT

For months my newly adopted daughter, Mei-Mei, had been shouting "Hello" loudly enough to embarrass me as we entered any restaurant, store, or even walking down the street. She insisted on greeting everyone effusively as though she had known him or her a long time and hadn't seen them in years. Likewise, when we were leaving an establishment, or ceased chatting with a neighbor, the good-bye's were loud and unending, as though she expected never to see these people again.

I tried to stop her. "Don't say, 'Hello' to strangers," I told her. She looked at me blankly and ignored every word. For the first several months I was often running after her snatching her back from climbing into some kindly stranger's lap. It was the same when she said, "goodbye".

Eventually I realized how stupid I must sound; to Mei-Mei everyone was a stranger, even her own newly adopting family. So if she said "Hello" to us, kissed us and sat in our laps, why not with everyone else? Once I realized that everyone was a stranger even Mommy, I tried to explain the concepts of "stranger", "friend", and "family". Although Mei-Mei was still F.O.B. so to speak, she was following English well and had the intellect of any bright three-year-old. Mommy, Daddy, big sister, the dogs are family," I told her. Mei-Mei would nod wisely. "We have more family : like Nana and Grandma. With family you can say hello and goodbye, kiss them and sit in their laps, if you want to. "

I found it easier to define these categories of people on the basis of acceptable behavior towards them, rather than on how long we'd known them or how close we felt with them. Specific actions were concrete and easy to pantomime; lengths of time and types of relationships or feelings were too vague for a three-year-old with three or four months of English experience.

"Then we have friends: Emily and Rowan. We say hello and goodbye, but we don't kiss, we shake hands. Sometimes Mommy has a friend that you don't know. That person isn't your friend yet. You can say hello, and goodbye, but you don't kiss them or sit in their lap until you get acquainted."

Strangers were harder still. "A stranger is someone Mommy doesn't know. We don't know a stranger's name, or where she lives. So if we say "Hello' it's once and maybe you could shake hands if Mommy says it's O.K." But how do I explain the checker at the market, Peggy, with whom I chat so cozily ? Is she a stranger?

I didn't and still don't know the answer to these questions. This is a confusing area to children coming from an orphanage setting. Relationships are a mystery. There is no previous experience with which to match them. Even the relationship of Mommy, Daddy, siblings, grandparents are unfamiliar and therefore confusing.

When I first introduced Mei-Mei to her maternal grandmother I explained that this was "my mommy" and Mei-Mei became terrified. She would have nothing to do with her grandma until I realized her fear must have something to do with what "mommy" meant to her. "Mommy" was defined, I suspected, as " the new person who took you away from where ever you'd been before". Given this understanding, it was no wonder she was terrified: she feared being given to a "new mommy", this old smiling round-eyed, white-skinned lady who looked nothing like the older Chinese women Mei-Mei might have seen. With this realization I reassured her that, "I am your mommy and you will stay with me. This is Grandma. We are saying Hello and then Mei-Mei and mommy will go home together." My daughter relaxed visibly as she absorbed this information. At last I knew the right words to use to calm her ever-present fears of being passed from one adult to another without end.� �Patty Cogen

My Daughter the Banana

Thu, 05 Jul 2007 18:36:39 GMT

There are long days when I finally glimpse myself in the mirror and am shocked at what I see. It's not the gray of my hair and wondering if I'm too old to be the mother of a toddler that alarms me. It's not how tired I look; I know this too shall pass. Rather, I'm shocked because I look "white", I look Caucasian. I expect to see an Asian face look back at me.

I spend most of every day face to face, in close proximity with my daughter. She is Chinese by birth and American by adoption. After focusing upon her for hours at a time, my internal world is permeated with her black almond shaped eyes, her glossy fine black hair, her warm-toned skin and her broad dimpled face. When I look in the mirror my internal self is still seeing in Chinese. My eyes grow wide at the disparity between what I expect and what I see.

I thought when this happened it would wear off in a few days. I asked a "white" friend who adopted a Chinese daughter three years earlier if it happened to her. "Yes," she replied, "and it never wears off."

I puzzled over this. Why were two grown women with good self-esteem having trouble keeping a firm hold on our self-images? My next thought was, if we adults are having this happen, what is happening to our daughters? The most pervasive image in their daily lives is our faces, our pale, high and narrow nosed, blue eyed, red or brown-haired visages. What then do they expect when they look in the mirror? To see a "white girl" I suppose.

Whenever I look at my family I see the diversity we present: three Caucasians and an Asian. However, when my Asian-American daughter looks at her family, she sees only Caucasians. What does this mean for us and for her? My sense is that we are overly aware of our diversity whereas she is less than fully aware. In our politically correct community and circle of friends there are no negative remarks. But there are no positive remarks made either, perhaps because people don't know what to say. What would I like them to say that would give all of us a good sense of who we are without being corny ? I wish I knew.

Since coming to America at four years of age my daughter has gravitated towards Asian people, or any dark-haired person. If there are three Asian women dining in a restaurant, she has to go and say hello. If there is an Asian child in the park she wants to play near by.

Reading the book, We're Different, We're the Same, my daughter often picked Caucasian features as those most like hers. Sometimes she seemed confused about what her features looked like. She was more certain about picking what I looked like. Could it be that in the year she's been in our family, she is loosing the image of her own face?

I try to have us look in the mirror together when we brush our teeth or comb our hair. I try to take time to focus and comment on our looks, and how they are different and how they are the same. I decide to share my experience with my daughter, to let her know we both are struggling with this issue. This is an opportunity to talk about what makes skin lighter or darker, how birthparents contribute to and shape how we look.

My daughter is obsessed with making us the same regardless of our different racial origins. First it was a barrette thing. I bought a bunch of barrettes for her and she had her own ideas about their use. Everyone in the family, including both dogs, had to wear them. For weeks the entire family (including Dad) went around the house with a selection of colored plastic in our hair (or fur).

When we went out I would forget to remove mine and people would comment, "Oh, look, you match!" I found myself delighted that finally people acknowledged we were a mother/daughter duo. Who else would wear matching barrettes? My daughter loved being seen as belonging to me. For both of us it became a wonderful way to forestall the strangers' inevitable question, "Is she your daughter?" and the unspoken implication that if we didn't match racially, we couldn't be related.

Now the matching takes other, more conscious forms: we both wear sun-glasses, we both wear a red shirt and blue pants; we both have eggs for breakfast, we both have a bandaged "hurt" on our left thumb. I am thrilled we have found ways to be the same and yet different.

There's a non-matching piece as well. My daughter insists on wearing mismatched socks. Is this a comment on how two things that don't appear to go together actually can do quite well? I like to think so. The other day she stared at an African-American man and a blond woman strolling together. We talked about how they were "different" and the "same", just like we were. The concept of race is not one easily explained to young child, so I just leave it in simple, concrete terms: pale skin/darker skin; big and little noses; round eyes/almond shaped eyes; straight black hair/kinky hair/ brown wavy hair etc.

My daughter spent four years seeing herself reflected in Chinese faces and bodies. Somewhere inside she has a picture of herself through the mirror of these other people. But that image has been occluded in less than a year by her new family, her new environment. Consequently I considered it vital to find a school which had a diversity of teachers, and families; a school that was proactive in helping children identify and appreciate their own and others similarities and differences. I was fortunate to find such a school and in less than a year my daughter's drawings and self-descriptions became both accurate and confident.

One of my Chinese friends laughed when I told her about my mirror experience. "Your daughter is going to be a banana, " she said.

"What do you mean, 'banana'?" I asked, slightly offended and totally puzzled.

"You know, a person who's yellow on the outside and white inside is a 'banana'" she explained. "You are an inside out banana!" and she went off into gales of laughter. I realized she was right, recently I had felt I was "passing" for Caucasian.

"Yeah, I get it, " I said, chagrined, "It's an Asian 'Oreo'".

My friend stopped laughing. "What's an 'Oreo'?"

� Patty Cogen

Seeing Things Differently

Thu, 05 Jul 2007 18:39:31 GMT

Children raised in families have an assortment of non-verbal behaviors to cue their parents to their needs and feelings.Out of this communication arises "family skills" for getting needs met. Children who have no maternal caregiver develop a different set of cues, and a different set of skills, survival skills. Sometimes these children show a lack of cues, or their skills may rely on coercive, aggressive or manipulative behaviors to get what they want. A few cues may be unique to the child$s country/culture of origin.

The list below compares the behavior of internationally adopted children to the behavior of children raised in a middle class anglo home environment from birth.

Internationally Adopted Child		Birth Child
Eats anything and possibly everything		Picky about food and often eats very little after about 6-8 months of age.
Never whines or fusses. Parents describe their child as "too good to be true" or "the perfect child"		Whines and fusses when tired or needy, when parent is distracted or on the phone.
Goes to sleep alone in a dark room and doesnt make a peep allnight. Waits in bed in the morning until parent retrieves child.		Doesn't want to go to sleep, especially alone. Wakes in night and calls for parent. Gets out of bed or calls for parent in a.m.
Does not expect or ask verbally or non-verbally for help or to have needs met, even when frustrated. An older, verbal child may express need in an overly adult fashion ex. "We have a problem here..."		Expects and demands help frequently and usually vocally.
Is exceptionally persistent and never shows frustration with task.		Becomes frustrated several times a day and lets parent know.
Has minimal or no facial/body expressions beyond a serious gaze or is "happy all the time". Child is either completely controlled or falls apart, often without any gradual shift.		Child has a variety of moods and feelings conveyed by a range of facial and body expressions including sad, mad, puzzled, tired, thrilled, irritable. throughout the day even if generally even tempered.
Cries or vocalizations all sound the same regardless of need.		Has different cries or sounds for different needs.
Child doesn't appear to notice or feel temperature changes. Never cold: no goosebumps or shivering.		Child shows signs of cold and notices temperature changes.
Child ignores wet and/or dirty clothing or diapers.		Child shows signs of disliking dirty or wet clothing/diapers and often alerts parent to fact after 8 mo.- 1yr.
Appears unaffected by transitions or changes in routine or major moves from one location to another. May have a delayed reaction hours or days or after event. Or, is unable to handle transitions including small changes without "falling apart" i.e tantrums, withdrawing, becoming clinging etc.		Reacts to changes of routine with protest after 6 months of age, and to larger changes with clingyness and sleep disruptions.
Child (10 months or more) shows no concern when parent leaves the room.		Child cries, fusses, watches parent, and may follow parent who leaves the room after age 6 mo.
Child plays alone without checking back with parent or expecting attention, often for long periods of time.		Child plays briefly alone after walking is established, but checks in frequently and runs out of "parent juice" within 10 - 30 minutes.
Child uncomfortable with dependent relationship, rejects parent's help and takes care of self in ways that indicate child doesn't expect to be cared for by adult, i.e. refusing to let parent hold bottle for child, ignores parent when being changed or dressed.		Child enjoys and is comfortable with dependence on parents and shares caretaking tasks i.e. holding bottle together, makes eye contact when being changed.
Child uncomfortable and may avoid with physical closeness especially with parent and/or seeks closeness indiscriminantly with other adults.		Child enjoys, seeks, and prefers physical closeness with parent.

Tips to Encourage Attachment

Thu, 05 Jul 2007 18:43:01 GMT

For any of the areas below, consider your child's "family age", the number of weeks and months your child has been a member of your family, rather than chronological age as a guide to "appropriate behavior and expectations".

Feeding: Anticipate your child's hunger. Encourage your child to make eye contact with you as she eats. Hold child on your lap while you feed him or her or while child feeds herself. Help child to recognize feeling empty and full. Make eating a time of physical and emotional intimacy.

Sleeping: Have child sleep in your room; a separate bed is fine. Tell child you are always available, and respond even to small sounds or cries in the night to develop your child to trust you at night as well as during the day. Stay near your child as he/she falls asleep. Remember, your child is only a few weeks or months old in "family time"; you wouldn't expect a two month old baby to put himself fall asleep alone.

Bathing: Bathe with your child and engage him/her in water play and body exploration. Skin to skin contact as well as eye contact are critical to building attachment.

Toileting: Help your child relate to you with eye contact and vocalizations when you change a diaper. Help your child learn to tell you when he/she is wet or dirty. If your child was toilet trained prior to adoption, expect accidents and perhaps a return to diapers. Remember to teach about and help your child to use our style of toilets.

Dressing: Dress or help dress your child, using this as an opportunity to have safe, contained physical contact, to teach vocabulary of body parts, and to comment on similarities (claiming): "Look we both have fingers on our hands!" or " You have brown hair and I have black hair: we both have hair!"

Injury: Respond, regardless of whether your child does, to any hurt or bump no matter how small. This is the way to teach your child to expect care when hurt, emotionally or physically. Model or encourage crying when it's appropriate, not stoicism, even in older children.

Emotions: Name and model all sorts of feelings. Use exaggerated facial expression and body language, and give words, phrases and dialogue for how to react emotionally. A basic beginning repertoire includes: happy, sad, confused, mad, and tired. Additions include: thrilled, furious, and frustrated.

Playing: Play with your child. Don't expect your child to know anything about toys or objects that are most familiar to you. Teach your child how to play.Minimize frustration; begin with toys that are for babies and toddlers.

Verbally: Describe what you and your child are doing to develop both vocabulary and your child's understanding of "how and why the world works". Include frequent references to how it might have been done one way in the orphanage (you sat in a chair and were fed quickly because lots of other kids were waiting) but in a family it's done a different way (you sit in my lap and I feed you slowly).

Picking up/Carrying: Remember "Family Time" when you debate whether to pick your child up. Most infants are carried without question until they can walk well, around 15-20 months. So give your self a good year of carrying. Get a backpack or front pack to help when you're doing chores. This close physical contact is critical to attachment and to bonding.

Socializing: Don't let your child go to other adults indiscriminately. Develop your child's sense of appropriate intimacy and expectation of care from just parents. Only parents should hold their child for the first month, and after that only extended family, if the child is comfortable. Define the following levels of intimacy : parents, family, friends, acquaintances, and strangers.

Frustration tolerance: Help your child develop ways to express frustration by demonstrating facial expression, physical and verbal ways to ask for help. Recognize when your child should be frustrated and coach your child to ask for assistance at that time. Emphasize the pleasure of getting (and giving) help.

Getting attention: Help your child learn to ask for attention. Demonstrate physical and verbal ways of asking for attention. Note when your child lets you "ignore" him or her for too long (phone calls, conversations with friends), catch yourself and explain to your child they have the right to ask for your attention, even when you are busy. Encourage child to do this.

Sharing: Children from orphanage settings sometimes share because they don't thing anything is really theirs. Help your child learn that certain things, including parents, belong to them and can not be taken away. Expect a short period of sharing, then a long period of possessiveness and eventually a genuine ability to share.

Sibling and Family Rivalry: Adopted children are often more jealous of sibs and parents or even parents showing affection to each other.

Regression: Expect it, even encourage it. This is your child's chance to be a baby with you.

Attunement/ Mirroring: Attunement is mirroring the emotional tone of your child. This and mirroring behavior and vocalizations helps build a child's sense of self and attachment. � Patty Cogen

International Adoption: Risks & Realities

Thu, 05 Jul 2007 19:11:09 GMT

There are numerous reasons why parents choose International adoption, but each case usually has a unique story attached to it. Some people have an affinity for a certain culture, some for humanitarian reasons, and some because they believe the risks are less than those for domestic adoption. Whatever the reason, any family considering international adoption must be well informed and accepting of the risks and realities of adopting internationally.

Lack of Information:

The information that is received on any child is typically minimal. The referral information will most likely include little to nothing about the birthmother. The child may have a genetic predisposition for medical or psychiatric illness which will not be known as family histories are not provided. A history of alcohol/drug abuse is not often known. Whether or not pre-natal care was obtained is typically unknown. Complete orphanage records are not sent. Sometimes diagnosis are made and test are performed that do not make any type of medical sense. When parents are lucky, a medical report may be available providing information as growth parameters, past medial history of what occurred in the orphanage and many times a video and pictures. While all children from International adoption are considered to be at minimal risk, this information when taken to a Pediatrician can help to uncover other more significant problems that are not visualized by the referral source.

Medical Uncertainties:

The countries where children are primarily adopted from usually have inferior medical technology and limited diagnostic capabilities. Although most of the children have some form of medical care, the standards of medical care for the children may not be the same as that for the general population.

Until recently, many infectious diseases were relatively rarely seen in the the United States, but they are a way of life in many countries. Children may be tested for certain diseases and be negative at the time the test was taken. However, that does not ensure the test was accurate or that the child has not subsequently become exposed to the disease. Viruses and infections can sweep through an orphanage. Children who have had frequent colds and ear-infections (not always known) may have built an immunity to some medications and some may have some hearing loss.

Orphanages do not provide children with well-balanced diets so the children tend to be small in stature and underweight which can have immediate and/or long-term medical implications.

The lack of well-balanced diets can lead to vitamin deficiencies or other associated conditions. Due to the lack of physical and intellectual stimulation, the children are generally developmentally delayed with poor muscle tone which may or may not mask a medical or neurological condition.

Environmental Conditions:

Uncontrolled water-air-soil pollutants, lead paint and industrial use of lead are some of the environmental hazards faced in some countries. Alcohol abuse and cigarette-smoking are socially acceptable behaviors in many countries, even during pregnancy.

Children With Special Needs:

The definition of "special needs" has come to mean children with physical disabilities or medical conditions, however, it is often not so simple.

The lack of a medical and social history, available medical care, living conditions, environmental conditions, disease, and incomplete and/or inaccurate referral information leave so many unknowns that we can not say any child is healthy.�

Although International Physicians may be capable at diagnosing visible medical conditions, there is little to no awareness of psychological problems. The emotional and physical impact of the living conditions may lead to long-term difficulties. The younger the child, the more unknowns there are as the child has not reached many of the physical and developmental levels necessary for more complete assessments.�

Many children are described as "healthy" by the referral sources or foreign government, but this needs to be taken in the context of the above conditions and the unknowns should be considered carefully.��

Other Risks and Realities of IA:

No-one can predict the future of any adoption program in any particular� country. Referrals of children should be considered tentative until the adoption has been finalized and the child is home. Countries may unexpectedly close, laws and requirements may suddenly change causing delays or moratrarium on all adoptions. (like what occurred in Romania). Other reasons, such as birthparents changing their minds, referrals lost to in-country adoption, or children may become seriously ill, could result in the child no longer being available for adoption.

If all of the risks of IA were to become realities, no-one would choose to adopt internationally; however, many times� the risks do not always become realities and there are many families who have adopted healthy, happy,� flourishing children who are thriving under the loving care of their new parents.

The Transracial Adoptees Bill of Rights

Thu, 05 Jul 2007 19:35:00 GMT

Adapted by Liza Steinberg Triggs from "A Bill of Rights for Mixed Folks," by Marilyn Dram�

� Every child is entitled to love and full membership in her family.

� Every child is entitled to have his culture embraced and valued.

� Every child is entitled to parents who know that this is a race conscious society.

� Every child is entitled to parents who know that she will experience life differently than they do.

� Every child is entitled to parents who are not looking to "save" him or to improve the world.

� Every child is entitled to parents who know that being in a family doesn't depend on "matching."

� Every child is entitled to parents who know that transracial adoption changes the family forever.

� Every child is entitled to be accepted by extended family members.

� Every child is entitled to parents who know that, if they are white, they benefit from racism.

� Every child is entitled to parents who know that they can't transmit the child's birth culture if it is not their own.

� Every child is entitled to have items at home that are made for and by people of his race.

� Every child is entitled to opportunities to make friends with people of her race or ethnicity.

� Every child is entitled to daily opportunities of positive experiences with his birth culture.

� Every child is entitled to build racial pride within her own home, school, and neighborhood.

� Every child is entitled to have many opportunities to connect with adults of the child's race.

� Every child is entitled to parents who accept, understand and empathize with her culture.

� Every child is entitled to learn survival, problem-solving, and coping skills in a context of racial pride.

� Every child is entitled to take pride in the development of a dual identity and a multicultural/multiracial perspective on life.

� Every child is entitled to find his multiculturalism to be an asset and to conclude, "I've got the best of both worlds."

This article is published with permission from Pact Press.Pact, An Adoption Alliance,4179 Piedmont Avenue, Suite 330, Oakland, CA 94611Website :www.pactadopt.org Email :info@pactadopt.org

�

A Gift Only Adoptees Can Give

Wed, 11 Jul 2007 13:53:51 GMT

It's a gift adoptive parents can't give, birth parents can't give, or adoption professionals can't give. Only other adoptees can give it to one another.

I'll never forget sitting next to an adoptive mom at an adoption carnival where I was speaking. At the end of the day the time came for the children and teens to come on stage and show the parents an adoption art project they had been working on.

When all the kids were in place one of the therapists yelled, "Who's adopted here?"
Everyone's hands flew up and squeals of delight burst forth from the little ones.

"Me!" they yelled in unison.

The mom leaned over and said, "I've never seen that expression on my daughter's face. Look at her! When she said 'me,' her face absolutely glowed!"

Something unique happened to her daughter that day. What was it? Was it the excitement of being with kids the same age? Was it a sense of pride about her artwork or love of the spotlight?

I don't believe so. I believe it was because she had been given a gift that was brand new to her-the gift of fellow adoptee friendships!

The psychological drive that makes this gift so special is that it involves our basic need for connection. Drs. Brodzinsky and Schechter, adoption specialists with 30 years of combined experience, say that connection to an adoptee is like food to a starving man.

But connection to what or whom?

As an adoptee, I would guess it involves something to do with our lost heritage.
For those adopted at infancy or a young age, any connection to our heritage helps satisfy that need. Original birth certificates. A name or photo of our parents. An adoption story that included our birth parents. A reunion with our birth parents.

If we were foster kids and adopted at an older age because of troubled parents, that need for connection may manifest in an unexplainable loyalty based on vestiges of fantasy of what life might have been like had we had nurturing parents and remained in their home.

Many times this connection with our birth families is not an option. International adoptions often make it impossible. Sealed records keep vital information irretrievable.
Nonetheless, our friendships with one another are downright amazing!

The Amazing Gift

By being in the presence of fellow adoptees, we discover:

. We Are Like Family. Linda says that knowing adoptees has created a wonderful bond because there is a kind of "sisterhood" and "brotherhood" amongst us that has filled some of the void of not knowing her heritage.
. We Are Drawn to One Another. Gary said that his young daughter seemed to gravitate to other adoptees in her preschool class. Of course she didn't know they were adoptees, but there was that pull.
. We Have a Unique Emotional Language. Sherry says that adoptees can "read" each other from just a few words or their body language, which she says makes adoptees feel like they belong to each other.
. We are like Triple-Chocolate Cake. I never had an adoptee friend until I was forty-five. Her name is Jody Moreen. We spent hours in our favorite little tea room sipping spiced tea and "talking adoption." Life doesn't get much better than that!

Looking back, I can say that not having a fellow adoptee for a friend was like going through life and having missed triple-chocolate cake!

If your adopted child doesn't have fellow adoptee friends, start searching!

� Sherrie Eldridge, 2007. Based on Sherrie's second book, Twenty Life-Transforming Choices Adoptees Need to Make (Pinon Press, 2003)

The Love Language of an Adoptee

Wed, 11 Jul 2007 14:20:46 GMT

Imagine yourself facing a huge blackboard and running your fingernails over it, from end to end! It's enough to make one cringe just thinking about the possibility.

There is an emotional reaction within many adoptees, comparable to that finger-over-the-blackboard, sensation. To clinicians, it's called cognitive dissonance but to lay people, it's mixed feelings. A good example would be feeling happy and sad at the same time. For moms describing it to your kids, you could call it "double-dip feelings."

Adoptees experience mixed feelings when good-intentioned people make certain statements about adoption. Whenever I speak with parents on this topic, I share the following chart of six well-intentioned statements, how the adoptee often hears them, and then how to translate the intentions into the love language of the adoptee. This is adapted from my second Twenty Life-Transforming Choices Adoptees Need to Make.

There is one requirement before you read these statements. You must not let yourself feel guilty! We have all said these things at one time or another.

Communicator's Intent	Well-Intentioned Statement	Adoptee Translation	LOVE Language
Child will not feel rejected; cast good light on birth mother	Your birth mother loved you SO much that she gave you to us!	"Love is what got rid of me."	Your birth parents weren't able to parent ANY baby/ANOTHER baby at that time.
Create a sense of being wanted	You are a chosen child!	"I might have been "chosen," but first I was given away."	You have 2 sets of parents, one who gave you birth and another that gave you home and love. We are so glad that we got you!
Adoption is a blessing	Accentuate the Positive! (Count your blessings..count them one by one.)	Only say nice things about adoption or mommy and daddy will get upset.	Everything in life is happy and sad. The same is true for adoption. It's okay for you to feel sad and happy and to talk to us about ALL your feelings.
Describe parentage; ignorance	Illegitimate	I am a mistake.	God made you and He doesn't make mistakes!
Create self-esteem	You are special!	It's not okay just to be me. I have to try hard and do good so they'll like me.	We love you and always will, just as you are!
Create sense of belonging, inclusion	We love you JUST LIKE our own!	Why are you trying to make me like you? I'm not!	We love the unique things you add to your family!

Speaker and author, Sherrie Eldridge, an adoptee herself, is passionate about assuring those touched by adoption that they can grow because of the unique challenges adoptive family living presents. She is the author of the highly-acclaimed books Twenty Things Adopted Kids Wish Their Adoptive Parents Knew and Twenty Life-Transforming Choices Adoptees Need to Make and FOREVER FINGERPRINTS...An Amazing Discovery for Adopted Children (EMK Press). As President of Jewel Among Jewels Adoption Network, Inc., a non-profit adoption educational organization, she offers extensive online resources, including inspiration, encouragement, projects for parents and kids, newsletters, and free workbooks (www.adoptionjewels.org). For speaking, www.SherrieEldridge.com.

Helping Adopted Children and Teens with Identity

Wed, 11 Jul 2007 15:02:39 GMT

Imagine a May pole, with three shining ribbons streaming from the top. One ribbon is the deepest of purples, another, the richest of greens, and the third, the most vibrant of reds.

It's a beautiful summer's day and several young children dressed in white are dancing around the streaming ribbons, with arms outstretched, trying to touch the ribbons. They have no idea of the significance of the ribbons, or that their life task as adoptees is to braid these ribbons someday.

They do know, however, the basics of adoption because their parents have openly shared with them from day one. Adoption and the subject of birth parents are not foreign subjects-they are part of the beautiful dynamics of our family. "We are so happy that your birth parents gave you to us!" "Let's pray for your birth parents before you blow out your birthday candles."

As early as age three, your child may ask when she can meet her birth mother/father. However, adopted children don't truly comprehend the depth of meaning in those words and "parrot" their birth and adoption stories, grinning from ear to ear. This is misleading for parents because you may believe the big grin and happy story are indicative your child's peace about adoption. Remember, that adoption, just like everything else in life, involves pain as well as pleasure, and your child will discover that in the years ahead.

Start Early with a Coloring Project

By the age of two or three, when your child shows likes coloring, grab the opportunity to engage him with a coloring project called "The Story of the Braided Ribbons," located at www.adoptionjewels.org (downloadable on your computer). To make it a keepsake, print it in color on parchment paper. Reinforce the words "Birth Mother/Father," "Mom and Dad," and "Adoptee." Explain to the child "Red is for you, because you were adopted. Purple is for mommy and daddy because we adopted you, and green is for your birth mother and father because we love them for giving you to us." Every time you mention a color, have the child color part of the braid. Coloring will be scribbles, but you will be taking your child to the next level of adoption awareness and understanding. Perhaps your child can create one of these each year and you can include them in his Life book.

Buy Ribbons for a Braid

When your child reaches seven or eight, her cognitive abilities have further developed and she'll be able be able to reason, "Yes, I was adopted, but first I was sent away." Questions and tumultuous emotions will arise at the most inconvenient times (while you're in the bathroom or in the car at a busy intersection). "Why did she give me away?" "Was I a bad baby?" "Did I cry too much?"

This is prime time to teach them how to braid their ribbons because they now have the ability to begin understanding abstract concepts. Tell your child that you're going to do a fun adoption project together. Prior to this, you may want to show him the braids he colored when younger, reminding him of the meanings of the colors. Take him with you to the fabric store and let him choose red, purple, and green ribbons.

Tell her that an exciting part of being an adoptee is coming to understand how each person involved in her adoption is related to her and what they have given her to help her become the wonderful person she was created to be. Say, "Each ribbon has a purpose, each a vital contribution, and each a unique position with the other ribbons. Each ribbon is a work of art, but braided together, they become a magnificent masterpiece."

Teach that every time she discovers something new (feelings, thoughts, or facts) about her birth and adoptive families, whether hurtful or happy, it is an opportunity to make an addition to her braid. Explain that it's okay to feel sad, mad, glad, or scared about adoption and that she can share these feelings with you.

Deepen the message about the significance of the colors. "The purple ribbon represents your adoptive family, chosen to nurture you when you were given to us from your birth family. The green ribbon represents your birth family and their special gifts to you, like the gift of birth. The red ribbon represents you--a unique weaving together of nature and nurture into one marvelous human being, with awesome potential."

Teaching your child to weave every part of their story, whether painful or pleasurable, opens the door for helping them resolve upcoming teen identity issues of integrating their dual identity, of nature and nurture, and biology and adoption.

Get Creative-How to Begin

Young Children: Color the Braid (www.adoptionjewels.org)
School Age: Make a May pole with long, streaming ribbons
Teens: Make a friendship bracelet with purple, green, and red

Why Adoptees Get Mad at their Moms

Wed, 11 Jul 2007 15:05:00 GMT

Many moms of adopted children can't figure out what they've done wrong, what makes their children reject them, even though they have literally poured their very souls into their children. This anger may manifest in shouting matches, temper tantrums, refusing to let you hold her hand when walking through the parking lot, or refusing to go for a walk with you on Mother's Day.

It's downright hard for a mom not to take this rejection personally, but it is absolutely necessary that you don't-both for the welfare of your child and your own sanity.

If you understand the core reason why your child is rejecting you, it will be easier for you to detach from an emotional response and help your child comprehend the source of her anger and deal effectively with it.

Misplaced Anger

Anger is a scab over a wound, a secondary emotion. In other words, it happens in response to another occurrence, which is pain. No doubt, your child has the anger problem, which manifests in rejection toward you as a mom, but what is the great hurt? You haven't hurt her! You've done everything humanly possible to demonstrate your great love for her.

In reality, the anger is misplaced. Your daughter is not angry at you; instead, she is furious at her birth mother for leaving her behind. No matter how loving the birth mother and the adoption plan, the absence of the birth mother translated to your child as pure abandonment. That is the deep hurt beneath the scab.

Because your child doesn't understand this dynamic, she lashes out at you, with misplaced anger. The birth mother isn't around, so you receive the brunt of her anger.

You may be at the end of your rope, feeling crushed beyond belief by her multiple rejections. Truth be known, your child may wonder what is wrong with her-what is the cause of this overblown anger toward you?

How to Help

Understanding adoptee loss is the key to helping yourself and your child overcome this common adoption hurdle. Many parents read Twenty Things Adopted Kids Wish Their Adoptive Parents Knew, make notes in the margins, and then give it to the teen to read. This has opened many conversations.

If you can help her understand the source of her anger, then she can begin to manage it through grieving her loss (professional help may be needed here) and going forward toward healthier relationships, with you and others.

Changing an Adopted Child's Name

Wed, 11 Jul 2007 15:08:13 GMT

Changing an adopted child's name is of great concern to parents of international and domestic adoptions. One mother wrote, "When a child is adopted at age five or six, or later, do you feel it's appropriate to change the child's name? Should we consult with the child's wishes? Doesn't changing the name give the message that the birth family is bad, or something that should be hidden?"

There is core adoptee issue in this mother's questions about names.

A Name Establishes a Sense of Connection

Adoptees have a deep need for a sense of connection. Adoption experts Drs. Brodzinsky and Schechter say in their best-selling book Being Adopted: The Lifelong Search for Self that an adoptee's need for connection can be compared to a starving man's need for food.

Because the adoptee's connection with the birth parents was severed at birth, or later, there is a deep need to feel a sense of connection to them. This may not always be possible, in fact, with the increasing number of international adoptions, it may be next to impossible. However, there are other ways of establishing a sense of connection, such as visiting the country of origin, attending a heritage camp (www.heritagecamps.org), or fixing an ethnic meal.

Another aspect of connection needs to happen with you! We need to know that even though "we aren't bone of your bone or flesh of your flesh" that we grew in your hearts instead of under them. We need to hear our adoption stories, repeatedly. My dad delighted in saying, "You were so small, I could hold you in the palms of my hands," until his dying day. In addition, I delighted in hearing it just as much as he did telling it.

Bottom Line about Changing Names

Should an adoptee's name be changed? Personally, I believe it should be preserved and honored at all costs. It IS the link to the "past" portion of our dual identity. For parents to wipe it out would be one more severing and loss for the adoptee. It is something we can be proud of-something that proves we aren't "aliens," as many adoptees secretly believe. If it is changed, it likely will cast an unfavorable light on the birth family, instead of honoring them. Birth parents deserve much honor, even though their history may be negative or missing, for they gave you the gift of a beautiful child.

Our grand daughter who joined our family through adoption was named "Gracie" by her birth family. Our adult children have honored her birth mother and the heritage she gave by preserving the designated name as her middle name and adding their own first name-"Megan." By the way, Megan means "pearl." She's our pearl of a girl!

A Tool to Help Adoptees Resolve Loss

Wed, 11 Jul 2007 15:10:13 GMT

Loss? My child hasn't experienced loss! This is what many adoptive parents want so badly to believe. However, it is a reality of adoptive family living. Connie Dawson, Ph.D, an adoptee, author and speaker, and attachment specialist says, "Understanding how grief and loss affects adoptive relationships is an inoculation geared to prevent later problems."

It's one thing to understand that your child has experienced loss, but it's another thing to know how to help him grieve it successfully.

An Adoption Project

This tool can be used with children, ages seven and up. It can be used as a family project, as a parent/child project, or a counselor/client project. Here are the steps:

1. Tell him that you are going to work on an adoption project together.

2. Find a box that can hold several items-possibly 12 X 16 and 6 inches tall.

3. Make a "Sad List"----about his birth family, about the failed reunification, etc.

4. Select items together that are representative of each loss and put them into the box (You can use small items or photos from magazines and newspapers. Go to the dollar store-it's a great place to find the items. One teen that I worked with from Romania said that she had tears inside that wouldn't come out. We found round, blue pieces of glass wrapped in mesh, and those represented her unshed tears). Put the lid on the box.

5. Have child take items out one at a time and tell you how he feels about each one-- how he felt, where he was, what other people said, the smells, and the sounds. Help him get in touch with his anger. Explain that it is okay to be angry and to "get all the angries out." Assure him he can say anything-things he thinks are unspeakable. "I hate my mommy for not keeping me." This has to be done to get all the pain out. With truth and confession, there is freedom!

6. Validate his emotions. To validate means "to say that it's okay to have that feeling."

("If I were you, I would feel the same way." "It must really hurt, doesn't it?" Or, "You have a right to be angry!")

7. Teach him to forgive each person who has hurt him. (I like to use the illustration of having the person who hurt you strapped to your back. Ask him how heavy that would be. Ask him what awful things that person might say. Ask if he wants to grow up with all that happening. Then tell him that to forgive, means to cut that person loose. You might even want to draw pictures with him around this theme.)

8. Teach him that hurtful things can cause us to grow strong. Have him replace each item and say thank you and ask how he thinks he might grow stronger from each hurt.

9. Teach him to let go. Tell him that you'll put the box in a special place until he needs to use it again and then at that time, add another item.

Whenever I share my personal grief box, some people say, "Isn't it depressing to take it down for another loss and look at all the losses you've experienced?" I always assure them that the opposite is true-it is a reminder of how much I've grown!

Moms, look for changes in your child's emotional and spiritual health after doing this exercise, after he's had time to process it. You will be amazed that the grief box has turned into a gift box, and that grief was really a gift in disguise!

Named With Love

Wed, 11 Jul 2007 16:10:18 GMT

Our kids are starting to talk. Our son yells "DOG!" from one side of the room to call one of our Corgis towards him. Our daughter runs up to my legs and throws her arms around them, saying "Maaa" to let me know she wants to be picked up. I watch them daily as they discover that they have names for all that they love.

While we waited for our daughter's referral, we worked at picking out names. I remember the lists, the combinations; all we did to try to make sure we'd give her the right name. On the day the call came, one of the first things we were asked was if we'd chosen a name. We had: a first and middle name. But the name we gave when asked that first day was not the name she had on her original birth certificate, nor, as it turned out, the one she would have on her amended birth certificate either.

During the wait for our first adoption, the reality of another women as my daughter's first mother changed shape in my heart. She evolved from a ghost to a court report to a picture to a name; a person. She became no stranger; as my love began to grow exponentially for our new daughter, I also came to feel more bonded to her first mother by our mutual love. No stranger, because if I were to see her one day, I know that I would chose to reach out to her, call out her name.

Several nights over the past eighteen months I've fallen asleep and dreamt of her. Usually, the dreams are the same. We're sitting on a courtyard in Guatemala speaking in Spanish. We're playing that game of exchanging what we love best about our daughter, reminding each other of new things to say. She tells me what she wants from me, and I promise her two things: that my mouth will never forget how to form her name, and that the name she gave our daughter won't be taken away, as it is changed.

The first time I had this dream, we were a few months post-referral and I hadn't thought twice about changing our daughter's birth name. But then, that dream awakened that idea that, if we took away our daughter's birth name, her first mother wouldn't have the same access to her in dreams and prayers. Some people believe that, in international adoption, the children's first mothers are the ones my husband and I are supposed to bury as the ink dries on the final adoption decrees. That we should swaddle our children close and let ourselves forget a time when we were not yet with them.

But how could I forget the presence of the woman who called our daughter forth, a woman who loves the same person I love?

We ended up keeping our daughter's birth first name as her middle name and adding a first name of our choosing, so she'll always have a special name for all the people who love her to sing in dreams and prayers. A whole name that honors her origin and acknowledges that her great story did not begin with us while also making room for our soul-shaping love in her life. We've done the same for our son. I thought of names again more recently, when we received the surprising phone call from our agency telling us our son's first mother had just given birth to a baby girl she'd like to place with us for adoption, if we were willing, and we were asked to chose a name. I held the phone to my ear as our caseworker passed along to our lawyer that we'd accepted the referral, tears coming to my eyes when I heard that her first mother and my husband and I had all chosen the same name.

Sometimes, despite the unlikelihood of connection, connection takes place. I'm thankful we were wise enough to open ourselves to it. As we wait for our new daughter to come home, I watch our toddler son and daughter open their mouths and call their desires into the world, and smile, knowing that the names we call them reflect the love of the women who brought them into the world, as well as that of the parents who'd move the world for them.

Bones That Float: A Story of Adopting Cambodia

Wed, 11 Jul 2007 16:12:19 GMT

Even before we adopted, I loved hearing and reading birth and adoption stories. I always found something so fascinating about the way a child arrived into a particular life. Imagine my thrill then, when the latest book I received to review featured a luminous storyteller writing about love, friendship, and destiny through the experience of adopting a son from Cambodia. Kari Grady Grossman's Bones That Float: a Story of Adopting Cambodia (Wild Heaven Press, 2007) is my favorite type of book- impossible to put down and haunting long past its end.

From the first page, the reader is drawn in by powerful questions such as: why do certain children come into certain parents' lives? how profound is the transformative power of parenthood? and how can love make up for loss? It's in the mystical journey these questions inspire that Grady Grossman's writing weaves three stories.

In one, Kari and her husband long for a child and eventually adopt Ratanak from Cambodia; the couple travels, photographs and experiences the country, and lets its history begin to sink into them. After they return to the U.S., they struggle to give their son the best of both U.S. and Cambodian cultures and to determine what their duty is towards their son's first country and family.

In another, the reader follows Amanda/ Maly Prom, a Cambodian refugee and dear friend to the Grady Grossman family, as her family suffers and survives the violent rule of the Khmer Rouge, and eventually emigrates to rebuild a life in the western U.S.

In a third, the reader follows Sovann, Kari's moto driver and eventual friend and employee, and glimpses what it might be like to make a life in this ravaged country with no possible escape.

It's these three stories which add amazing depth to this memoir of adoption and go such a long way in helping the reader understand the hypnotic horror and hope Cambodia has to offer in an intimate and unforgettable way. Each of Grady Grossman's chapters begin with an epigraph, but the one that sticks with me the most as I consider her work is: "Life shrinks and expands in proportion to one's courage," attributed to Anais Nin. To adopt internationally and write this story is courageous, but what is most courageous of Grady Grossman is her continuing effort at making a difference in Cambodia.

By founding the Grady Grossman School in the Chrauk Tiek village, by donating a generous percentage of the proceeds of her book and by remaining engaged with her son's birth country and culture, she brings education, possibility, and hope to those facing "dismal poverty, government corruption, and environmental destruction" in her expanded world.

I offer Bones That Float high praise and believe this spellbinding story deserves a place on every bookshelf, as a book that makes its reader aware of the reach of love, as well as of the connections between all citizens of the world. For more information on Bones That Float, The Grady Grossman School and what you can do to help, please visit: www.BonesThatFloat.com and www.GradyGrossmanSchool.org .

Babyproofing Your Marriage: How to Laugh More, Argue Less, and Communicate Better as Your Family Grows

Wed, 11 Jul 2007 16:14:43 GMT

Like many adoptive parents, my husband and I gained experience in childproofing long before we gained experience in parenting a child.

We childproofed our house for our home study visit - outlet covers secured, toxic materials raised to high shelves, safety latches attached to the windows- early on in the process. By the time our daughter arrived home, childproofing wasn't even fresh in our memory. It was just something we'd done to prepare our home for our child, to make it safe and welcoming.

The book Babyproofing Your Marriage: How to Laugh More, Argue Less, and Communicate Better as Your Family Grows (Collins) by Stacie Cockrell, Cathy O'Neill, and Julia Stone springs from a similar concept; it's the how-to behind keeping your marriage healthy and fun as you welcome children into your family. Written by three friends, it collects the marriage and parenting experiences of the authors, their friends, and a considerable number of perfect strangers into a practical guide for today's trying-to-do-it-all parents.

Cockrell, O'Neill and Stone dive into issues such as romance, communication, sex, child rearing, work, housekeeping, time management and in-laws with purpose and a sense of humor. Babyproofing Your Marriage is full of advice to help you integrate your original husband and wife roles with your new dad and mom roles.

Moms and dads will find something (if not many things!) to identify with as the book fairly presents male and female perspectives throughout various phases of parenthood. Even better, you'll both find great tips such as the "Dad's Training Weekend", "Five Minute Fix", and the essential and too-easily-underestimated "Divide and Conquer" which are sure to refresh your approach to each other and to your new familial responsibilities. Cockrell, O'Neill and Stone make sense in their observations and suggestions; they give straight-forward advice from a "been there, done that" point of view.

It's true that Babyproofing Your Marriage employs stereotypes such as the workaholic, sex-starved dad and the bathrobe-wearing, martyred mom to represent common pitfalls of parenthood, but the authors' hyperbole seems used to catch the reader's attention, to wake you up. Sort of a "Hey! Just because your new child is helpless doesn't mean you can ignore your partner! The joy of your marriage is what made you want to grow in your love in the first place!" Their nudging works.� By the end of the book, you've paid attention to all the little things they suggest and realized they might just make a big difference. You're ready to cast off the stereotypes and become your own version of a happy, healthy spouse and parent ready to enjoy the chaotic wonder of your life.

Spend some time with Cockrell, O'Neill and Stone- their chapters are great stand-ins for your real-life parent friends dishing their advice over lunch.particularly if your real-life parent friends are too overwhelmed or sleep deprived for this kind of chat. Whether you're a first-time parent, a parent in the process of adding more children to your family, or just a parent needing a boost of spirits, I highly recommend Babyproofing Your Marriage. It may not be an adoption-specific book, but the help it provides is just as necessary for adoptive moms and dads.

True Bravery

Wed, 11 Jul 2007 16:17:47 GMT

I think of my husband and myself as brave. After all, we have embarked on one of life's ultimate adventures: an international adoption. We put on our bravest faces every day when we pass the still baby-less nursery, when friends and family continue to ask, "Any news yet?", when no one seems to understand how difficult it is for us to put our total faith in the hands of adoption professionals in a different country, and most of all, to wait when our arms ache for the presence of the daughter we know only from dreams and from pictures.

Day after day, it amazes me that we keep persevering, having faith that our family will be united one day. It makes me very proud of us, but I can get a little self-pitying too. On those days when we're waiting for updates, when we feel so alone in our personal struggle, we need a sense of perspective that we won't take from those around us, unless they're adoptive parents themselves. At least that was how we felt until we got the ultimate perspective in the form of a new personal heroine: our daughter's birth mom.

We received the DNA results required by the government for Guatemalan adoptions on a Saturday afternoon in April. My husband got our mail from the box and leafed through it while walking up our driveway. We were not expecting to get the results, which include scientific proof of parentage and a picture of your child in the arms of their birth mom, for another week, so we were surprised to find a large Labcorp envelope peeking out just in front of our junk mail.

Anxious to see another picture of our daughter, and to finally see her birth mom's face, we tore the envelope open. What we saw inside can only be summed up as a revelation. Imagine the emotions that you might feel when looking at a photograph of a work of art, such as the Mona Lisa, or a natural wonder such as the Grand Canyon . Take that sense of awe and wonder and multiply it by a million. That's what we felt when we saw the picture of our daughter's birth mom holding her in her arms.

We were amazed by her beauty, her lips and skin and eyes a carbon copy of our daughter's. Most of all, we were silenced by the strength and courage that emanated from her birth mom's eyes, and by the admiration that this made us feel. After all, in all of our bravery as adoptive parents, could we compare ourselves to this young woman, making the ultimate sacrifice of losing her child to provide her with a life of opportunity? Could our love ever be that brave? We will never know the answers to these questions. Our love for our daughter will play a different role in her life. But what this experience of coming face-to-face with her birth mom's presence has shown us is that we must always honor her bravery; how could we ever downplay or ignore something so significant? Because although she is thousands of miles away, this woman will always be part of our parenting- that part which urges us and shows us how to be better parents every day by opening our hearts in the face of both easy and challenging circumstances. She will forever be a part of our lives as our family loves her in silence and in conversation.

We will cherish the force of her birth mother's love so that our daughter may always know where her own brave eyes came from.

The Complete Book of International Adoption

Wed, 11 Jul 2007 16:19:08 GMT

When my husband and I started our adoption journey, there were a lot of books about international adoption we didn't buy. This is a major statement from two book lovers, but a true one. It seemed that the majority of the books on the adoption bookshelves were either too negative (focusing solely on the challenges of parenting a child through adoption), too shallow (treating Guatemalan adoption the same as Russian adoption) or just too dry (and when you're in the middle of paper-chasing, you need a real page turner to keep you going). So we went against our nature and mined other resources in order to become educated and bolstered throughout the process.

Our minds expanded with new information, though our nightstands lacked the expected adoption reading. My nightstand void remained until I received Dawn Davenport's The Complete Book of International Adoption: A Step by Step Guide to Finding Your Child (Broadway Books) to review. Having been in the process with either our daughter (now home) or our son (still in Guatemala ) for 14 months and being blessed/ cursed with an ever-so-slightly obsessive personality, I consider myself to be well-informed about international adoption. Davenport 's book, however, presented me with even more information than over a year of experience, other research, friendships and internet groups have. Furthermore, it was a pleasure to read.

The Complete Book of International Adoption: A Step by Step Guide to Finding Your Child actually lives up to its title by carrying its reader through the initial considerations of whether or not you should adopt internationally to adjusting to your child's first months home to celebrating his/ her personal history and birth culture. It's a great find, with clear, detailed, and up-to-date information on the international adoption process between the U.S. and 17 other countries: China , Russia , Guatemala , South Korea , Ukraine , Kazakhstan , Ethiopia , India , Colombia , Philippines , Haiti , Liberia , Taiwan , Mexico , Poland , Thailand and Vietnam . Davenport covers the emotional and practical aspects of international adoption evenly and seamlessly. Some of my favorite sections dealt with how to find and choose an ethical agency, how to survive the wait, how to travel internationally and still keep your sanity and how to deal with insensitive adoption comments.

To broaden her coverage even more, Davenport includes several pages of perspectives from a variety of adoptive parents at the end of each chapter. Best of all, I loved Davenport 's voice. From her incredible My Prayer for All Children in the beginning of the book to her 50 page-long resource section, she comes across not only as an expert, but as a mom you'd want to sit down and chat with. Her compassion and sense of humor reach out to you and draw you in.

Whether you are embarking on your first or fifth international adoption, I highly recommend The Complete Book of International Adoption: A Step-by-Step Guide to Finding Your Child as one of the best books on the subject. Davenport will open your eyes and brighten them as she carries you through the life-changing journey of international adoption.

Medical Conditions in International Adoptees

Fri, 13 Jul 2007 13:01:40 GMT

Potential medical conditions

Orphans from Asia, Eastern Europe, Africa, and the Americas tend to be from the lowest socio�economic stratum and suffer from all the diseases of poverty. International adoptees may have intestinal parasites, tuberculosis, HIV, syphilis, hepatitis A, B, and C, hypothyroidism, metabolic disorders, malnutrition, lead poisoning, anemia, and fetal alcohol syndrome.

Medical problems in adoptees vary with the children's countries of origin. Hepatitis B, C, and HIV infections, although rare, [2] are more common in children adopted from Asia, Eastern Europe, and Africa, and are encountered less often in children from the Americas. [3] Lead poisoning can be expected in all adoptees, but it is found most frequently in children from Asia. [3] Fetal alcohol syndrome is most prevalent in children adopted from Eastern Europe. [3]

Developmental, psychological, and behavioral issues

International adoptees also can be expected to exhibit developmental delays, since the developing brain is sensitive to early insults, such as severe maternal malnutrition and neglect in the�first year of life. Alcohol, in particular, is a direct toxin to the fetal brain. Children may look normal, without features of fetal alcohol syndrome, but still be profoundly compromised. Also, life in an orphanage causes 20%-33% developmental delay, especially in speech (T. Ochs, MD, unpublished data, 2004).

Furthermore, the longer a child lives in an orphanage, the more likely he or she is to suffer developmental, emotional, and behavioral problems that can be especially challenging for new families. Creating and maintaining emotional attachments can be difficult for previously neglected children who have been forced to turn inward for comfort. Reactive attachment disorder may occur after severe emotional neglect and multiple caretakers, without one becoming a surrogate parent. These children may act like angels outside the home and like demons with their adoptive families, and consequently, nobody believes the parents' horror stories. Also, autistic spectrum disorders are not uncommon in this population. Children with self-stimulating behaviors (eg, rocking or head-banging) need immediate evaluation. In addition, all adoptees may have symptoms of post-traumatic stress disorder when they are removed from familiar surroundings.

Remarkably, the vast majority of international adoptees do quite well in their new families within a few months, despite initially demonstrating developmental and relational deficits. In some children, however, difficulties may remain over longer periods or worsen.

Internationally adopted children also may suffer from inherited psychiatric disorders that typically are unknown to the adoptive parents, who are given little or no medical and psychiatric history of the child's biological family.

Immunization concerns

Immunizations may or may not have been given, even if appropriately recorded. Also, efficacy of administered vaccines is debatable due to host and storage concerns. These factors make orphanage vaccine records unreliable, although South Korean and Central and South American records are the most likely to be valid. If the immunizations noted in the record look valid, and 2 doses of a specific vaccine were given, the last at least 6 months ago, immunization titers may save repeated vaccines.

Repeating immunizations is also a reasonable choice. Pneumococcal conjugate vaccine (PCV7), Haemophilus influenzae type b (Hib) vaccine, and varicella vaccine are not commonly listed on adoptees' �immunization records, and rubeola vaccine is often given at less than 12 months of age. Also, a rubeola vaccine may not include rubella. Even in children with positive immunization titers, a booster dose of vaccine may be indicated.

BCG vaccine is almost always given to orphanage children, but is, unfortunately, not completely effective in preventing tuberculosis infection. However, the PPD (purified protein derivative) relies upon an appropriate cellular-mediated immune response, which may be adversely affected by malnutrition. For this reason, placing the PPD may be delayed for a couple of months, or, if given at the initial exam, should be repeated in 6 months. A fresh BCG scar means that the PPD can be delayed for 6 to 12 months. A positive result is greater than 10 mm of induration, in which case the previous history of BCG vaccination must be disregarded. [4] A chest x-ray and appropriate treatment must follow.

Recommended screening tests

Laboratory results included in adoption referrals vary in reliability, since laboratories in developing countries are not regulated as tightly as those in the U.S. Multiple patients getting stuck with the same needle may test negative for hepatitis B or HIV in the country of origin, but yield a positive serology in the U.S. It is recommended that these tests be repeated 6 months after initial testing in the U.S. See Table 1 for a complete list of recommended screening tests for international adoptees. [4]

Table
1

Recommended Screening Tests for International Adoptees

Hepatitis B* (HBsAg, HBsAb, HbcAb)
Hepatitis C* (HCAb)
HIV 1 & 2 (ELISA screen, then PCR if positive)
RPR for syphilis, and may need treponema antibodies if positive
PPD (If done on first visit, repeat in 6 months, if negative)
Stool for ova and parasites
Stool for culture, if indicated
Complete blood count
Complete metabolic profile

Thyroid stimulating hormone
Lead level
Immunization confirmation
(If older, or parents insist. Repeating vaccines is a cost-effective option.)
Developmental screening
Ophthalmological exam
Dental exam
Psychological evaluation, if indicated

*Repeat in 6 months

For adopted children who may have developmental delays and are under 3 years of age, a referral can be made to the Early Intervention program for free evaluations and free or low-cost therapy. For older children, the public school system is obligated to do educational evaluations and interventions. Private therapy is often indicated as supplemental or complementary to school services. Resources related to international adoption services are listed in Table 2.

Table
2

International Adoption Resources

Organization

Services

International Adoptee Clinic, Children's Memorial Hospital

Contact:
Physicians call:
1.800.540.4131

Parents Call:
1.800.KIDS.DOC

Comprehensive screening tests and follow-up care for infectious diseases
Written comprehensive assessment, treatment plan, and referral recommendations to primary care physician
Onsite neurodevelopment, speech pathology, nutrition, and other specialist services

Adoption Pediatrics, Ravenswood Medical Professional Group

Contact:
Todd Ochs, MD
773.769.4600

Formal or informal consultations
Review of medical information, physical examinations, developmental evaluation, comprehensive laboratory evaluation, and follow-up care
Referrals to Early Start Program (Early Intervention), and to adoption medicine specialists in Chicago metropolitan area

American Academy of Pediatrics, Section on Adoption and Foster Care

Contact:
www.aap.org

Connections with adoption medicine providers nationwide
Educational material and links to adoption sites

Early Intervention, Illinois Department of Human Services

Contact:
www.state.il.us/agency/
dhs/earlyint/

Contact information for Illinois Early Intervention services and other resources for children with potential developmental delays

Joint Council on International Children's Services

Contact:
www.jcics.org

Education and networking resources via annual conferences (Aprils in Washington, DC)
Country-specific adoption updates

Comeunity

Contact:
www.comeunity.com/
adoption/health/growth

International growth charts

Centers for Disease Control and Prevention

Contact:
www.cdc.gov/travel/

International travel health guidance system

Conclusion

Upon arrival to the U.S., internationally adopted children must be screened for a number of infectious diseases. This is important for the health of the adopted child, the new family, and the community. Pediatricians also need to appreciate the complex physical and emotional challenges faced by these children. Then, it is possible to arrange appropriate evaluations and care for the potential medical, developmental, psychological, and behavioral concerns specific to international adoptees.

Is HIV a possibility?

Fri, 13 Jul 2007 13:06:03 GMT

HIV testing of international adoptees is a controversial topic in the field of international adoption. Debate regarding this topic has been fueled by reports in the press about the increasing incidence of HIV in China. As a result, many adoptive families traveling to China (as well as to other countries) have requested more information about the HIV status of the child they are seeking to adopt. This has resulted in families seeking HIV testing before or during the adoption process, as well as adoption agencies offering this test to families, often while they are in China completing the adoption process.

In many cases, the foreign governmental adoption authorities (e.g., China Center for Adoption Affairs in China) have responded to the requests by doing the basic HIV ELISA screening test.

Screening tests for HIV are designed to yield some false positive results, but not false negative results. This means that the initial test done (usually the ELISA, which identifies antibodies for HIV) will show positive results in some people who do not have HIV. Once the initial test is positive, then more specific tests are routinely done. Frequently individuals with a positive ELISA test will not actually have HIV. With HIV, the ELISA is backed-up frequently by one of two tests, the Western Blot or the PCR. Both of these tests are is more specific than the ELISA in identifying antibodies to HIV. The PCR, or Polymerase Chain Reaction is designed to identify the viral genetic footprint. Unfortunately, the PCR is a very expensive and complex laboratory test to perform, and results from the PCR are dependent upon the quality of the laboratory doing the test. Regulation of laboratories in adoptees' countries of origin is often problematic.

In addition to problems performing the HIV ELISA test, is that performing the test itself may increase the child's risk of actually acquiring HIV. For this (and other reasons), most adoption physicians recommend that testing for HIV (as well as Hepatitis B and Hepatitis C) be performed after a child arrives in their home (adopted) country, and then again six months later.

The real problem with HIV testing is that the antibody tests do not discern between maternal and child antibodies. HIV antibodies can cross the placenta. Maternal antibody may persist in the child's blood stream for two years, or more. So, it is not hard to imagine what happens to children who test positive for HIV antibodies, without the benefit of back-up tests. The Russian experience has been tragic for infants, who were warehoused until their ELISA's turned negative. Two and three year-olds have been so damaged by neglect, by the time they converted to negative, that they suffered from the effects of prolonged institutionalization. Undoubtedly, some antibody-only children became infected during that time, and children who needed anti-HIV medication were not identified early enough to treat them.

A final dilemma is what to do about children who are adopted in their native province, and then are tested (as per parent or agency request) for HIV and have a positive ELISA test. The majority of these children will not have HIV, but it is doubtful that a safe, timely and accurate PCR test will be able to be done for those children. Unfortunately, their adoptive parents may be confronted with a decision that will undoubtedly be very difficult. Do they turn down their adopted child, not knowing whether or not she/he has HIV or not? And, if they do disrupt their adoption, do they get another referral, and, if so, when? Do they bond with their adopted daughters and sons, or should they wait until the HIV ELISA is negative?

In short, many physicians experienced in international adoption medicine do not recommend routine testing of HIV in China for the following reasons:

Back-up testing, which is more accurate and utilizes the PCR test, is not widely available, reliable, timely or safe. Even back-up testing, if done before the test itself has become positive, may not be 100% reliable.
Exposing a child to multiple blood draws will increase his/her exposure to blood and body pathogens without significant benefit for the children.
False positive testing with the HIV ELISA test will result in children being labeled with HIV who, do not in fact, have that diagnosis. It is possible that these children will not be retested, at least in a timely manner to expedite adoption at a young age.
About 3 to 5% of children who test negative for Hepatitis B while in China actually test positive once they are in their home country. Thus, experience with this similar blood borne pathogen shows that the testing for such infections is not reliable, even though the test for this disease entity is more widely available, more easy to perform, and the disease much more prevalent.
The current risk of a child being adopted in China, and actually having HIV, is currently very low. No adoption pediatrician has seen a Chinese adoptee with HIV in 8,000 tests, in a recent survey. In addition, it revealed that the actual number of internationally adopted children with HIV is less than 0.2% of the total numbers of children being adopted all over the world.

Undoubtedly, it would be tragic for a family to adopt a child in China and find out, upon arrival testing in the home country, that the child has HIV. But if we remind ourselves that adoption is all about finding homes for children who are in need of permanent families, then it is easy to see that this child will have a much better prognosis in a family than continuing to live in an orphanage, where it is unlikely that aggressive treatment for this devastating disease will be available.

The decision for HIV testing in a child to be adopted is one that needs to be made by each family, in conjunction with the adoption agency, after careful consideration of the risks to the child and benefits for the family. Again, focusing on the overall purpose of adoption as being for children may help families to better accept the risk that comes with NOT having testing done in China. Until HIV testing can be done reliably, safely, timely, and with no risk of false positives (or negatives), it cannot be recommended as being in the best interest of children or adoptive families.

Todd J.Ochs, MD,  FAAP Adoption  Pediatrics,  S.C. 841 West Bradley
Place  Chicago, Illinois 60613  773-975-8560	Fax: 773-975-5989    Deborah
Borchers,M.D.,  FAAP Eastgate Pediatric Center  4357 Ferguson Drive, Suite 150 
Cincinnati,OH  45245  513-753-2820   Fax:  513-753-2824

A Different Perspective

Fri, 13 Jul 2007 22:08:55 GMT

Imagine for a moment.

You have met the person you've dreamed about all your life. He has every quality that you desire in a spouse. You plan for the wedding, enjoying every free moment with your fianc�e. You love his touch, his smell, the way he looks into your eyes. For the first time in your life, you understand what is meant by "soul mate," for this person understands you in a way that no one else does. Your heart beats in rhythm with his. Your emotions are intimately tied to his every joy, his every sorrow.

The wedding comes. It is a happy celebration, but the best part is that you are finally the wife of this wonderful man. You fall asleep that night, exhausted from the day's events, but relaxed and joyful in the knowledge that you are next to the person who loves you more than anyone in the world.the person who will be with you for the rest of your life.

The next morning you wake up, nestled in your partner's arms. You open your eyes and immediately look for his face.

But IT'S NOT HIM! You are in the arms of another man. You recoil in horror. Who is this man? Where is your beloved?

You ask questions of the new man, but it quickly becomes apparent that he doesn't understand you. You search every room in the house, calling and calling for your husband. The new guy follows you around, trying to hug you, pat you on the back,...even trying to stroke your arm, acting like everything is okay.

But you know that nothing is okay. Your beloved is gone. Where is he? Will he return? When? What has happened to him?

Weeks pass. You cry and cry over the loss of your beloved. Sometimes you ache silently, in shock over what has happened. The new guy tries to comfort you. You appreciate his attempts, but he doesn't speak your language-either verbally or emotionally. He doesn't seem to realize the terrible thing that has happened...that your sweetheart is gone.

You find it difficult to sleep. The new guy tries to comfort you at bedtime with soft words and gentle touches, but you avoid him, preferring to sleep alone, away from him and any intimate words or contact.

Months later, you still ache for your beloved, but gradually you are learning to trust this new guy. He's finally learned that you like your coffee black, not doctored up with cream and sugar. Although you still don't understand his bedtime songs, you like the lilt of his voice and take some comfort in it.

More time passes. One morning, you wake up to find a full suitcase sitting next to the front door. You try to ask him about it, but he just takes you by the hand and leads you to the car. You drive and drive and drive. Nothing is familiar. Where are you? Where is he taking you?

You pull up to a large building. He leads you to an elevator and up to a room filled with people. Many are crying. Some are ecstatic with joy. You are confused. And worried.

The man leads you over to the corner. Another man opens his arms and sweeps you up in an embrace. He rubs your back and kisses your cheeks, obviously thrilled to see you.

You are anything but thrilled to see him. Who in the world is he? Where is your beloved? You reach for the man who brought you, but he just smiles (although he seems to be tearing up, which concerns you), pats you on the back, and puts your hand in the hands of the new guy. The new guy picks up your suitcase and leads you to the door. The familiar face starts openly crying, waving and waving as the elevator doors close on you and the new guy.

The new guy drives you to an airport and you follow him, not knowing what else to do. Sometimes you cry, but then the new guy tries to make you smile, so you grin back, wanting to "get along." You board a plane. The flight is long. You sleep a lot, wanting to mentally escape from the situation.

Hours later, the plane touches down. The new guy is very excited and leads you into the airport where dozens of people are there to greet you. Light bulbs flash as your photo is taken again and again. The new guy takes you to another guy who hugs you. Who is this one? You smile at him. Then you are taken to another man who pats your back and kisses your cheek. Then yet another fellow gives you a big hug and messes your hair.

Finally, someone (which guy is this?) pulls you into his arms with the biggest hug you've ever had. He kisses you all over your cheeks and croons to you in some language you've never heard before.

He leads you to a car and drives you to another location. Everything here looks different. The climate is not what you're used to. The smells are strange. Nothing tastes familiar, except for the black coffee. You wonder if someone told him that you like your coffee black.

You find it nearly impossible to sleep. Sometimes you lie in bed for hours, staring into the blackness, furious with your husband for leaving you, yet aching from the loss. The new guy checks on you. He seems concerned and tries to comfort you with soft words and a mug of warm milk. You turn away, pretending to go to asleep.

People come to the house. You can feel the anxiety start to bubble over as you look into the faces of all the new people. You tightly grasp the new guy's hand. He pulls you closer. People smile and nudge one other, marveling at how quickly you've fallen in love. Strangers reach for you, wanting to be a part of the happiness.

Each time a man hugs you, you wonder if he will be the one to take you away. Just in case, you keep your suitcase packed and ready. Although the man at this house is nice and you're hanging on for dear life, you've learned from experience that men come and go, so you just wait in expectation for the next one to come along.

Each morning, the new guy hands you a cup of coffee and looks at you expectantly. A couple of times the pain and anger for your husband is so great that you lash out, sending hot coffee across the room, causing the new guy to yelp in pain. He just looks at you, bewildered. But most of the time you calmly take the cup. You give him a smile. And wait. And wait. And wait.

--Written by Cynthia Hockman-Chupp, analogy courtesy of Dr. Kali Miller

Tuning In

Sun, 15 Jul 2007 20:10:11 GMT

When my husband Ralf and I adopted our first child, Paul, in 1989, we knew virtually nothing about raising a child from another culture. We knew very little about Paul's birth country, had no connections with the Korean American community, and knew few Korean adoptive families. "Unprepared" doesn't begin to describe how little we knew about our impending parental experience. Looking back, it surprises me to remember just how unprepared we were!

That's not to say we weren't eager to learn. But even as recently as fifteen years ago, the focus of transcultural parenting was on the parenting more than the transcultural. The prevailing attitude at that time seemed to be to let things take their course, and to let our children guide us to the right amount of Korean-ness to weave into our family's fabric. There is a We were taught not to "force" Korean culture on our children. Discussion of genetic ties was practically nonexistent, and not unlike other adoptive parents, we felt safe adopting from Korea because there was less chance our children's first families could attempt to "reclaim" them. We became "tourist parents," got more familiar with Korean history, geography, and food, but didn't delve much deeper into the Korean American community than that. We were told that "love would conquer all," and that made us experts.

The wake up call came when Paul arrived at Washington National Airport in September 1989. When he was placed in our arms for the first time, everyone else in the airport literally faded away. The only ones who remained were Paul, my husband, me - and Paul's mother. Her presence was haunting - looking at him, I could picture her with the same eyes, him with the same mouth. Even if we never met, we were bound to one another in a way that no policy, social convention, or personal choice could ever change. How strange that this woman I had once feared in the abstract could become so real so quickly.

I was beginning to tune into reality, and a second experience in 1992 really opened my mind. A good friend and I had an opportunity to travel to Korea as escorts for our adoption agency. In addition to a whirlwind tour of Seoul, our itinerary included visits to my children's birth towns - the Seoul suburb Seongnam (where Paul was born), and Jeongson in Gangwon-do (Mara's birth town).

We visited Jeongson on a sunny October Sunday. We took advantage of a beautiful day with a leisurely stroll through the town. It's hard to explain how wonderfully ordinary Jeongson is. Apart from the gorgeous mountainous countryside that literally rings the town, there's little else to distinguish it. We passed shops, apartments, a small hotel, the police station, city hall, and a market.�Laughing children rode by on bikes, couples walked hand in hand, and music wafted out of open windows. Any one of them could have been a neighbor or friend of our daughter's family, or even her mother herself. Leaving was painful, the thought of never returning harder still.

I realized suddenly that this place, these people could have been our daughter's life, had circumstances been different. But they were lost to her forever. Even if she returned one day, and even if returning brought her back to her family, she could never fully regain the life she would have known there. The enormity and gravity of those losses hit hard. After just one afternoon in Jeongson, Korean people and everyday Korean life could never again be brushed aside as distant concepts. They were real - and they were very, very good.

During the adoption process, adoptive parents and adoption professionals prefer to focus on the positive aspects of adoption. Yes, adoptive parents are told about the challenges our children would face if they stayed in Korea - lives on the fringes of society, lack of family and education, probable poverty. But by and large, the discussion stays with positive topics - forever families, parenting, and the good lives our children will have with us. The role of Korean culture in the family is raised, but in terms of adoptive parent choice. We are encouraged to incorporate Korean culture into our lives, but are also told that it is really up to us. And although the subject of making and maintaining contact with our children's first families comes up, it rarely goes beyond advice to send letters and photos to our children's Korean adoption agency files. Rarely are adoptive parents given opportunities to consider more open adoption experiences. Although they do occur with somewhat more frequency now, they are certainly not the norm.

The adoption community generally uses the fact that children gain a family as the primary justification for intercountry adoptions. It's a potent argument - in the case of Korean adoption, loving families and security on one side, an institutional childhood and fewer life opportunities on the other. Although domestic adoption in Korea is increasing, cultural biases make its advancement slow. And with few social services available to mothers and families who place children in adoption out of financial need, intercountry adoptions from Korea are likely to continue for the foreseeable future.

But the families and material advantages our children gain through adoption come at a high price - the loss of cultural heritage and genetic connections. Yet gaining an adoptive family and maintaining birth and cultural ties don't have to be mutually exclusive. How much healthier for the children when adoptive parents know, right from the start, that nurturing their children's cultural and genetic identity is as important as nurturing their physical and spiritual health. And how much healthier for the parents when they understand that they are the catalysts for reconnecting their children to what they have lost.

To be that catalyst, adoptive parents must acknowledge some things that we may not have anticipated would be part of our adoptive parenting experience.

We have to accept our children as individuals and as Korean Americans. Playing down their ethnicity and ignoring first first families isn't the way to do that - embracing their heritage and accepting that they have families in Korea is. Acknowledging our children's genetic connections doesn't lessen our parental status in any way, because we fulfill it when we make the choices that serve our children best. Loving and supporting them for who they are does just that.

We need to acknowledge the misfortunes that brought our children's parents to adoption, and from which we have benefited. We therefore have a responsibility to speak out in favor of improved social services in Korea so families on hard times don't have to relinquish their children. We must offer our support to mothers who choose to parent their children rather than place them in adoption, and we must also work toward increasing and improving domestic adoption in Korea and by Korean Americans.

We must encourage the professional adoption community to teach new parents the importance of nurturing their children's self-esteem by nurturing their ethnic identity. Parent preparation must include the tools to do it, too: like more agency post-placement resources, earlier Korean community connections, and networking with other adoptive families. Parents should be counseled to disclose the kind of descriptive information about themselves and their families that will give their children a better sense of their genetic roots. And they should also be made aware of possibilities of increased openness, through intermediary communication and earlier reunions.

We must remember that our children didn't choose to be taken from their families, country, language, and culture. Therefore, nurturing their heritage isn't our choice - it's our children's right.� I returned to Korean in 2001, this time with my family. We went to Seongnam and Jeongson, and together celebrated another step on our family's journey. It's hard to describe the look on our son's face as he stood in the hospital nursery he had been in at birth, or on our daughter's as we shopped in the market in we know her family must visit frequently. Priceless. We are planning to return in a couple of years, and who knows where the next steps will take us?

In the blink of an eye, Paul and Mara have turned 15 and 13. They still are forming their identities, sometimes trying new ones on like sweaters, other times lapsing into the same personalities they displayed as toddlers. But several things are clear: They know they are Korean and are proud of it. They know they are connected to family in Korea that we feel connected to, too. They know we encourage and support them in their search for their identities and roots. In the truest sense of the word, this is what family is all about.

First printed in KoreAm Journal in 2004, and updated here to reflect my current preference for the term "parent" or "first parent" as opposed to "birth parent."

Pendulum

Sun, 15 Jul 2007 21:05:07 GMT

I'm on a pendulum that's swinging from side to side, taking me with it.

On one side of the pendulum is a family. Husband, wife, children. The family lives comfortably; although not rich, they have enough. The children are active, do well in school, have friends and activities. They speak a language different from their homeland's, don't look like their parents, and share no ethnic heritage or genetic ties with them. But the family is happy, its members content to be related as they are.

On the other side of the pendulum is another family. I'm not sure who this family's members are, if there is a husband, wife, other children. I don't know how they live, whether or not they have have necessities and luxuries, or if they struggle. I do know that the family's members look much like one another and that they live in the country of their family's history. I also know this: That someone is missing from this family, a son or daughter who was parted from one or all of them. I also know that someone in this family wonders if they made the right decision all those years ago.

The pendulum swings back and forth. When it swings toward the first family - mine - I feel the deep happiness that comes with being a parent and living a typical family life. But when the pendulum swings toward the other, I feel conflict and pain. Without this family's loss, my family wouldn't exist.

Now, years later, a birth mother, birth father or birth family lives with a loss I cannot begin to comprehend. I can't change the past that led to their loss, but I can affect the future. And I can tell them this:

I acknowledge your pain
I recognize that you were pushed to your decision by circumstances beyond your control
I am sad that I have the parenting experience that is rightfully yours
I love our children with all my heart
I hope you meet and know them one day

Would my husband and I have still adopted had we known then what we know now? I honestly don't know. But to cast that decision in today's light would be a betrayal of the commitment I made to my children then to love them for all time.

And so the pendulum continues to swing.

Neurodevelopmental Reorganization

Mon, 16 Jul 2007 11:19:54 GMT

About six months after my child arrived home as an infant, I began to notice some subtle areas of concern. Issues with sleep, behavior, mood-although "normal" toddler behaviors, a factor frequently pointed out by friends with bio kids-were occurring with frequency, intensity and/or duration that I had never experienced with my other children. Reading about how in-utero stress, early separation, moves and transitions may have had an impact on the developing brain, I worried. Although my child had been in good foster care, it was still not permanent and certainly not the way anyone would choose to begin life. If professionals were correct, that the less-than-optimal early environment had wired the brain in unhealthy ways, I wanted to know what I could do to make changes, especially since the young brain was still in a highly malleable state.

We visited a neurodevelopmental center, where the practitioner explained some basics. The brain develops from the base, up. When a child has less-than-optimal beginnings--including separation from the birth parent, foster care, or institutionalization--the brain may wire in dysfunctional ways. She presented us information that described how wiring problems at various levels could lead to certain symptoms. When I read the symptom list, I quickly recognized symptoms that come up again and again on adoptive parenting lists: problems with attention, speech, behavior, attachment or sensory issues. Neurodevelopment Interrupted: Signs and Symptoms

Through a series of non-invasive tests-creeping, crawling, eye movement, cross-midline movement, walking, and more-a neurodevelopmentalist pinpoints areas of the brain that need attention. Children who begin life in less-than-optimal circumstances are often found to have wiring issues in the lower, more primitive neurological levels. The brain may have flooded with stress hormones in-utero. Early infancy may have been spent in transitional environments instead of a sensory-rich surrounding with a single known caregiver present consistently from the moment of birth. In the case of a child who has undergone trauma (including separation from the birth mother, moves & transitions) or medical issues, it's feasible that the fight/flight/freeze parts of the brain were activated for months on end...when other parts of the brain that have to do with self-control and regulation should have been developing. The brain may be developmentally immature...or may have wired in unhealthy ways. That doesn't mean the child isn't smart or that the child is immature in other ways...it simply means that the brain development was altered because of those early life experiences. Unfortunately, problems associated with lower brain levels may not show up until a child reaches school age and begins to depend on his cortex. The cortex, the higher-level "thinking" part of the brain, relies heavily on the lower, "foundations" of the brain. When blocks in the foundation are missing, the child may not be able to function at his maximum potential.

Yet adoptive parents have the ability to impact those primitive parts of the brain -- the earlier the better. Research demonstrates that the human brain has certain windows of opportunity in which the brain is more "plastic" and open to change. Although some professionals are learning about later windows, most agree that changes can be made more easily and with more success when a child is still young. Children who retain birth reflexes can be given daily exercises to diminish and eventually eliminate these primitive responses that, while needed at birth, are no longer necessary and can hamper development as a child ages. Lower levels of the brain can be "rewired" or reorganized through movement specifically targeting areas that are not functioning at optimal levels. Specific exercises can diminish the signals to the fight/flight/freeze centers and increase the pathways in the regulation centers.

When I first heard about the connection between behavior and movement, I wondered if I was being sold snake oil. The neurodevelopmentalist detected what to me seemed like very benign problems, things that I never would have noticed without her professional eye: uneven midline movements, eye tracking difficulties, slight imbalances (virtually imperceptible to me) in creeping and crawling. Yet she assured me that these indicators of my child's neurological function were directly tied to the emotional/behavioral issues we were seeing. She gave us a list of daily exercises including: creeping, crawling, patterning, sensory stimulation, vestibular movements, and masking. Over time, the exercises were modified based on our child's progress. It wasn't easy to complete the number of required repetitions, but we knew it was essential to the program's success.

And slowly but surely, we saw changes. Through a local support group, we came to know other adoptive families who were experiencing similar breakthroughs.

After just 7 months of work, one mom reports on the progress of her daughter:

"She has "graduated" from pons work (YIPEEE!!!!) and has made a lot of progress in her midbrain work, and residual birth reflexes are gone. One area that has really improved is her eye tracking. This improvement has had a great impact on her visual acuity--she had perfect vision at her well-child check-up. Since the pons seems to be functioning normally, she no longer has that constant "DANGER!!" warning going in her head. I've been able to use a question or statement to redirect her from an anxious downward spiral in the past few weeks. Before, she couldn't stop herself. In addition, her dominance (eye, ear, foot, tactile, writing) is all moving toward the right. Previously she was all over the board--left eared, right eyed distant, mixed eye close, mixed tactile, right handed, left footed.

Here is a partial list of some of the things she has done in the past 2 months (keep in mind that she has always been an obsessively cautious child): ridden her bike with no training wheels (undeterred by multiple crashes) ;-); slid down fire poles on play structures; swung upside down on trapezes; walked Boomer, some friends' German Shepard (she has been TERRIFIED of dogs--now she says, "Mom I'm still afraid of strange dogs, but Boomer is nice so I'm not afraid of him"); and gone to her first day of kindergarten with enthusiasm (just yesterday). She did great in K, aced her "Primary Literacy Assessment," and can't wait for next week. She has become so much more affectionate and snuggly. I'm so encouraged and have fallen head-over-heels-in-love with my first great love all over again."

Another parent shares about her son's success:

"Our therapist began requiring all of her clients (working on attachment/trauma issues related to adoption) to get a neurodevelopmental evaluation. She found that when her clients did a neurological reorganization program that impulse control issues resolved that weren't "cured" through therapy. My son used to have outbursts of anger. He whined constantly. No "normal" parenting methods seemed to curb this behavior. The neuro work in conjunction with therapy resolved it.

In addition, our son used to have inappropriate response to pain. Our neuro evaluator has taught us that pain response is rooted in the pons part of the brain...an area we've worked very hard on. He's gone from not noticing when stung by a bee to normal pain response. He went from regular nightmares, night terrors and nap terrors to none. New situations and changes used to be very stressful for him and are no longer a great cause for concern."

Another mom reports that while they first had a neurodevelopmental assessment in the hopes of helping her daughter's speech that the first improvement they noted was a surprise.

"[At our first reevaluation], there were some areas where our daughter had improved, but speech was not one of them. You may find it interesting that the areas we noticed involved how affectionate she was. She has always been sweet, but hugging and kissing and cuddling have never been part of her personality. Well, she is so much more affectionate now, even hugging sometimes on her own. She babbles much more now, and picks up on words that we say and will try to say them."

A local center provides support for families with older children who are working at neurological reorganization, as the process is even demonstrating success with teens and adults.

Two years into a neurodevelopmental reorganization program, our child is happy and healthy. We credit neurological reorganization as being one of the primary tools of healing.

Race, Culture and Adoptive Families

Tue, 17 Jul 2007 09:35:56 GMT

Respecting and nurturing my kids' Korean race and heritage is something I take seriously. It's my responsibility as an adoptive parent, something I have no right to ignore or dismiss based on my personal views on race or culture. Parental belief in a color-blind society or a single human race is no good reason to deny children contact with their culture and community, nor is the fact that they may, from time to time, exhibit little interest themselves.

So presuming you agree, how do you go about doing it?

I think the first place to start is to think about the purpose of your efforts. Is it to make your children experts in their folk culture? Or is it to empower them to take their places in their racial and ethnic communities here in the US?

Although learning about folk culture may certainly be one of many steps along the way, I believe it's the latter. And if you don't share your child's race or ethnicity, you won't be able to do this on your own. You're going to need a lot of help.

So where do you get that help? Lots and lots of places. If you're like my family, you may start by "tourist parenting" - doing all you can to absorb your child's culture from any available source. I think this is an important phase in any adoptive family's cultural training, but it shouldn't be the only or last phase. In our case it was a way to get our cultural "bearings," so to speak, but it was only the beginning.

When children start school, and their racial awareness increases (and with it, the possibility of racially-motivated teasing from others), the focus has to change from folk culture to community. And this is something you can't learn from books or movies - this is something that takes contact with the people who share your child's racial and ethnic background.

My family is fortunate to live in the DC area, which has a Korean American population close to 100,000. This has given us access to people, organizations, activities, and events that would otherwise be unavailable to us. It has also allowed us and our children to make friends who have in some cases become our children's mentors - our daughter's taekwondo coach, for example.

We've been able to connect with the Korean American community in many ways. For example, through a Korean adoption support organization I'm active with, Korean Focus, my family has made connections with the Korean American Coalition chapter in DC, and with the Korean American Youth Association, another community service organization. These organizations have welcomed adoptive families into their activities, and have given us opportunities to volunteer - to roll up our sleeves and work alongside them, not just to attend their events as guests. But if organizations aren't for you, you can certainly still find ways to make individual connections and friendships - through parents you meet at your children's school, through churches, and through your activities.

Adoptive parents struggle sometimes with the decision to attend culture school, culture camp, and other cultural activities. There has been some dialog, even debate, over the years as to the importance of these. My opinion is that the debate is unnecessary - there's always room for more culture, and culture school may be your best source for Korean language lessons. However, I don't think that attending camp or school can be where your efforts stop.

Which brings me to Korean language. As someone whose educational background is in foreign languages and applied linguistics, who taught German and ESL for eight years in the public schools and another two or three more in community and private adult ed programs, I can speak with some authority on this subject. And I recommend putting the effort into learning the language if you possibly can. However, I know from my non-Korean-speaking Korean American friends that learning Korean can be as challenging to them as it is to adoptive families. But it's one thing I would have tried to do differently if I had it to over again, because I have learned from many adoptees how frustrating it is to go to their birth country without the language. Don't forget that there may be sources for Korean language lessons in your community even if you don't have a culture school - adult education classes through your public school system, for example (which is where I'm taking lessons this semester), or even online and computer-aided courses (like Rosetta Stone - my son is learning Japanese with Rosetta Stone, and hopefully in a few months I can offer some feedback on how Level I went. Anyone have any experience with the Korean version?)

A word about keeping up with Korean and Korean American issues: do. In the internet age, this is easy. Korea.net, the Korea Herald, and the Korea Times are online (as are many other Korean and Asian periodicals), and some offer news updates to your mailbox. There are any number of magazines you can subscribe to - we get KoreAm, Korean Quarterly, and Audrey, but there are many more. And don't forget that Korean movies, TV and music are one of the best ways to learn about popular culture.

And go to Korea!!!

Race, Culture and Humility

Tue, 17 Jul 2007 09:40:36 GMT

In my intercountry adoption experience, the discussion of race and racism is often lost to the belief that a color-blind society is possible. Looking back on my early adoptive parenting years, I can honestly say that the subject of race was rarely broached, and if so, only superficially. You'll have to figure it out, we were told. Love will conquer all.

But race and racism are something that white transracial adoptive parents need to look squarely in the eye. And on this topic, our opinions mean nothing, our idealism is meaningless. Away from the coccoons of our families, our children will face a world that we have never experienced and never will.

I think the very first thing an adoptive family like mine needs to do is acknowledge reality: Two white people can't give their non-white children the experience they'll need to navigate our race-conscious and often overtly racist society. And since no one in my family is culturally Korean American, reaching out to the Korean American community has been the only way to bring our children into contact with those who can teach them. This has meant creating as many opportunities as possible for our kids to develop meaningful relationships with other Korean Americans, through the schools they attend and through their and our family's activities.

But there's a rub. For some, transracial adoption amounts to no more than white ownership of people of color, ill-guided altruism, white privilege at its worst. Adoptive parent attempts to join the race dialog may be rebuffed. And our efforts to embrace our children's ethnic heritage may be seen as cultural appropriation - deserving of criticism rather than affirmation; laughable, artificial, lame.

When this happens, it should also be no surprise that some white a-parents throw in the towel. After all, if every effort you make to support your child's heritage is criticized for one reason or another, why even try? But how sad for the children, who then grow to adulthood unaware of what they may face as adults in our color-conscious society, and locked into false identities that fail to acknowledge who they are.

It takes humility for white parents to recognize and accept the challenges of raising children of another race and culture. Humility to accept that racism exists; to recognize the inherent privilege we enjoy as white people; to get out of our comfort zones and into our children's communities; to defer to people of color on the line between embracing and appropriating our children's culture; and to recognize that no matter how hard we try, on one level or another we'll experience failure.

But if we can find this humility, our children will gain immeasurably. They'll gain knowledge of the culture and community they lost when they were adopted, and the confidence to claim these as their own - things that all the love in the world, including ours, can't give them.

The Neuropsychology of Bonding And Attachment Disorders

Wed, 18 Jul 2007 14:20:24 GMT

While the role of the Developmental Neuropsychologist is to evaluate intellectual-cognitive, memory processing, learning aptitude, and problem-solving strategies, a critical duty may actually be in the evaluation of a child's emotional integrity and perception of relationships. The interplay between neurocognitive development and emotions encompasses basic neurobiology which suggests that human emotions, reactions, interactions and attachments may be strongly mediated by a combination of genetic, neurochemical, neurocognitive and environmental factors. As there has been a tremendous amount of discussion regarding "attachment disorders" in the post-institutionalized child, the current psychological research focuses almost solely on the effects of deprivation and abandonment and the creation of an "attachment disorder" without a more detailed understanding of the role of innate neurocognitive functioning.

While abandonment and institutionalization most certainly has a profound impact on a child's ability to develop trust, bonding and security in newly adoptive relationships, an emphasis needs to be placed on the integrity of the post-institutionalized child's higher-level neurocognitive abilities with a comprehensive assessment regarding the availability of "innate skills" needed for bonding, attachment and the development of appropriate social-interactional and reciprocal behaviors. While many children with post-institutionalized attachment disorders may display a combination of unattached or even indiscriminant behaviors (Ames, 1997), many post-institutionalized children display a very intense pattern of behavioral dyscontrol; aggression and violence; destructiveness to self and others; a lack of cause-and-effect thinking; indiscriminant affections to strangers as evidenced by being inappropriately demanding and clingy; or a pattern of social withdrawal, isolation and maintaining a self-stimulating posture. A principle complaint from parents adopting an older child is that the child may be out of synchrony with their environment resulting in difficulties in providing management, structure and organization.

The concept of a "neuropsychologically-based attachment disorder" seems most appropriate for many post-institutionalized children, particularly the child who shows a history of high risk pre and post-natal factors which may have influenced neurocognitive development. For example, there is a documented interaction between growth parameters and neurologic competence in profoundly deprived institutional children assessed in Romanian institutions (Johnson and Federici et.al., 1999). Children who have shown documented medical and neurological impairments along with extended time in institutional settings typically display very pronounced impairments in the development of appropriate social-interactional skills. Combined with suspected impairments in neuropsychological abilities, behavioral patterns can often be quite aberrant and intense in nature, often overwhelming the newly adoptive family.

Therefore, it seems only appropriate to broaden the horizon when assessing children for bonding, attachment or general psychological dysfunction by including a comprehensive assessment of neurocognitive abilities or deficit patterns. As children from institutional settings are at highest risk for medical, neuropsychological and emotional problems, an assessment of only the psychological or behavioral manifestations provides only a partial understanding of the adjustment issues which often produce tremendous stress on the newly adoptive families and treatment providers attempting to intervene and provide services (Johnson, 1997; Federici, 1999).

Careful differential diagnosis regarding neuropsychological versus psychosocially-based attachment disorder can help provide newly adoptive families with better parameters of understanding the post institutionalized child. Additionally, neuropsychological and neurocognitive rehabilitation approaches should typically supersede solely psychological or psychiatric/pharmacological therapies as providing direct interventions and increasing speech and language, sensory-motor, abstractive logic and reasoning and, of greatest significance, visual-perceptual analytic abilities. These brain behavior interventions strengthen the post-institutionalized child's ability to adequately "perceive" and process human relationships, emotions, facial expressions, social cues, and the necessary sequential "steps" needed to move towards a more healthy level of bonding and attachment. Too often, children from institutional settings are quickly categorized as having either a "reactive attachment disorder" or modicum of psychiatric syndromes ranging from Attention Deficit Hyperactivity Disorder, Bipolar Disorder, Post Traumatic Stress Disorder, varying types of depression and anxiety conditions or, very commonly, oppositional and conduct disorders or even autism/pervasive developmental disorders. While many of these psychiatric patterns may be co-morbid conditions, there needs to be a very aggressive but yet conservative approach in assessing the post-institutionalized child. Rank ordering developmental disabilities of the child as opposed to relying solely on the assessment of families or treatment providers may avoid misleading diagnoses and nonproductive therapeutic interventions.

Neuropsychological Evaluation and Rehabilitation of the Post Institutionalized Child

Wed, 18 Jul 2007 14:25:07 GMT

International adoptions have become prominent worldwide with the United States receiving the largest amount of immigrant visas issued to orphans. Eastern European countries, particularly the former Soviet Union and Romania, have been attracting families from all over the world due to the high volume of available children with desirable ages, ratio characteristics, and the definitive aspect of parental rights termination which has been a subject of recent controversy in the United States. Recently, there have been landmark cases in the United States overturning long-term custody of the adoptive parents due to the resurgent interest of the biological parents years later. In general, families completing international adoptions find the procedures much more expedient and cost effective as opposed to waiting on a list for infants in the United States which can be years of waiting, or the worrisome possibility of adopting an older child who has a clear documented history of abuse and neglect. Another motivation for families moving towards international adoptions has been media presentations worldwide which have highlighted deprived children residing in Eastern European institutions. Thousands of families have flocked to these countries with the hopes of rescuing a child from life-long institutionalization.

Interest in the post-institutionalized child has gained great attention in all medical and psychological disciplines throughout the United States and in the United Kingdom. International adoption clinics have surfaced throughout the United States following pioneering efforts by Dana Johnson, M.D., Ph.D. of the University of Minnesota, International Adoption Clinic; and Laurie Miller, M.D., Director of the International Adoption Clinic at the Floating Hospital for Children in Boston, Massachusetts. As there has been a significant increase in the amount of internationally adopted children coming to the United States (up nearly 130% since 1990), the need for international adoption medical specialists has surfaced. Specialists from all disciplines of pediatrics and developmental psychology have been on the forefront of evaluating internationally adopted children of all ages. Research has shown the long-term neuropsychological and neurocognitive status of these children can often present a challenge to adoptive families as the "hidden disabilities" of the effects of institutionalization may not surface until the child is of school age.

Post-institutionalized children have been exposed to a volume of high risk pre and post-natal factors such as poor maternal care, malnutrition, fetal alcohol exposure, smoking, neurotoxins, infections, prematurity, low birth weight, and a host of other potential complications. Goldfarb (1943), Bowlby (1951) and Spitz (1945) have clearly defined the effects of institutionalization or "hospitalism" as being strong contributing factors to later neurocognitive and emotional problems, particularly bonding and attachment deficits. Johnson (et.al., 1997) along with numerous medical researchers have intensely researched the health status of children from the former Soviet Union and Eastern Europe and have further documented the high risk factors which may impact later cognitive, learning and emotional performance. Rutter (1998) discusses developmental catch-up and deficits following adoptions after severe global early deprivation and finds a strong tendency towards resilience and short-term catch-up in the younger child group (adoptions completed prior to 25 months). Rutter goes on to explain that global cognitive improvement over the long course of time is still an unknown factor in many of the Romanian adoptees who have been exposed to high risk factors.

There is controversy regarding assessment and treatment procedures for the post-institutionalized child. Many professionals believe that the effects of institutionalization and deprivation will spontaneously abate and a "wait and see" is adopted in addition to the ideology that parents should "give the child time to adjust" as opposed to implementing aggressive assessment or premature diagnoses of handicapping cognitive or emotional conditions. Federici (1998) has emphasized the importance of immediate and aggressive neuropsychological and neurodevelopmental evaluations for all children, particularly the older post-institutionalized child who may present with very prominent behavioral and adjustment difficulties, whereas the child under the age of 24 months requires time to re-stimulate and reattach. Evaluations in the child's native language are of paramount importance. Many families worldwide are adopting children greater than 4 years of age and often find the child very challenging from the first day of adoption although may have been advised by various professionals or agency personnel that there needs to be this "adjustment period" and a family system emphasizing intensive stimulation, love and bonding in order to promote "developmental catch up" and normal family adjustment.

Given the research and current understanding regarding the damaging effects of institutionalization and the numerous high risk medical factors which may lead to neurocognitive and emotional delays and deficits, the need for aggressive neurodevelopmental and neuropsychological assessment of impairments followed by aggressive neurocognitive and psychological rehabilitation appears to be a necessary inter-vention for children coming from profoundly depriving backgrounds. While long-term follow up regarding the internationally adopted child are still being gathered, early information strongly suggests both neuropsychological and emotional sequalae of institutionalization for a large percentage of children being adopted at an age greater than 4 years. While many children appear to have been unscathed as the result of institutionalization, Johnson (1997) suggests that children who have resided in institutional care become a high risk population. Early intervention programs appear to be a critical factor in promoting optimal development and recovery from institutional damage although many "delays" may be chronic and static in nature.

Presented at the Conference for Children and Residential Care

Stockholm, Sweden

Institutional Autism: An Acquired Syndrome

Wed, 18 Jul 2007 14:30:35 GMT

The Tragic Downward Spiral of Institutionalization

Comprehensive medical and neuropsychological evaluation helps define current and future needs of the post-institutionalized child. Many children who have resided in very deprived institutional environments may present with a pattern of autistic-type behaviors which can often present as being overwhelming and confusing to newly adoptive families and treatment providers. Pervasive Developmental Disorders and autistic spectrum disorders typically involve biological and genetic abnormalities; coexisting mental retardation; varying levels of speech/language; motor and sensory impairments; stereotypic movements and ADHD patterns; obsessive-compulsive behaviors; and varying levels of impairments in social-reciprocal relationships. Newer findings in the causes and treatment of autism are focusing on a multi-factorial approach in the assessment and treatment with extra emphasis on understanding dopaminergic and serotonergic systems relevant to the pathophysiology of pervasive developmental disorders (Potenza, 1997).

A child with multi-sensory neurodevelopmental delays can often be diagnosed as having mental retardation with coexisting autistic spectrum disorder. Many children from post-institutionalized settings live in an environment where there is a mix of neurologically delayed children with children who have been abandoned and neglected. While there is certainly a high incidence of children with classic neurologic disorders and neurogenetically-based autism or mental retardation, careful research and evaluation of children residing in Romanian institutions have strongly suggested a pattern of atypical autism that may be related to institutionalization or an "Acquired Syndrome" (Federici, 1996, 1998). While accurate statistics are not yet available, more cases of atypical autism in post-institutionalized children are being reported by families and treatment providers around the world.

Rutter (1998) discusses Quasi-Autistic Patterns following global privation in Romanian and Eastern European orphans. Rutter discusses "autistic features" which were evident in children raised in severely deprived environments, with these features being very similar in some respects to those found in "ordinary" autism. These quasi-autistic patterns were found to be associated with prolonged deprivation and grossly interfered with the ability of the child to develop appropriate attachments and reach optimal cognitive potential.

A child's neurocognitive and emotional development rapidly moves towards a downward spiral following extended time in an institution. Hopelessness and helplessness sets in, with an increase in anger, frustration and extreme loneliness and despair. For children who have a relative degree of cognitive and emotional stability at the time of institutionalization, these relative "skills" can often be compromised following an ongoing lack of human contact and stimulation, or a chronic exposure to children having significantly more neurocognitive and neurodevelopmental impairments. In particular, children who may show classic autism or mental retardation in an institutional setting typically have very pronounced self-stimulating behaviors and rituals which tend to be automatic neurologic responses, whereas the relatively stronger institutionalized child may develop or "imitate" these responses over time as a way of finding a degree of social interaction, attachment and mode of passing time. These ritualistic behavior patterns may also serve to "detach and defend" against profound anaclytic depression and despair (Spitz, 1945).

More specifically, as children in institutional settings become more resigned to the pattern of despair, trauma, emptiness and true "detachment" from an outside world, a loss of developing motor, sensory and intellectual-cognitive skills ensues. Regression begins and becomes an insidious pattern. While there may be no precise measure to assess how long this regression (and loss) of neurocognitive abilities may take, estimates suggest that for every two months of institutionalization that a child may be delayed one month in cognitive and emotional skills (Johnson 1997).

Federici postulates that, as a child's memory of the few positive experiences of life gradually fades away, he or she may regress to the most infantile (safe) stages of development. This regression can ultimately lead to a very infantile and autistic state in which the child exhibits an emotionally detached and preoccupied personality structure and presentation which is virtually indistinguishable from classic autism.

Additional characteristics of Institutional Autism (or an "Acquired Syndrome"), are as follows:

Actual loss of physical height, weight and growth in the absence of a documented neurological condition. The profound negative effects of malnutrition, untreated medical problems and social deprivation may result in a degree of psychosocial dwarfism.

The child does not look to be anywhere near their actual age, nor is the sex of the child easily discerned.

A cessation of current language functioning with a documented history of appropriate language usage.

Rapid deterioration of behaviors to the point where the child exhibits primitive acting out behaviors due to profound attachment disorder and institutional trauma.

Profound nutritional and medical neglect over the course of years which may mediate body and brain development with the gradual emergence of an organic brain syndrome impairing language, attention and concentration, development of confusional behaviors and deficiencies in memory and learning.

Complete regression to self-stimulating behaviors such as rocking, head banging, hair pulling, self-injurious behaviors, and institutional language.

Regression and "detachment" from relative healthy and normal human contact to an "attachment" to others with similar pathology. This "group model" represents survival in an alternate form of social-interaction based on modeling, imitation and developing any type of attachment in order to survive institutional life.

Improvement in autistic symptoms following removal of trauma and with cognitive and emotional rehabilitation. Resurgence of autistic symptoms upon returning to institutional environment.

In promoting a better understanding of this unique and highly complex institutional autistic syndrome, families may be better prepared to adopt and raise an older child from an institutional setting. Furthermore, more in-depth understanding of a potentially institutionally autistic child may help neuropsychologists and allied medical and mental health professionals appreciate the impact of institutional effects on neurologic and psychologic functioning which is then altered over the course of time. Awareness of acute and chronic trauma on brain behavior relationships may expedite the implementation of cognitive rehabilitation strategies to be used by families immediately after adopting a post-institutionalized child.

In summary, comprehensive neuropsychological evaluation and proper understanding of the post-institutionalized (potentially traumatized) child may help develop an assessment and treatment model as current neurological and psychiatric categorization often does not allow for the nuances of atypical patterns. The complexities of many internationally adopted children has now presented families with a new set of challenges requiring multidiscipline interventions.

Building the Bonds

Thu, 19 Jul 2007 08:58:49 GMT

OUR SON

Our first toddler adoption was a little boy from Korea.� When his foster mother handed him off to me, she cried, and I cried.�� He barely whimpered. I felt relieved that he took to me so easily. I carried him in a baby carrier and slept with him at night. By the time we left Korea, I figured we were on our way to good attachment.

Once home, I carried him frequently, rocked him at bedtime, and slept with him at night if he woke crying. When he woke�at night,�he howled if I held him close.� He preferred to rest his head on my forearm, his body a careful 12 inches from mine. Just adjustment pangs, I thought, confident he'd soon warm up to me.

After a month, he was still stand-offish, and I was frustrated. Why didn't he feel more comfortable with me?� I blamed myself. Worked harder. Hugged him more. But he still remained standoffish.� And just as troubling, it seemed that my usuall in-love, mommy feelings-- the ones that had come so easily with my other five children -- just�wouldn't come.

�After reading about toddlers and attachment, I paid closer attention to his behavior. He would whine to be picked up, then arch away and slither down my hip, or he'd lean limply outward, making his 23-pound body feel like lead. On my lap, he leaned far away. If I didn't hang on, he would tumble off. And when I hugged him, he cried and thrashed as though my hugs were torture.

If I smiled at him, his eyes skittered away. If I tickled him, he resisted laughter with every iota of his being. He seemed constitutionally opposed to having fun with Mom. Not only that, he'd pinch tiny bits of skin on my arm, or pull one hair on my head-accidentally, I first thought. Except that those things happened too often to be accidental.

None of this was big stuff. But considered together, it left me with a constant low-level irritation and a feeling of being rejected. When I recognized his behaviors as a sign of attachment difficulties, I was both scared and relieved.

There was a reason I was struggling with my feelings towards him. I wasn't a rotten mom. I felt differently about him because he wasn't doing his part in the dance of attachment.

� Attachment, after all, is a relationship-a two-way street. A mother falls in love with her infant partly because of the lovable things the baby does-nestling in, quieting when being cuddled, enjoying being fed, smiling and cooing, preferring Mom above everyone.

So why was he so resistant? It wasn't because he was a rotten kid.� No.� It was fear, plain and simple. He'd spent his first seven months of life in a hospital, with no chance to become attached to anyone. His next 13 months had been with his foster mom, who handed him to a stranger-me-and walked away.

He feared losing another mommy, so he was doing everything he could to make himself unlovable. Resisting hugs, avoiding eye contact-it was all self-protection.

It broke my heart to realize how wounded he was. But it also spurred me to act. Since we'd missed out on his infancy, I decided we would redo some of it. I treated him like a much younger child. He went everywhere with me. I slept with him. I fed him bites at mealtime and bottles at bedtime. I played on the floor with him. I began rocking and holding him close every day, giving him kisses and reassurances that I would always be there.

This cuddle time made him cry -- he resisted it fiercely at first.�� But I persevered.� And�each day, as I cradled him and told him how much I loved him and wiped away his tears, I found myself truly falling in love.

I still second-guessed myself often. It was tough, tiring work, and I worried that stirring up so much emotion wasn't good for him. But�each day�after being held and allowed to cry his sadness out, his spirit unfailingly seemed lighter. He seemed relieved that I'd stuck with him through his tears.

His eyes sparkled. He accepted cuddles. He was playful. He'd have hours or days of better behavior, and I'd get glimpses of the child he could be. Over the days and weeks, cuddling bothered him less and less.� His rage subsided.� He even began to seek out hugs and love.�

I still remember exactly where I was when he came and climbed into my lap and asked for a hug all on hs own.�� It was possibly the sweetest hug I ever got in my life.

After six months, I could look back and see how far we'd come. We still had work to do, but by then he was so much better-more loving, giving hugs, sharing laughs with me. It was harder and slower than I ever imagined, but completely worth it.

Now, at age nine, he is a normal well attached, happy kid.�� Recently he was playing a game with cousins where you had to answer questions.�� Everyone was asked what they loved.�� Other kids said ice cream and pizza.� He said, "I love my mom."�

OUR DAUGHTER

Three years after our son came home, we decided to adopt another child. When we were referred a 10-month-old girl from Ethiopia, I hesitated. I had hoped for a younger infant. Even though our son at that point was doing well, I was so afraid of dealing with attachment problems again.

But when my husband saw that picture, he knew in his heart he was looking at his daughter.� Bolstered by my husband's certainty, I added my signature to the referral papers, and prayed everything would be okay.

A month later, our agency's director visited Ethiopia and decided that our daughter was probably six months older than the original estimate. Estimated age on homecoming: 20 months. Exactly the age our son had been.

My heart clutched. Yes, we had gotten through it with our son, but, oh, I did not want to go through those highs and lows again. I cried for days over that new birth date, even though I knew that a number on a piece of paper didn't really change the child. She was the age that she was, and in spite of my fear, by that point I also was convinced she was meant to be ours.

I gave myself pep talks.� Our experience with our son made us better equipped to parent a child with attachment issues. I reread my favorite books on attachment and gathered my courage.

And then came our daughter. After living with her birth family for her first year of life, our daughter had spent the next 10 months in a busy Catholic orphanage. She was one of 15 or so toddlers in a tiny, crowded room with one or two caregivers. Halfway through her stay there, she was moved to a different room with different caregivers, but the same overcrowded conditions. Not an ideal start at life.

The day the nuns handed her to us, she was very still. She barely moved for two days, just watching us. Then she began reaching her arms out to me. I carried her everywhere, fed her bottles, and slept with her at night. By the fourth day she had turned into a sparkly, delightful cuddle-bunny.

For weeks I waited for the honeymoon to end, but it never did. When she had been home seven months, while cuddling at naptime, she said to me, "Thank you, mommy. Thank you, happy, me."

She came to me with an open little heart, fell in love with me immediately, and never let go. I know now what a gift that is.

I still wonder why our two children responded so differently to the trauma in their lives. Maybe our daughter had excellent nurturing in her first year, and that's what carried her through those long months in the orphanage. Maybe our son found those first seven months in the hospital so traumatic that he was unable to bond with his foster mom. Then again, our daughter is a people person, and our son is more reserved.

�Maybe it simply comes down to personality. We'll never know for sure. We do know, however, that we are tremendously grateful-for our son's healed heart and for our daughter's miraculously unbroken one. Though their adjustments were very different, both children were meant for our family.

Making a Difference in the World

Thu, 19 Jul 2007 09:21:49 GMT

This morning I read a post on a friend's blog describing a kind of restlessness she feels.� I could really relate to what she wrote.

John and I have recently been having similar discussions about Ethiopia, wondering if there is something we could do there that would be truly meaningful, and in a bigger way than just through adoption. Adoption is huge for a few children, and we are so grateful to be able to do that. But adoption doesn't touch the true need in Ethiopia.

In the reading I've done about poverty and disease (The End of Poverty by Jeffrey Sachs, Mountains Beyond Mountains by Tracy Kidder), it seems that most experts have concluded that monthly food hand-outs and bundles of hand-me-downs from first-world countries aren't the answer.

Poverty-stricken communities need the opportunity to help themselves. To do that, they have to be healthy enough to work, and they need basic things like clean water and affordable schools and health care to be freely available.

John and I have wondered if there is truly a way that we could do something lasting- something that would truly impact a poverty-stricken community in a positive way. We keep coming back to the water thing. Can you imagine being productive if you had to walk three hours a day just to get your family's water supply?

I read about a couple who retired to Africa, where they supervise the drilling of wells in poverty-stricken communities. John and I talked about how neat it would be to go to the communities where our Ethiopian daughters were born (Wollaitta, Ethiopia and Harar, Ethiopia) and drill wells. Even just a well or two in the most poverty-stricken parts of both towns seems like it would make a difference for a lot of people...

It sounds like a stretch to me.part of me thinks we're being grandiose to think we could make a meaningful difference. And there are so many unanswered questions.� Where would we get the money?� Would our children understand?�� Would they be safe?

To tell the truth, I'm not sure if I'd want to live in Ethiopia full-time. I'm an air-conditioning, hot showers, and microwave kind of gal. And yet I do know I want to do something.� Maybe�a three month mission trip�would be�more my speed.� We'll keep on thinking, and praying, and dreaming.� Who knows what doors will open in the future?

Educating My Daughter

Sat, 21 Jul 2007 06:51:17 GMT

When I adopted my daughter Alesia in 2004 she was 13 years old.I knoew school would be a challenge for her, but I never imagined the hassles I would face from educators and an indifferent school.

I had met her when my choir sang at her orphanage in 2003, and instantly knew she was my daughter. I thought she was about 7 years old and was astonished to learn she was 11. She was so tiny. I decided that no matter what the challenges, she was meant to be my child, and went ahead with the adoption. Alesia has made an amazing transition and she is a wonderful child. There have been challenges, but I wouldn't trade her for anything.

Alesia is a very smart, creative girl. She figured out the remote controls on my TV the first hour she was home. She can fix anything around the house. She loves to take materials around the house and make things - without any prompting from me. She likes Kleenex boxes. She makes photo frames from them. She took a Barbie stand and fixed it with pieces of coathangar to hold her jewelry. She made a little basketball hoop for her little brother the first day he was home. So I know she is highly intelligent.

We live in an area with good public schools nearby. When I enrolled her in school, she was tested in Russian, and placed in 7th grade. She was in 7th grade in Russia, so I thought it made sense. There was a 6 week intensive ESL program for several hours a day, right at first. Her communication skills grew tremendously. I was told after that, she was given a lot of breaks in class, because the teachers didn't expect her to be able to comprehend everything in English.

The first summer she was home was 2005. We had just moved into a house with my mother. We planned to tutor Alesia intensively that first summer, so she could keep up in 8th grade. My mother fell and broke both shoulders, and there was no tutoring possible. The whole summer was a nightmare of hospital and nursing home care, then a huge amount of in-home care. I was working full-time. So Alesia's tutoring just didn't happen.

By the time Alesia had been in 8th grade just a few weeks, I knew something was terribly wrong. She could speak English pretty well. She couldn't really do her schoolwork, though. I would re-teach her everything, every night when I got home from work. Mother helped her, too. She just didn't "get" it. We worked one night on Thomas Edison. I talked and talked about him. We read about him.After breaking for dinner, I asked Alesia what he invented. "New York and Chicago?" she replied. My heart sank.

I talked to her teachers. They said she was fine, it was just a language issue. I knew they were wrong. I talked to a friend who is a teacher. She urged me to push to get Alesia help. The school flatly refused to test her for learning disabilities. I had her tested at Sylvan in January. They said her reading was barely on 2nd grade level. The teachers at school kept grading her based on "how hard she tried" and ignoring her real issues. I finally got a meeting with the school psychologist in the spring, and he refused to give her an IEP or test her for disabilities.

I was so frustrated. I talked to the school board about getting Alesia the help she needed. They wouldn't help me - even though my county has all kinds of programs for kids that are special needs, that are violent, that get pregnant, etc. I talked to the principal of a charter school that helps immigrant children with language issues. He refused to admit Alesia because she would be older than the other kids by a couple of years.

I enrolled Alesia in a tutoring program called Kumon. It helped her some, but I didn't feel it really worked that well, for her.

Finally, I had Alesia tested for learning disabilities. She has an auditory processing disorder. Finally, there was a name to it! I enrolled her in Lindamood Bell, a program that specializes in tutoring kids with learning disabilities and increasing their reading and math skills. She bloomed. Her reading comprehension went from 2nd grade to 6th grade. She even talked more clearly, after just a couple of tutoring sessions. The change was remarkable.

I had to take Alesia out of school and homeschool her last year. She didn't pass the test to go to high school and I didn't feel she was ready. The school offered no remedial help - just a repeat of 8th grade. At great expense, I hired tutors and Alesia worked through the lower grade curriculums for months. She did really well, despite the Auditory Processing Disorder.

In a few weeks, my bright beautiful daughter starts high school. She reads all the time now, for fun. She loves to learn. I think she will be fine. I have already asked for an IEP, and now they have to give me one because she has a documented learning disability.

What parents of older kids have to do is to become advocates for their children. Even a good school doesn't know YOUR child. You have to insist on the right care, test them, find tutors - do whatever it takes. Never assume the school will do the right thing - they don't know your child like you do.

� Dee Thompson, 2007

Dealing with Nosy Questions

Tue, 24 Jul 2007 14:21:41 GMT

The guy in the pharmacy waiting room pushed me over the edge. My daughter Alice, a sweet but rambunctious toddler, was having a timeout in one of the vinyl seats, occasioned by her urge to run away from mommy in the store. I kept one eye on Alice and the other on the pharmacist who was filling our prescription.

The waiting area was empty except for us and a pleasant-looking, fortysomething man. Predictably, the questions started.

"Is she adopted? Where's she from? How long have you had her? Was it really expensive to adopt her? Isn't it a shame how people in some countries just throw away their girls?"

On and on the interrogation rolled, undeterred by my terseness. The man seemed completely unaware that he was probing into parts of our lives that we have every right to keep private. How does one deal with a person whose idea of small talk is telling a 2-year-old that she was "thrown away?"

Mercifully, the pharmacist called me to the counter. As I completed my transaction, I kicked myself for even answering the man. A person with a legitimate need for information about international adoption deserved more than I could give in two minutes. A person who was simply indulging his curiosity deserved much less.

Families formed through transracial adoption, whether international or domestic, are naturally conspicuous. Most people who adopt across ethnic boundaries love to talk about it, given appropriate circumstances. Our children are cherished; they have filled our hearts with joy.

We teach them about adoption; we attend playgroups where they can meet other similar families. We advocate for our children in schools. We locate resources and role models that will help our children balance their birth cultures with their American lives. Despite our best efforts, the incessant questions from strangers chip away at our foundations.

At home, we're telling our children that adoption is a special way of creating a family, and that their birth cultures are something to celebrate. Meanwhile, repeated encounters with people like the man in the pharmacy send them a different message. The message is that our children are peculiar; that their families are not normal; that the people whose DNA they share are barbaric.

And, often, that the kids are "lucky" to be adopted by "would-be saints" such as their parents. These negative messages are usually, but not always, unintentional. People have an instinct for categorization; when they see situations that don't fit the norm, they comment. Most exchanges are harmless. But the cumulative effect is to undermine the legitimacy of our families.

We knew that our decision to adopt transracially would mean kissing our cozy anonymity goodbye. But our daughter never volunteered for this ride. And people often speak to us as if our child is deaf-as if she does not hear and internalize conversations that go on around her. So I'm printing up business cards with contact information for our adoption agency and several good Internet sites. The next stranger who plies me with private questions in a public place is going to get one, with the comment, "Oh, if you're interested in adoption, here are some excellent resources."

When Alice is old enough, we'll discuss whether she wants to handle inquisitive strangers or prefers us to run interference. And we'll teach her ways to respond without revealing information that is hers alone. Meanwhile, don't be surprised if you meet me in the check-out line and I politely decline to recite our family history when you ask, "Is she adopted?"

Alice is not a public exhibit. She deserves to be protected from adult questions that subtly invalidate her family's right to exist. Alice was adopted, once upon a time. But now she is simply my child and our hearts are knit as tightly as any parent's and child's can be.

Julie Higginbotham and her family live in Chicago. This article originally appeared in Adoptive Families Magazine.

Quietly Mothering

Tue, 24 Jul 2007 14:46:46 GMT

Open Adoption Birthmotherhood is interesting, especially when visits are involved. I find myself often feeling motherly towards Ariana, even prior to the birth of Nicholas which brought out a whole new realm of Mom-type-emotion.

Upon our first visit, which was when Munchkin was roughly four months old, an overwhelmed Me walked into Jeff and Denise's home, taking in the home of where my Baby Girl was being raised. I found her sleeping, peacefully, though we were making quite a ruckus, on her playmat in the middle of the living room floor. I knelt before her, awestruck by both her beauty and how much she had grown in such a relatively short amount of time. She was no longer the wrinkly, pucker-faced little newborn. She was now an adorably dressed, full-bodied, curly-haired baby. This was my first experience in thinking, "They grow so fast."

True, I had been sent many pictures between her birth and that first visit. But pictures don't always feel real. Part of me has always felt as though I was staring at some other woman's child, not my own. To see her, so beautiful, in front of my face, in live, three dimensional being, I was overwhelmed with a sense of love. And pride.

And then it happened.

One of the reasons I placed was an all-consuming fear that I wouldn't know how to be a Mother. No one told me that you learn all of the "Motherly-type-things" once you become a Mom; it happens, instinctively. Once Nicholas was born, I realized that you just know how to wake up in the middle of the night, change a diaper with your eyes half shut and half-sleep your way through a feeding. I thought that, since I wasn't feeling overly happy during my pregnancy, that I would never learn to love my child. No one explained that an unplanned pregnancy can bring ambiguous feelings and stress but that, yes, you will be able to love your child more than anything you've ever known.

So, as I sat staring at this beautiful child, the dog bounded into the room, excited to see company. While Jeff and Denise tried to calm the dog down, she jumped over Munchkin, knicking her face with one of her dog-fingernails. Immediately, before Ariana could even open her eyes and begin crying (which she did), I scooped her up and cuddled her close to my chest.

The feeling was indescribable. And so very confusing.

Here I was, holding my child to calm her down and soothe her pain and it felt so very right, so very natural. It was then that I realized, oh, it is an instinctual feeling. You do just "get it." It was at that moment that I began to feel a sadness creep over my soul. My eyes were just then beginning to open to the many lies that I had told myself or let myself believe about my ability to parent. I would have been a fine Mom, just strapped for cash. I could have learned the same things that every other parent learns by the seat of their pants. (Because, how can you learn to do it until you do it? Right? Right.) And the love, so natural, was always there, I was just scared to open my heart to any of it.

And so, now on visits, I have to walk that fine line between being a birthmother and being a Mother. Munchkin is not my child to say, "No, we don't hit people." It feels weird to sit idly by while someone who came forth from my body is parented by people she refers to as Mommy and Daddy. I often sit, quietly Mothering in my head, and say, "No, no, Ariana. It's okay. Come to Mommy, I'll make it all better." Yet, to tell her to go to her Mommy, she would walk in the opposite direction of me and it is simply something I have to live with; it's just the way it is.

(Originally published at The Chronicles of Munchkin Land in January 2006.)

Getting Real

Tue, 24 Jul 2007 14:48:28 GMT

"What happened to your REAL family?"

The classic playground question -- to which the adoptive parent often replies (and coaches the adopted child to reply) that of course, the adoptive parents are the real ones. Well, sure we are. But so are those people who birthed our children.

Sometimes I think the syndrome of adoptive-parent reluctance to allow the term "real" to be used for any parent but the a-parent goes hand-in-hand with the a-parent's terror regarding the idea that their child/ren may someday want to search for their biological (genetic, first, birth, real....) parents. I'm working hard to talk the talk regarding support of search and hope that, when and if push comes to shove, I'll also be ready to walk that walk with my kids.

I hope by the time the issue arises I'll feel strong and ready to support my kids, always repeating the mantra, "it's not about me, it's not about me...." Acknowledging that my kids' first parents are real, and really important, is an early and crucial step in that journey. I sometimes wonder how much our fear of sharing the term "real" (or "mother" or "father") with the birthparents stems from a root insecurity about our own right to be parents.

As one who struggled with infertility, I believe this can be a particular problem for adoptive parents who have never made biological children, because then the whole infertility/insecurity syndrome gets thrown into the mix. (But infertile parents don't have an exclusive on the behavior pattern.) If you're trying to be an effective a-parent of an internationally/transracially adopted child, I've learned, you're better off accepting and openly acknowledging several tough truths, to wit:

Your child had a life before the adoption.
Your child's biological parents are absolutely as real as you, the a-parent -- even if you've never seen them and in fact are currently unable to get information about them. Your child has a right to call them whatever your child likes. You're real, but they're also plenty real, just like your child is real. Conceiving and birthing a child are huge, real things, just like daily parenting is a huge, real thing. Why not acknowledge all that with your child at a young age, instead of letting this term get to be so loaded by stubbornly insisting that you're the only "real" one? Your child's ultimately going to use the terms he/she prefers anyway, regardless of the words you teach and use.

Adoption can be a band-aid for a problem, but it's not a perfect fix. Your child may always feel a hole... the lack of information and daily contact with genetic family ... and for some kids, that's a huge hole. For some kids, not. But the hole is not about YOU, the a-parent. It's about your child and your child's first parents. Don't try to come between them, or even between your child and the "ghost" of those folks, if the real people aren't accessible. You can acknowledge and support the child's feelings about the lack, whatever those feelings are, but you'll never be able to fill that hole -- you're not the right shape. It's not your fault; that's just the way adoption is.

A second big loss of international adoption is loss of the right to navigate and understand the birth country as a native. Do whatever you can to acknowledge and remedy that loss, but don't ever pretend it doesn't really matter. Don't allow yourself to believe that the joys of being Western and speaking English (or whatever) like a native and having a middle-class (or better) upbringing make up for that loss. They don't. To be an adoptive parent means, in a deep sense, that you are always sharing your role -- and this is true even if your sharing is only psychological, rather than sharing time with a bio-parent-on-the-scene. Parents who are raising their biological kids don't have to do this, and it's a hard thing. It's a knife in some ways--that lack of full "ownership" of your child and your child's filial love. (Even though, of course, no earthly person truly "owns" the child, not even a biological parent.)

Nevertheless, you must come to some kind of inner peace about that sharing -- and to openly acknowledge that you know you're sharing, and that your child can have very strong (sad/mad/glad/whatever) feelings about the first family, and that this is all OKAY. This heart-work has to be done if you're not going to become toxic as a family, to some degree.

International adoption has turned me into a much more grown-up person than I ever was, and I say this as someone who came to it pretty late (39) and after a lot of prior heartbreak. It can be a slow process, and painful, but it is possible to move from a place of ignorance/naivete to a place of more understanding. I think many people are willing to learn for the sake of their kids -- though it sometimes takes a long, long time. In the tale of the Velveteen Rabbit, being deeply loved is what makes the rabbit "real." May we all love our children so deeply that we're willing to expand our ideas about who a real parent is, and create a family circle that encompassess all aspects of who our children have been, are, and will become. Julie Higginbotham

I Cannot

Tue, 24 Jul 2007 14:55:52 GMT

I cannot change the past. What has happend is forever a part of history, our life stories merging with one another through choices, lack of choice, circumstance, fate and love.

I cannot change how I feel. That isn't to say that how I feel doesn't change; it does. But all of the pointing out how what I feel is wrong won't make me magically see the light. My experience, which I cannot change, have shaped those feelings. I feel because I have been.

I cannot change your own reality. For I cannot change your past. I cannot change how you feel; that is up to you to do through your experience, your choices, your lack of choice, your circumstance, your fate and your love. Your passion. How I live my life, how I love my children and how I accept my reality doesn't change your reality unless you let it. I am not responsible for your choices, your lack of choices, your circumstances, your fate or your love. I can only tell you of my reality.

I cannot predict the future. I don't know how my children will react to my reality in the years to come. Yet as I just said, I cannot change their reality. As they grow, mature and make their own choices and accept their circumstance in life, they will form their own realities. How that includes or discludes me will be up to them; my reality will be to accept their own. My reality is raising them with the knowledge to make those future choices, whatever they may be.

I cannot stop wanting change. For all of the things that I cannot change, I yearn for it. I beg for it at night. I plead for it in my prayers. I push for it in my words, knowing full well that I cannot force you to believe, feel or change anything about your own reality. Even still, with that knowledge, I want that change. I want my children to live in a world, someday, where they don't have to be ashamed to say, "My sister was adopted but we're still siblings even if she does have boogers," and, "My Mom raised my brother but not me but it's okay because we're all kinda kooky, even the awesome parents who raised me." I want them to be accepted, black and white, parented and placed, water and wuh-ter, as siblings, as friends, as children and as adults. I want the change to help foster that aura of acceptance.

I cannot change the world on my own. But maybe, just maybe, if more people begin to accept others' realities as different from their own but mutually acceptable, maybe then, just maybe, that change won't be big and scary. Maybe then, oh please, my family will be allowed to operate in whatever fashion we see best fit.

(Originally published at The Chronicles of Munchkin Land on my birthday, 2007.)

The Difference in Motherhoods

Tue, 24 Jul 2007 15:03:17 GMT

He likes chewing on the monkey's hand. He gets frustrated when he can't pull said monkey down off the playmat arch. During bath time, he likes to hold a wash cloth, his rubber duckie or his wash cloth. He doesn't like water in his eyes. When he wakes up in the morning, he greets me (or Daddy) with a big smile. He loves to be naked. And he will pee on you without warning.

His current favorite sound is a gurgling "g," which he can do for hours on end. He loves to chew on his Taggie blanket and now, just purchased, his Taggie book. Speaking of books, he loves them; we read to him constantly. He likes his mirror but he will wing it at your face. Sitting in the bouncy seat shortly after a feeding is usually a pretty good way to get him to poop. He watches Martha Stewart; perhaps someday he'll bake me a fantastic cake.

Watching him get his shots breaks my heart. When it comes to binkies, he's picky. He's nosy. He snores in his sleep. When he gets excited, he kicks his little feet and waves his arms all while making the cutest cooing sound known to mankind. He smiles the biggest smiles in the world when Daddy says, "Boo!" His pouty lip can bring tears to the eyes of stone cold Men. His skin is so soft and it always smells good. Except when he poops.

He rarely spits up unless I say, "He rarely spits up." Then he likes to prove me wrong. Rebelling all ready! He doesn't mind me dressing him for the day. Sitting in his high chair is a new excitement, even though we're not feeding him solids yet, just getting him used to the chair. I take a million and one pictures and the child doesn't mind. Music makes him move. He likes to lay on the big bed. He likes fans, light fixtures and his fishy mobile.

When he is ready to go to sleep for the night, he gets a little fussy. He wants to cuddle in close. He will flail his left arm around if you don't hold on to his hand. And he wants his butt patted. The Butt Pat is magic. If he starts fussing again, just start patting the butt. Magic. And as soon as he falls asleep, his whole body relaxes. He smiles in his sleep. Sometimes he makes giggling noises. And when we lay him down in his crib for the night, he stretches his arms and legs, finds his little spot and drifts off to dream land.

I can say all of this about my son. I could say more. I could go on and on about the little intricate details of his wonderful daily life for pages upon pages. I could tell you every last thing he likes and doesn't like. I could tell you what makes him giggle and what makes that lower lip stick out further than my own. I could tell you what will scare him and what won't have any adverse effect. I know which diapers will work and which ones will give him an allergic reaction.

And he's not even five months old yet.

My daughter is over two years old and I can't tell you half of this information. Not because Denise doesn't do a good job at telling me but because I'm not there. I don't know her nightly bedtime routine. I don't know if she has a blankie. (Though I do know she has a cup that goes downstairs with her.) Allergies? I don't think she has any but I can't say that for certain. I don't know what her favorite toys are though I know she likes to line them up around her. I don't know what she's scared of and what is normal.

There are some days when I feel so close to my daughter. And there are days like today when I feel like the farthest thing from her soul. It hurts, really. I'm gonna go cuddle my Little Man to sleep.

(Originally published at The Chronicles of Munchkin Land in April 2006.)

Call Me Mom

Tue, 24 Jul 2007 17:39:50 GMT

I know this may be controversial, but I just wanted to give my two sents' worth on the issue of older adopted kids addressing their adoptive single parents.

I first became a single mother at the age of 41. For months before I went on my first adoption trip, I wondered what my daughter would want to call me. She was 12 years old on that first trip.

My Russian was minimal, although I was making a big effort to learn the language. I carefully thought out how I would tell her, "Look, you can just call me Dee until you feel comfortable enough to call me Mom."

My process had begun when my choir sang at Alesia's orphanage, and I started thinking about adopting the little blonde girl I met. I got in touch with a missionary who worked at the orphanage and started writing notes to Alesia. So I had been writing to Alesia for months before adoption trip #1. Thus, Alesia knew me, a bit. I always signed the letters Dee, however, to avoid awkwardness.

The first meeting in more than a year was awkward and touching. I got out of the car and saw Alesia walking with a friend. I called out to her, just her name. She turned and scrutinized me, then screamed "Dee!" and ran up to me and threw her arms around me. I had to work hard not to cry. She was all skin and bones, and dressed in ragged mismatched clothes that were miles too big.

We went into the orphanage and met with the social worker, who didn't want to be cooperative. The agency rep asked her to walk outside. That left me and Alesia and another agency rep inside the office. Alesia was shy and clearly felt awkward.

The other agency rep said to Alesia in Russian, "This is your new Mama." Alesia was shyly looking down, studying her feet. She looked apprehensive at the word "mama" - which is the same as the American word. I knew enough Russian to know what was said. I said quickly "Tell her she can call me Dee, until she feels comfortable with Mama, or Mom. In America, I call my mother Mom." They translated that, and Alesia looked relieved.

She called me Dee that first day, around the other girls. She led me around by the hand, always huddling against me, protective of her mama-to-be. I felt so sorry for the other girls who had nobody. It broke my heart, the more time I spent with these lovely, smart 11 to 14 year olds. The second day or so, Alesia was calling me Mom-Dee, then finally, just Mom. She has never called me anything but Mom since then.

I don't have any great insights to share about attachment or bonding, except that I truly believe calling me Mom helped my daughter attach to me. I know another single mom who adopted two older girls and they don't call her mom, they call her by her first name. I don't think that's the best situation. I think the mother should've insisted on Mom or Mommy, or something along those lines. The attachment has taken longer. That's just my observation.

My daughter doesn't confuse me with her birthmom, who she lived with until age 6. To her, I AM her mama, and her birthmom is her birthmom. Her birthmom never called, wrote, or visited Alesia in 6 1/2 years in the orphanage, so Alesia was out of practice using any term for mother.

When I adopted my son, the first meeting went a little differently. The orphanage assistant director, a kindly older lady, introduced me, asked him if he wanted to be adopted, and we talked for a while. He looked at a photo album of my home and the other family members. Finally, he was asked what he wanted to call me. He looked at me and grinned. "Mama!" was his enthusiastic answer. We all laughed. "OK, then, that's fine with me!" I said. "Or you can call me Mom, like Alesia."

My attachment with my son has been swift and easy. He calls me Mom. He went around the first week hugging me constantly and gazing up at me in adoration, saying over and over "My Mom." He has been home now since May 2007 and is already well attached.

Some children who are older may associate the word "mama" with negative feelings, so it's understandable they would feel awkward using the word. However, if there is another "mother" word they can be taught to use, I feel like that is the best situation.

As a single mother, I never really felt like a "Mom" until the first time I was in a store and I heard a little voice calling Mom! and I automatically looked around for my daughter. When I realized this little person would always know me as "Mom" my heart just melted.

To older adopted children who crave a stable home and family, you are the mama [or daddy] and I think using those terms helps solidify the bond, even if it seems strange at first.

� Dee Thompson 2007

Women Who Notice: Speaking Up & Reaching Out

Tue, 24 Jul 2007 19:19:39 GMT

My second daughter, adopted as a baby from China,�was a challenge to parent. She came to me with an awareness of�her loss, memories of a woman she loved, a sensitive nature and an intense personality. My first three years with this beautiful and intelligent child drained me emotionally and physically. I learned what I had to do in order to help her with her adoption issues, and re-wiring my life, I did what was needed. I don't remember the details...but I remember being tired! And scared and anxious and resigned. We made progress together, but teaching a baby to love you is a lonely business.

�

My daughter grew to feel safe and secure in tiny little steps. I rejoiced in the smallest of things: her first unsolicited kiss at 15 months old almost stopped my heart! I spent most of my day, every day (and a lot of my nights) meeting her needs and teaching her to trust; it's hard to�comprehend the immense amount of energy that can go into adoption-parenting, unless you're familiar with the bittersweet experience of bringing a child back from the edge.

�

I had a lot to learn about support systems, both for my child and for myself, and if I had to do it again I would be as proactive in finding�assistance for myself as I was about finding resources for my daughter. I would help my family and friends understand the work I was doing with my child, and I would ask for their emotional support. I would let them know exactly what I was dealing with, and how important it was for them to put their arms around me and my baby, literally and figuratively. Adopting a child opened a whole new world for me, but I think I was too blurry-eyed to realize that my friends and family weren't sure of how to offer to help, or even what I was trying to accomplish. What had become second nature to me in doing attachment-work with my daughter probably made me look like a rigid and over-protective parent to an outsider, and probably made me appear unapproachable.

�

I�wanted a coach, a mentor, a friend who understood--I needed the village that was supposed to help me raise my child! I didn't get the whole village, but I did find women who reached out to me, who extended sisterhood and who told me I was doing something valuable by mothering. They noticed. I held on to their words of honesty and support, and was enormously touched whenever another mom mentioned how well my little girl was doing. Simple words�had a powerful impact:

�

"You are a great mom," my own mother told me one day, after watching me slog through months of attachment-parenting.

�

"You are a strong woman," an adoption therapist told me, which gave me�the mantra to get through my week.

�

"We are so thrilled for her!" a group of moms told me with excitement when�my toddler was finally able to sit happily�on the play parachute at Gymboree. It was a big day when she decided to go for a gentle circle ride with the other babies, instead of clinging to me in fear. The moms' sincere celebration of my baby's big�step forward�surprised me; that they had noticed what�my daughter was working to overcome, and had shared�their appreciation of her accomplishment, meant the world to me.�

�

More than time alone or bubble baths or even chocolate, the�words and company�of other mothers re-energized me to be the kind of parent I wanted to be. Moms who understood what I was trying to achieve, who acknowledged and validated my time with my daughter, were my cheerleaders. They gave me the words to go forward and the words that re-filled my inner reserve. I was, and continue to be, extraordinarily grateful for the women in my life who spoke up and reached out to me, who helped keep my attitude healthy and happy, and Who Noticed when I needed it most.

�

There is invisible strength in Motherhood, and we need to watch out for one another. Giving a struggling mom�a compliment, noticing the incremental progress of�her child, or offering your encouragement (or shoulder to cry on) are�not-so-random acts of kindness that fuel the thankless job of parenting. Showing up with a flat of flowers and planting them, dropping off a DVD and a bag of chips and dip, or simply sending an admiring email, are�motherly gestures we can do for tired moms to help void the feelings of isolation that parenting challenging children can engender. We can do this for each other; we can extend a hand, we can connect, we can all notice a mom who is in need of the essential, human magic of other mothers.

�

~~~~~~

�

ADOPTION TOOLBOX http://AdoptionToolbox.com

Excerpted from Adoption-Parenting: Creating a Toolbox, Building Connections

(2006 EMK Press)

Connecting With Our Children

Tue, 24 Jul 2007 19:48:53 GMT

"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 / 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 registered with the national organization ATTACh, go to the following websites:

www.attach-china.org and www.attach.org

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

Adoption and Divorce

Tue, 24 Jul 2007 20:11:53 GMT

Divorce isn't the ending that any parent envisions when they begin the journey to adopt. In addition to the normal stress of a dissolved relationship, a parent may feel extra guilt over inflicting an additional trauma on a child with a history of loss. How you handle yourself during the process of divorce can mitigate some of the guilt: recognize that when a parent chooses to demonstrate a "good" ending to a bad situation, it can set an incredibly important example. Whether a couple's divorce is amicable or acrimonious, a child needs to be guided through his own pain and confusion. When a parent is able to display emotional leadership, and implement a family emotional-behavioral plan to weather the upheaval of divorce, it teaches an adoptee that there is life-after-loss. Ask yourself:

1) What is your behavior modeling for your children? How are you "teaching" them to handle adversity/sadness/anger?

2) Are you expressing YOUR feelings in a healthy way?

3) Are you age-appropriately HONEST with your kids about your divorce? Do you answer (or bring up) questions in a straightforward manner, without getting overly upset?

4) Do your children truly understand that THEY had nothing to do with YOUR divorce?

5) Are you allowing your children to mourn the loss of "how life was" with two parents (even if the ex-spouse was less-than-perfect)?

6) Do you give spoken/unspoken permission to your children to love their other parent, and do you reinforce that relationship?

7) Do you validate your children's emotions?

8) Are you showing them how, in spite of divorce-loss, to be happy?

9) Are you allowing guilt over divorcing one of your child's parents to immobilize your good parenting (are you able to confidently set boundaries, and enforce house rules)?

10) Can you put your adopted children's emotional needs as your HIGH PRIORITY over everything else, for at least the year after your divorce?

. Understand that you and your spouse are the marriage role models that your children internalize and replicate. Divorce is a sad solution, but worse, is staying in a bad/sad/mad marriage and allowing your children to understand your negative relationship with your spouse as "normal". Your marital relationship could become THEIR family structure as adults.

. You cannot be the parent you need to be for your kids IF YOU ARE CHRONICALLY UNHAPPY or in a dysfunctional relationship. Get help or Get out.

. Avoid building a loving, fantasy parent out of an absent-by-choice ex-spouse. You don't want your child to be hurt by a parent who shows little interest in visitation or who "abandons" your son or daughter, but it is better to place an honest, non-denigrating explanation where it belongs (on the absent parent's personal problems, or sad choices, for example), and to help your child deal with this loss upfront. Covering for an ex-spouse in order to protect your kids' feelings will eventually backlash at YOU.

. Normalize therapy for your kids: Therapists are Feelings Doctors and we all could use a tune-up. If you are seeing a marriage counselor or individual therapist, tell your kids in a serious, but matter-of-fact manner. Talk about why smart people seek help. Your normalizing therapy as a healthy choice will go a long way in helping your child see a counselor, if it is indicated.

. Divorce will trigger an adopted child's loss issues. It is an opportunity to identify and talk about the core issue of loss, validate feelings, offer empathy, and help build your child's resilience with coping skills. An adopted child's awareness of his feeling that divorce = abandonment, and WHY he feels the way he does, is a huge step toward him being able to successfully deal with the stress of this major life change.

Copyright 2005 MacLeod, All Rights Reserved
Originally published in Adoption Parenting: Creating a Toolbox, Building Connections edited by Jean MacLeod & Sheena Macrae, Ph.D.

RESOURCES on DIVORCE for Parents
Divorce After Adoption: Practical Tips for Parents
www.adopting.org/adoptions/divorce-after-adoption-practical-tips-for-parents.html

Books about Divorce for Adults, Teens and Children
www.divorce-books.com

Helping Your Kids Cope with Divorce the
by M. Gary Neuman

FAVORITE BOOKS about Divorce for Children
Help! A Girl's Guide to Divorce and Stepfamilies (American Girl Library)
by Nancy Holyoke

Dinosaurs Divorce by Mac Brown & Laurie Krasny Brown

Let's Talk About It: Divorce by Fred Rogers

It's Not Your Fault, Koko Bear by Vicky Lansky

Sandcastles Way

Just for Kids on Mother's Day

Tue, 24 Jul 2007 20:21:12 GMT

Do you think about your birthmother? Most adopted kids do! It's normal and natural-- your birthmother is part of you, and you may yearn to know about that piece of yourself. You may have questions for her; you may wish to know details about your birth, or the real answer to why she left you.

Mother's Day can be a day of mixed emotions for internationally adopted kids who have no contact with their birthparents. You may feel love for your absent birthmother, or sadness, or even anger! You may even feel guilty for thinking about your birthmother if you believe your adoptive mother would be hurt by your questions or sad feelings. You may feel ALL of these things occasionally, and it may feel confusing to have all of this swirling around inside. Try to remember:

. It's okay to love two moms

. It's okay to feel happy or sad or mad when you think about your birthmother

. It's okay to share your real feelings with your mom or dad

Honoring your mom on Mother's Day is a wonderful tradition. It is an opportunity to make your mom, who loves you and cares for you on a daily basis, feel special and appreciated! Mother's Day can also be an opportunity to think about the woman that gave you life. It can be a chance to focus on understanding how you have become a beautiful part of BOTH of your moms.

Creating rituals and taking symbolic action are ways people deal with deep emotion. Sometimes 'doing' can help you express yourself when finding the right words for what you are feeling is difficult. Talking about adoption and birthparents can be tough! You may wish to choose an action or ritual that symbolizes your thoughts or feelings about your birthmother (or create one of your own), and enlist your mom's help. Honoring your birthmother doesn't diminish your love for your adoptive mom on Mother's Day. It simply recognizes your birthmother's essential contribution to your being, and enlarges your family circle to include an important piece of YOU.

IDEAS
Write a letter to your birthmother, and keep in a special box. The box can be a place to store your thoughts and feelings, and small treasures that remind you of your early life.

Paint a picture: use your feelings and your imagination and make a picture of you
with your two mothers

Make a cake the day before Mother's Day to celebrate your birthmother on a new occasion: "Mother's Day Eve".

Talk to your mom about your feelings about your birthmother. Your mom will understand, and sharing your emotions will make you feel lighter inside.

Create a book about your life, and describe the traits you think you have inherited from your birthmother, and what she might look like (look in the mirror!).

Light a candle, and send a blessing, a thought or a prayer to your birthmother.

Plant a flower or a small tree, as a symbol of your own roots (your birthmother) and blooming branches (your adoptive family).

View the moon when it is full, and know that it is the same moon your birthmother views at night, from across the ocean. A moonbeam connection!

Copyright 2007 MacLeod, All Rights Reserved
First published in Mei Magazine 2007 www.meimagazine.com

Seeking Therapy for an Adopted Child

Tue, 24 Jul 2007 20:43:46 GMT

Parenting is a tough job. Adoption Parenting is a tough job that comes without directions. Baby books, Child-Care books, and Parenting and Discipline Books are all based off the societal, biological "norm". Without any kind of a map, how can you discern which of your child's problematical behaviors are derived from age-related flare-ups and which are evolved from the life-long issues of adoption?

Without some help, you probably can't. Adoptive parents are not prepared by the adoption process or by the model of child-rearing they themselves were raised with, to understand the extra layer of emotions that adopted children live with. Moms and Dads have not been taught to recognize the masked anger, sadness, shame or fear that is a part of some adopted and foster children's psyche, and they have not been trained to help their children deal with the emotions that spring from the pain and loss of their children's early lives. Adoption Parenting is different; children who were adopted domestically and internationally, at birth or as an older adoptee, will process core issues and experience life transitions on a different timetable and with a different twist than their biologically parented peers.

The cause of troubling behavior in a child is a tough call to make when a parent is left in this kind of uncharted Adoption Parenting twilight zone. It is easy when a child is young to rationalize his or her objectionable behaviors as being part of the terrible twos, threes or even fours. It becomes more difficult to accept as the child gets older, and it becomes terribly frustrating for an adoptive parent trying unsuccessfully to use traditional disciplinary methods on a rebellious pre-teen or adolescent. It's important for a parent to realize that a child's behavior is only a symptom. The real underlying problem may be an adoption-related issue.the difficulty is deciding if your child's issues are disturbing enough to himself or to others, to seek professional assistance. Children who harm others, animals or themselves, or act destructively, need immediate help. For other children, who move in and out of intense emotions or behaviors or who try to hide their trauma, it's harder to discern if therapy is required.

Questions adoptive parents can ask themselves to help evaluate the need for a therapist consultation:

Is your child's behavior interfering with a normal enjoyment of her life, school and family?

Is your child's outward compliance or quiet opposition, really a control, anger or fear

issue? Is she passively angry at you for leaving her at school or at daycare; are there hidden or underlying abandonment issues?

Is your child acting out (angry, disruptive) or acting in (depressed, withdrawn)?

Is your child's anger frequently inappropriate?

Is your child's supreme "self-control" or manipulative behavior really an underlying need to control you, and everything else in her life?

Do you find yourself parenting "around" your child's issues and hot-buttons? Do her tantrums (and the timing of when she decides to have one) control family life and activities?

Does your child whine constantly?

Does your child have anxieties and fears that she can't control? Do her fears change over time, but never really go away? Do they rule where she'll go, what she plays or whom she'll see?

Does your child have difficulty with her identity? Are there cross-cultural or trans-racial concerns to factor in?

Does your child's behavior affect her relationship with you, your spouse or her siblings?

All children may exhibit some of these issues while growing up, but parents usually recognize a red-flag behavior by its intensity and persistence. Worrisome moods and behaviors can fall at either end of the 'healthy' spectrum; everything is a matter of degree, but if your parent instinct has 'concerns', you are wise to listen to it and to seek help.

Finding a Therapist
Finding a therapist skilled in the specific issues of adoption and attachment can be a challenge. Your homestudy or placement agency may have the names of highly regarded local contacts. The Association for Treatment and Training in the Attachment of Children (ATTACh) is a national organization that lists member therapists and clinics on their website: www.attach.org. ATTACh has instituted a detailed membership registration, which is now required for qualified therapists who wish to be eligible for referral. Other highly informative websites that provide names of parent-recommended adoption and attachment therapists can also be found by doing an online search.

Attachment therapists recognize that a child's minor or major adoption issues can interfere with a secure, intimate attachment with his or her parents, and can negatively impact the family as a whole. Attachment is about relationships, and a reputable adoption/ attachment therapist will treat not just the child, but include the immediate family. Traditional talk therapy and behavior modification may not be as effective in correcting adoption-based problems as some of the methods used by attachment therapists. Theraplay, nurturing Holding Time, Re-parenting, EMDR, Biofeedback and Narrative Therapy are popular techniques, and a competent therapist should empower the parents with the knowledge and skills to reinforce the emotional work at home.

When parents are finally at the point of seeking outside help for their child, they are usually stressed, worried and confused. Many parents have had no previous experience with psychotherapy and are not sure what to expect during the process. An initial parent-only consultation with a potential therapist to discuss his or her philosophy and methodology is important to finding the best 'fit' for your family. If you have adopted internationally, it is essential that the therapist you choose is aware of the realities of institutionalization and its effect on a child, both developmentally and emotionally. Is the therapist knowledgeable and experienced with:

Attachment Theory and Treatment?

Post Traumatic Stress Disorder (PTSD)?

Sensory Integration Disorder?

Fetal Alcohol Spectrum Disorders (FASD)?

Institutional (physical or sexual) abuse?

Transracial adoption issues?

Does he or she understand that post-institutional or internationally adopted children may also display sensory, neurological, neurobiological or speech and language issues that need to be addressed by a "team" of specialists, concurrently with attachment therapy, for best results?

Domestic adoptions bring their own set of complexities. Is the therapist experienced with the intricacy of open adoption, birthparent search or the data compilation and personal review of a child's pre-adoption history? Many children adopted domestically, particularly from the foster care system, have vivid and often painful memories of living with their birth families.

An informed therapist will understand that your child's present behaviors are in part a consequence of his or her past, and will not blame the child's resulting conduct on your "inadequate" parenting.

Fees and Philosophies
Parents should not be afraid to ask what a therapist charges per session and how they accept payment. How long is each session and is there some flexibility built into the session time (can you go overtime five or ten minutes for an appropriate closure)? Is the therapist available for consultation in between sessions by phone or email, and does she or he charge extra for these services? How can the therapist be reached in a crisis?

Parents should also ask what therapies will be used in the office and what your role as parent will be. Unlike most traditional therapy, you should expect to be participating fully, and interacting with your child in each session. For an adopted child, attachment and security with you is the primary point, with the ultimate goal of the child internalizing that relational strength and self-regulating their own behavior.

Every therapist works a little differently; styles vary with the different kinds of therapists, the work they do, and the needs of their clients. A child may really benefit from multiple approaches, including the services of other professionals from neuro-psychology, sensory integration, and speech and language. Your therapist may continue to strategize as your child progresses through the stages of healing, building on treatment with variations. Successful adoption or attachment therapy takes a creative and united team of therapist and parents to support the child while trauma is resolved.

The timeframe for treatment is also varied, ranging from a few consciousness-raising sessions to a much lengthier process for more severe problems. As therapy advances a therapist will constantly reassess the client's progress and treatment plan, and therapy can be either shorter or longer than originally anticipated.

Parent Support
Support for parents is an important component of successful adoption or attachment therapy. If a Mom or Dad is too overwhelmed, depressed or emotionally burned out to participate in the child's treatment, then therapy will fail. A therapist should ideally provide the parent with educational resources, a parent support group and if necessary, a referral to a personal therapist and anti-depressive medications. Recognizing that the parent continues the work done in the office at home, seven days a week, is vital on the part of an empathic therapist.

Adoptive parents need to realize that their child's troubled behaviors can be a normal result of what their child experienced before joining their present family. As parents, you look for ways to protect your children and to soften the kind of life-blows that some of our children have received, and that no child deserves. Therapy can be challenging work for any family, and it won't allow you to soften or protect. It will open feelings and conversations over the truthful realities of your children's beginnings and will give you the insight and the capability, the map and the directions, to bring your family very close together.

Copyright 2001 MacLeod. All Rights Reserved
Originally published in Adoption TODAY Magazine; also published in
Adoption Parenting: Creating a Toolbox, Building Connections (EMK Press 2006)

RECOMMENDED READING
Straight Talk about Psychological Testing for Kidsby Ellen Braaten, Ph.D. and Gretchen Felopulos, Ph.D.

Parenting the Hurt Child: Helping Adoptive Families Heal and Grow
by Gregory Keck, Ph.D. and Regina M. Kupecky, LSW

Attaching in Adoption: Practical Tools for Today's Parents
by Deborah D. Gray

Nurturing Adoptions: Creating Resilience After Neglect and Trauma
by Deborah D. Gray

Twenty Things Adopted Kids Wish Their Adoptive Parents Knew
by Sherrie Eldridge

Adoption Parenting: Creating a Toolbox, Building Connections
edited by Jean MacLeod & Sheena Macrae, Ph.D.

Parenting With Narratives: The A, B, C's of Adoption Stories

Tue, 24 Jul 2007 21:48:04 GMT

"All children struggle with "Who am I?" as well as "Who are we--as a family?" The story of the life of an adopted child "needs to go deeper" than statements of fact. The adopted child needs to experience her story from many perspectives and with both the mind and the heart. He needs to know that the mystery of his spirit is fully welcomed by his adoptive parents. She needs to know that her unique story has its place among the community of stories that have emerged over the generations, among the cultures and nations of the world. By bringing stories into the home and by creating their own stories--together--parent and child are jointly creating interwoven stories of their family history.

Stories need to have a central place in the ongoing development of the adoptive family." (Daniel A. Hughes, Ph.D.)

Once Upon a Time is a magical phrase that conjures up a faraway world from long, long ago. For our internationally adopted children, it is also a phrase that bridges the huge chasm between their early lives and who they are now. When life feels like a fairytale of good and evil, love and loss, reality and fantasy, it sometimes takes a story to create sense and meaning. How will your child see her or his adoption? What "story" will they read into their own lives as they gain awareness of what happened to them as young children? Parenting narratives (stories with purpose) help the child to see a complex tale from different perspectives, and can give a child the opportunity to examine serious thoughts and emotions in a familiar format. They also allow the parent to present the truth in several age-appropriate ways and provide point-of-views that are personally empowering to the adoptee.

Parenting narratives can take shape through a parent's use of

. Children's literature

. The oral tradition of storytelling (a favorite at bedtime)

. A co-created Lifebook

. Adoption videos or photographs

Realizing that there are gentle and creative ways to approach the issues of adoption and the intense feelings of adoptees, and that children's books and story-telling can help provide the tools, is a relief for all of us adoptive parents who have taken on this monumental job without much tech support.

A child's attunement to his or her adoptive parents, and co-creating a Life Narrative with an adopted child, are both part of an overlapping, circular process. The parent-child narratives

Adoption issues are normal. Some require a therapist's attention, but the issues that most often get expressed by adoptees are usually addressed at home by mom or dad. We want our children to express all of their feelings surrounding adoption because it allows us to do our job: we are the responsible parent and we need to encourage, support, listen to, and walk with our adopted children through their personal stories and beliefs.

The benefits of Parenting Narratives are what I call The A, B, C's of Adoption Stories:

Attunement and Attachment -- stories can help teach a post-institutional child the meaning of family, and help him or her to learn to love, trust and feel secure

Building Identity -- children need a foundation for "self"; they need the truth AND they need to feel empowered by their story. Kids can't go forward without a past!

Communication and Connection -- children need to be able to talk about adoption's tough stuff, and they need to be able to count on YOU being there next to them when they do

A = ATTUNEMENT and ATTACHMENT
Our internationally adopted children come to us missing the first steps of the Dance of Attunement. Attunement happens between a newborn and a mom as they learn to pick up and respond to each other's verbal and non-verbal cues. Voice, eye contact, facial expression and touch, all play into this amazingly essential give-and-take; a baby learns she has control over this all-important mom (equating to control over her own world), and she learns she can trust mom to understand and respond to her needs.

This natural dance between mom and baby is the foundation of attachment. It takes place in hundreds of moments every day, and is so hard-wired into healthy moms and bio-babies that it is not even noticed. When a child and a parent are attuned to each other the child is able to self-regulate. This doesn't mean that she is tantrum-free, but that she is able to draw upon the inner structures she has in place (from her mom) to calm down and make sense of her moods and feelings. A child who is securely attached is not ordinarily out-of-control angry or fearful; she is attuned to her mother's unspoken words and expectations. She knows the

A post-institutional kid has missed the early formative groundwork that moms and infants do with each other, and must be taught to attune/attach. It is much harder to do with an older baby, toddler or child who has had their trust bruised, but it is crucial in having the kind of bond (and behavior) that brings joy to the entire family. In order for us to have the relationships that we dreamed of having with our children, we need to work a little more at connecting to them-and we need to teach them to connect to us. Attunement is a graceful dance between two people who know the steps, who can both lead and follow, and who can anticipate the change in music.

How do we foster this dance, this connection, in our toddlers and older children? Most of us are not experienced attachment therapists or adoption social workers, yet we parents can do what moms and dads have always intuitively done to connect: we can create shared emotional experiences with our children. We can involve our children's "perceptions, thoughts, intentions, memories, ideas, beliefs and attitudes" (Dan Siegel, MD). We can use our facial expressions, voice, and body movement to MATCH and/or RE-DIRECT our children's affect and response. We can verbally help our children understand what they are feeling by communicating our own feelings.

We can tell stories.

Stories are universal and personal. They can be utilized as shared emotional experiences, and we can use dramatic voices and active body language to help our children become involved. We can share our own emotions, and help a child reflect back on their own. When we are aware of our children's body signals and emotional cues, we can tailor our storytelling to feed our children's needs.

We can connect on the cognitive level, and from our hearts.

Adopted children may need to re-learn to love, trust and feel safe. They may need to learn about families and relationships-children who have lived some or most of their young lives in an institution cannot be expected to understand the unseen structure of a family, or the role of a mom or dad. Stories and books don't make attachment happen, and they don't heal a traumatized child or cure attachment disorder. But used with a parent's awareness of attunement, they can provide a "warm fuzzy" on the long chain of warm fuzzes that are necessary to build a loving relationship.

CHILDREN'S BOOKS can provide the tools to facilitate stories that promote parent-child attunement. Tools are not always easy to use. reading a story to a child is fun; reading a

Storybooks can assist children who are navigating a new environment. They can be used to begin a conversation or open a topic, and can be personalized to a child's circumstances. Books are user-friendly and non-threatening, and can help a parent find the words that unlock shared feelings.

Parenting favorites that claim and celebrate the nurturing bond between a parent and young child:

Baby-Steps by Peter McCarty

I Love You Like Crazy Cakes by Rose A. Lewis

Even If I Did Something Awful by B. Shook Hazen

I Promise I'll Find You by Heather P. Ward

Little Miss Spider by David Kirk

I Don't Have Your Eyes by Carrie A. Kitze

Mama, Do You Love Me? by Barbara M. Joasse

The Runaway Bunny by Margaret Wise Brown

I Love You As Much. by L. Krauss Melmed

Hush Little Baby by Sylvia Long

Over the Moon: An Adoption Tale by Karen Katz

Tell Me Again About the Night That I Was Born by Jamie Lee Curtis

The Little Green Goose by Adele Sansone

Hazel's Amazing Mother by Rosemary Wells

Owl Babies by Martin Waddell

Using Books to Create Closeness
Almost any book with any kind of happy or sad "feeling" can be used to leverage attunement. Older children can be similarly reached with a good tale and an exploration of its theme. I read the dog classic Lassie Come Home (the big, beautiful, illustrated version of the original, by Susan Jeffers / Rosemary Wells) to my nine year old, who had been adopted from China as a baby. We were both teary-eyed by the end of the story, and I took advantage of the opportunity. I asked, "How do you think Lassie felt when she was lost and all alone?"

We talked about poor Lassie, who had been abandoned and who was searching for her birthparents-oops! I mean human family. Well, you get the idea. adoption, and the feelings a child has about her/his adoption, can be discussed via a story without an older child shutting down. The attunement came after we discussed Lassie's sad, dire circumstances: I told my daughter "If Lassie had been my dog, I never would have let her go! I would have searched every inch of England AND Scotland, and I never would have stopped looking until I found her!"

I didn't change the sad stuff the poor dog had to experience, but there is always more than one take we can make on every finish. "Changing the ending" of a sad story doesn't mean I stealthily add an ending that is happier... it means that I can help my child change HER PERSPECTIVE of the ending. The truth never changes, but our understanding of it can.

"Changing the ending" are words for a powerful tool: our parent voices giving our children alternate perspectives, choices, and control over circumstances they may encounter in their own lives. It doesn't mean censorship even in the 'protective' sense-- it means empowerment. Words ARE powerful and although they can be hurtful, they can also help heal and strengthen.

My daughter and I ended up in a hug after sharing our sadness (and relief over Lassie making it home!), sitting close together, both of us enjoying the moment and each other.

When using stories to do "the dance of attachment" with your child:

. Infuse your stories with drama and feeling

. Take verbal and non-verbal cues from your child (listen and watch!)

. Reciprocate with the next-step verbal/physical cue (show them!)

. Give actual words to shared emotion

. Encourage physical closeness

When reading stories, keep in mind:
Books that might appear "too young" for a child's chronological age, may be very appropriate for that child's emotional age. Do not hesitate to use younger-level picture books that have stories that touch all ages on a deeper level. The books do NOT have to be about adoption to be useful.

Reading a book with your child in your lap is cozy and comforting. Alternate with having your child sit directly in front of you, knee-to-knee, while holding the book up and open.�

"The most powerful of our non-verbal communication instruments is the face. A child's face, and yours, is a barometer expressing interest, investment, curiosity, joy, fear, anger, confusion, or doubt." (Dr. Bruce Perry)

Some children are wigglers, and have a difficult time sitting still to listen. Author Susan Olding suggests a solution that worked for her family:

"A few disastrous experiences showed me that if I ever hoped to get my daughter to accept me as I am (somebody who loves to snuggle up with a book or twenty), I'd also have to show her that I accept her as SHE is (somebody who NEEDS to move, to think!) So from the time she was about eighteen months on, I built in time before, between, and after stories to shake the sillies out. In our house this even included the special privilege of jumping on the bed. At that stage, I also read a lot of "action" books to her (Eric Carle's Head to Toe comes to mind) and we'd both act out the pictures. I also allowed her to turn pages (until and unless she sabotaged that, in which case I would just put the books away.)"

Use a lot of expression! Be passionate! Use gestures! Some children have difficulty in "getting" non-verbal cues, and are helped with story interpretation through exaggerated, dramatic interaction. Change the tone and volume of your voice (whisper to get a child's attention). Stories with repetition and catchy say-aloud lines are fun to read together.

Be aware of your child's physical and verbal cues. If a story makes him or her uncomfortable, stop and talk about it. Trust and emotional safety are key to attachment, and it is up to the parent to listen to the child, acknowledge the child's discomfort, and take the lead in either continuing the story, deciding to offer another story, or by suggesting a different joint activity.

Story-time can be an example of "reciprocal communication of thoughts and feelings, and shared activities" (Dan Hughes, Ph.D). Dr. Hughes' P.L.A.C.E philosophy --Playful, Loving, Accepting, Curious, and Empathic interactions--reinforces attunement, and according to Dr. Hughes, facilitates the capacity for fun and love. Ask your child specific questions about what they think and feel about the story. Share your own opinion/feelings. "Spin" the story and explore alternate endings. Have fun together!

There is no perfect, pre-determined set of children's books that work for every child. Therapists that work with narratives believe that the parent understands the child better than anyone else, and will have a better feeling for stories that will touch the child on some emotional level.

Narratives are a PROCESS; There is no "right" way to tell a story; if you screw up, there's always another chance to re-tell it!

Dealing with Disney; Disney movies are a particularly vivid form of cultural "storytelling" that children (and parents) either love and cherish, or hate and fear! We can use these films, if our children are open to them. Elaine Hannah wrote:

"Disney movies can be a wonderful starting point for discussing bigger life issues. When my daughter has expressed fear of the necessary mean character, be it witch, queen, or stepmother, I explain that without evil there can be no happy ending. Without a nasty character how would we measure the character of the good one? In life good things happen and bad things, there are good people and bad. There can't be one without the other. I try to boil the story down to the bone. There is challenge and evil, but courage and pureness of heart triumph and everyone lives happily ever after. Sometime on a daily basis."

A Disney movie, like a dark fairy-tale, is an opportunity for talk, and for a release of emotion. It is an opportunity for a parent to attune with a child and help them emotionally "re-write" the ending. We can use Disney to declare what we, as parents, would do to help our children no matter what happened. AND what our brave, creative, strong children could do to help themselves!

CLAIMING NARRATIVES take parent-child stories a step closer and deeper, and offer a warm and caring "re-write" to a missing early chapter of the relationship. Typically, a claiming narrative is told in first person using storytelling's oral tradition, and is used to build or repair an emotional bond.

Claiming and Re-parenting
Mom or dad tells the story of how they would have taken care of the adopted child, if he or she had been born to them. The tale can begin in imaginary-utero and progress to the detailed, daily maintenance of a well-loved infant. Most children, even older children, like to be occasionally babied, and a claiming narrative allows a parent to physically act out caring for a "baby" while simultaneously telling the story. The emotional connection of re-enacting a happy, playful infancy is further reinforced by expressing the poignant, underlying wishes of both parent and child:

Mom: "I wish you had grown inside of me"; or, "I wish you had been my baby from the very first moment of your life"; or, "I wish I could have taken care of you the way you should have been taken care of"

Child: "I wish you had been my birthmother"; or, "I wish my birthmother could have taken care of me"

A child that expresses a wish to be with his or her birthmother is generally not taking a personal shot at the adoptive parent. A child feeling "safe" enough to express this kind of honesty is usually speaking to the loss that has rocked his or her world, and is not trying to be

Dan Hughes said that a parent that helps their child "co-construct an interpersonal reality gives a child the tools that she needs to make sense of the internal and external worlds in which we live."

We parents give meaning to our children's experience, and we help them learn to analyze how they feel and what they think. Our children borrow our strengths, and our filters, and by sharing ourselves (our thoughts AND emotions) we help them grow. Ultimately, an attuned dialogue on a sensitive topic like birthparents could prove to be an affirmation of the strength of the adoptive parent-child relationship. Children's books can provide an introduction into this kind of sensitive parent/child dialog:

"I may never know you
but I wonder
who you are,
and what you look like.

Do you wonder too?

The full moon glows
heavy in the night sky
a beacon of
beauty and truth.

Why did you leave me?

It's soft light
filters through rustling leaves,
making shadows
that play on the grass.

Do you remember me?"

(excerpted from We See the Moon by Carrie Kitze)

Claiming and Family Membership
Claiming narratives have traditionally been used to pass on a family's history and rituals. Older adoptees can benefit from "family stories" that introduce their new family members (Great-Grandma Millie and Crazy Uncle Ed), and that include the adoptee in the group experience. It is a huge comfort for a child to feel that she belongs in her adopted family, that

Susan Olding made audio-tapes for her young daughter that recounted stories from Susan's own childhood, and used the connecting power of a mother's voice:

"The stories on my daughter's most recent tape are indeed 'family stories.' Tales about me when I was a little girl, and a first version, storybook-style telling of her own baby story. The Family Narrative has been so important for my daughter. She ADORES those stories of my own childhood naughtiness or silliness. She likes to hear how her grandma (my mother) responded. This morning she asked me if Grandma was young when she adopted me. I gently reminded her that I was born to Grandma, not adopted by her. For a second I thought this might upset her. But instead, she said, "Hey! I know a birthmother!""

A claiming narrative does what the Story Maven, Sharon Falter, states is the most important reason for reading books and telling stories in the first place:

"Storytelling creates a connection between people. What more can a parent give to their child than the gift of a story? It is a gift of meaning. It is a gift of understanding. And it is a gift of self."

B = BUILDING IDENTITY
"When a child is born of the Bear clan, you've got to tell him what it means to be part of the Bear Clan. He's got to be given a name that fits with Bear Clan customs. He's got to know that he has this whole identity and that identity goes right back to the myth, right back to the beginnings of time. That is strength. That is power. That makes you feel good about who you are. And if you don't know who you are, then you don't know where anything else fits." (Native American / retold by Rev. Katie Lee Crane of First Parish of Sudbury-UU)

Helping a child develop an identity that includes the past, the present and the future is integral for a child to feel whole. For adopted children five to ten years old, identity may be the consuming core issue. Their realization of the blank space in their early family history coincides with the hollow feeling they carry inside, with a profoundly sad result. They don't know who they are.

How do we help our adopted children develop a sense of identity? Particularly, how do we help international adoptees feel pride about where they were born, AND help them be comfortable in the world they live in?

We can tell stories.

"I still wonder about my life in China.

I love my parents very much and I
wouldn't want any other family, but
I think I will always miss knowing the
parents that weren't mine to keep.

My mom says that I am a brave kid
and that my life has been an amazing
adventure-that I have experienced
enormous changes, and I have survived
them all. I like to think about it that way;
it helps me bring both my sides together.

I was born in China and now I'm from
here, and my before and after is all part
of who I am: one girl from two places
who is growing up to be at home in this
big, wide world."

(excerpted from At Home in This World by Jean MacLeod)

As parents, we also tell stories to change a child's view of themselves. For instance, the protagonist in At Home in This World has had sad things happen to her, but she is not a victim. She is coming to terms with her story and it's enigma, and she is empowered by her (and her parent's) particular view of her life. The Family would categorize At Home in This World as a "Successful Child Narrative". The Dulwich Centre, specializing in Narrative Therapy, would call it an "Alternative Story".

"There are many different sorts of stories by which we live our lives and relationships - including stories about the past, present and future. Stories can also belong to individuals and/or communities. There can be family stories and relationship stories.

An individual may have a story about themselves as being successful and competent. Alternatively they may have a story about themselves as being 'a failure at trying new things' or 'a coward' or as 'lacking determination'. All these stories could be occurring at the same time, and events, as they occur, will be interpreted according to the meaning (plot) that is dominant at that time. In this way, the act of living requires that we are engaged in the mediation between the dominant stories and the alternative stories of our lives. We are always negotiating and interpreting our experiences." (Alice Morgan, Dulwich Centre, Australia)

How do we negotiate and interpret these important stories about identity in a way that allows our children to really integrate what we are saying about them? A narrative can help to change a child's reality (or "internal working model", as trauma-specialist Dr. Bruce Perry calls it). Dr. Dan Siegel has been researching the kind of narratives that have the power to effect positive change in our adopted children. What he has found is that certain interactions can model and facilitate brain-integration of the thinking and feeling-the key is in using verbal and non-verbal signals at the same time to help integration of the story take place (language plus emotion, for example).

Dr Siegel uses the word collaboration for attunement, and he stresses that it can be taught to parents to use with their children. This includes involving a child by sharing "eye contact, facial expression, tone of voice, gestures and timing and intensity of response." This also means sharing reflective dialogues about inner "thoughts, feelings, perceptions, memories, sensations, attitudes, beliefs and intentions."

Both Dr. Siegel and Dr. Hughes have researched and clinically validated the importance of marrying thought and feeling when working on attunement/collaboration and attachment. It is impossible to really help a child deal with their adoption stories or adoption issues, without having or fostering parent-child attunement. It is the BASIS for telling stories, and on a much deeper level, for building a child's identity. Healthy growth isn't possible without a firm foundation.

Attunement with our children helps them to create their own positive self-image. Therapist Denise Lacher said, "If you change the story, you can change self-understanding." I just call it "spin", but they both work the same way. When you talk with your son or daughter about their birth story and abandonment, you have the power in your words to make your children feel like Heroes or like Victims. We are all multi-storied people, and we have choices we can make about our life-narratives.

Narrative Spaces
Narrative Therapy uses a correlating concept called "Narrative Spaces", that is helpful to apply to our kids. Below, I am using an example with permission from the Dulwich Centre website, but applying it to an adoption story:

Picture Stonehenge. Between the gigantic boulders that form the circle, are big spaces. An adoptee is used to getting his or her story told by the big, powerful boulders (society-at-large and the media), and has not had much choice but to internalize a demoralizing reality: "unwanted, abandoned, unloved, left on a street corner."

But the spaces "in between" the boulders are equally powerful. A parent can utilize those spaces to bring a different, alternative meaning to what the boulders have proclaimed. For example, the space-in-between: a child who was left on a street corner as a baby and later adopted is not a pathetic, perennially wounded kid. He/she

By helping our children to see the spaces in their story and in the world around them, we can give them a tool that is truthful and life-changing. Words have the power to change; it is a force majeure to hand that power to our children, so they know that the rest of their story, their ending, is within their control.

Lifebooks
A pre-adoption life story, or Lifebook, can help define a narrative space, and an adopted child can better learn to acknowledge the empty places in her history when they are re-framed and normalized by the principal adult in her life. It's all about empowerment; a co-created Lifebook (shared words and emotion!) gives a child ownership of her life story, and all of her thoughts and feelings.

Dan Siegel said that we can "collaborate in the construction of a coherent reality for our child, and help them connect the past, present and future to create an autobiographical form of self-awareness."

LIFE NARRATIVE BOOKS for children
At Home in This World, a China adoption story by Jean MacLeod

Twice-Upon-a-Time: Born and Adopted by Eleanora Patterson

Before I Met You: A Therapeutic Pre-Adoption Narrative by Doris Landry, MS

When You Were Born in China by Sara Dorow

When You Were Born in Korea by Brian Boyd

When You Were Born in Vietnam by Therese Bartlett

Over the Moon: An Adoption Tale by Karen Katz

We See the Moon by Carrie Kitze

Tell Me Again About the Night I Was Born by Jamie Lee Curtis

Through Moon and Stars and Night Skies by Ann Turner

When I Met You by Adrienne Ehlert Bashista

The 'Baby' Lifebook
A 'Baby' Lifebook is easily created by putting chronological photos in a sturdy mini album. Begin in your child's birth country, with the earliest referral photos you have of your child. Include photos of the birth family, foster family or orphanage caretakers, if you are lucky enough to have them. Add photos of your child's city or province, the local people and rural countryside (use the internet to obtain pictures if you or your friends were unable to take them yourselves). Periodically flip through the album with your young child, and matter-of-factly discuss each photo. No writing required! This automatically, naturally and regularly makes parents use words like adoption, birthmother, orphanage, abandonment, finding place, Baby House, and foster parents.

The photos also give parents a chance to talk about how the child must have felt at the time of each photo, judging by the facial expressions and body language in the pictures. Talking about the 'emotion' in the photos help children to think a little more deeply about what they are looking at, and helps parents get comfortable with adoption conversation. Use copies of the original photos for a Baby Lifebook, so that a child can keep the album on his own shelf. You can end the album at a first birthday at home, or first adoption anniversary, but it doesn't really matter; the focus just needs to be on the child's life, pre-adoption, and on his transition to his new family and home.

C = COMMUNICATION AND CONNECTION
Stories COMMUNICATE our thoughts and emotions. They CREATE A CONNECTION between people, AND between the past, present and future. Life Narratives are an identity tool that can present an opportunity to use stories and mixed media as part of an attuning activity. Creating a Lifebook, watching and discussing an adoption video, and looking at pre

ADOPTION VIDEOS and PHOTOGRAPHS can be used as a jump-off point to conversations about a child's early life, and can give clues to a child's pre-adoption history. Looking at these tools analytically, a parent and child can discern the emotions of all involved and sometimes deduce relationships, level of pre-adoptive care, and a physical and developmental history.

In looking at your child's adoption day video or photos and the first months or year at home, it's important to talk about the emotions that the baby in the images might have been feeling, and the emotions your child has today watching herself on tape. It's okay to talk about the fact that she might have been scared, or grieving a caregiver or foster family during the adoption, and you might point out how your own happy expression does/doesn't match hers in the video. Ask her if she can see the difference, and can she guess why?

"Where did I come from? What did my birthparents look like... what will I look like? What was my life like before I met you? Why was I abandoned?" are questions my daughter has asked me, and she and I have looked for clues together. We might never find definitive answers, but we piece together what we can and find comfort in the process.

How can adoptive parents make sense out of the sometimes trivial, sometimes confusing, sometimes overwhelming information we have for our children?

We can tell stories.

My daughter and I watch her adoption video and discuss the feelings she had when she met us, that are evident by viewing her reactions on tape at ten months old. We talk about how happy I look, and how wary she looks. We watch her private interaction with her caretaker and understand more about her life in the orphanage. We watch, and talk about the area she is from, what the local people look like, and why she might have been placed where she was found. Without a lot of concrete answers to give our children, a lot of small clues can be surmised by viewing video footage or early photos of the adoption, and of the first months at home:

What was the caregiver's personality? Name?

Was your child healthy, well-fed, happy? Developmentally on target? (if not, look for visual clues "why")

What was she wearing?

How did he play? What amused him?

What was her reaction to you? Is this how she still deals with change? (one clue to personality and early life experience)

Did he look sad, happy or scared when he met you, and did his expression change over the next two weeks together, and next couple of months at home? What do you think she was thinking/feeling?

If you visited the orphanage, where did he spend his time?

What was the atmosphere? Who were his friends/crib-mate?

What were How did your child interact with her/his caregiver?

What were her milestones, once home? First tooth, first word, first step?

Photos and video helped to familiarize my daughter with her beginnings, and the visuals helped me to talk with her about the bittersweet side of adoption. Our video is part of my daughter's life story; it is part of my 'mothering' story. It is a precious piece, because it captures loss and love, and the first tentative moments of family connection.

Pictures do tell a story. but it's equally important to communicate how you and your child feel about what is gleaned from these visual puzzle pieces. An empathic, attuned parent-child relationship will remember the "dance" steps through the questions of childhood, the angst of pre-adolescence, and the teen identity crisis. Ultimately, we want our children to be comfortable with all of their pieces and with who they are, and giving a child ownership over their history is part of a Parenting Narrative.

Attunement, Building Identity, Communication and Connection.

The A, B, C's of adoption stories provide us with some of the fundamental tools of family. We can't be untruthful about a child's life story. but we can help our children connect a narrative that hangs together from the fragments that are known, and re-story the whole with our love and strength.

Copyright 2005 MacLeod, All Rights Reserved
Originally published in Adoption Parenting: Creating a Toolbox, Building Connections (EMK Press 2006)

NARRATIVE RESOURCES

Connecting with Kids through Stories:
Using narratives to facilitate attachment in adopted children

Parenting with Stories:
Creating a foundation of attachment for parenting your child (WORKBOOK)
By Melissa Nichols, M.A., Denise Lacher, M.A., and Joanne May, Ph.D.

Adoption Lifebook, A Bridge to Your Child's Beginnings
By Cindy Probst

Lifebooks, Creating a Treasure for the Adopted Child
By Beth O'Malley

Daniel A. Hughes, Ph.D.
www.danielahughes.homestead.com

Daniel J. Siegel, M.D.
www.drdansiegel.com

Bruce Perry, M.D., Ph.D. / Childwww.ChildTraumaAcademy.org

Dulwich Centre / Narrative Therapy
www.dulwichcentre.com.au

Trauma Academy

By Denise Lacher, M.A., Todd Nichols, M.A., MPAff, and Joanne May, Ph.D.

and post adoption photographs together can combine the most basic collaborative, co-constructive attuning elements of Dr. Hughes' and Dr. Siegel's theories and research.

was a brave, strong baby with an iron will to survive, who overcame the odds. and who is imbued with traits to conquer the world!

Attachment Center

s he has full membership along with her parents and siblings, and that the membership can never be revoked. A parent can emphasize family kinship by telling stories that celebrate connections.

actively hurtful. It is actually a remarkable opportunity to attune: an adoptive parent that meets this sort of sad, wistful statement with empathy, and words of understanding, will help the child desire to turn to mom or dad for comfort.

child will see the illustrations, and also be able to read your face. "The most powerful of our non-verbal communication instruments is the face. A child's face, and yours, is a barometer expressing interest, investment, curiosity, joy, fear, anger, confusion, or doubt." (Dr. Bruce Perry)

I like to discuss a story a little when it's over, and acknowledge what the main character has or hasn't done with what has happened. What would my daughter do? What would I do? What are the choices?

story that evokes emotion, shared conversation and empathy, is a little harder. The beauty of using narratives to adoption-parent is that it is already part of what most of us normally do with our children. It is just done consciously with an extra level of awareness, and with an end result in mind.

steps! What the mom offers, teaches and imparts to the child is reciprocated back to her in a solid relationship-- it is the dance, tightly and lovingly choreographed. As a child pays attention to the mom's requests, and the mom pays attention to the child's needs, trust grows and invisible boundaries are laid and respected....

that I advocate are NOT meant as therapeutic tools. Several forms of narratives are used by professionals to help children who have been traumatized or who are seeking help for specific social or developmental difficulties. An excellent source for further information can be found in the book and workbook from the Family Attachment and Counseling Center (see resources), or in the work of attachment therapist Daniel Hughes.

Josiah's Journey Home;

Tue, 24 Jul 2007 21:51:43 GMT

Josiah's Journey Home...four days of a mother's journal while bringing a little boy to his family..

Day One; January 20, 2003

Someone asked that I give more details of our trip to bring Josiah home this past week with thoughts that it would be helpful to those preparing to travel or waiting hopefully to travel. With that thought in mind I will try to give some highlights and perhaps provide some points of interest if someone has a specific question.

So.....we left Indianapolis on Saturday.......flew United to Dulles, Washington, to Vienna, Austria to Sofia, Bulgaria. We arrived Sunday at 1:15 in the afternoon.........having flown LOT Polish Air in March 02 and having that as my only point of reference, all I can say is: WOW! Austrian Air is the BMW over the Yugo I flew last year! They outdid themselves in everyway..........high marks for their entire group from comfort, timeliness, food, politeness, helpfulness and cost. We booked through Northwest Travel in Portland, OR and they too did an amazing job..........the same flight schedule with a local travel agent was much more: Northwest has a "frequent users" discount as they book lots of European travel.

We were met right on time by our coordinating team in Sofia (only one of the many things I really appreciate about this team: they are very prompt and if they say they will be someplace at a certain time, they are!), and delivered safely to our hotel. As we were not picking Josiah up until Monday, we had a little down time to try to catch up our jet lag.........what a great thought.........unfortunately, we were so excited that we couldn't sleep so watched TV in two hour shifts all night long! We met our driver/escort as planned at 8:15 am in the lobby and renewed a nice friendship while we traveled to Targovishte.........about a four hour drive on a "normal" day...........this day we encountered snow and a closed road so it was much closer to 5+.

Leaving the orphanage..........

They range of emotions at this point is hard to describe..........excitement, anticipation (how much had he grown and changed in ten months?), even sadness knowing that the chance of our returning to this place/people again is probably small. The Director met us outside as she was going to go home for the afternoon (she had working the early am shift on this day) and was waiting for us to arrive before she left. She was VERY effervescent and hugged me very hard and kissed me on both cheeks.........I sensed her mix of emotions also.........she had cared, TRULY cared for our son from six days of age........and tomorrow the orphanage would be much quieter with him gone! (I have told you before he is "mischievous".......another word for strong willed.........which pleases us no end as he has a strong "survivors heart")

We went to her office and while there was much shuffling of paper and conversation, they asked me for his new clothes. I asked if they wanted me to dress him and the head nurse(through translation, said "no, this is special for me to do for him")............It would have been special for me too but understood her needing to have this time of transition and saying good-bye...........while I would have this joy for many years to come. She returned in a few minutes and said he was sleeping........I asked her to not wake him as I knew we had something's to complete and some pictures to take for some other families(figured that a well rested toddler might travel better than a tired one....).

SO we relaxed somewhat..............and about ten minutes later I happened to glance toward the door and there he stood. How can I even begin to write the flux of emotions? He held up his arms and came right to me........ I was fairly sure that he did not remember me at all but it sure melted my heart (as if it wasn't mush already!!). Thumb stuck in his mouth, he snuggled in for almost five minutes before wiggling down. His big brother traveled with me (aka: "THE STROLLER") and Josiah took an immediate like to the big guy on the couch...........they snuggled together while we finished the "formalities" and then it was time to go.......into the snowsuit and out the door...........all very quickly done in about an hour and a half. I was not allowed to see any other children this visit..........sure glad I took advantage of the Director's offer to show me the whole place in March. She explained it is hard on the children not leaving when someone is going home.........that is why the actual "transfer" takes place in her office. Once outside, she again gave me a hug and kiss and said "chou, chou" to Josiah and into the car we went..........what a mix of feelings...........he was such a trouper..........we had much discussion and many jokes about the number of times the car had been throw up in! Josiah went to sleep to handle his stress.........he traveled beautifully........we took turns passing him back and forth and kissing on his little head!! We had a little "unplanned stop" arranged by a Sofia policeman...........we made him a "gift" and were quite silly by the time we returned to the hotel...........more plugs for the Hotel Rotasar.............they are amazing..............they brought room service due to our extreme exhaustion and unwillingness to put Josiah through much more on his first day out...........we did do a bath which was mostly traumatic.............my heart melted once again confirming my choice to bring "the big brother" when the hulking 16 year old offered to put on his shorts and show him how to take a bath.............clean boy, clean jammies, joyful hearts, full bellies, dreams fulfilled, thumb in mouth and off to sleep he went.............not a peep until six the next morning..........

DAY TWO: January 21st, 2003

I must not have bored all of you to tears last night........granted.........some had tears.............

So small son snuggled down in the middle of that big bed and slept soundly: while mommy did not. It was a strange type of night that I wanted to cherish for as long as possible and sleep seemed like such a waste. So many nights we (my husband Brad and I) had talked of this little one and dreamed of "the firsts" that we would be blessed to experience in the days ahead. This first night with him was one of those "firsts": his first bath behind him, smelling of Johnson's baby lotion from a soothing back rub, curls still damp, thumb firmly in place(such a comforting friend, I am sure), I lay next to him and listened to him sleep. I was exhausted and yet sleep would not come: so many times I reached over to touch his cheek just to make sure he really was there. Sofia is noisy at night: dogs barked, car alarms sounded, people passed beneath our windows and the sun came up.

Josiah woke with a look of confusion which quickly changed to a grin and two little arms reached up to be held. What more could a mommy hope for but to be needed and asked for so quickly? We awakened his big brother with a pounce and a tickle........much to the delight of both boys. They chased each other through the apartment while I showered and thought seriously of a quart of espresso to go................perhaps two quarts............perhaps an IV of espresso.............

We wandered downstairs to the dining room for breakfast of eggs and veggies, orange juice and yogurt and honey for Josiah. The ladies waited on us like we were royalty and the little prince had only to smile to have them running here and there just for him! He absolutely refused to sit in the evil torturous highchair and chose mommies lap instead (I really like this boy's style!).

We met our translator in the lobby at ten and were off to his medical exam. First into a small office where a woman looked in his ears and down his throat...............neither of which impressed Josiah in the least. The woman was pleasant, I thanked her and upstairs we went to another small waiting room. The Dr. came out and apologized, called Josiah by his Bulgarian name (he obviously was anticipating us) and explained that he must see two ill children first. We assured him this was fine and waited perhaps 15 minutes. The Dr. was wonderful with him: pulled Josiah up on his lap while he worked on his paperwork and gave him things off of his desk to keep small son's hands busy. The exam was very non invasive and more "procedure" than actual "physical". The Dr. wished us much happiness, helped us on with our coats and we were done. Downstairs to pay the bill..........we were told to pay in US dollars but they wanted to give change in lev. Our translator was not impressed and let them know rather clearly what she thought of their efficiency!! She departed with our US dollars, told us to wait, went and exchanged the money for lev and paid them in lev. She told them she would be back in a few hours with another US family and they should get themselves together before then!! Sure glad she is on our team!

Off to have his VISA picture taken: very specific shot that required one ear to show. He looks like a convict, a very tired convict. Back to the hotel for a snack and a nap for all.........with him curled in my arms, we grabbed a two hour snuggle/rest. We had planned a walk/shop trip when we awakened but found that Josiah was having such a great time playing that we were content just to watch him explore and stayed put. I brought lots of fun toys..........and wastebaskets and paper were the chosen things to move around. Such simple joys.

Bath number two went off with less stress and fewer tears..........another day passed and our little one was processing his changes fairly well..........we were just in awe...........how many of us could/would exchange homes, people, food, routine, clothes, noises, and still smile, play, initiate hugs, and sleep in the midst of such change? I had been told repeatedly that he is "strong, mischievous, and sometimes difficult".................and how those things were holding him steady now. We are blessed.

OFF to the Consulate tomorrow and then..............home!!! Kay

Day Three; January 22, 2003

The end of day two arrived, Micah(big brother, 16) and I agreed, we NEEDED to sleep and so with that in mind, we shut off the TV and found our respective blankets(those wonderful heavy duvet covered blankets.....such a smart idea). Using Josiah as an alarm clock at the beginning of day two proved to be hazardous to breakfast and allowed time only for quick showers and out the door.............this time we called the reception desk and asked for a six am wake up call. With good intentions, we turned out the lights and hoped to rest. Well.................that same elevated level of watchfulness and excitement from night one crept in again........I watched Josiah sleep and counted our blessings. All the determination and "I can do it myself" slipped from his face as he slept. All that remained in sleep was a sweet little boy that miraculously was my new son.......loved for almost a year and now within touching and kissing distance...something that I took advantage of and finally rested while he did the same.

Breakfast was wonderful, the espresso more that wonderful, closer to heaven like (sure that God knows Bulgaria is the master of Shopska salad and excellent coffee!). Josiah ate well: banana and yogurt with honey and all of my cheese from my plate. Still hesitant to drink much of anything offered: milk, juice and water. I rethought the answers from the parting conversation with the orphanage Director............she said he was used to having slightly sweetened tea each day.......ahhhh...........much better response when offered tea. I needed a "brain jogger" but then remembered him drinking tea from a bottle back in March. Once again, he absolutely refused to sit in the highchair and preformed that marvelous toddler maneuver: back arched, legs stick straight, arms flung wide and voice yelling..............we decided that whatever the reason for such strong feelings......we would skip further highchair discussion until we got home.

We met our translator in the lobby at 8:15 and off to the US Consulate. The one stop that I was concerned about and had "power dressed" for...........I think I confused this interview with a previous instruction to "wear a dress"(must have been for going to court if I planned on attending the hearing), none the less, I dressed very nicely and felt confident.......I was however, not prepared for the uncomfortable feeling that came when our translator, with us in tow, cut in line outside the Consulate office. (Side note: I am the person that when grocery shopping allows EVERYBODY to go in front of me because of the quantities of groceries we have to check out). So I was probably oversensitive to the looks we received as we went to the front of the line. Our translator said "all children are prioritized and go first" but it was strange to move in front of people who had been waiting longer than we had. The procedure was easy: slide your passport (and your child's) through a slot outside the building, wait for them to look it over and slide it back to you. A metal door opens and you literally "slide" through into the building. All baggage is scanned (dumb me, the man asked me if I had anything mechanical in my purse: I gave him the camera and forgot to give him the little CD player....and then the batteries......duh...........). We moved out of that area, out a door into almost a courtyard and then back into a room with another waiting line..........once again we were moved ahead of people............a woman appeared and called our name.........we quickly paid our fees........waiting while he really perused the US dollars.......he gave me a receipt and the woman herded us upstairs to a large office where she took her place behind a desk. This is where the big brother, "Micah the Stroller" really came in handy...........he played with Josiah while I worked with the lady behind the desk. She frequently glanced over at the two boys and smiled.........very low key and pleasant as we went through the papers she needed. Our packet was a combination of things I had brought with us and things that the Bulgarian team had made sure were prepared. This part was painless and woman was quite nice: she took us to another room to wait again. Two other American families were also waiting. One by one we were called up to a window......passports checked again............a few questions asked by another very pleasant woman: "Are you aware of his ethnic background, do you know of any siblings, are you aware of his medical need(Josiah is missing his left eye), and we were done with her. Our translator said "very well, we are done here" and we were...........hey, this was supposed to be scary! It was not!!

Side note: DO NOT TAKE PICTURES OF OR AT THE CONSULATE! Very bad idea: our translator stopped Micah before he clicked...........said "not allowed at all".....just a word of warning.

We returned to the hotel and let Josiah relax a little...........he was very comfortable in the apartment but was defiantly showing stress "out and about". He let me rock him to sleep and a little nap was enjoyed by all.

When he awakened we decided that this being our last day, if we wanted to do any shopping, we had better go. Josiah figured out the routine and ran to get his hat as soon as we picked up our coats. Into his sling (being a wiggly wiry guy I wasn't sure this would work..........he loved the closeness and settled right in) and out we went. A big thanks to Fred for his warning that Bulgarian elevator doors swing out.......not slide back like they do in the US! I would have spent allot of time in full panic if I had not known this going into the cute little stainless steal 3 X 3 very small movable box they claim is a "full size" elevator. Sure looked like a dangerous demo toy size to me!

Sofia is cold, snowy, icy and somewhat dirty right now.............kind of that "morning after look". Glad that we chose a sling over a stroller as I don't think he would have tolerated being that far away from us plus the "sidewalks"(almost non existent) are virtually impassible due to ice and snow. We wandered for about an hour, bought some coffee and chocolate (what more could you ask for: coffee, chocolate and a new baby!). Josiah was not impressed with the noise and crowds of people and almost shrunk into my shoulder..........big brother was the one who said "enough, he doesn't like this"........so we headed back to the hotel.

We decided to be daring an order something "Bulgarian" off the menu for dinner..........no English translation on these things. Well ...let's just leave it being said "it was an experience". Our translator stopped by to visit that night and laughed so hard at us..........we had managed to order the greasiest non vegetable items on the menu! Live and learn!

Very very mixed feelings as we bathed Josiah and tucked him in for one last night in his country of birth. We began to pack and some tears were shed...........mixed sadness/joy/anticipation again. Grieving the departure and parting with people we have grown to know, enjoy and respect. Reality of the term "sweet sorrow"...........it is not likely we will ever see these wonderful people or this amazing country again............an ending and a beginning. It was time to go......the next step in the journey to bring Josiah home. Our hearts and arms full................we listened to morning come and watched the sun wake up the city as we wakened a little boy and dressed him to travel from this wonderful place. Time to go home to his new family.

Now..........do you REALLY want to hear about the twenty -two hours that Josiah did not sleep on the way home?

Day Four; January 23, 2003

........I hope that this journal is bringing you some smiles and hope............both for those families waiting to travel and those are just getting started. It is adventures of a lifetime.........what a blessing to be allowed to have one of these little one's join our family.

Day four started in the dark early morning of January 23. We had both taken time to roam the apartment during the night...........big brother and myself. Josiah seemed oblivious to the major changes that had taken place in his short little life...........so many more changes awaited him and he had no idea of how big the day ahead would prove to be. We were grateful that he slept. Bags were all packed...........all that remained was to awaken Josiah and dress him for the big day of travel.

As he rubbed the sleep from his eyes his look of confusion broke my heart.........he had put forth so much of a brave front all week in the midst of all the new sounds, new people, new environment, car rides and picture taking..........now he looked at me as if I somehow could help him make sense of it all. My spoken Bulgarian is weak at best so my heart had to fill in the void..........I wrapped him in his blanket I had brought him and we rocked in the darkened room as I told him of the day ahead. We turned on the light and I began gently to dress him............as soon as he hit the floor, he looked at the bags and his big brother waiting with his coat, flashed a grin and pulled his hat on. One last glance around and we headed for the elevator. We were all somewhat quiet.

Our driver met us in the lobby...........right on time as usual. As we checked out of the hotel, I thanked the young woman behind the desk for taking such wonderful care of us all week..........she shyly accepted the praise and said something in Bulgarian to Josiah............Micah had already taught him how to give a "high five" and he held up his little hand to her and then burrowed back into my neck. We piled bags into the car and were on our way.

Leaving our driver was hard......this was my second opportunity to spend time with him..........a shy quiet young man with a quick sense of humor..........he was amazed that I had brought him a gift this visit...........I assured him he was a vital part of the "team" and we were grateful for his help. I slipped him my remaining lev and told him to go to breakfast.........he ducked his head and gave me a quick hug and he was gone.

Into the airport..........it seemed different than when I had passed through in March..........perhaps my memory was bad or perhaps it had been improved. We checked our bags and wandered towards the gate.............Josiah stayed very quiet during our waiting period. As the plane left the ground, tears slipped down even though I tried to hold them back. Such a gift the people of this country had allowed us...........here he sat in my arms after such a long wait. Exhaustion, joy, and anticipation filled us again...........how many more days of such extreme emotion could we survive?

We landed in Vienna after a very short flight............Josiah traveled fine, enjoyed the snacks and was content to just sit with us on the first "hop" towards home. I was silly enough to show him that we could actually get out of our seats and walk! What ever possessed me to show him this activity? What was I thinking? Well..................we boarded the flight from Vienna and our long day REALLY began..........we walked, we talked (I am fairly certain that we met EVERYONE on that flight!), the flight attendants were charmed so they were at his complete beck and call. The headset connected to the Mozart Lullaby's was a total bust.............evidently the ear sets were almost as evil as the highchair or certainly closely related!! Food is a great thing..........of course.........one hopes that all those new foods are going to stay put because I sure didn't want to see them again! The "throw-up" bags turned out to be our best friends..........not in the more traditional use of them but as trash bags...............he walked up and down and asked everyone for their trash!! He filled three of them and I thought surely now that the entire plane was clean he would sleep a little......Mommy and big brother desperately needed to nap! Didn't happen.....................we landed at Dulles, Washington after 9 hours and 50 minutes with a pint sized janitor still raring to go.............

We only had two hours to disembark, claim our luggage, clear customs, clear INS, recheck our luggage, find our terminal and check in................I was loosing my easy demeanor at this point and was sure there was no way we could accomplish all these things in such a limited amount of time. I handed over the manila envelope that I had been told to guard with my life to the customs man.............he was very nice and pointed me to the INS office..........again...........we were met with smiles and went right to the front of the line...........personally, I think that everyone should travel with a beautiful child........seems to make people remember their priorities. They took his passport and we sat down (well, Micah and mommy did!) the small person had kicked into overdrive and boy was he driving...................within five minutes, we were done and ready to go (perhaps they took pity on the two exhausted adult type people with the small one with the Eveready battery!). As we left the room..........they clapped for our new son who was now an American Citizen. It was nice to be home...........at times in the past week we had experienced a wide range of response from people we met............not all positive........was it the blonde American with the obviously Roma child? Was it the young "husband" that I was traveling with? Was it the "adoption" itself that guarded people's smiles? We will never know.........but as we left that government office...........there was nothing but acceptance on the face of the workers.........thanks.

We actually made our connecting flight............right up until it was supposed to board and they cancelled the flight. Now the tears were truly frustration and exhaustion.........Josiah was doing wonderfully............he had no idea that things were not going as planned. United offered to put us up for the night and fly us out in the morning.............I told them this was not acceptable..........I had told my three year son that "Mommy will be home with your new brother on Thursday and you can come to the airport to pick us up". No way was I not going to show up for him. Feeling like we had walked all the way home..........I didn't know what more to do. I looked up at what I am sure is one of God's "direct front line workers": this wonderful United employee began to speak Bulgarian to my son...........and he grinned from ear to ear! She told me that she just told him that she would work this out..........to hold on for a few minutes longer. She called Chicago to check the weather as she wasn't going to allow us to fly into nasty snow. She made another phone call and handed me boarding passes and $30.00 for dinner and said "head to gate C"............you will have to fly to Chicago and then to Indianapolis but you will be home tonight! She told us she was from Varna...........and profusely thanked us for "loving a small one from my country".

We landed in Indianapolis at 11:10 pm and were greeted by one very sleepy three year old in pajamas that matched his new brother's jammies (prearranged!) and five other siblings...........our oldest was unable to meet us due to a college commitment. Josiah unwrapped from around my neck and went right to his daddy...........a first meeting for them. A year of prayers answered.

Thanks for sharing...................Kay

My Unique Family

Tue, 24 Jul 2007 22:10:52 GMT

If someone had told me a few years ago that I would build my family through the overseas adoption of older children, I would have probably just laughed. I had been a single woman, plowing through the choppy seas of the dating world for many years, but I was still looking to get married and start a family the normal way.

Now, I am still single, but I am an adoptive parent. My life is great, but my family is very different than most. My 15 year old daughter was adopted from Russia almost 3 years ago, and my 10 year old son is newly adopted from Kazakhstan. .

Adopting my daughter was an amazing adventure. I have never even considered international adoption

In 2003 I was asked to be part of a choir to go to Khabarovsk, Russia, to sing Handel's Messiah with the symphony there. We sang at an orphanage and I met 11 year old Alesia. I knew she was my daughter the moment I saw her. I had dreamed about her the night before - even though I had no idea we would be going to her orphanage the next day.

It took more than 18 months to make the adoption a reality. I had to contend with bureaucratic snags, an orphanage director who didn't like Americans, a lack of money, an unsupportive agency, some very negative friends and family members, and a boyfriend who couldn't handle the idea of fatherhood. I was a bit anxious about adopting an older child, but my heart told me it was the right thing to do. Through it all, I prayed a lot, and focused on bringing my daughter home.

Alesia has been home now for two and a half years and is now 15. We have had some challenges, but we are a strong family, held together by love, faith in God, and a lot of laughter.

Older children who are adopted by singles or couples face many issues that babies or toddlers don't. Older children have usually had to learn to be tough to survive in orphanages. Many develop a range of PI [post institutionalized] behaviors - everything from hoarding food, to an inability to show affection, to chronic lying. They often have little capacity to love and trust. I have seen these behaviors in my daughter, although not to a great extent, and she is over them now. Alesia spent her first 6 years with an alcoholic, single teenaged birthmother. Despite that, Alesia is now a sweet, good-hearted girl - she just had a rough start in life.

In 2005, I decided to sell my condo and buy a house with my mother, who was looking for a retirement home. I would be there to assist her as she grew older, and she would help me with childcare. We were fortunate to find a lovely older home in a quiet residential area of Atlanta.

A few weeks after we moved in, my mother fell and broke both shoulders - a disaster. My daughter had been home less than a year and still wasn't speaking English too well. My house held many boxes to unpack. I was working full time. For several days, I was in shock, spending hours at the hospital while a friend cared for my daughter.

When he was able, my only sibling, my brother Bruce, came over from his home of Columbia, SC [three hours away] to help me with everything. If he had not come, I would have had to take a leave from work, unpaid, and I couldn't afford that. I was so heavily dependent on him throughout the crisis that it really made me think. I began to feel strongly that my daughter needed a sibling. I am in my 40's and obviously won't be around forever.

Once my mother was out of danger and on her way to recovery, I started researching, trolling the internet looking at photolistings of children available for adoption. I decided to adopt another Russian speaking child, to help my daughter with bonding, and because I also speak a little bit of Russian. It's heartbreaking, looking at all the photos and wondering, which child should I choose? Which child would fit in our family?

Finally, I prayed about it. I asked God to give me some help, some sign to know which child to choose. The moment I opened my eyes, I saw a listing of a little boy named Igor. He was missing his right hand due to a frostbite accident while in the care of his alcoholic birthmother. He looked very similar to how my brother looked at age 9 - same burr haircut, freckles, unsmiling little face. He was born in July 1996 - the exact same month my father died. This was my son. I felt it.

It took some time and prayer to get my mother and my daughter onboard with the idea of adopting little Igor. He was not too adorable in the photo. My daughter, who had never seen anyone with a limb difference, was appalled. In Russia, people who are in any way not "normal" are hidden away, out of sight, usually in remote institutions. My mother just worried that raising a "handicapped" child would be too difficult.

looked at other listings, but little Igor stayed in my mind. I prayed and prayed about it, for months. Finally, one night Alesia was in my room, sitting next to me at the computer as I looked at photolistings. I deliberately went back to Igor's listing. She shrank back. "No Mom, not that boy!"

I said gently, "Alesia, a lot of people will simply not adopt a child who is 9 years old. He has no chance if he stays there. People thought I shouldn't adopt you because you were older - but you needed a mom. You needed a family to love you. Don't you think this little boy would love to have a mom? Think about that."

Alesia changed her mind. My mother gradually accepted the idea. I knew they were both scared for me to go overseas for several weeks. I wasn't thrilled with the idea. However, I just knew this was the child for us. The agency coordinator cut the fees so I could afford it. I cashed in a 401-K rollover and started the paperwork.

Last summer, while waiting for my INS clearance, I wrote and published a children's book, aimed at helping my son adjust to America. I based it on personal experience, and did a lot of research. I called it Jack's New Family, An Older Child Adoption Story. It's written from the standpoint of Ilya, an 8 year old Russian boy who has lived his whole life in an orphanage in Russia. Now that he's been adopted he must adjust to life in America with his new mom and older sister, learn English, and try to become an American boy named Jack. As he tells the story in his own words, he marvels at the many differences between an American home and a family, and his experiences as an orphan.

I knew what a tough transition it would be for my son. When I had adopted Alesia, she had never been to a restaurant, rarely used a napkin, and never lived in a place with decent plumbing. She had only ridden in a car a few times in her life. I was totally unprepared for how unsophisticated she would be. I have learned so much since she came home. That knowledge went into making Jack's New Family a unique book.

In February 2007, when I finally got word I could travel, I was thrilled to finally be able to get my son home. I had just gotten the published copies of the book and had a copy for my son ready.

After a grueling total of 15 hours flying and a one day layover in Astana, I arrived in Petropavlovsk, Kazakhstan. I spent a month in Petropavlovsk - the coldest March of my entire life! I had never seen so much snow. It never melted. Petropavlovsk is just below Siberia. I have lived in the south my whole life.

Every day, as I spent time with "Igor" at the orphanage, we became close. Kazakhstan has a mandatory 14 day bonding time required before court can take place, which is a very good thing. Every day, I told my son stories about my family, and gave him photos. He was fascinated.

On the 4^thvisiting day, I showed him a list of American names, explaining through the translator [ironically also named Igor] that life in America would be easier with a more American name. He chose "Michael" with no hesitation.

When the judge pronounced Michael mine a few weeks later, I jumped up and down and hugged everyone with me - the translator, the agency coordinator, the social worker from the orphanage. Finally, with tears in my eyes, I ran outside and grabbed up Michael and said in Russian "I am your MAMA!" He grinned and gave me a big hug. Just remembering it makes me want to simultaneously smile and cry.

Michael has been home since May 9^thand is adjusting beautifully to everything - even the Atlanta heat. Despite the fact that Michael spent his first 8 years with an alcoholic mother who severely neglected him, he has a sweet nature. He is the most loving and affectionate little boy. He is mischievous, too - he regularly pops his big sister on the fanny, vetoes wardrobe choices, and mimics his mother and grandmother's southern accents - but not in a mean way. He also doesn't let his missing hand stop him from doing anything.

Michael read Jack's New Family in Russian a couple of times before he came home. I think it helped him to understand that America would not be full of cowboys and movie stars, and he wouldn't get everything he wanted, every minute of the day. He has chores here. He has a bedtime. He has to eat vegetables. He also has a Mom, sister, and Granny who adore him.

Jack's New Family was published by United Writer's Press. It's a valuable resource for children who speak only Russian, because it's in Russian and English. It's great for parents, because it gives them an idea of how big a transition it is for an older child to go from living in an orphanage, to being in a family.

Jack's New Family is also a great way to teach American kids about a different culture, and it tells a timeless story of an orphan finding a forever family. [You can order it at www.unitedwriterspress.com/bookstore/childrenyoungadult.html ]

I have recounted my son's adoption adventure in my blogsite, Jack's New Family, An Older Child Adoption Story.

I hope my story will inspire others [whether or married or single] to adopt older children, whether here or abroad. There are so many wonderful children who need and deserve a loving family. My children have enriched my life so much, and I have made it one of my life's missions to help older children find homes.

� Dee Thompson, 2007

Lifebooks Create Memories Where There Were None Before

Tue, 24 Jul 2007 22:25:00 GMT

What is your earliest childhood memory?� Think really hard, and don't continue reading until you have something in mind.

For me, I thought it was when I was three years old.� I went on a camping trip with my parents in Kentucky and fell in the campfire.� Fortunately, my quick-thinking daddy caught my arm before I had suffered any burns.

Back to your earliest memory.Do you actually remember being there?� If you're like many of the people I've asked, you don't actually remember your "earliest childhood memory".� Rather, the image etched in your mind is courtesy of a story or photo presented to you and therefore you feel like you were there. Incidentally, my first actual childhood memory (where it is truly my memory and not that of a story or photo that described the event) is of a birthday party my parents threw for me when I was five years old.� Now, do you have a different answer to my original question?

With biological children, baby books are often used to preserve your memories of everything surrounding the child's birth and subsequent milestones.�� Rolls upon rolls of film are developed and shared with excited family members.� However, with internationally adopted children, there is almost never a baby book, only occasionally any photos, and rarely an opportunity to hear personal anecdotes.� As your child grows, his "earliest childhood memory" is likely of you!

For the adopted child, it is important to have access to a lifebook containing the images (when available) and story of the life a child has before joining the adoptive family.� The lifebook is child-centered and therefore generally starts at the child's birth and continues with pages about:

�� the birth mother and father

�� the place from which they came (town or country)

�� the reasons leading up to being placed for adoption

�� the time they spent in foster care or in an orphanage

�� people that provided care during the transitional time

The lifebook usually ends with placement in the new home.� It can also include pages about legal documents or court appearances, referral pictures and medical information, and other events or milestones occurring prior to joining the adopting family.� The list is endless!

Creating a lifebook may seem like a daunting task, especially when there is not an abundance of information about your child's life before becoming a part of your family, but it is actually easy and fun.� There are numerous books and web sites available with information to get you started, tips for handling the unknown or any sensitive parts of a child's pre-adoption history, and (if the child is old enough) suggestions for ways to include your child in the creation of the lifebook.

If you take the time to do this, your child will thank you many, many times.� A lifebook helps fill in the missing pieces, creating "childhood memories" where there were none before.

Considering the 'Why I Was Placed' Page in the Lifebook

Tue, 24 Jul 2007 22:43:35 GMT

Someone recently posted a question to one of the lifebook discussion groups I moderate on how to phrase the "why I was placed" page in the lifebook. It seems that what the birthmother had said was that she refused to raise her. Shortly afterwards, other group members shared their beliefs that the reasons stated in the paperwork were not always true and because of that another member suggested that she was goingto wait until she could get information from the actual birthmother, with whom she had recently made contact, before any lifebook pages dealing with "why" were solidified. Following the "wait and see" comment, a birthmother in the group shared her belief that it was likely a birthmother's circumstances *at the time* that helped her make the decision to place her child for adoption.

My thoughts actually came closest to those shared by the birthmother in our group...

�First, I think we have to be proactive when it comes to discussing adoption and lifebook content. I don't think we should wait for our children to come to us. Children have active little minds. Curiosity is at an all-time high. They need to explore. I think it is one of our roles as parents to encourage that exploration and cater to their curious nature. Knowledge is power! If you tell your child her life story and talk with her about adoption topics, the more comfortable she will be when confronted outside of your presence. Often, we as parents address inquiries in public or also from within our family and circle of friends about something related to our child's "adoptedness" or process of adoption. Although your child may hear your responses to such questions, the types of questions that other children will ask of her are quite different in nature. I think it is better to prepare our children for the inquisitive comments from their peers than wait for them to relay those questions to us as after the fact.

NOTE: This opinion of mine is even stronger when in reference to a child adopted internationally or by a parent (or parents) of a different race or culture, because I'm assuming that inquisitive peers will initiate adoption/race/family questions earlier when there are apparent differences, such as skin color.

Although it is not the best correlation, perhaps you could think of the familiar slogan (is it by a cigarette company?) that says "truth...the anti-drug". When parents wait for signs that their child is sexually active or drinks, smokes, uses drugs, is failing school, etc. to talk on those topics, it is most often too late. I am awestruck, myself, at how early children are exposed to negative influences and how early these topics need to be discussed these days! Yikes!

Believe me, I'm not suggesting that adoption conversation is negative in any way...the point I am trying to make is that when parents are proactive, children are "armed" with the knowledge that will allow them to react appropriately and with confidence. Naivet� is not always a good thing and being caught off-guard is awkward for anyone!

Second, there is something to be said about the (in)accuracy of the information put in the adoption paperwork. I'm pretty sure that I am victim of that myself! The way this is handled in the lifebook, in my opinion, is only *partially* based on whether or not you intend or expect birth family contact. Obviously, hearing the words directly from a birthmother, face to face, in the same language that you speak, is pretty convincing. However, even if you develop contact with an international birth parent through an intermediary searcher, something could still get lost in the translation, either by the information relayed by the intermediary or through the
language barrier. Or, if enough time has passed, there is also the possibility that *Time* has caused the originally stated reason to be thought of in a different light. For example, when a birthmother makes an adoption plan, perhaps she is feeling some of the following: fear, worry, anger, bitterness, confusion, doubt -- and makes the decision out of desperation. There are likely umpteen factors that go into such a decision. There could also be outside factors, such as alcohol or drug dependency that play into it. Especially if the pregnancy resulted from something that the birthmother is less than proud of, she may spend the months and years following the birth and relinquishment/abandonment to justify her actions so that she can begin to make peace with herself and allow herself to move on.

How many times have we done something we regretted and then later made excuses for why it happened? Perhaps a birthmother that originally says "I refuse to parent my child" later realizes the lost opportunity she had.� Maybe five or ten or twenty years ago her life circumstances were different, youth may have made her immature, or she faced difficult times. Now as a more established and mature woman with time for reflection, the birthmother may be expressing feelings of love or grief for what she lost and insists that the feelings she experienced years ago were similar to the ones she feels now. Maybe?

Who knows? Perhaps "I refuse to raise her" really means "I refuse to let her grow in an environment where she is not nurtured and does not receive appropriate or adequate care." The ultimate sacrifice!

Third, if birth mother contact is not possible, likely or desired, I think we *have* to use documented details of our child's adoption paperwork.� Denying the information we have just because it may not be true may come back to bite us. If you have a *strong* reason to believe that the information is false and you don't think you will ever be able to hear verifiable words that would contradict it, I would offer as a suggestion:� "The paperwork says .... and while we cannot verify whether or not this is true, this is the information that was included in the paperwork at the time your adoption was processed."

That way, when your child is old enough to browse her own adoption papers, she will not find anything that contradicts what you have (or have not) told her.

How many times have we spoken about something -- sometimes even with a strong conviction! -- and then later discovered that we were wrong.� Admitting when we are wrong is a very powerful character trait. There is nothing to be ashamed of when our original statements were based on a sincere wish to share our child's history with what we presumed to be factual information. You never know... perhaps I will need to retract my stance on these issues! I, myself, could be wrong.

Good luck with your lifebook pursuits!

Lifebooks: From the Child's Perspective!

Tue, 24 Jul 2007 22:53:02 GMT

I have been helping people with their lifebooks for several years now.� I'm always careful not to insist that a lifebook can only be done one way, as each child and each adoption is different.� The parent is the best judge of what approach will work best with a particular child.� However, when people misunderstand that a lifebook is the child's story and not the parents', I kindly voice the opinion that the lifebook, a therapeutic tool, discusses the following:

�� The child's birth

�� The birth parents

�� The reason an adoption plan was made

�� Interim care between life with birth family and adoptive family (if applicable)

�� Meeting the adoptive family

�� Finalization of the adoption, with emphasis on adoption being permanent

Thankfully, there are some, albeit limited, opportunities to intersperse personal thoughts and feelings, for example on the page that deals with your first meeting.� Overall, I think many adoptive parents have a comfort level with knowing their own story and therefore feel more adequately capable of telling it than the topics more commonly found in lifebooks.� If you want to record your thoughts or describe your path to adoption, perhaps consider a separate album, journal or diary for your child to be given when the child is older.� But, if you honestly want to create a lifebook, then remember the focus...the child.

Think of it in this light...� a few years down the road, when your child begins questioning her origins and wondering why her birthmother didn't "want" her (the child's words and not mine) I'd be willing to bet that text describing her parents' courtship and infertility, for example, aren't going to mean much.� If you can anticipate the questions, the text will come more naturally.

Just something to think about...

Why are you writing the lifebook?� What questions will it help answer?

THE BABY LIFEBOOK: no writing required!

Wed, 25 Jul 2007 09:57:13 GMT

Helping our adopted children deal with their lifestories, and with the emotional
memories all of our children hold, can make parents feel overwhelmed and under-trained! It's good to know that we don't have to come up with the perfect story presentation all at once; adoption understanding is a process for our kids, and we can begin to talk about adoption, and a child's own lifestory, in baby steps...

Our children can realize the implications of abandonment andadoption within a safe, supportive structure that we parents put in place for them. It is important to address the emotional component of each child's story, and it is helpful for our children to know that they are not alone in their experiences, or in their feelings. A child grows into understanding terms like abandonment, but doing emotional-narrative groundwork with them when they are very young, helps them to integrate grief or anger when they do connect the dots. My 8 year old hears her truth-based stories, but still chooses to put her own fantasy spin on her early life--and that's okay. My 11.5 year old has ALWAYS felt the reality of abandonment and adoption, but can also now take strength from her knowledge, and what she has 'survived'.

TALKING HONESTLY
There is no honest way to discuss your child's life story and past identity without talking openly about birthparent loss, the sad conditions that led to a happy adoption, and the feelings that these dichotomies engender for everyone involved.

Our internationally adopted children had fighting spirits or they wouldn't be with us. What happened to them via abandonment or institutionalization needn't be celebrated, but their own will to survive can be honored and acknowledged. If we don't talk about this with them, how will they ever connect to and integrate both the bright and the dark of their early lives? Talking honestly can be hard, but sometimes "the only way out is through"-- and taking baby steps with a Baby Lifebook can make the commitment to open communication easier for mom and dad.

REFRAME
Co-creating an early life history with an adoptee gives the parent an opportunity to share thoughts and feelings, and to help the child reframe early events. This intimate relationship / identity work can:

1) Help a child claim parts of herself, and her birthfamily, through her past

2) Reinforce the adoptive family's claiming love for the child and her history

3) Teach a child to view herself as brave and empowered

Lifebooks can reiterate the anger and sadness some of our children feel about the choices made for them, while also introducing additional perspective. Our children's feelings need to be able to co-exist with fact: "bad stuff happened to you that shouldn't happen to any child, and you don't have to be happy about it. You can be proud that your baby spirit never gave up. . . that it is possible for you to accomplish great things in spite of, and *because* of, what you went through and what you are feeling." Children that eventually own ALL parts of their past will find that their lifestories are empowering, not crippling.

THE FOUR FEELINGS
It's easy to overlook the power of a lifebook (or baby lifebook) on anadopted child. As parents, we can really think about the images we are handing our kids, and be prepared to talk about not just the photos, but the emotions that lurk behind each innocent picture. Even very young children can learn The Four Feelings: Happy, Mad, Sad and Scared, and can apply them to people's expressions in photographs as they browse their lifebook albums. For a child, this is an empowering step! Identifying feelings is the first leap toward understanding that adoption is both a happy life event, and a great personal loss. The lifebooks and baby lifebooks we create, or co-create, for our children, are both historical documents and tools of connection. We can make them fancy or simple, but if we are willing to discuss what lies beneath the print and behind the pictures, we can also reach a special place in our children's hearts. . .

THE 'BABY' LIFEBOOK for YOUNG CHILDREN
A 'Baby' Lifebook is easily created by putting chronological photosin a sturdy mini album. Begin in your child's birth country, with the earliest referral photos you have of your child. Include photos of the birth family, foster family or orphanage caretakers, if you are lucky enough to have them. Add photos of your child's city or province, the local people and rural countryside (use the internet to obtain pictures if you or your friends were unable to take them yourselves).

Periodically flip through the album with your young child, andmatter-of-factly discuss each photo. No writing required! This automatically, naturally, and regularly makes parents use tough words like adoption, birthmother, orphanage, abandonment, finding place, Baby House (Russia/EE), and foster parents.

ALSO, the photos give parents an important opportunity to talk about how the child must have felt at the time of each photo, judging by the facial expressions and body language in the pictures. Talking about the 'emotion' in the photos helps children to think a little more deeply about what they are looking at, and helps parents get comfortable with adoption conversation on a truly intimate and connective level.

Use copies of the original photos for a Baby Lifebook, so that a childcan keep the album on her own shelf. You can end the baby-album at a first birthday at home, or first adoption anniversary, but it doesn't really matter; the focus just needs to be on the child's life, pre-adoption, and on her transition to her new family and home.

HELP for PARENTS
I use some of the above resources in my own workshops (and on my ownkids!) and have found baby lifebooks / lifebooks / life narratives to be as emotionally important for PARENTS, as they are for children. I think that helping our sons and daughters with their stories allows us to process our OWN feelings about our children's early lives-- and gives us an empathic place in their pre-adoption experiences.

RESOURCES

LIFE NARRATIVE WRITING GUIDES
Lifebooks, Creating a Treasure for the Adopted Child by Beth O'Malley http://www.adoptionlifebooks.com/

Adoption Lifebook: A Bridge to Your Child's Beginnings by Cindy Probst http://www.lifebooksource.com/

Homemade Books to Help Kids Cope by Robert G. Ziegler. MD

China Lifebooks by Kay Graap's http://www.foreverfamilycreations.com/products.html

LIFE NARRATIVE BOOKS for internationally adopted children
At Home in This World, a China adoption story by Jean MacLeod

Before I Met You: A Therapeutic Pre-Adoption Narrative by DorisLandry, MS

Twice-Upon-a-Time: Born and Adopted by Eleanora Patterson

When You Were Born in China by Sara Dorow

When You Were Born in Korea by Brian Boyd

When You Were Born in Vietnam by Therese Bartlett

Over the Moon: An Adoption Tale by Karen Katz

Tell Me Again About the Night I Was Born by Jamie Lee Curtis

Through Moon and Stars and Night Skies by Ann Turner

When I Met You by Adrienne Ehlert Bashista

USING NARRATIVES WITH YOUR CHILDREN
Parenting with Narratives, the A,B,C's of adoption stories
By Jean MacLeod (search Voices of Adoption)

Connecting with Kids through Stories:
Using narratives to facilitate attachment in adopted children
By Denise Lacher, M.A., Todd Nichols, M.A., MPAff, and Joanne May, Ph.D.
http://www.familyattachment.com/pages/connectingwithkids.html

Parenting with Stories: Creating a foundation of attachment for parenting your child (WORKBOOK) By Melissa Nichols, M.A., Denise Lacher, M.A., and Joanne May, Ph.D. http://www.familyattachment.com/pages/parentingwithstories.html

Adoptees and Their Siblings

Wed, 25 Jul 2007 17:53:06 GMT

What's a Sibling?

When families break down, relationships become complex and complicated. Sibling relationships might include biological siblings who were relinquished or removed at birth, half-siblings, step-siblings or current/former foster siblings. Not all couples are married, so a sibling could also include: "Mom's ex-boyfriend's daughter."

Importance of Sibling Relationships

Regardless of how complex these relationships might sound, or how tangled the vines on the family tree, it is important to recognize the love and connection that might exist between siblings.

In abusive and/or neglectful families, it is common for siblings to nurture and protect one another. Teenagers who have assumed a protective role for younger siblings experience intense grief when they are not permitted to visit their younger siblings anymore.

Separating Siblings

Approximately 75 percent of children in foster care in the United States have a sibling who is also in care. Sadly, although social workers, foster and adoptive parents are aware of the importance of sibling connections, the multitude of their other responsibilities often makes this a low priority.

Across the nation, states vary in their policies regarding sibling placement of foster and adoptive children. In the child welfare system, siblings are often separated in order to increase their chances of adoption.

It can be difficult to find adoptive families who are willing to take in a sibling group. In many cases, only younger children�are adopted, while teenagers remain in foster care.

Other reasons why sibling groups might not be placed together include:

1.) Size of the sibling group: It's more difficult to find foster families for large sibling groups. Also, agencies have regulations regarding how many children can be placed in a foster home.

2.) Willingness of kinship care providers: Relatives might only be willing to take in children to whom they are related by blood, and not half- or step-siblings.��

3.) Special needs of some siblings: A foster/adoptive home might not provide the resources and support needed by one special needs member of a sibling group.

Some children might still remain in the custody of the biological parent. In that case, contact between siblings depends upon whether this was an open/closed adoption and�whether visitation is allowed and facilitated between the biological parent and the adopted child.

Grief at the Loss of Siblings

When I was in foster care, I saw my brother only once. It was Easter morning, and I had saved up and bought him a basket of candy. I still remember watching his brown eyes widen at the goodies I had for him.

I was fourteen years old; he was eight. We played kickball in the backyard. He ran around the bases with an expression of intense concentration - and I didn't have the heart to tag him out with the ball.

In earlier years, while my mother was dying of cancer, I had become my brother's 'mother.'� Undoubtedly, I wasn't the best surrogate mom in the world.�My cooking abilities were�sorely lacking... But I loved him, and I was always there for him. When he woke up crying in the night, fearful of nightmares and thunderstorms, I came into his room and read him stories.

Losing�Joshua wasn't just like losing my brother - it was more like losing my child.

What Can We Do to Reunite Siblings?

In foster care, when siblings cannot be placed together, it is essential to facilitate regular contact.

Will this be difficult?� Yes, certainly.

Is it worth it?� Yes, most definitely.

How can it be done?� Here are some methods:

1.) Social workers need to create a visitation plan, and involve the children and the adults at their current placements in its formation and evolution over time. This plan needs to include concrete, practical steps and an accountability component.

2.)�When/if siblings are placed in separate foster homes, make sure those homes are in close proximity to one another. Visitation will be more likely to occur if their foster parents or social work doesn't have to drive several hours to facilitate.

3.) Facilitate frequent contact between siblings with letters, email, cards, and phone calls. Make the extra effort to buy stamps and mail the letters, especially for younger children.

4.) Arrange for joint respite care, and invest in camps like A Camp to Belong (information below).

Allow for Sibling Grief

If children are sad after visiting their siblings, please allow them to share and experience those feelings. Listen to them -- but don't use this as an excuse to end the sibling visitation because it's too hard on you afterward.

To learn more about a camp that reunites siblings, please visit: www.camptobelong.org

Source:

Child Welfare Information Gateway

2006 Bulletin for Professionals

Sibling Issues in Foster Care and Adoption

�

The Power of Picture Books

Wed, 25 Jul 2007 20:46:41 GMT

As a former foster child, youth advocate and Children's Librarian, I am reminded almost daily of the power of children's literature.

Picture Books have the power to positively impact parenting, promote literacy, increase emotional vocabulary and teach caregivers the value of positive reinforcement.

Well-written Picture Books can equip individuals to cope with their daily lives. They can assist children in making sense of loss and/or displacement. They can teach coping mechanisms for dealing with bullies.

Here are some of the most powerful and life-changing Picture Books that I have come across lately. I encourage you to take advantage of their insights. These books are available for purchase at the UK version of amazon.com

Burningham, John. Edwardo: The Horriblest Boy in the Whole Wide World. Red Fox, 2007. ISBN: 0099480131

Edwardo starts out as a perfectly normal boy. Sometimes messy, sometimes noisy and once in a while he drops things. Most boys his age behave the same way. But the adults in this child's life begin to shower him with criticism. They tell Edwardo that he is noisiest, nastiest, dirtiest boy in the world.

Not surprisingly, the more negative reinforcement Edwardo received from his caregivers, the worse his behavior becomes. It is only when the adults in his life take time to consider Edwardo's strengths and look for opportunities to praise him that his life begins to head back in a more positive direction.

This book is an important reminder to parents, teachers and caregivers to consider the impact of hastily chosen words. It can be shared in parenting classes geared toward preventing child abuse and promoting positive reinforcement of children.

Coffelt, Nancy. Fred Stays With Me. Little, Brown, 2007. ISBN: 0316882690

A little girl whose parents are divorced insists that her dog, Fred, accompanies her from one parent's house to the other. Her dog's presence provides her with a sense of continuity and stability, as she bounces back and forth between two homes.

A friend of mine, who teaches parenting classes for divorcing parents, wishes that every judge in family law and every attorney who practices family law had a copy of this book in their waiting rooms.

Jossee, Barbara. Nikolai, the Only Bear. Philomel, 2005. ISBN: 0399238840

Nikolai the bear feels different from the other orphans. Staff members at the orphanage don't speak his language. His games are perceived as too wild and rough. The adults around him seem unable to communicate with him or understand his motivations.

But from the moment that his adoptive parents appear, they make every effort to connect with him. When he growls, they growl back. When Nikolai claws the air, his adoptive mother reflects that gesture back to him.

His adoptive parents come from another country and speak a different language. But they are willing to learn to communicate with him. They are not afraid to take his hand (or paw) in theirs, and to express pride and joy in his accomplishments. Because of their acceptance and approachability, Nikolai begins to trust them.

This book is an excellent resource for young children on international adoption. I hope that someday a book will be written for foster children to address their needs in such a readable format and in such an emotionally perceptive way.

Kasza, Keiko. A Mother for Choco. Putnam, 1996. ISBN: 0698113640

A motherless bird seeks a place to belong. After a series of other animals draw attention only to their physical differences, Mrs. Bear appears and demonstrates what mother-love looks like at its finest. She takes Choco into her loving home and introduces him to his new (foster/adopted) siblings.

Lovell, Patty. Stand Tall, Molly Lou Melon. Putnam, 2006. ISBN: 0399246819

This book does a wonderful job in connecting with the day-to-day, real-life experience of childhood. It starts out with: "Molly Lou stood just taller than her dog and was the shortest girl in first grade."

Children can relate to feeling small, changing schools and facing bullies. Whenever I read this story aloud to children in Kindergarten through second grade, they feel more empowered to face bullies - and they fall in love with Molly's grandmother for giving Molly such a secure base and great advice.

Molly's parents are absent in the book. We never see them or hear from them. Her best advice comes from her grandmother, which makes this book especially approachable for children in out-of-home placements. When Molly moves away from everyone and everything she has ever known, this experience resonates with children who have experienced foster care.

O'Neill, Alexis. Recess Queen. Spoken Arts, 2002. ISBN: 0804569177

Mean Jean the Recess Queen rules the playground. Nobody bounces until Mean Jean bounces. Nobody kicks until Mean Jean kicks.

Change comes only when newcomer Katie Sue offers Mean Jean something that she has never had before - a friend.

This book captures with humor and accuracy the motivations driving a school bully, and offers a great introduction to conflict resolution for children in primary school.

Prigger, Mary Skillings. Aunt Minnie McGranahan. Clarion, 2005. ISBN: 061860488X

A story of successful kinship care placement, based upon a true story in the author's family history. Aunt Minnie's solitary and somewhat regimented life is interrupted by the arrival of her nine nieces and nephews. These orphans need a place to live, and their problem-solving aunt is determined to provide it for them.

While the townspeople shake their heads and predict disaster, Aunt Minnie comes up with a brilliant new system: "The oldest looked after the youngest, the ones in the middle looked after each other, and Aunt Minnie looked after them all."

Weninger, Brigitte. A Child Is a Child. Minedition, 2004. ISBN: 0698400062

When two young frogs are abandoned by their parents, all the other animals agree that this is truly a sad and terrible thing, yet they keep coming up with excuses not to get involved.

Blackbird can't take them because "frogs can't live in a bird's nest." Mole doesn't think his molehill will be a good home either. Hedgehog points out that he is always on the move.

Meanwhile, Mama Mouse meets the frogs and decides to take them in. The other animals initially try to discourage her saying, "Frogs need completely different things than we do."

But Mama Mouse replies, "That's ridiculous. A child is a child." She and her children welcome the frogs into her family, and encourage the other animals to help out in providing for them.

My friends who have adopted or fostered children have told me various stories about the various levels of support and approval that they have (or haven't) received from friends and family. This book is a nice tool to either educate the people around you, or just bolster up your own sense that, yes, you are doing the right thing.

Zolotow, Charlotte. A Father Like That. HarperCollins, 2007. ISBN: 0060278641

Young children growing up in single-parent families often struggle to verbalize their feelings of loss. In this book, a boy growing up without a father lists the activities that he wishes his absent father would share with him. He decides that when he is older, he will be the type of father that he never had.

The Stigma of Foster Care

Wed, 25 Jul 2007 21:42:09 GMT

Foster Care Alumni of America, a national organization of former foster children and their allies, has a Postcard Project, designed to share the unique Culture of Foster Care: www.fostercarealumni.org

One of the entries in this ongoing project shows a little girl in a war-torn country.

The caption says: "They said I had an attachment disorder. Really, I had a life disorder. I attached accordingly."

I think of this postcard each time I read or hear of young people whose behavior is pathologized and/or medicated, simply because it has been taken out of context.

This topic came to mind while I watched a Leslie Stahl interview titled: Lost and Found. The topic was reuniting foster foster children with their biological families.

As a former foster child, I watched the series of interviews with mixed emotions. The more I watched, the more I began to feel deep concern for the children being interviewed. There can be a thin line between news reporting and exploitation.

I call this 'the Drew Barrymore' syndrome. Most adults learn to define the boundaries of their levels of self-disclosure. But young people are more transparent - and that transparency can make them vulnerable.

Are there any incidents from your life as a teenager that you would not like for strangers to watch on TV?

The first teenager to be interviewed was 13-year-old Samara, who had been in foster care for her entire life, and felt depressed (wouldn't you?) Every holiday that went by that she didn't have a family to spend with was painful for her.

Samara has recently been reunited with her mother through "Family Finding." They showed a clip of Samara and her mother on Oprah. The mother had a look of joy and rebirth on her face. Why not? She had been given grace; an unexpected gift, a lovely young daughter, a second chance.

But Samara's face was clouded by skepticism. Understandably. Over the years of spending holidays alone, of not having a mother around her, Samara has taught herself not to cry, not be vulnerable.

As the clip from Oprah is shown onscreen, Leslie Stahl comments on the fact that Samara seems to be finding it hard to look at her mother, how she keeps looking away. Stahl attributes it to Samara's "mental problems."

Mental problems? Not necessarily. Too often teens-in-care are pathologized by the "professionals" in their lives.

Try this: Have you ever found it difficult to look at someone whose actions have hurt you? Can it be hard to trust someone who has let you down?

Rather than labeling Samara as a troubled young teenager, I see her as a person of strength and courage. This is a bittersweet reunion, which came many years too late.

Samara has made the choice to forgive her mother, and their reconciliation will be not be one single event, but a process of getting to know one another again and building trust.

Life is not a Hallmark movie. The credits have not yet rolled. Samara is 13 years old and it troubles me that for the first 13 years of her life she was given drugs and labels, when what she really needed was a family and love.

On to the next two teenagers in this interview, siblings Beverly and Melvin. They were reunited with their father -- only to discover that he was an alcoholic, their mother had died from a drug overdose and that their father has a total of 10 children, none of whom he has cared for.

In their interview with Leslie Stahl, Melvin began to label himself as "defiant" because of his reluctance to build a relationship with his long-estranged father. But the look on his face, and that of his sister, was not one of defiance. It was disappointment.

Imagine if you had built up hopes about your long-lost father. How he would come back into your life with a reason for being gone for so long. He was... abducted by aliens... in the Secret Service... stranded on a desert island.

But, all the time he had been thinking of you, right? He had always been thinking of you. In that dream, your father isn't off fathering other children. He's not drowning his sorrows in a bottle.

When dreams die, we feel sadness and anger. We feel disappointment. That is the natural reaction to facing the rift between what is ideal and what is reality. Teenagers are idealists; they want adults to display perfection. It is hard to face our frailty, our humanity.

Melvin listened to his father's promises to "be there for them always" with an impassive expression on his face. That's not mental illness. It's emotional survival. There is a very real possibility that their father will be unable to fulfill his promise to Melvin and his sister, and they will be left alone again.

Where does that leave us? Youth advocates and social workers who want to make a difference? The adoptive/foster parents who want to love and be loved by the children in our care? Even former foster kids like me, who sometimes face initial distrust from the teenagers that I reach out to because I have become a "grownup," and adults are not always trusted?

It leaves us with the reminder that human behavior is best understood within its context -- and that labels are no substitute for love.

When Your Older Adopted Child Comes Home

Thu, 26 Jul 2007 05:43:37 GMT

When I adopted my 13 year old daughter in 2004, I was a total newcomer to parenthood, and a newcomer to the world of adoption. I tried to prepare carefully and do everything perfectly, but of course I still made many mistakes. Recently, I have been asked for advice by several new parents, blessed by their adoptions of teenagers.

In any adoption of a child over the age of 2 or 3 years old, I think the most crucial thing is to learn the child's language, at least a few key "mommy" words and phrases. Your child will not learn English overnight. You will need to communicate for several weeks or months before the child will be able to function in English. I took a formal class in Russian, but even though I have a facility for languages and speak French and Italian, the Russian was really difficult. I finally just told my teacher that I really just wanted to memorize parent words and phrases, and she gave me a handy list. She also made me a CD, at my request, so I could pronounce things correctly. Additionally, I listened to CD's in my car, although they were of limited value because they were aimed at travelers. I finally found a set of professionally produced CD's aimed at parents, but I didn't think the phrases they taught were necessarily going to be used every day - for example, "I love to see you laugh." Using all those sources, I was finally able to cobble together a limited Russian vocabulary.

My biggest issues with my daughter, the first year, were communication issues. I would say something, ask her if she understood, and she would say yes, but she didn't really understand. Sometimes she would just misunderstand. She felt very isolated, and the lack of ability to communicate was depressing to her. I tried to get her to learn English very quickly, with tapes and flashcards, and a Leap Pad. However, I didn't find out until much later that she had a learning disability, and that impeded her learning. I think the experts say that although a child can become conversationally fluent pretty quickly if they are totally immersed in a language, it takes about 5 years to be able to function academically in a new language.

Make sure that you have available to you a translator that you can call on to help you talk to your child in their native language. I have a friend who is a Russian translator, Kate Humphrey, and I tried not to call her too often, but there were several times I had to call her to translate something for me. Since my daughter was 13, Kate translated the "Birds and the Bees" talk the second day Alesia was home. I felt like she had to learn that information quickly, in case she started her period. At different times, Kate also talked to her about school, different American customs and manners, and many cultural differences. She was an invaluable friend to us.

I also used a translation website sometimes, but it was not ideal. I asked Alesia early on if she liked raw vegetables, and the website translated it as "Do you have an affinity for crude vegetables?" Well, she thought that was bizarre.

Be prepared that it might take a while to get your child onboard with American hygiene standards. In the orphanage, my daughter was used to only changing her clothes once or twice a week, and only bathing once or twice a week. I had the translator tell her, in Russian, that we wear clean clothes every day, and we bathe every day and wash our hair, but she didn't like that. I went in her room every morning to inspect her clothes, and check the laundry hamper to make sure yesterdays clothes were in there. I trusted her to bathe, and when she had been home a couple of months I noticed her hair was looking greasy, and I discovered she had not been showering every night. I hit the roof. I screamed and yelled, and scared the poor child half to death, but I knew she understood about bathing. So, as punishment, I started watching her shower every night, to see that she washed carefully with soap, and shampooed her hair. Then, she got where she liked me being in there, and wanted me in there when she showered. It took months to break her of that habit.

Many countries have different plumbing issues than we do. Russians are taught that used toilet paper is to be put in a wastebasket, not flushed down the toilet. The wastebaskets are emptied frequently, but the bathrooms can still be quite smelly. As soon as I took custody of her, I told my daughter, and demonstrated [in pantomime] about flushing toilet paper down the commode. Nevertheless, she still threw it in the wastebasket for quite a while before I broke her of that habit. Many third world type countries don't use toilet paper at all, much less flush it anywhere. You will be wise to research that before your child comes home.

Do not try to do everything with your child the minute she comes home. The over-stimulation can be very stressful and lead to moodiness or tantrums. I kept things very low-key for weeks after my daughter came home; no parties, no big groups, no crowded theatres or restaurants. My cousin had wanted to meet us at the airport with signs and balloons, and masses of cheering relatives, but I vetoed that idea. Just like with a baby, the older child needs to be in an un-stressful, low key environment, with you meeting all her needs.

Do not try to force affection on your child. Older children are often not used to hugs and kisses, and find it quite bizarre that American parents expect affection. I had to slowly get my daughter used to hugs and kisses, and kissing me. She desperately craved affection though, always wanting to sit right next to me, and sometimes leaning her head on my shoulder. Try to gradually introduce pecks on the forehead, light hugs, and whatever level of affection feels right for your family. Keep in mind, though, the child needs to ease in gradually.

Do not listen when your friends try to tell you that your child is just like an American child of the same age. I had many caring, thoughtful, intelligent friends, themselves experienced parents, who told me my daughter was just typical for a girl her age. I had to explain that no, she was emotionally several years behind her peers, and she had witnessed neglect and trauma that no American child from a middle class family witnesses. Sometimes my daughter's reactions were perfectly normal, sometimes not. The important thing an adoptive parent must do is be able to distinguish normal kid behavior from orphan behavior, and that can be tough.

If your child has been in an orphanage more than 6 months, they will likely have at least some institutional behaviors. They may hoard food - my daughter did, keeping stale food stashed away in her bedroom, even after I warned her about attracting bugs. They may be sneaky - as in my daughter's not taking a bath because she didn't feel like it. Orphanage caretakers had told her if she bathed every day it would dry her skin and hair out and she would look awful. The orphanage child may be incapable of sleeping in a dark room by herself at night. Even now, my daughter needs a large lamp on, and the radio, and the door left open. So does my son. When they were small and with their birthmothers they had been left alone at night. So they are quite fearful, and may not grow out of it.

My daughter always asked me, right at first, if she could go to the bathroom, every time she had to go. My son did the same. Now, they both just go, no permission needed. They each asked permission to eat anything in the kitchen, until I got them used to getting snacks for themselves. My daughter got me started on that. I make sure there are always healthy snacks around, like bananas, raisins, cheese, etc.

Expect the child to be resistant to American food. My daughter ate everything in sight when she first came home. Only later did she become picky. My son didn't want to eat much when he came home, sometimes outright refusing to eat even a small meal. I finally questioned him and found out someone at the orphanage told him everyone in America was fat, and he would probably get fat! Both kids prefer soft meat to hard or grilled meat. They like things like baked fish, meat loaf, and soup, much more than grilled or fried foods. Find out as much as you can about the child's diet at the orphanage, and try to switch them gradually to an American diet. Be prepared for the child to either gorge themselves with food, or completely refuse it, at first.

The most important tip I can give you is this: Educate yourself. Read everything you can about kids adopted from orphanages, the customs of the country your child is from, other parents' experiences, etc. I regularly check out a number of online forums for discussion of adoption issues, and read adoption magazines. Talk to other parents. If you are in a large metropolitan area, find a FRUA chapter in your area. Ask your agency about other parents in your area that you could speak with about your child. If necessary, form your own support group. I formed a very informal support group here in Atlanta for parents of kids adopted from Russia and Eastern Europe, and we meet occasionally and lets the kids play while we visit. It's great to be able to exchange ideas.

I have read numerous books about how to handle the behaviors of an adopted child, although there are few resources for parents of older children. Dr. Ronald Federici's book Help for the Hopeless Child, was quite helpful. I also liked Beyond Consequences, Love and Logic, by Bryan Post and Heather Forbes. They offered very different perspectives, yet I gleaned valuable information from both of them.

Educate yourself about your child's educational needs. Older adopted kids are typically 2+ years behind their peers, due to language differences and poor education. My daughter was sent to a poor village school, and since her learning disability was undiagnosed, never retained much of what she learned. My son was a good student in Kazakhstan, but his birthmother never sent him to school, and he had only completed the 2^nd grade when he turned 11 a few weeks ago. I have had to get my daughter tutored in a home school situation [see the article I posted on this on this site]. You must help your child learn English, after first testing them in their native language to find out a baseline of what they know. You must advocate with the teachers and the school, and find the best school to address your child's needs. This can be a daunting task, depending on your financial situation.

Make sure your child understands you are family now. Problems are solved by families together. These are some things I've had to teach my children: Children are not punished for eating too much, or getting hurt on the playground. They will always be cared for, not left alone. I won't get drunk and neglect them. Etc. There are so many ways a real family is different from an alcoholic, neglectful birth parent or orphanage caretaker, and you need to explicitly explain this to your child, using a translator if necessary. My daughter was amazed that I cared about her homework, made her eat meat, made her brush her teeth, etc. She had no clue about being in a family, and it's been a learning process for me to know what to teach her, and for her to learn how to trust me to care for her.

Love is a starting point for a happy, well-adjusted child. Love your child, but recognize you have to educate yourself and forge your own particular strategies for your unique child. Recognize behaviors you can change, and when a professional needs to be brought in.

� Dee Thompson, 2007

Adoption Parenting and Disability

Thu, 26 Jul 2007 09:47:29 GMT

Illness and Adoption

I have a chronic illness, Crohns' Disease. It's a condition which affects the auto-immune response of the gut (mouth to anus). It's pervasive, debilitating and beyond the gut can affect blood, organs, mood and fertility. It made me infertile, and gave me osteoporosis. It required major surgery, which requires me to handle�appliance change daily. It also gives me a great desire to survive and a huge empathy for anyone else who is struggling to survive, whatever their struggle

My husband and I came to adoption late. He didn't have a need to have a child, and so when we didn't make a child between us, he could leave it as much as be engaged enough to 'take it'. We took the Eurostar train to Paris from London (it goes under the English Channel) and had a very un-British but very Gallic passionate discussion up and down the Champs Elysees. Parisians smiled at the passion and let us be. We came home committed to adopt.

Failed via Homestudy, we appeal

Having worked with a hugely supportive social worker, we hit impasse at Panel, a group in the UK which�ratifies a Homestudy. They can and yes did overturn our case as presented in the Homestudy. And yes, there it was - the chronic illness.� Crohn's. Cited.� How could I manage 'me', with all the paraphernalia required to do that? How could I manage kids with needs as big or maybe even bigger -albeit different - to mine?

Well, the Panel hadn't talked to my physician to get his personal view on my capacity to cope. So I did, and he was absolutely on my side. He presented a report which showed how I micro-manage my heath daily, and how I have integrated coping with it long term. How I work with my medical advisers, don't shirk tests when something goes a bit physically awry.� How I am pro-active in terms of dealing with my illness.� And how all the negatives, the stresses, the depressions faded when I made my decision 30 odd years ago that I was going to survive beyond my disease, and the operation that saved my life, an Ileostomy ( partial removal of the gut). Fortified with this report, we appealed the decision which said we could not be adoptive parents.

We chose to attend Panel in our Appeal, and we won our appeal. My illness, how I manage it with strength and sense was understood. It was accepted that I manage the risks that my illness brings, and that there was no need to fear I would not prioritise the needs of my adopted children over my own needs.�

Parenting with Disability

I am a fit woman; I go to the gym regularly. But my kids see their mum sometimes coping with stuff that is hard for them.� Often simple illnesses can debilitate. If I get a stomach bug, which is thankfully rare, it hits home hard.� My body doesn't store salt. I can lose half a stone in water weight in two days, and this impacts ability to parent vertically! (I have to lie down, which makes my kids unhappy uneasy and sometimes angry; it's hard for an adopted to child to think they might lose another mother).

But I have the wherewithal to deal with dehydration. I use SCOOPS, the same wonderfully simple salts drink that is used in Africa to combat famine dehydration. I take my medical equipment and medicine on our trips to China. Airlines are so helpful on this; I get extra carry-ons with my 'stuff' allowed if I carry physician's letters. I am prepared and proactive. And that is how I tackle all health glitches

Strategies for coping

All parents get tired. We all need strategies to cope with our tiredness, which often happens exactly when the kids get tired too. Too many clubs, sport activities, families constantly on the go.� I have an advantage in dealing with tiredness. Because of my illness I have learned to strategise to deal with tiredness, and know how to keep my energy levels optimal.� For example, we plan for nights we come home late home from clubs. We feed the outside cats and foxes first, we deal with Dog and Cat next, then we load the washing machine, fix the lunchboxes, and set out the clothes. All in fifteen minutes as opposed to our normal lazy thirty.� It is team work. And because we know the plan, tempers rarely fray.

How the kids view me?

An Ileostomy may save life, but it distorts the body. It makes others look with horror if they glimpse it.� I change quickly and carefully at the gym, and the kids know why. Not because I can't cope with how I look, but because others are less able to cope. I also have learned to deal with invasive questions; my right to privacy remains mine.but so does my right to lead a normal life. And the children have learned that too. These are useful lessons for children to learn. My transracially adopted children have been equipped from a very early age with my strategies for dealing with invasive questions asked of them, a useful tool for them. It's a bond between us.

Managing Risk

My illness and how I prioritise family needs over my personal needs is risk management. It's about my support circle too. I am privileged to parent my children, and I am aware that I would not fit the criteria to adopt from China now.

I also think parenting with a disability gives a rare empathetic view into the difference and alienation adopted children might feel - in the society into which they were adopted. So I parent with strength, using the insight I have gained into 'being different'.

Returning to Birthcountry: The Journey of the Soul

Thu, 26 Jul 2007 11:00:29 GMT

Returning to the country of birth of adopted children. A journey, at once real, spiritual and emotional.

How?� To return is both a journey from home to the homeland and a rite of passage in the life of the family. It's a pilgrimage, to thank the people and the country for your mutual child. It is emotional balm and healing for a child who grapples with loss. And it's a travel trip, to drink in the culture of your child's birth.

Being there with your child and the smells and the food and the sheer immense difference of it is "the journey real". Walking with your child in the streets where perhaps their birthparents walked, looking round a corner for a fleeting glimpse of face that looks like your child is headily emotive and deeply spiritual. Watching your child grasp hold of history and roots is real and emotional, and stitches your family together. This links once more your child to first community of care.. with you.

Every language has words for all these journeys back. This in itself is headily powerful in its welcome from the people there. They will understand why we return: �a pilgrimage, the journey of the soul.

Heritage and Transnationally Adopted Children

Thu, 26 Jul 2007 12:20:06 GMT

Heritage cannot be sealed and bottled, to be spooned. To survive, with all its powerful headiness and ability to sustain a sense of self and well-being, it must be distilled and allowed to mingle with the air in which it finds itself. Heritage needs to be used to live.

For my children adopted from China, what their Chinese heritage means for them is bittersweet.� And so it is most probably for children adopted from other cultures and societies. My children's heritage isn't about ribbon dancing, or water buffalos, or dimsum and language class, although these are part. My children's heritage, a snapshot in China's history, tells of a country in transit from country rags to global riches, a country of vast and complicated difference. It tells of a country where wages for most are low, where conditions for living and working are hard and where family planning is decided by the state and not within a family. It tells of a country where some children are adopted overseas because the state system cannot properly accommodate all the children in need of social welfare or new families. It tells of tough parental decisions to let go a child: on the steps of an orphanage, the gates of a factory, the side of a road. It tells of parents who may have abandoned their child and never looked back or intended for the child to survive.

It tells of Chinese people, kind as people are the world over, who've lifted a foundling child and given that child a chance at life. It tells too of mothers in China, in the countryside and in the cities, still with their children. In poverty, in poor domestic situations. but still with their children.

How hard this heritage is to explain to our children! How can they use it to make sense of themselves? How can it help build self-esteem?� It's for us, their parents of the present, to explain the contradictions and conundrums which lead our children to live with and be loved by us.� We are here to help our children make their mark in our communities, to help them 'bend the air', just as - for a little while - they bent the air in China. We are here to help them develop pride in their heritage despite the prejudice that their heritage may engender in the societies in to which we bring them.

How best to explain? Heritage needs to be lived to come alive. A birthcountry visit is worth a million words. My family, my children adopted from China and I, have made several visits back to China; the children make sense of China with their own eyes. What can a child's eyes make of China? Well, what my children see changes as they mature, and their understanding of the conundrum of their heritage expands, is exponential, each visit. They see with the simplicity of a child's vision; perhaps that vision sees clearer than any adult exposition of heritage.

Is this too tough? To permit a child to see conditions and situations which may have applied to them? To look at begging, poverty, substance abuse and poor housing conditions? Yes, it's tough but it's placed in context. And the context is more than simply seeing difficult scenes. It's seeing Chinese children going to school, playing in nurseries, in play-parks. It's jostling in a queue for tickets for rides in the parks, blowing bubbles with Chinese bubble-makers, sharing an offered balloon with yet more kids in the parks. It's shopping, looking at how things are different and some are the same. It's thinking the whys of cooking and sanitation!

It is facing the suspicion with which our family is regarded in parks, in restaurants. It's having ordinary people take time to explain how our family shocks because we are part of the politics of family planning made real - and how that is shaming.

It is receiving the knowledge that there is welcome in the welfare institution, their first community of care. For my children, it is knowledge that staff there call the children by their given Chinese names. It's wonderful to see a child realise she is both her Chinese and English name; and her names only name who she knows she is now! The sum of two contexts... One child, two names, one identity

Heritage is part of but not the sum of identity. Identity is what a person chooses to make of history, the personal narrative that is the web and waft of the whole person, enabling their personal narrative to develop. A child who is held by "loving hands" (parents from the present, carers from places in the past) will be able to paste the snapshot of their heritage and history in to their Book of Life whether or not it's in their lifebook. With a grasp of living heritage, adopted children can move on from the roots of the past to future routes - which knowledge of love's journey make easier to take.

Heritage is a part of composite identity. We owe it, must show it in its reality, in birthcountry visits, to our kids. As responsible parents, how we choose to show and tell about their heritage, when in birthcountry and once home, is critical. We must also offer our children a sight of their heritage without gloss but without gloom. Why? Because our children rely on us to start them on that journey..roots and routes. We help the seam their past - through our present family - to the future which beckons them.

�

Emotions and Birthcountry Visits

Thu, 26 Jul 2007 14:17:28 GMT

CYCLING THROUGH EMOTIONS

Over the course of a visit to a transnationally adopted child's birthcountry, especially if it's planned to visit their institution or foster family, it's likely that the child will run the gamut of every emotion. Even simply planning a birthcountry visit can produce emotion.our adopted children often fear the unknown, fear transitions.� With a birthcountry trip the fear is of the unknown, yes, but also of the known, however unconscious the knowledge of their birthcountry has become.� Children also may become hugely energized about making the trip. We parents need tools to deal with the emotions we and our children almost inevitably will experience.

A birthcountry trip with every emotion possible sewn into its fabric needs careful preparation. Experienced families have found that preparation with books, drawing pictures, and using maps to deciding the route is worth-while preparation for the trip. The child is entitled to be party to the planning.� More, it makes planning for the trip a family task; that is a huge safety net for a child unsure he or she wants to make the trip. It helps an anxious child feel secure that the whole family are going - and the whole family are coming back!

Then, we parents need to understand that in making return visits to their birthcountry our adopted children may cycle through all of the four basic emotions of fear, anger, sadness and happiness. For those families who make just one visit, it is likely that the tour through the emotional wheel won't be sequential, that emotions will present and re-present in a patchwork response as the child struggles to come to terms with feelings. Often, too, the child will freeze these feelings, pack away the emotions, and families will find that it is months after coming home that the child dares to release how they felt.�� On a first trip it is very likely that work to grasp the feelings were will continue well into returning home. For families who have made more than one trip, feelings about being in birthcountry often arise and can be dealt with straightaway; the child feels secure enough about being there to let emotions out and let parents deal with them. For these families, rather than emotions packed away to deal with later, we come home unpacking how we've dealt with it.

Let's take a quick tour of the emotions that may arise in a birthcountry visit, and how we parents might think to deal with them.

FEAR

Fear may begin before the trip.� Fear of "going away", fear of "going somewhere", it's shorthand for the journeys our adopted children made to us, even if they are going back with us.

And arriving in birthcountry? The fear is intensified by the immediate sounds smells and colors. It's not easy to prepare for this. A Chinatown in the west, for example, isn't the same as a town in China. And then, on landing, the fear is made instantly worse because - as children do - our children look immediately to us, their parents, for help. And what might they find?� They find parents who are flummoxed and tired, unable to figure how to call a cab or find a train, unable to speak with their normal confidence to others and ask for help.� The parental edifice of strength crumbles in the eyes of the child. Where is the child going to hide? Will we (parents) regain our normal strength and confidence? If not, what? And if the child becomes afraid, s/he may turn away from us. Both parents and children, not coping.

Helping

How can we help these initial fears?� It's important for returning families to take time after touch-down. Try to get sleep as soon as possible and try to grab some easy food. Then hang out together very quietly to regain family composure. Go for an easy walk or two, and get the hotel to write directions back to the hotel and the names of places you want to visit for cab drivers. �Stay close to your child. Hug and carry your child as much as s/he will let you. Get a room with one big bed (and ignore strange looks). Eat foods you can share. Don't criticize if your child if your child doesn't like local food. Do take time to mooch round supermarkets and wonder at 'same and different' from home.� We parents have to lead on opening up the dialogue with birthcountry.

An orphanage trip

Fear comes as baggage in trips to the child's first place of care. It's not just being there, it may even be going there. The journey may upset the child emotionally.� The decision to visit should be worked out beforehand. Not all kids can cope. The orphanage trip need not be part of a birthcountry trip if parents feel it might overwhelm. Nonetheless, we parents have to remove our own anxieties from making this connection. Children often cope far better in reality than imagination. On the other hand, our parent agenda for visiting the orphanage (delivering gifts, seeking information) should not drive the visit. If needs must we can deliver our agenda without taking along the child. But many families find children grow in understanding of their first months and years by reconnecting. For some children, for whom birthparent searching is well-nigh impossible, connection to the orphanage is the deepest connection to birthcountry they can achieve.

Dealing with fear

How do we parents deal with fear? By hugs, by closeness, and by acknowledging that fear is a proper thing to feel when you feel out of control. An orphanage visit is hugely heady, and indeed may trigger memories even our children didn't know were held deep inside them. What tools do we adoptive parents have to hand?� Parents can help regulate children with a quiet compassionate hand on shoulder, an acknowledgement that we too feel strange, but that fear dissipates when you face it. It's the pre-worked signal (a squeeze maybe) that means a child wants to leave now. It is empathy and true parenting - knowing exactly when a child has faced quite enough, and needs to retreat to recharge strength and ability to cope.�� Re-charging? My image is that of a child with a smaller sib seated on their lap, sitting on my lap, with all of us rocking for stability.

ANGER

After fear comes anger. Adopted kids on birthcountry visits can be very angry. Anger at being taken out of routine, anger at parents' not coping, and anger at all the wrong foods. Children need supported in their anger. We as responsible parents need to remember that anger very quickly surfaces over deep feelings of loss.�� We parents may be at a loss ourselves to deal with the feelings of raw anger which may be freed in our kids when they arrive in birthcountry. We have to be in a place to support our children. We have to be abler to contain our own emotions.

Loss of "fit"

Children feel anger at loss of fit.� They ask why they had to be lost to their birthparents.� What was that caused this (are they to blame?)? We parents then feel guilty: are we right to ask our children to look at these losses, to have brought them back to birthcountry to confront them?? My elder girl has enunciated her anger by saying sharply that being in China can make her feel extremely angry and very sad. She sees families in what she feels must be equivalent situations to hers (mainly women begging with kids) still WITH their children. She is angry at her birthmother for not trying harder to keep her. She asks why if these mothers can do it, why not hers?

Tools

When we very often can't do other than offer other reasons for our child's loss, how do we deal with this sort of anguished anger? What are the tools?

~Allow the anger. It is the children's right to have it. But remember in birthcountry and afterward, we parents may have to defend or explain the societal reasons that underpin our children's need for adoption. We have to do this even when there is a part of us that screams at birthmothers, birthmother, you were wrong to leave my child.

~ Give all possible answers truthfully and appropriate to age, and don't offer an untruthful safe way out. Over time as our children grow and re-question events, they may be better off allowing anger early so that in teens this anger is put where it belongs. It is our job to make safe our children's connection to their birthparents, because if we don't, who will?

SADNESS

Resolution

After anger comes maybe a resolution. Families often find that as anger resolves, there is a catharsis. Many families fear catharsis, thinking that if they avoid birthcountry visits any crises our children may have in belonging to our family will be averted. But, these are crises waiting to happen, and the fact that they happen IN birthcountry may in fact be healing... Why?� Because facing anger and fear in birthcountry is supported and made possible because our adopted children come to birthcountry within OUR family. Finding out about the losses that began a child's journey an adoptive family is hard for that child to bear. Finding out about losses is beyond even thinking about first family and first community of care. It brings with it great sadness for what might have been and what was. But dealing with this sadness and loss in birthcountry allows the first glimmering of understanding of how to bind all this into the future.

Comparisons

When we parents take our children back to their orphanage, their first community of care that cared for them after birth family, we ask them to meet who 'they were'. It is likely they will meet current children from that community, and will draw comparisons. They may also find themselves drawn by the staff back to the status of "a child from there". For adopted children, this other previous identity, another view of "Who I Am, at base" is very hard.� It may diminish esteem; it may make the child feel labeled an orphanage kid.

Tools

What tools are there for sadness?

~Allowing sadness is so important. Allowing the child to pick up the emotional pieces of their past life and examine them within the circle of current family is so important.

~Realize that it is important to allow that the examination of past life may not be peaceful! The child may feel anger at looking at all the aspects of sadness just described. We parents have to be very strong, and not let our emotions round wanting to protect our children get in the way of letting them simply FEEL. Hug and touch are very important, but the lightest of touches may seem to burn our children when they are emotional, so keep to the lightest of touches.

~ Claim the children! When the children are confronting the past, it may be that we parents have to act as a barrier to stop invasion of our children by people from their past. Don't be afraid to claim your child when fear and anger and sadness are showing. This may be necessary at the orphanage. We parents will need to engineer a delicate balance of social custom and claiming. such a hard tool to hone. Roughly translated? If the staff invade, hold your child tight.

HAPPINESS

And then there is the happiness of being in the birthcountry - and in coming home. Our children are entitled to both, adoption brings that privilege.

Being comfortable?

It may be good to come to birthcountry not to make a pilgrimage but just to meet friends. Families who make more than one birthcountry trip often find the children are aware that they are not who they might have been in birthcountry. They may look the same, but they do not behave the same. How they 'are' is foreign. Would this still pertain if they are with birthcountry friends - when we parents are absent? Yes, because social behavior is cultural and most adopted kids take the ethos of our families and the behaviour of our societies. Our kids fall between the stools of fitting in by face and being set aside by social 'mores'. Can being in birthcountry make up for that lack of fit?

What makes children happy when in birthcountry?� It is perhaps having family with which to explore it? Our families are security for our adopted children, a way of reaching out to birthcountry. Without our families, our children would not be socially recognized.� As former orphanage kids, they may have lived in a community, but it would not have been a family, nor recognized socially as one. So through us, they have a right to be treated with respect in birthcountry. At child level, though, what makes children happy in birthcountry? It's doing things. Things we never could have taught them. Things that seem to defeat standard literature on innate and learned behaviour. "Mum! Watch me!" is the cry, and there they are accomplishing feats they didn't learn from us. In China I have learned to stand and watch when my children 'perform'. In shops, on the road, walking, in play parks, under bridges watching dancers practice. Swimming, swinging, Tai Chi, Wushu. Some of the narratives my children's actions tell astonish me. Am I looking at their parents in them? Whatever, I see children enthralled in happiness being just a little bit part of the people of their birthcountry

FAMILY GLUE

My children 'own' their birthcountry. My elder girl says that is her job to show us her birthcountry, and she says it with an expansive wave of her arms, see MY country. She feels strongly she belongs there as much as here; we as her parents must let her share her birthcountry. Just we shared when she first came into our home.

People say that transnational adoption is a bit like a broken jigsaw. Pieces that fitted when new don't fit any more, bits are missing, and perhaps some of the pieces are from different puzzles.� AH but the birthcountry visit can act a little like a kaleidoscope; turn it and new patterns emerge.� And what emerges is the importance of family. The ability to support a gamut of emotions.

It's doing things together as an adoptive family in birthcountry that matters. More, it is letting the children feel the gamut of their emotions while cradled by the strength of our family that is the key to an adopted child's sense of security in birthcountry. Our family underpins, tacks and then helps sew together all the other emotions of fear, anger and sadness that arise, and allows for happiness and pride to emerge. We adoptive parents are the rock on whom our children lean as they find roots in the country of their birth. And as they experience all the heady emotions of the trip....

Opening the Dialogue

Thu, 26 Jul 2007 14:29:46 GMT

Love is required but not enough to cement the bonds of an adoptive family. Adopted children come to their new families with a past, and sometimes memories of it. In order to truly join their new families, these kids need to make sense of why they had to leave their birth family. Nobody is placed better to help an adopted child make sense of their past, and take pride in their roots than their adoptive family.� Adoptive parents are parents plus. They deliver the love, they set the boundaries, they heal the hurts and they take on the sleepless nights caused by teens and babies! But more, and right from the minute that their children arrive (as babies, toddlers, pre-schoolers, tweens and teens) they deal with how their child views their past. Why must they do this? Well simply because adopted kids have lived their past. With the simplicity of a child who thinks all adults know everything, kids guess rightly or wrongly that adoptive parents can see right into their past. And if parents don't bring that past into the open, the children feel the past must be much too murky for their new parents to deal with. and they claim the responsibility for getting lost from birthparents. WRONG! �So, adoptive parents must be proactive and open the dialogue for 'Talk Adoption' from even before a child necessarily understands what's being said.� It's good practice for adoptive parents to start the talk right away; often parents find opening the dialogue harder than their adopted kids find hearing it. Kids have lived their story, adoptive parents have to learn it and tell it together. Tough on parents!

At EMK Press, "The Toolbox Press" where I am an Editor, we offer tools to help parents help their children. Here are some ways that parents can open the dialogue and get 'Talk Adoption' underway. even if a child is very young. They work with older kids as well.

Telling stories. This is paramount. If a child reacts well to simply-told true l life stories belonging to the child, then parents can go with that. If not, narratives about a fictional child whose story of course closely resembles that of the adopted child can be used. See www.emkpress.com Parent Guides for work in this field.
Lifebooks and Lifestory Work. �Parents working WITH the child work wonders. Most kids love to star in their own book (however parents present it). UK Lifebook guru Joy Rees suggests that parents start lifebooks with the adoptive family and work backwards, thus seaming the child first into the adoptive home. Joy's Guide will be on the EMK Press site shortly.
Roots. Adoptive parents must make their child feel good about their identity and personal gifts. Adoption expert Holly van Gulden suggests parents use a pebbling technique, small seemingly throwaway remarks positively linking the child to birthparents. These may sink if the child isn't ready to hear them, but when little ears twitch when they are said, they sink IN. The response may come, but later - and the child knows anyway that their adoptive parent grasps the 'stuff' that kids feel conflicted about.
ROUTES.� Opening the dialogue to 'Talk Adoption' isn't about wallowing in the past. It is there and designed to help a child cope with growing up. It's about the routes a child takes, real and emotional, in dealing with adoption

EMK Press's new title Forever Fingerprints by Sherrie Eldridge's deals with routes and roots. �Little Adoptee Lucie finds the connection to her birthparents via her fingerprints, but OH, please note that when Lucie dreams, she has her birthparents AND her adoptive parents dancing with her in a circle. She has squared that circle. She's made a map, she will cope with ROUTES. That is the subtext of this wonderful book which has so many layers waiting for expansion by little kids and by much older children too. Forever Fingerprints is a key to opening the dialogue. Through words, illustration and deep meaning this book helps parents find a story that makes 'Talk Adoption' possible.

� SM MACRAE 2007 All Rights Reserved. A fuller article on "Opening the Dialogue" appears in EMK Press's title "Adoption Parenting: Creating a Toolbox, Building Connections" available from Amazon and EMK Press

Adoption Parenting

Thu, 26 Jul 2007 14:40:36 GMT

Love for our children

In parenting, it is very humanly right that we want our children to love us. We are pre-disposed to giving them love, and we look to be loved and adored straight back. Nature primes us to cherish small children. It's no accident that the physiognomy of the small child is designed for maximum appeal. Children of the human species need parents; we are all born too weak and immature to survive without adult help.

Kids who can't love

But where does that leave parents whose children don't "adore straight back"? And that's more than often the case for new parents of adopted children. What are the reasons for kids not allowing themselves to be cherished? Some of it may be the child's personality. More will situational (events leading to adoption) or at the least environmental (extent of decent care in the period before adoption). Kids who don't want to enter into a symbiotic dance with their parents/carers are kids who for some reason don't trust this relationship. It's called attachment disorientation.

Of course, attachment disorientation is not confined to adoptees. Many of us may have lived through difficult times in our families.� A mother ill soon after the birth, an ill child - and the bonds of attachment are broken. And we may still suffer from this as adults. In terms of our adopted children, how much more traumatic is the broken bond when a child loses his/her mother totally, suffers multiple placements� and only later comes once more into family, our adoptive family?

Attaching in adoption

There has been much research done, and the body of research grows daily, into why many children find attaching after the loss of birthfamily so hard. This research shows why trauma continues to impact adopted children, even in settled and happy lives post-adoption. But the research addresses only half the issue, is only half of the equation. Children need to be attached, but they also need available to them a parent willing to make attachment possible. Being willing to take up that charge makes an adoptive parent the responsible parent of their adopted child.

The responsible parent

It is crucial that adoptive families address the "other half of the equation", how we as parents develop attachment techniques as the foundation of adoption parenting. We need to help our children come under our parental wing until they are strong and mature in their own adult right. Without us, our children will not build security enough to mend the tears in their psychological make-up that their first losses brought about. Without us, the child can't mend enough to contemplate that first loss. Without us the child can't begin to understand that first loss, and grow despite and because of it. Without us the child-become-adult can't see that while loss is a fundament in their psyche (it happened) they still can grow in strength and maturity. They can build a personality that incorporates loss inside a rightful sense of self. Without us the child will forever blame first loss for all failures.

Thus, we parents are needed by our adopted children. It is coincidental that meeting those needs will also validate us as parents. The needs of the child are paramount. We are the responsible parent to our children.

Difference accepted

No one size of attachment parenting as cement for an adoptive family can be said to be better or to fit all. Children and parents are individuals. How growing up under a particular parent's wing works out will depend on the 'birds that are working to get the flying pattern right'.�� And adoption changes a family - the innate has to give way to a learned family functionality. A baby eagle may be loved by his adopted mother sparrow, but he will have growing needs she struggles to understand and provide for. That's a metaphor, but adoption brings it as a heads-up that perhaps all parents should heed.� Parents need to know and assess what their kids' needs are and learn how to meet them. Plus, they must do this despite their own possible propensity to parent in a way that struggles to meet those needs.

The first and paramount tool in our parenting toolbox, therefore, is our own self-knowledge. If we are not secure, well-balanced adults who can admit our faults and failures,� ask for help for ourselves when we fail, ask for nurture from partners, family and friends, then we not only fail ourselves, we fail our kids. When dealing with our children's needs, we have to ensure our own needs are dealt with and out of the way. If we look at parenting as a see-saw, then our adult judgment is the fulcrum. If our sense of balance, responsibility and understanding of our children is lacking, we cannot balance the see-saw if our children's needs are heavy. So, we both steady and help balance. A tall order if we have an unresolved narrative of our own childhood.

Adoption parenting is about teaching children to fly, recognizing our flight patterns don't match theirs, and delighting in the difference. We also need to know that our own flight patterns are sound.that they won't be upset by shadows of parents who might know our children better innately than we do. We adoptive parents need to know how to become the parents our children trust with their fears and their joys. Our children need to have courage to ask us who they are, why their birthparents let them go, why they look how they do, how they feel about all of these things. If a child feels a parent can't cope with answering this, the child will swallow the questions. And the feelings of loss, loneliness and lack of self worth will seep from the past into the present of our families.

Narrative parenting, Opening the Dialogue

Dealing with this is best done through a great sense of openness about "what happened" to our children. Good parenting which cements a family means being able to talk the very deepest things with our children - and sometimes in the briefest of interludes (car, going to swim class). It is seizing the "moment" that a child offers, and running with it. It's a living life book for the child, one which works backwards from the present and the safety of our family to the past - and back to our family in the present, and hence to the future.

Tools to bring our children close to us

Parenting with attuned sensitivity also may mean choosing to keep our children with us far longer than is normal in our Western society. we may choose to home-school, we may choose adoption breastfeeding or comfort nursing, we may choose just to sit rather longer at the kitchen table than most families do. We may talk, draw and play, all in each other's company. We may co-sleep, we may give our older kids permission to chat on internal phones to us after bedtime about dream-time worries.

We need to be ready to talk about how they look the same and different to us, and we need to open about how racist western society is, and show our children we don't condone it. We have to give them tools to deal with this. We have to know when it is right to talk about difference with our kids, when to steer them towards same-race role models, when to back-off when they take off as teens and young adults with these same peers.

We need above all to be able to read our kids' needs without the blinkers of our needs. We need to know whether certain behavior is a cry for help and where it's just plain naughty. In my family, the "cry-for-help" behavior can't be disciplined, it needs dealt with by open understanding ("I know what you are doing and it's because... Isn't it?"), and a hug. And at night time, it is always answered.

We need to advocate for our kids, and provide them with all the help they need if they come to us with issues and difficulties from their lives before us. We need also to think where to stop; therapy should never be used to make our child simply fit our family better. This latter is a very tough call; we love our kids; we want them to fit our family, society, and all the aspirations we have for them as adults. But we have to remember their difference, and when it truly is 'just them', let it be.

Only by giving children a strong knowledge that we care for them (the whole child, quirks, losses and all) can they proceed to develop beyond out family and its love to form strong bonds with others in wider society. Further, if we show our adopted children how it feels good to be loved and understood, inside a family then we will give them a true sense of what they lost when they lost their birthfamily. They need from us so very much.� No-one can grasp, handle, tackle what is lost if they have no measure of the loss. In giving our children our understanding, we are showing them what their birth-families might have given if that family had not been broken. And this affirms what ours is today.

Acceptance: Our children as individuals

This last act of giving in order to receive can be painful for parents. To do it, we can't be blown out by the wind and storm of our children's needs. We have to be very strong individuals, ready to help our children assert - through our parenting - their individual needs. In helping them move forward, we need to be ready to let them look back to their past before us. Only thus can moving forward seem safe. One of the greatest gifts adoption parenting can give is family - the gift of family brings an understanding of what family is. The birth-families of our children are candles blowing in the wind. until our children can hold the light themselves we guard the past to help our children grasp their futures.

Warrior Moms

Thu, 26 Jul 2007 16:22:44 GMT

Warrior Moms
by Jean MacLeod

I didn't sign up to be a Warrior Mom.
It was awarded to me by default:
I showed up to mother a baby.
In the early days of our adoption,
I clanked around in oversize Armor that hung heavy and slow.
It took me awhile to realize that it had been designed for me to grow into...
I'd been outfitted as a Warrior Mom
but didn't understand what I was fighting.

It was with fear and steel
that I dealt with awful knowledge:
I was fighting for the love and affection
of a baby who no longer trusted.

Making a child's world right
is all-consuming and never-ending.
I figured out why I wore Armor: it held me up at the end of the day.
So many invisible dragons to slay!
I battled for my baby
and I battled to be her mother.
I took rejection-- arrows glancing off metal-- and came back for more.
I demanded a place in the life of my daughter
and I learned to share her with her past.

I became a Warrior Mom
and ditched the Armor, but kept the shield.
Not for me, but to protect the child that became mine
through sweat and tears and years of no sleep!

Who knew this Mom could tilt at windmills
angry feelings and powerful ghosts?
I don't cook, can't sew, won't craft
but I learned I could fight
and I don't give up.
Sometimes it takes a Warrior Mom
to claim a child who has gone past love.

Untapped, under-appreciated,
a Mother's Will is Mighty.
It can make love spring from metal
And change Armor to open arms.

SHORT-TAKE: A Little Bit Irish

Thu, 26 Jul 2007 16:45:05 GMT

Hanna, my seven year old from China, was in the tub. I was helping her rinse the shampoo out of her hair when she asked,

"Am I a little bit Irish?"

My mind swept over some of our recent conversations about our family heritage, and I answered, "Well, ethnically you are Chinese. But since I'm a little bit Irish, then culturally, you are a little bit Irish, too."

"When did it happen?" Hanna wanted to know.

"When did WHAT happen?" I asked, concentrating on her soapy head.

"When did I become a little bit Irish" she explained patiently. "Was it when you kissed me for the very first time?"

I paused, shower wand in hand, and watched my daughter squeeze water out of her hair. I thought about the tiny, bundled baby that had been handed to me at the Anhui Hotel seven years earlier, and I remembered how her head felt against my cheek. I hadn't wanted to scare her; my baby-kiss was soft and swift as I cradled her upon my shoulder. Unremarkable, it was the first kiss of many thousands, yet now, through Hanna, I see it with fairytale eyes:

My first kiss to my adopted daughter infused her with my love, my world, and the generations of my unknown ancestors! Like Sleeping Beauty wakening with a kiss from her Prince, the mother-daughter kiss called forth a magical intermingling: a covenant leaping past genetics, it bestowed Hanna and me upon each other.

For Hanna, a kiss was clearly not "just a kiss"; my pragmatic daughter had chosen to make sense of the vast, familial complexities of international adoption with a powerfully simple symbol of promise and connection.

"Yes" I said finally. "I think that's when it happened."

We were SWAK.

Under Three Flags Between Two Worlds By Laura Gannarelli

Fri, 27 Jul 2007 08:19:00 GMT

October 3, 2004

It has been several weeks since my trip to South Korea.� It has taken this long for me to adjust physically, emotionally, and mentally back to my life as a Chicagoan, for I am a Korean adoptee.

�Going back to South Korea is never a vacation for me.� The complicated mix of memories and emotions that accompany both the preparation to leave and the readjustment upon return is never an easy one because I have to make the cho8ces of� "Do I visit the orphanage?" or "Do I want to search my birth records?" and "Do I go in search for my sibling?" instead of simply "Do I need sunscreen?"

�While growing up, I focused on achieving the American dream.� I didn't know at times how to explain to anyone, including myself, why I was so driven.� But there is nothing like having experienced poverty to motivate a person.� Add to that the feeling of rejection from your motherland, having to readjust to a whole new country, culture, and language, to start with a clean slate, to leave everything behind, both mentally and emotionally.

�I had to shut the door to that part of my past in order to become American.� I felt there was no other way.� I had to become American-and fast.� It wasn't until the summer of 2003, when I was in my mid-30s, that I felt the time had come for me to learn about my Korean heritage.� It was time to no longer ignore the country that I came from.� I was both surprised and scared at being drawn back-I had thought I would never go back.

�I returned to South Korea 27 years after leaving at age 7.� The shock stayed with me all of last year.� The trip was both the best and worst experience of my life.

�I have vivid memories from those first 7 years.� I remember each event that led up to my adoption as well as my thoughts and feelings.� There is a running movie in my head and all I have to do is press "play" to se it n my mind's eye.� Since I didn't have anything else, those memories were my pictures, my scrapbook.

�My visit this year was for Gathering 2004 in Seoul, a conference for Overseas Korean Adoptees, which was held Aug. 4 through 8.� It drew about 400 Korean adoptees, ranging in age from 18 to their late 50s.� It was the third such gathering arranged by adoptees, but this was the first one held in South Korea.

�It has been 50 years since Korean adoption began in 1954, after the Korean War.� Today, about 200,000 children have been (and continue to be) adopted all over the world.� Fifteen countries were represented at the conference, including Australia, Belgium, Canada, Denmark, France, Germany, Italy, Korea, Norway, Sweden, Switzerland, Thailand, the Netherlands, United Kingdom, and the United States.

�Typical getting-to-know-you questions were: "How old were� you when you were adopted?"; "Which agency were you adopted from?"; "Have you searched for your birth family?"; "Do you speak Korean?"; "What place has the best mandu?" (Korean dumpling).

�To talk to someone who looks similar to you but has a German, Australian, or Danish accent can be disconcerting. You think to yourself, "Wow, if I closed my eyes, I would never know that they were Asian!"

�Whenever I return to South Korea, I hear two themes: "We are sorry and ashamed that we had to send you away for we couldn't take care of you," or "Even though you didn't grow up in Korea, remember where you came from, for you are Korean."

That second always gets me.� I have no idea what being "Korean" is.� If you were to ask me to tell you what being "Minnesotan and Swedish-Italian" is, I could go on for hours, regaling you with stories, colloquial phrases and how to make a mean hot dish.

I now realize that I went back to Korea for the second time in two years to understand what "being Korean" is, going beyond the food and the simple greetings.

�I want to understand, to be among "real Koreans" and to see whether I had retained any of it.� So I watched and listened to see how they relate to each other-just as they watch us, for even thought we look Korean, they know we are not.

�The result of the trips is that I no longer expect to see a Caucasian face when I look in the mirror.� I can now appreciate that I come from a very rich culture that is 5,000 years old.�

�But most important, I am no longer afraid of Korea.� I am learning to accept the fact that my family history begins with me, and that is one of immigration and adaptation.

Laura is the founder of "Paper Lantern: Resource Center for Korean Adoptees." This non-profit organization develops and hosts programs for both parents, children and adult adoptees of all nationalities by devloping programs that relates specifically to the adoptee experience. A fall panel discussion with adult Korean adoptees will be held Sept. 30th in Chicago. Please go to www.paperlantern.org for more details You can also email them at koreans@paperlantern.org

Reprinted with permission from the author as it appears in the Chicago Tribune

�

My Dream

Fri, 27 Jul 2007 11:34:36 GMT

By: Meghan

My dream is that one day when I go on vacation, my two sisters won't be stared at and that my brother and I won't have to guard them from stares.

My dream is that the Confederate flag won't be raised and hatred won't be known.

My dream is that my sisters will be called by their names and not "adopted girls" or "bi-racial".

I want them to be free.

That is my dream.

Meghan is a 9 year old girl who is one of five children, two of whom are transracial adoptees.� She wrote the essay above as an assignment in her third grade class during Black History Month.�

A Virtual Village

Sat, 28 Jul 2007 14:16:28 GMT

Hillary Rodham Clinton wrote that it takes a village to raise a child. It's a wonderful adage (whatever one's politics); one that I think has particular significance for children adopted from China if "village" is read as a stand-in for community. But it's a virtual village that our children adopted from abroad require. and that is the thesis of this article

Our children come to us having been part of two, maybe three, "communities." Each has had an impact on children - in the womb, with family members (birth and foster), and in their institutional settings. Though not all the effects will have been positive, they exist as part of our children's lives and shape, to some degree, how our children will come to see themselves.

Becoming a part of our families might not feel quite as wonderful to our children as we'd like to think it should. To get to us, our children have to lose their community. An institution is not a family, but for our children it was where they were nurtured and sheltered. Leaving this community can be immensely hard: my elder daughter was clearly quite traumatized after we plucked her from her orphanage when she was 18months old. The "great outdoors"- even when we were in China- was a very different world for her.� And coming "home" to our home was shocking for her. She didn't know animals, grass, or the food we ate. Nor did she know what family was about.

I know well from friends who have adopted older children that they feel keenly the loss of their orphanage friends and caregivers even when they seem positive about their new lives. Language, too, separates our children from us and our care and our broader community. Even babies in China have receptive language skills in Chinese which must be lost before they can tune into the new. Looks also startle, and as our Chinese children grow older, in some parts of our English communities, they are no longer seen as the "cute" babies that they once were.

Adults and children can be cruel about difference, so I was determined to integrate my children into their new community before I tried dealing with baggage from their past.� I focused on choosing a school and nursery with caregivers who would help ease the transition my children were making into a new community of kids, but I was clear that I would be the one to address whatever issues arose from their former experiences.

On many mornings I sat with my kids at the school and nursery until they felt safe in letting me go. At those moments I learned a lot about the "kid community" into which they were entering. I also worked at improving my children's social competencies and language skills within our community before I began having them interact with a local group of children adopted from China. I felt that these children present yet another community with its own set of potential effects. If all of this happened too soon, I believed it could lead to overload for my children.

What I wanted most was to settle my kids into a British version of what should have been their birthright in China - our family and friends.

Our Children Weave Their Identities

Children love to feel as though they belong. But some children find having more than one identity very hard. For example, in Britain some Chinese people claim that my children are "one of theirs." But my six-year old daughter utterly rejects this idea. In her view, she lives in Britain and she is British. For her, the Chinese community is not her community. She also rejects being called a part of the community of "children adopted from China." And this year, while on her fifth visit back to China and her orphanage, she found meeting the children who were there very, very hard.� When she is at her orphanage, she is not called by her British name, but she is given back her Chinese name. It is hard to meet a different part of yourself and deal with it when you are this young.

In Britain, I am prepared to accept that my children will decide how Chinese they want to be. But my husband and I feel that as a family we must visit China as often as possible. And when we go there we meet with friends of our family and visit the children's orphanage. As I watch my daughters struggle in China to deal with their other selves, I delight in the strength they seem to draw from being with us in our family.

As they work to sort through who they are, I believe my children need to be presented with a composite identity, an identity which allows various parts of them to slide over each other. It may depend on geography, on needs, and on identification with what each child is "made from." Beautiful pearls are formed out of grit. This is how I see my children forming their identities. Grit survives transplants from community to community.

When we arrived home in the spring 2002 from our annual trip to China, I looked for help in figuring out how to deal with the combination of my six-year- old's absolute need for us, her acceptance of her Chinese identity while she was in China and her rejection of this identity in the United Kingdom. I wanted to try to better understand how she managed to come to terms with being an "orphanage girl."

How could our daughter cope with having "parents of color" (in her case, Caucasian), when the stares of the Chinese told her she had an odd family? How does she feel to be British, to behave as she does because she is a British child, but to be one with a Chinese face? How does she feel about not fitting into her first country/community because of her different upbringing, one that is normal in the community in which she now lives? How does she feel about looking different in her adopted community even though her behavior confirms her as a community member?

Seeking Answers in the Virtual Community

These weren't issues that people in my own local community could deal with. So I turned with gratitude to what I call "the virtual village" of the Internet and listservs. In the "virtual" Chinese adoption community, riches of information, experiences and opinion are available, and many minds are brought together to be mined to benefit our children.

I�have used these listservs mercilessly. As I toss out more questions, I receive more answers, and from these responses I can make a better analysis of the "best approach" I can take to helping my daughters address issues of identity and community. Perhaps the richest resources I've found have been older adoptees, whose feelings about the need for connections to their past seem to increase with age and maturity. I have absorbed what they've said but at times it seems as though some assume larger-than-life stances on some issues. Or so it seems to me.

Some older adoptees seem to regard the adopted community as doing nothing more than creating a ladder of enablement for a child who grows enough to start to grasp the loss of the first birth community and culture and to readdress these losses. I am certainly not in any position to refute the individual needs of adoptees as they mature. But I know now that my small children want us, their family, first and foremost. Their community is, I suppose, still very narrow and driven by a need to be cared for by a person who is bigger (in all senses) than they are. If they now rest contentedly in this community, is it my job to urge them to start to seek a place in their first community?

I took heart from an adult adoptee I "met" one day in a virtual village. She heard me speak about my child's happiness and trust in our family and her aversion to various Chinese subcultures in Britain which don't appeal to her. This distant correspondent understood my daughter's vulnerable pleasure at being a Chinese ex-patriot in China as if she was coming home to show her new riches of health, wealth and experience. This woman also validated my approach by being a powerful advocate for how I am meeting my daughter's needs at age six and assured me that adopted family and first communities can sit together in comfort. She also let me know that as long as community is what weaves strands together, identities can be woven into a very strong adult cloth even when the cloth is woven out of disparate strands of identity.

This virtual village stretches across continents and seas. Its members find strength in the village's common denominator which is helping our kids grow whole in body and mind. To me, this is very supportive community to "live" within and serves my needs as a parent of children adopted internationally. It also serves my children's needs.

In "real" communities we tend to gravitate to those who offer what we feel most at home with. And so it is in virtual communities.� However, in the virtual community I have access to so many views that there are times I wish the views I read weren't so disparate or their content sometimes so difficult for me, as an adoptive parent, to take on board. A Dr. Spock guide offering simple advice, delivered as gospel, would be a lovely excuse to ignore the messages which are gritty. The virtual community can be gritty, but as I have said, so are my children's needs. It takes a virtual village to raise a child adopted from abroad.

I believe our children are well-served by the exchanges we, as their parents, have as part of this virtual village, just as they are by what happen in real-life communities. Surely whatever village can serve our children, it is a community worth being a part of.� It is by listening to our children and watching them that we can learn how to help them work as each works at developing her sense of personal identity.

Giving Back: Adoption and the virtual village

Sat, 28 Jul 2007 14:43:13 GMT

It takes a village to raise a child. Or so Hillary Rodham Clinton asserts. OK. In these days of listservs, blogs and Youtube, it's certain parents are signing into the virtual communities of the internet to check out their parenting. Adoptive parents are there in droves, too, in their own bit of e-space. Blogging, youtubing, Yahooing.

Why? It's an an impetus for PARENTS to connect. In the flood of material we now hear, many adoptive parents feel inept or if not that well somewhat powerless. The power lies with sending countries, birth families and lawyers... how easy is that?

It is NOT easy. But in adoption we families - though we offer our homes and ourselves, WE are not the family our children expected. Adoption brings uncertainty, and maybe even non-acceptance by real space friends and family. The internet with its capacity for responses out of locality, out of real space, seems enticing. Families post under the cloak that e-mail affords about adoption and family formation.

How do we support anonymity? How do we support families we kno need more? Here is a personal,what happended to me.

Serendipity took charge of my life when UK adoption services risk-assessed our proposed third adoption from China of an out-of-birth-order child to our existing children from China. My husband and I welcomed this pre-Homestudy assessment, we thought it would power our arm, and so did our social workers. But the risk-assessment failed. The panel deciding on it advised that an older child would be better left in birth country, even if instutionalised, and that our existing adopted kids 'balance' would be put in jeopardy.

In between the tears, I was furious. The panellists commenting had no experience of international adoption, no understanding of what institutional care can effect on a child. I vowed I would one day BE a local social services adoption panellist advising on adoption matters - and yes, I am now, having served for a year, the toughest, best most enlightening year of my life.

I also vowed to serve our adoption community across the globe. A space for a third child at my table endures. But I used the feeling that the gap leaves to fuel my desire to help other families prepare properly and thoroughly to adopt, and having adopted, be the adoptive parent their adopted children need. Serendipity took charge once more, when I was 'head-hunted' by Carrie Kitze at EMK Press. She wanted to create a new e-list which helped parents get perspective on the tough stuff which adoptive parents face, with the ethos that no one piece of parenting advice fits all.

The fit was perfect for me, and the group began. And the virtual village of Adoption Parenting group listserv evolved; to join us visit http://groups.yahoo.com/group/adoptionparenting/. From small hundreds of initial members to thousands today, we offer a written topic every two weeks, which allows members to exchange freely on individual parenting perspectives. We have reached out across the globe, to Europe (including the UK) to North and South America, to Asia and to Australasia. What connects is the real need to get a bottom line for each of our adopted kids. is there a hidden fount of knowledge, a shrine, that if only we can access it, we hit parenting Nirvana? No.

Rather, connection to the virtual village of adoption parenting enables friends, people we 'know' we want to talk to. We take them on trust (the internet is not local), but the essence of our Adoption Parenting list is of a considered interchange of parenting views. It's a bit like sitting at the kitchen table drinking coffee with friends. You can talk the tough stuff but not lose a friend over it. Views slip and slide over each other, but at the end of the time on a topic, we get up refreshed, with a good perspective on what we need for our parenting. And we take away an understanding of what other tools our fellow adoptive parents need which are different to ours. It's enriching, and that's what a virtual village is. Hands held out to support, perspective offered - but no offence taken when we take from the communal toolbox only the tools we feel we need to parent our individual kids. I am glad to be part of this community.

And what of the book that grew from the list, "Adoption Parenting: Creating a Toolbox, Building Connections"? It too presents a full and varied toolbox of adoption parenting tools that parents can utilise according to need. It too was built on the notion of offering perspective on parenting. The voices that it contains speak with the authority of seasoned parents and expert professionals. The voices become friends - much like the comradeship of our virtual village. In a sense, this book is the hard copy version of our virtual adoption parenting village.

Thinking of Adopting? You Can Do It!

Sun, 29 Jul 2007 10:35:17 GMT

Each year, millions of Americans consider adopting a child. Unfortunately, many rule out adoption due to lack of knowledge or fears of what they will encounter during the process.� As a result, people's dreams of having a family aren't realized and children needing homes remain in orphanages or foster care.

The good news is that there are many excellent resources available to help guide you on your journey including some that allow you to learn about adoption from experts in the privacy of your own home.� Moreover, many of the things that prospective adoptive parents fear about the adoption process turn out to either not to be problems at all or can be addressed if you're willing to keep your options open.�

Here are five common concerns and their answers:

1.� "I would like a baby, but all our state adoption agency has are older children."� At first, it may seem impossible to adopt an infant or even a child under five.� Private agencies, religious-related organizations, private adoptions, and foreign countries often offer infants and younger children.

2.� "Local adoption agencies say I'm too old to adopt."� While it's true that there are rules on age, they vary widely.� The age restrictions of your state agency will likely vary from that of a private agency or that of foreign countries such as Russia, China, Korea, and Guatemala.� Some look at the ages of both of the perspective parents, others only one.� If you keep your options open there's almost certainly a path for you to adopt.�

3.� "Will I be able to handle a special needs child?"� The answer to this question largely depends on how much time, knowledge, and energy you have to devote to a child and how involved his or her challenges are.� Usually you can get the knowledge you need to raise a child with special needs from your doctor, specialists with your local school district, and from online sites parents and professionals have created.� Of course, the most important part is to know what you're prepared to handle before you adopt, and work with your adoption professional to find the right match for you and your new child.

4.� "How will a child fit into my family?"� Adopted children blend into a family just like a biological child does.� Once you get past the initial getting acquainted period, your adopted child will seem as naturally a part of your family as any child ever could.� Plus, there are plenty of families with both adopted and biological children.

5.� "How will an adopted child impact my life?" Virtually everyone says their child enriched their life far more than they ever imagined.� There are very few "sure things" in life, but the joy and love an adopted child brings you are about as certain as anything can be.

Most people have lots of reservations when they start thinking about adoption.� Adopting an older child, a child with special needs, or a child of another race or nationality all bring their own questions and concerns.� Let me assure you that this only normal - and you are not alone.� However, do not let these fears keep you from exploring your dream of starting or growing your family.�

Adoption is one of life's most wonderful endeavors.� If you are thinking about adopting a child, please take time to get answers to your questions.� There are a number of top sites, fellow parents, and accessible experts who are ready to help you.

Behavior and the Adopted Child

Sun, 29 Jul 2007 10:47:13 GMT

I was recently at the conference "Raising and Healing the Adopted Child: Effective Strategies for Helping Your Child Reach their Highest Potential" in the Baltimore area.� The speakers included Dr. Federici, Dr. Mason, Dr. Gordina and Nadya Molina, M.Ed., BCBA.

Nadya Molina is a behaviorist that works with Dr. Federici as well as having her private practice, Alternative Behaviors in Falls Church, VA.� Nadya gave a three hour talk about behavior and the adopted child.� It was an excellent talk and the audience was glued to their seat during her session.� I wish I would have attended a session like this 13 years ago before I started parenting.� I think all of us as adoptive parents agree that life tends to go smoother in our households when our children's behavior is appropriate.

Nadya talked about how she became a behaviorist.� When she was growing up, her best friend had Downs Syndrome so she felt a calling to help people with special needs.� Nadya has worked for numerous school systems, has a master's degree in Severe and Profound Handicaps, and has worked with people with mental retardation, autism, eating disorders as well as with people with unique behaviors that they have not been able to tackle on their own.� She recently became board certified in Applied Behavioral Analysis (ABA) which is often used with children with tendencies on the autism spectrum and has also been found effective for other children as well. She has worked with people with deficits since 1986 and is a parent of a special needs biological child.� Her office is located in Virginia; however parents and adults call her from all over the country to assist them regardless of the type of behavior they need to change.� She has even gone to Iceland to help families.� She has helped individuals overcome all sorts of behavior including orphanage behavior like rocking, hoarding food and head banging as well as eating disorders like bulimia.� She assists people of all ages including young children and adults.�

Nadya shared many of the techniques she uses to assist people to change behavior.� She indicated that each post institutionalized child is very unique and no "one size" fits all intervention in behavior modification.� Here are some of the pertinent hints in assisting our adopted children.

Tell your child what to do versus what not to do.� I think as parents we all want what is best for our children, but it is not uncommon for us to say things like "don't go in the street", "don't touch that", "be good".instead of directly� saying "walk on the sidewalk", "play with your toy instead of touching that", or "I like when you play with your truck".
Find out why the behavior is happening.� �� Is your child craving attention, bored, internal anxiety, on auto pilot or trying to escape.� Observe and try to figure a pattern of why and when the behavior is happening.
Use "Time In" versus "Time out".� I think most of us grew up with the "time out" concept.� Our parents put us in the corner or sent us to our room to discipline us.� Nadya indicated that this is not a good technique for our children coming from orphanages especially when we first bring them home.� Orphanage children are already used to little attention and "time out" alienates them more.� She suggests you keep your child in close proximity to you, but don't give them attention or eye contact during this "time in" period.
Use immediate reinforcement for appropriate behavior.� Nadya shared the example of potty training.� As soon as your child goes pee pee on the potty, give them their candy or sticker.� Don't wait until they wash their hands.� Children need to understand that the behavior they just completed is the one being reinforced.
Use short, clear, concise directions and consequences.� Avoid giving lectures and talking too much.� Tell you child specifics as "brush you teeth" or "put your truck in the toy bin".� "Use clear directions without negotiation."
Write simple stories about social situations and phrases to explain sequences of events to your child.� She recommended books that Carol Gray has written on Social Stories T (available on Amazon).� In these stories, you break down tasks for your child in simple steps.�
The "Drill Phrases" drill the child into a specific task.� She used the example of "Stop - Think - Make Good Choices" (sort of like the fire chief saying, "Stop, Drop and Roll").� The use of drilling phrases help children process and retrieve information quicker and effectively; which is a major deficit within post-institutionalized children.
Schedule breaks for your child.� Nadya used the example of shopping.� Like most working parents, a lot of us try to tackle our shopping on the weekends.� She gave the example of shopping for three hours.� She said schedule breaks (have a snack, go to the bathroom, etc) periodically through your shopping time.� Yes, it may take longer, but this helps prevent meltdowns from your child.
Do not remove the demand or task if your child expresses himself with unwanted behavior (for example, meltdowns).� Parents get tired both emotionally and physically.� It is not uncommon for us to just give in to our child because we just don't have the energy to deal with the unwanted behavior.� Nadya recognizes that this can be very difficult on parents, but do not give in to your child.� It is ok to modify or adapt.
Create rules.� Nadya said to teach your child rules.� For example, "only hug your family". This type of rule helps your child attach to family members rather than others which can help with behavior challenges.

She recommended several books that may be of interest to adoptive parents including "Navigating the Social World" by Jeanette McAfee and "A Work in Progress" by Ron Leaf (both available on Amazon).

To contact Nadya Molina, visit www.AlternativeBehaviors.com or call 703-732-2469.� She can also be reached through Neuropsychological and Family Therapy Associates by visiting www.DrFederici.com or calling 703-548-0721.�

For a recording of Nadya's entire presentation, please contact Robin Bartko at 410-916-1542 or via email at Robin@ThinkingOfAdopting.com

Attachment & Adoption - From an Adoptive Parent's Point of View

Sun, 29 Jul 2007 13:25:50 GMT

I wanted to share with you some thoughts and information on forming a strong attachment with your adopted child - from an adoptive parent's point of view - and let you know where you can learn more about attachment.

If you're adopting, you may be wondering how you and your new child will "bond" or "attach". If so, you are not alone. I know that my husband and I certainly did. We wondered how our new son would react when he first saw us. How we could help make his transition to our home as warm and loving as possible. And, what we should - and shouldn't - do to help him form a strong bond with us as quickly as possible. And, most of all, we wondered if he would love us.

Unfortunately, with all the paperwork and tasks during our adoption process, I'm a bit embarrassed to admit that we did little more than wonder and worry. We didn't take the time to learn about attachment in adoption.

However, we now know how important attachment in adoption is for adoptive parents. In fact, it's so important that when the United States signs The Hague Convention on Intercountry Adoption (which is expected to take place in�2008), prospective adoptive parents who will be adopting from China, Guatemala and other countries covered by the convention will be required to take training on attachment.

Why is attachment important? Unfortunately, for all adopted children, their very first attachment - the bond with their birth mother - was broken. And, as Dr. Lark Eshleman, author of Becoming a Family: Promoting Healthy Attachment with Your Adopted Child has told me, this break is traumatic for the child no matter when or how it occurred.

If that wasn't enough, while your new child is waiting to be adopted and is not yet part of his or her forever family, he or she is not in an ideal situation to recover from this initial trauma and form strong attachments despite the best intentions of the caregivers. In the worse case, the child can suffer additional trauma if bonds with caregivers are broken or his or her needs are not being met. As a result, some children can develop attachment challenges that will have to be addressed. Since adopted children come from all types of backgrounds, you really won't know about your child's situation until you get your referral and possibly until you bring your child home.

If you are in the process of adopting, now is the time to learn so you can help make the transition easier for your child and yourself, recognize the signs of attachment challenges if they were to occur, and be prepared to help your child if they need it. As they say, "An ounce of prevention is worth a pound of cure."

Dawn Choate, a mother of four including two daughters adopted from China, recently shared the story of the attachment challenges she faced with her daughter, Hannah, on ThinkingOfAdopting.com. Dawn talked about how difficult it was for her to realize that Hannah was having attachment challenges and her struggle to find the resources needed to overcome them in order to "Heal Hannah". It's a very heartfelt and emoitional story, told from an adoptive parent's point of view. If you haven't yet heard Dawn's story, Healing Hannah,�I urge you to do so.

If you're wondering how our son reacted the first (and second) time he saw us, he cried his eyes out. That's right! You'd have thought that we were the scariest people around and that he would never want to leave the orphanage. And - despite how we felt at the time - what we learned later was that was a good sign. A sign that he had formed an attachment with his caregivers, and that once he got to know us he could form a forever bond with us as his mother and father. And while it didn't happen overnight, it did ... and it sure feels wonderful!

Adoption Stress and Family Conflict

Sun, 29 Jul 2007 22:46:58 GMT

In my experience, a majority of the cases of international adoption that I follow have a happy ending. However, as with any story, there are cases where international adoption may be more than what the family had bargained for.

My pediatric practice is unique because I see families from all walks of life, but my international adoption panel is a special part of my clinical practice. These families are often well educated, financially stable, and career motivated people. These families are often older and sometimes lack the experience of raising a child.

Adoption stress can plague anyone involved in international adoption. The process starts before the adoption actually begins and long before the internationally adopted child even arrives into your home. Issues with infertility, parental age, and the desire to have a child are just the beginning stages of adoption stress.

During the adoption process and difficulties encountered can exaggerate the tension felt by parents. The adoption process itself is a drawn out procedure that can take months to years to complete.

The adoption process is often unpredictable. It can become a long and emotionally draining journey for parents. The financial cost, lifestyle adjustments, and the piles of paperwork of adoption only add to the tension.

Unexpected challenges may arise during the process. Adoption referrals may be withdrawn after you attach to the child, or the country from which you are adopting may suddenly close its adoption program. A prime example of severe adoption stress was created for families when Romania closed its doors to international adoptions. When this occurred, hundreds of families were caught in the pipeline, and their children were condemned to living in an institutional care environment despite the fact that there was a loving family somewhere in the world that had already developed a bond with them. Parents invested a great deal of emotional energy into these children. I know of one particular case of a woman who, even to this date, visits her child in Romania every six months and cares for her from afar. Like these cases, there are still many families waiting to bring these children into their forever homes.

Another cause for adoption stress is when a family loses their referral. I have seen cases where, during the pre-adoption medical records evaluation, the child was assigned as a very low risk for adoption classification. By the time the family contacted their adoption agency in order to accept the referral, the child had been placed with another family domestically because the excellent health conditions of the child.

The opposite type of such a referral would be the high risk adoption. This too can create a significant amount of stress. Because of medical uncertainties and the potential that the child may have serious medical problems, families may refuse this type of referral. Families have related to me that the feeling and emotions that they encounter after refusing an adoption referral are ones of guilt, confusion and the feelings one may encounter with mourning the loss of a child.

In all the above mentioned scenarios, families were forced to deal with a tremendous amount of emotional turmoil, and the child had not even arrived in the United.

The post-adoption period can be the final chapter of the adoption stress story. It has the potential to catapult the stresses experienced in the pre-adoption period spinning out of control, especially if the adoptive child has a serious emotional or medical problem.

Mandatory physician visits, extensive laboratory investigations and subspecialty referral can transform what is supposed to be a happy time to one of extreme tension. This often happens when the adoption medicine physician discovers underlying medical conditions that went undiagnosed, especially if the condition is life altering, such as HIV infection.

Fortunately many of the diagnoses uncovered in the post adoption period are not as serious as is HIV infection, but even a mild case of Giardia intestinal infestation can cause undue stress for the adoptive family.

It is at this point when the adoption stress has reached its peak that is can transform itself into a full blown anxiety or depressive syndrome for the adoptive parent. For some parents, these feeling are difficult to accept because they occur at a time when one is expected to experience joy and happiness and not sadness and despair. After working so hard to achieve the adoption, parents may be reluctant to confess their negative or ambivalent feelings to their spouses, especially if the adoption idea was theirs to begin with. Ignoring these feelings and this delicate situation is never a good idea. The problems will not go away; they will progressively worsen over time.

As you can see, adoption stress can affect almost anybody involved in international adoption. It can affect families with problematic adoptions as well as near perfect adoptions.

In order to prevent discord between the husband, wife, and other members of the family unit, families need to become educated. If one feels that the adoption is not as they planned, or that it is more that they signed up for, seek counseling immediately. All adoptive parents should be prepared to experience some degree of post adoption stress.

I often hear from families make the following statement: "I only want to adopt a normal healthy child." I can understand their wishes, and I know that there is a parent for every type of child. Adoptive families, however, need to understand that they are not immune from future medical issues. Even in case of biological children, no one can tell you that the child will be healthy. As a parent, all you can do is provide support, love, and a warm family environment to raise your child. They will grow and develop despite our wishes and or plans. There is no perfect road map to raising children, both biological and adoptive. Medical, social and emotional problems can affect anyone. Parents need to be prepared to recognize problems and seek professional help when needed. This is the job of a parent.

By George Rogu M.D. Medical Director and founder of Adoptiondoctors.com and Adoptioneducationclasses.com

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Is Honesty the best policy during the home study?

Tue, 31 Jul 2007 06:37:23 GMT

My husband and I are getting ready to begin the international adoption process, and wondering whether it is necessary to disclose something. Thirty years ago, my husband was convicted on a drug possession misdemeanor. The conviction has since been expunged and the record is sealed. We know honesty is the best policy, but since the record is sealed and the conviction expunged, is this something we need to disclose during the home study?

Yes, honesty is always the best policy. While I understand that this incidence happened thirty years ago, it is still necessary to share with your social worker during the home study of this incidence. As you stated, you are adopting internationally, so you will be required to have State, Federal and possibly FBI fingerprints done. Even though you believe the charges were expunged and the record is supposed to be sealed, there are many offices who will be reviewing your fingerprints. So keep in mind that there is a chance that your husband's conviction will come out and then you will look deceitful, if you had not previously made a full disclosure to your social worker This was not a crime against a child or a crime with a weapon and it happened thirty years ago. If there has been no further incidences and your husband attributes this to immaturity and his youth, it seems explainable and should not preclude you from adopting. The social worker will state just that the incidence occurred, there were no further incidences and that after a careful examination of your home, he or she felt it was a safe environment for a child to live in. At times, an adoption agency will request that the social worker write a 'revised' home study, leaving out any mention of past indiscretions or even the typical statement that you do not currently have any drug or alcohol issues, because some foreign countries have difficulty understanding this when translated. A thorough complete report including past and current issues is sent to USCIS and of course the agency, but the revised home study is for the dossier to be sent to the country you are adopting from.

I hope this answers your question. Good luck to you and your husband as you pursue your journey to creating your forever family.

Best Regards,

Leslie Zindulka, LCSW-R

adoptionsocialwrokny.com or Adoptiondoctors.com

Marriage and Adoption

Tue, 31 Jul 2007 06:51:38 GMT

Question: My partner and I have been living in a loving relationship for 5years and have our wedding date set for October 2007 will this be a problem regarding adoption?

Congratulations on your upcoming wedding! Being in a loving relationship for five years, six by the time of your wedding certainly demonstrates your commitment to one another. It is wonderful that you would like to start a family, as soon as possible, and provide a home for a child who needs one. That said, adopting a child and becoming a parent is a lifelong responsibility. When adopting domestically, a birth mother may look for a couple who has been together for many years, as you and you fianc�' have been and not be concerned with the length of you marriage, but usually would like to see a couple in a 'better' place than she is emotionally and financially. When adopting internationally; however, there are more stringent guidelines that must be followed regarding age and length of marriage. For example, in Korea you must be married at least 3 years and may not be older than 45, most other countries you must be married at least 1 year and be between the ages of 25-45 years old. So the answer to your question is really no, you'll most likely just have to wait a little while.

Good luck with your wedding plans and hope your adoption plans work out as well.

Best Regards,

Leslie I. Zindulka, LCSW-R

Ms. Leslie Zindulka, L.C.S.W.-R is a New York State licensed clinical social worker with over a decade of experience in the adoption field. Ms. Zindulka has both personal and professional adoption experience. Ms. Zindulka writes a monthly column for the AdoptionDoctors.com Web site and limits her practice to adoption home studies. Her clients include married couples, singles, stepparents and those over forty. Request a home study consultation

Visit Leslie online at: Adoptionsocialworkny.com & Adoptiondoctors.com

Salmonella infection

Tue, 31 Jul 2007 07:07:11 GMT

There are two main types of salmonella there is the "normal salmonella that we think of in this country which is acquired through undercooked foods. There is also something called salmonella typhi or typhoid fever.They are both salmonella infections. Normally however when we say salmonella infection it is nontyphoidal salmonellosis.Without knowing the clinical context it is hard to know exactly what is going on with your child, for example was this in the blood, stool, or spinal fluid ?

I will quickly summarize what happens with salmonella infections.

It can present in 5 ways.
�

Acute or chronic asymptomatic infection- salmonella has an ability to hide in the gut and to be shed it the stool for a prolonged time. This ability seems to be facilitated through the early use of antibiotics. This is why in this country we do not jump to treat all cases of salmonella. We do treat however if we feel the child is at risk for a severe illness. A child may be hospitalized to isolate him/her from the other children so that they do not start an outbreak.
Gastroenteritis- an illness of vomiting and diarrhea with fever. This can be recurrent if they are exposed more than once.
Focal infection- salmonella can spread about the body after an enteric illness but then the salmonella would not necessarily be found in the stool after treatment, but it can be found recurrently in the blood.
Bacteremia- salmonella in the blood, normally once it is treated it is gone unless it finds a home in the bone for example.
Enteric fever- a prolonged bacteremic illness where the child appears very ill usually needing hospitalization. The factors that determine if a child gets really ill are young age, virulent organism, hemoglobinopathy (such as sickle cell), leukemia/lymphoma(rare so young and ruled out by a blood test), immunosuppressive drugs, problems of the immune system either they are born with (scid) or acquired (HIV).

�
Without a more thorough history it is impossible to say with any certainty what is going on with this child and unfortunately this is the risk that we are faced with many times in international adoption.A child should not have serious long term effects from an uncomplicated infection from salmonella in general, But it is important to know therefore was the illness a normal gastroenteritis or was it something else.

�
Written by James Reilly M.D. of Adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship.

The Rewards of Adopting Older Children

Tue, 31 Jul 2007 09:25:24 GMT

Waiting for a child is extremely hard and emotionally draining, particularly when it seems that everyone else has what you want the most - a baby.� But stop and think about how it must feel to be a child with no family.� There are millions of children in our world who desperately need a home.� Most of these children are not infants, but they are still young enough to need holding, cuddling, security and most of all, they need love. They need parents to read them a bedtime story, to teach them to ride a bike, to hold them when they are hurt, kiss them good night and make them feel safe and special.

Every child needs and deserves to have a loving, protective family. Too many are not given this opportunity because they were relinquished or orphaned after infancy. Rather than adopt a slightly older child who is in need of adoption now, many prospective parents still wait until they can bring home a baby.� For every single baby adopted today, there are hundreds of older children who continue to grow older as they watch little ones leave an orphanage. Most of them are healthy and desperately want to have a family.�

While those adopting an older child will need special preparation, the rewards are absolutely amazing.� The world is no longer a lonely place for a child who has a family. Many older children have never had the experience of having their own clothes, toys or books. In all probability, they never spent a day at the beach or had a picnic.� They may never have had a ball to bounce or seen a kite. �A plentiful meal may be unknown, much less a snack. Each day the changes are remarkable as an older child sees the world through new eyes.�

For parents who bring such a child into their lives, the world is forever changed. The rewards are endless, for this child now has a promising future.� And for children who come into a family at an older age, the world is no longer a lonely place, as it was before adoption.

Too often, toddlers, preschoolers and school age children are overlooked when people consider adoption. Yet, given the chance, an older toddler or older child can provide enormous joy and tremendous rewards to a family. An adoptive family can help make the world less lonely for one very special child. �Give this some serious consideration if you are thinking of bringing a child into your life through adoption.�

Welcome Home!

Tue, 31 Jul 2007 09:25:44 GMT

When a newly-adopted baby joins the family, both parents and child face a period of adjustment, as new parents get used to the new role of parenting, and the baby adjusts to his or her new home and family. Both parents and children have different experiences than families formed through birth. Pregnant moms get months to slowly prepare for parenthood, and lots of social support. It is harder for adoptive parents, because the wait can be long, and the arrival of the child quite abrupt. Society does not have the same expectations of the new parents, or the new child, as they do for a mom coming home from the hospital with her new child, and others do not make the same allowances, or offer the same support.

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Helping your new baby to adjust to home and family

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It is important to understand that the process of adoption and the removal from an orphanage or foster home to an entirely different home in another country is a huge change for a baby, and it can be quite traumatic. Try to see the world from your baby's point of view, and be sensitive to her or his personality and preferences, and his or her cues, signs of distress, overstimulation, anxiety, exhaustion etc.

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Be aware that your baby may be still grieving. Babies do grieve the loss of those who cared for them, sometimes for weeks and months. Some babies withdraw emotionally, or cry inconsolably for the first few days. This grief often emerges once they are more settled in their new home.

The baby has not only been separated from those to whom she had formed an attachment, but from a familiar and predictable environment. Babies are very sensitive to the sights, sounds, smells and feel of an environment: the smell of their care-giver, the smell and texture of her clothing, the type of bottle and formula, and how they receive their food, the feel of a diaper and their clothing, the hardness of their crib mattress, the weight of their covering, the amount of light in the room, the language and background noise they hear. The very limited world orphanage or foster home was familiar, predictable and stable. Suddenly, they are trust into the arms of strangers who are totally different from their familiar caregivers, and whisked through an alarming series of new and strange environments, from the hotel room, the busy streets, the official buildings to the plane ride home. Babies are often overwhelmed and exhausted by this barrage of new and often scary experiences. Your home is just the last of these scary new environments, where he or she is placed in yet another new crib, in yet another strange room, in a place that smells, sounds, and feels different from anything he or she has ever experienced. Babies have jet lag: their days and nights are mixed up. Many babies "fall apart" when they are safely home, as the cumulative stresses overwhelm them. Many parents report that their babies' sleep patterns are disrupted, that they wake and cry at night, and that they fuss and cry a great deal. Parents can become exhausted, frustrated and discouraged.

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Here are some hints on helping your baby to adjust to his or her new home and family.

1. Ease the trauma of transition as far as possible. In some countries, you can visit your baby in the orphanage several times before taking him or her away, but in others, the baby is abruptly taken and handed over to the parent's care. The total sensory impact of this sudden removal from familiar sights, smells, sounds and textures is often traumatic. Anything you can do to provide continuity can help. Ask about your new baby's routines, likes and dislikes. Some parents have been able to send a receiving blanket or soft toy beforehand to the orphanage with their own body scent on it (sleep with it under your nightwear) so their baby recognizes them by smell. Even if washed on return, it will then have the familiar smell of the orphanage to comfort the baby. Before you meet your baby, eat in an ethnic restaurant, so your breath and clothing may smell more familiar to him or her. (Though the nurses in the orphanage may smell mostly of disinfectant!) When you receive your new baby, leave the original clothing on for the first few hours if possible, keep at least one piece of clothing if permitted (take new clothes to exchange) and keep it, unwashed, in the crib for a few days. Keep your baby on the formula and foods given in the orphanage for at least a few days, and make the transition to new formula gradual. Take tapes of local music home to play at home, to ease the transition there.

2. Minimize your child's exposure to anyone outside the family for the first few weeks. Let no one else hold the baby except the parents, even at the airport on your triumphant arrival home!! Isolate yourselves with your new child at home for the first week or two, with as few visitors as possible. Do not let visitors hold your baby. If family members want to help, ask them to bring meals, do shopping and errands, or clean the house. If challenged, say the social worker or doctor advised this early isolation.

3. Recreate the baby's routine. An unvarying and predictable daily routine will help your baby feel more safe and secure. Staying at home with the baby helps create this routine. Keep everything quiet and low-key for a few weeks - no welcome home parties, or other excitement.

4. Focus on building attachment in these early weeks at home.

i. Mom should do as much of the baby care as possible, to establish the primary bond.

ii. She should hold and interact with the baby when feeding him or her. Do not allow your baby to bottle-feed by holding the bottle alone. This is a key bonding activity, where the mother should be offering the food and maintaining eye contact. When the baby is eating solids, the mother should always feed him or her herself. Do not encourage early independence in self-feeding. Hold your baby on your lap if possible, with eye contact. If the baby must be in a high chair, keep him or her very close to you, between parents if possible, and touch your baby often, use lots of eye contact and conversation. If your child insists on self-feeding, play interactive, reciprocal feeding games - you put a Cheerio in her mouth, she puts one in your mouth.

iii. Lots of physical contact is very important. Mom should hold and carry the baby as much as possible. Cuddle, caress, stroke and rock. Gentle wrestling and tickling are fine if not over-stimulating. Cuddling your baby with eye contact while rocking her or him in a rocking chair is very beneficial. Use a baby sling or cloth carrier (Snuggly, Baby Bjorn etc) to carry her or him facing inwards against your body, wear your baby all day while you go about household tasks, or out shopping or walking.

iv. Engage in frequent playful interaction with your baby. Do not leave your baby to entertain herself or himself for long periods. All of the traditional "baby games' are great: pat-a-cake, blowing "raspberries", peek-a-boo, counting rhymes with fingers and toes (this little piggie) "riding" the parent's leg, rolling a ball back and forth, imitating the baby's sounds, etc. Play together with baby toys.

v. Newly-adopted babies should be responded to when they cry in the night. Leaving a baby to cry is not appropriate for newly-adopted children. Mom should stay with the baby as she or he falls asleep, rocking, singing, caressing, etc. Parents should comfort the baby whenever he or she cries in the night. Many babies adjust better when they sleep in the parents' room, either in their own crib near the parents' bed, or with the parents in the Family Bed (if you choose this option, be sure to follow all safety recommendations to ensure the baby does not suffocate on or under soft bedding, get lodged between the bed and the wall, or adjacent furniture, or get suffocated accidentally by parents) Others, including your pediatrician, may advise you to teach the older baby to sleep by herself or himself, by letting him or her "cry it out". Only when a child seems securely attached, should parents begin to encourage their baby to learn to sleep through the night alone. Be sure to eliminate medical causes if your baby's sleep is restless and frequently interrupted by waking and crying: intestinal parasites, ear infections and lactose intolerance are possible causes of poor sleeping.

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Adjusting to parenting the adopted child

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1. Prepare as much as you can beforehand, so you know that you can anticipate when your baby comes home. Find out what behaviors are typical for babies in this period of adjustment, and what expectations are realistic. Read books about adoption, attend any seminars on adoptive parenting, talk to other parents about their experiences at support group meetings. Be sure to learn about how adoption will change family life, especially about post-adoption depression, and the ways you can help to minimize or prevent it.

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2. You will have jet lag if you travel to get your child, and you can expect to feel exhausted if your baby does not sleep through the night, and has her days and nights mixed up. Get your support system in place before you return; arrange with family, friends or commercial services to come home to a house that is clean and tidy, and well-stocked with food, so you can recover from jet lag. Enlist help with laundry, meals, errands, babysitting older children, or taking them on outings, etc.

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3. Take time for yourself, your spouse, and your other children. You need to take care of yourself. Make sure you eat nutritious food, get some exercise, and some recreation. Don't neglect your marriage. Arrange for a babysitter and go out with your spouse for an evening. Your other children are having to adjust to the new child too. Give them some one-on-one time, and take your older child out for an outing, just the two of you.

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4. Get help from your support network when you feel stressed. If you feel overwhelmed, exhausted, and depressed, or are feeling frustrated or worried about your child's behavior, talk it over with another adoptive parent you know and trust. Those who have not adopted may not be as sympathetic as parents who have been through it. Don't hesitate to call your social worker about problems, and don't pretend everything is fine when there are problems. She will be able to reassure you that your experiences and feelings are normal, and give you helpful advice.

Post-Traumatic Stress Disorder in Internationally Adopted Children

Tue, 31 Jul 2007 09:40:59 GMT

When we adopted our eight-month-old baby from a Chinese orphanage, a disturbing incident occurred when our travel group took our babies to a photographic studio to have their passport photographs taken. All the other fifteen babies and children cooperated nicely, but when it was our baby's turn she screamed and screamed for at least ten minutes before she could be persuaded to sit in my arms, with me covered by a black cloth.� She was absolutely terrified by the total darkness required for the photograph.� When we got home, we found she screamed in the car at night - the only time when she was in total darkness, as we used a night light in the bedroom.�� Looking back, I now know that she was experiencing Post Traumatic Stress symptoms.� Being in the dark triggered again a trauma she experienced in darkness - very likely her actual abandonment at several months of age outside the orphanage gates, on a street busy in the daytime.

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As time went on, we also noticed that she was very upset after we attended large gatherings of adoptive parents with their children.� Even at age four or five, she would have night terrors afterwards. Here's the reason why these events disturbed her.� Our travel group of sixteen families met our babies all at once in a totally disorganized chaotic and noisy scene in the brightly-lit hotel foyer, and when I look again at the video and photos, our new daughter was frozen with terror and horror when I first held her in my arms.� Even years after adoption, that neurobiological response of extreme fear was triggered by the sight of many white couples with their Chinese children.

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Many of our internationally adopted children will children mystify and frustrate their parents by overreacting, expressing excessive and irrational fears.� These children may be excessively clingy, refusing to be separated from their mother for even a moment.� They may scream if they see a woman of the same race as themselves, rage or "space out" at an event with adoptive families, or have nightmares afterwards.� They may refuse to go to sleep at night, and waken screaming again and again in the night. They may express extreme anxiety about food.� These are common behaviors reported by worried adoptive parents.� Sometimes parents totally misinterpret a baby's seemingly positive behavior.� They may proudly point out how smart the baby is, as she is so alert and interested in everything that is going on, or be delighted that she goes happily into the arms of everyone she meets.� She is actually hypervigilant.

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They may be symptoms of Post Traumatic Stress Disorder.� Yes, babies can and do develop PTSD after experiencing trauma in their early months: terrible experiences that elicit intense feelings of horror, fear, and helplessness.� Babies and small children in trauma experience "hyperarousal", when their brains are flooded with stress hormones and chemicals.� Because they can't 'flee", they respond by "fight" - crying and raging to get help and rescue, or "freeze" -disassociating or mentally shutting down just to survive the experience.� Because these children lack a loving family to mediate traumatic experiences, and because the traumatic experience may persists for weeks and months, they cause long-term changes in the brain. These early traumas remain stored in the brain, and they will experience the same traumatic arousal when a later situation reminds them of that first trauma.� Because their brains are flooded once again with the stress chemicals, and they focus again on surviving the trauma, they are incapable of thinking or doing anything else: they cannot learn. They will respond by re-living the traumatic event by having flashbacks, daydreams and nightmares, or becoming over-aroused (hyperactive and aggressive and hyper-alert for potential danger), or under-aroused (numb,� passive, mute, and withdrawn).�� PTSD interferes with the process of attachment and learning.� Typically, children with attachment problems also have PTSD symptoms.� Trauma also contributes to developmental delays and learning problems.

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We adoptive parents need to know that our children have experienced three potentially traumatic experiences.� Whether a particular child is deeply traumatized or largely unscathed depends on his or her genetic personality traits, age and the response of those adults caring for the child.

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1. Abandonment by their birthfamilies.� Our babies have suffered the primal loss of the person nature intended to love them most- their birthmothers.�� Some of our babies, as in domestic adoptions, will be even traumatized by early abandonment soon after birth. The bond which has developed through pregnancy has been severed.� Growing research shows that there is a bond between the infant and the biological mother already at birth - the baby can recognize her voice, for instance.� Some adopted children have "anniversary reactions" every year around the time of their birth and abandonment, when they misbehave badly for a few days.� Those who have already formed an attachment to their birthmothers, who are abandoned as older babies, toddlers and children will more often be traumatized.�

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The physical experience of abandonment can be very traumatic in some countries.� In China, children are left alone in a public place, in order to be rescued by strangers.� They are left on sidewalks, on steps outside or seats inside public buildings, in alleys and market places. They are often left when there is no-one to spot the escaping relative - at night, or at dawn.� Imagine that little baby, all alone and vulnerable outdoors or in some vast, echoing building.� The baby is helpless and alone, left in danger in a public place.� When she cries in terror, strangers eventually come to pick her up. This experience is devastating to the baby, because the abandonment has been committed by her own mother, and she has to deal with this crisis all on her own.� For a baby like my daughter, awakening all alone in the dark in an unsafe, unfamiliar public place is a life-threatening experience.� Older children in China are often abandoned at places like train stations and bus stations, told to stay in one spot and wait, while their relatives disappear in the crowd forever.� Imagine the growing fear and terror of that child as the hours pass!�

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2. �Living in an orphanage is traumatic for many children.� They live in bleak rooms filled with cribs, and too many of them live their early lives almost entirely in the crib.� Because orphanages typically have strict schedules for feeding, babies are not fed when they first feel hunger, and may wait for hours to be fed.� Because there are too few caregivers, they may wait many hours to have their diapers changed, and thus experience discomfort, and even pain with severe diaper rash.� When they cry from pain, perhaps from an ear infection, they often do not get the pain relief and loving attention they need to feel better. Other babies are crying all around them.�� They may spend weeks sweating from extreme heat, or shivering from extreme cold, - in the 1990s, Eastern European babies got frostbite!� Even in well-funded orphanages, few have enough staff, or sufficiently well-trained staff, to pick up and feed, change, comfort and play with each baby on that baby's own internal and individual schedule of need.� Babies are left to cry hopelessly when they are hungry, wet, soiled, hot, cold, in pain or distressed, bored and lonely. Few of the babies get the one-on-one attention every baby needs for optimum development; the experience of being special, beloved and cherished by one devoted caregiver all day and every day.� Some orphanages still do not have enough food, clothing, heat, and medicines to meet the children's physical needs.� Some of our children have witnessed other babies sick and dying.� Moreover, some of the conditions and practices in orphanages in different countries are actually abusive and traumatizing.� In China in the 1990s, and still in poor orphanages today, babies were often tied down on their backs all day� in their cribs, or tied by their feet to potty chairs all day.� In Russia, babies were swaddled tightly at feeding time to speed up the process. In Romania, the staff locked the babies in their room at night, and left them alone untended until morning.� In some places, harsh verbal physical chastising of babies and toddlers is permitted: early potty training in China, for instance, has been traumatic for some adoptees.� And in any orphanage, there is a risk of emotional, physical and sexual abuse from an undetected individual worker abusing a selected child, and from abused older children abusing younger ones in turn. One orphanage was known to allow men into the nurseries to sexually abuse infant girls at night.�

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3.� Being adopted is traumatic to many children.� For the parents, meeting their new child, and taking him or her home is a joyous experience.� It is entirely different for the child in many international adoptions. It is a time of fear, helplessness and terror.� We as parents know how much better off the child will be in a loving family, and in good home where every need will be abundantly met.� But all our children know is that they are being taken away from everything familiar to an entirely new and scary world.� They have adjusted to the predictable routines and often plainly furnished one or two rooms of their orphanage home, and are accustomed to caregivers who look familiar and speak a familiar language.� They are used to the sounds and smells of the institution.� Many have never left this small, confined and narrow world.� Then they are thrust into the arms of adults who look and smell different from orphanage workers, who speak a different language, and who take them away in cars and buses to hotel rooms, then in airplanes to a totally new and different country.�� Transracial adoption is especially terrifying for many children, as Caucasian Americans look so different.�

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Many adoptive parents spend their first few days with a traumatized child.� Some babies and toddlers scream and cry for hours and even days in panic and terror, fighting their parents' efforts to care for them and comfort them with kicking, scratching, biting and desperate efforts to escape.� Other babies cope by 'zoning out".� They disassociate, by retreating mentally to their own inner world.� They are quiet, passive and withdrawn.� They are stiff and unresponsive to touch, and recoil from their parents.� They don't cry.� Sometimes, they don't eat.� Some parents, totally misinterpreting their child's blank eyes and emotionless face, become convinced that the child has mental retardation, and have refused to adopt that child.�

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Some countries are better than others in easing the transition and reducing the trauma: the normal Chinese practice of an abrupt and final handover, perhaps after hours of stressful travel, in a strange hotel or office, is far more harmful than the gradual introductions in some Eastern European countries when parents must make several daily visits to the child in the orphanage before removing him or her, and parents may stay with a local family until the court date.

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Even events after arriving home can add to a traumatized child's fears.� Our baby was malnourished and sick.� I took her to the doctor at once, and she had all her testing done that day.� She had to go to the hospital for her blood work, but her veins were so tiny from poor nutrition, that it took half an hour of agonizing jabbing until enough blood could be collected.� For well over a year, she screamed non-stop when we had to visit the doctor, from the sight of the building onwards.�

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After adoption, as they begin their lives in America, our children may still suffer long-term from their early traumas.� They may live in a constant state of fear, with those stress hormones and chemicals interfering with their normal brain development and attachment. Babies who fight falling asleep, and waken crying at night are often truly afraid of sleep.� Frightened babies may be very fussy and needy, and suffer from extreme separation anxiety - the "velcro baby".� Some will remain withdrawn, and unresponsive, or you will see them suddenly "freeze" for a few minutes.� Certain sights, sounds, smells or physical contact will cause extreme reactions of terror, rage or 'closing down".�� As they grow older, children will re-enact their traumatic experiences in their play. Concerned parents may take them to doctors and therapists who know nothing about the impact of the three traumas, and who may misdiagnose hyper-alert hyperactivity as ADHD, unresponsive or avoidant behavior as "disobedience' or tantrums as Oppositional Defiant Disorder.

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We adoptive parents need to know that post-institutionalized children are all at risk for PTSD.� We need to understand that a baby less than a year old can have sufficiently traumatic experiences to continue to experience long-term effects after adoption, and that this can impede the child's ability to attach and to develop normally.�

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We need to read and learn about the causes and symptoms of PTSD in adopted children before we meet our children.

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When we travel to adopt our child, we need to be empathetic, and see the adoption process from our child's point of view.�� We should know how our child might respond to in the first few days, and make plans ahead of time to minimize our child's stress, or change our plans for outings after we adopt.�

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When we arrive home, we should minimize the number of new experiences for our child -we should plan to stay quietly in the house for a few days, restrict visitors, and delay medical testing if necessary.�

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We need to identify trauma reactions and respond appropriately.� We should avoid all trigger experiences if possible until the child is ready and able to cope with them.�

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For most adopted babies and children, all that is needed to heal is appropriate parenting.� But many typical American parenting practices only reactivate the trauma response in a child, and further implant it in the brain at the expense of more positive learning experiences.� Remember; when a child reactivates trauma responses, the brain cannot do anything else!� The most obvious example of inappropriate parenting is letting an infant cry at night.� The Ferber method is not appropriate for our adopted children - Ferber himself has said so!� If your baby resists falling sleep, and wakes crying in the night, it is very possible that she or he is experiencing a PTSD reaction.� Leaving these children to cry themselves to sleep only compounds the damage to the brain.� Another inappropriate practice is "Time Out".� To a traumatized child, "time out" feels exactly like being abandoned, and he or she actually relives that experience all over again.

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So, what is appropriate parenting for traumatized children?� It is the "reparenting" and 'attachment parenting" used to promote attachment.� The goal is to minimize the re-experiencing of trauma, because if those pathways in the brain are not reactivated, the brain will prune them out by age 6.� Instead, we need to rewire the brain, replace those unhealthy neuropathways with positive experiences of love, happiness, curiosity, security, trust and so on.�

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Reparenting is regressing to a younger age. The emotional age of post-institutionalized children is usually much younger than their chronological age.� A baby abandoned at birth may not have had the opportunity to develop emotionally at all, and at adoption may still be at the emotional age of a newborn.� She needs to be care for as a newborn, not as a 10 month old.� Reparenting means bottle feeding older children, rocking and cuddling children to sleep, and comforting them when they wake at night, and even playing "baby games' them and letting them act and babble like babies.

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Attachment parenting means empathizing with children, consistently meeting their needs to end the "cycle of unmet needs."� It involves lots of playful, loving and deliberate interaction with all the senses.� Babies are carried in their parents' arms, or in cloth baby carriers facing inwards, fed in their parents' arms with eye contact, and sleep near or with parents at night.� Discipline is with "time in" or "holding time".� Fixed daily routines help the children feel that the world is safe and predictable.

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If the child continues to have symptoms of trauma, there are effective therapies available which can heal the child suffering from PTSD.� Many are helped by Holding Time, some by play and narrative therapy, some by EMDR - Eye Movement Desensitization and Reprocessing.

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Celebrating Parenthood

Tue, 31 Jul 2007 09:42:53 GMT

May / June 2007

During the past year Wide Horizons For Children has helped make almost 500 men and women parents for the very first time. One of the many wonderful parts of adoption work is witnessing the dramatic change in people when they become parents. At this time of the year we celebrate mothers and fathers so it seems appropriate to think about these very special relationships.

The joy and love one feels for a child is unlike any other feeling. Until becoming a parent most of us would not automatically risk our life for another human being, but that changes when you have a child. The intensity of that parent-child bond is so strong that most parents would not hesitate to put their child's welfare before their own. As parents, we do this all the time in many different ways.

More than twenty years ago I worked with a wonderful couple who were in the process of adopting a child from another country. Each of the parents had a high level career and was dedicated to making a difference in the world. The wife had lived abroad and worked as a volunteer at an orphanage; the husband held a high level position in an important non-profit organization. In my meetings with them prior to adoption they each seemed to be extremely intelligent, kind and serious people. Almost a year later they brought home a beautiful new son and the focus of their lives changed dramatically. Now all they seemed to think and talk about was every burp and all the other bodily functions of this baby. Even more surprising, almost everything that either of them said had the lilt of baby talk. The transformation was quite startling!

A few years later this couple welcomed another child into their lives. Gradually they transitioned back to their adult communication styles but with an overlay of funny stories about their children and pride in their accomplishments. It was clear that the careers were still crucial to each of them, but their children were now the center of their lives.

In general, women dream of taking care of a child while men think about having fun with their son or daughter. Many years ago a prospective adoptive couple were showing me, their social worker, around their beautiful home. The wife made it sparkle in preparation for my visit, part of their home study process. With great delight she showed me the lovely nursery she had prepared for a baby and all the accessories for the car, crib, bathtub, etc. Although this happened more than 20 years ago, I vividly remember the husband sitting in their living room and telling me that he couldn't wait to have "little peanut butter and jelly smudges" on their TV screen! Their individual dreams of parenthood typified a difference in fantasies that moms and dads have even before a child joins the family.

Increasingly, more dads take on the stay-at-home caretaker role, but in most cases it is still the mom who stays home with their child. First time dads are often surprised at the strong emotional ties that quickly develop with their new son or daughter. Most moms have these strong feelings even before their new child arrives in the home. The bonds are forged from the time they see their new child's picture or first learn that there is a child waiting for them.

Being a parent is the toughest job in the world. It can be both exhausting and emotionally draining. Unhappy words from a child can stab a parent in the heart. Most of the time, children adore their parents, but not always. They have the potential to cause enormous pain when they are not happy or something goes wrong in their life. Indeed, at times they may be quite angry when we make decisions that don't support their wishes. We want to protect our children and we also want to see them grow into self-confident, thoughtful, intelligent and independent young people. It's all part of growing up and it's not simple. It is challenging and can be very frustrating - and it is a very long haul to adulthood! Yet, it is also the most rewarding relationship you may ever have.

Eventually we have to "let go." It starts when your child first goes to school and continues in stages until the day when they move out to live on their own. All parents have gone through it, or will get there. Nevertheless, even after your children are grown and totally self-sufficient, they will always need you to be there for them and you will always want to be a part of their life. You will be internalized in your child's minds and heart and he or she will carry you inside forever. Don't ever minimize your importance and worth in your children's lives. Without any doubt, you are the most important people in their world.

Parents deserve to be celebrated and congratulated frequently, but most days no one will tell you what an important and terrific job you are doing. Some day, perhaps years from now when your children are adults, they will look back and let you know how much they appreciate what you have done for them. For now, while they are still young, remember that every kiss, hug and smile you get from your child is a celebration of how important you are in their life every day, all year long.

Recognizing Attachment Problems in Internationally Adopted Preschoolers

Tue, 31 Jul 2007 09:48:28 GMT

One of the known risks of adopting a child from an orphanage is Reactive Attachment Disorder. Individuals with the most serious level of this personality disorder are unable to give and receive love. They cannot develop the ability to form successful relationships, or accept responsibility for their actions, and lack cause-and-effect thinking, empathy towards others, and a conscience. They are typically angry, oppositional, defiant and do not trust others. Insecure attachment can be ambivalent, avoidant or disoriented-disorganized. Reactive Attachment Disorder is a continuum, from very mild attachment issues to the severe cases of extreme autistic or sociopathic behavior. Some people prefer to label milder cases as attachment problems, and limit the term Reactive Attachment Disorder to serious cases.

Until recently, many adoptive parents assumed that only post-institutionalized children adopted as toddlers and older were at risk of developing Reactive Attachment Disorder and that babies under age one would quickly and completely overcome early emotional deprivation once they were in a loving family. Indeed, this may be a factor in choosing only to adopt an infant. But many adoptive parents are discovering that children who seemed to have attached well as infants begin to display symptoms of attachment problems as toddlers, preschoolers, or in elementary school. As they grow older, new inappropriate behaviors, typically more extreme or excessive than developmentally normal, may indicate emerging unresolved attachment issues.

WHY DO POST-INSTITUTIONALIZED CHILDREN DEVELOP ATTACHMENT PROBLEMS?

For normal emotional development, babies need a primary caregiver who responds quickly, consistently and lovingly to their demands, so they learn that their needs for food, clean diapers, pain relief, etc will be met. Through these interactions, they develop trust and attachment. Babies need to feel that their world is safe and secure. The baby has an internal cycle of need-rage-relief-trust, which should be completed hundreds and hundreds of times. Babies also need a one-on-one interaction with a caring individual who cuddles, plays interactive games, sings and talks to them. They need to be touched, to receive and give smiles, and to get lots of eye contact from a loving caregiver. This consistent, constant, warm and playful interaction with the caregiver is how a baby learns to receive and to give love.

Orphanages cannot provide continuous individual one-on-one care. In many institutions, a succession of nurses give minimal physical care, changing diapers infrequently, occasionally washing the babies, and propping bottles so the babies feed themselves. Babies are left alone for long hours in their cribs. With a ratio of one caregiver to perhaps ten or twenty babies, she cannot attend to each infant when the baby cries from hunger, pain, and discomfort, or for attention. When she does not respond to crying, the babies never learn to trust that their demands will be met. Nor do they get the cuddling, baby games, baby talk, and other playful interaction they need.. As a result, babies may give up trying to get their needs met, and feel only the emotions of rage, helplessness, fear and shame, never developing the trust, and the sense that the world is safe and secure, that are essential for successful attachment.

BUT MY BABY BONDED RIGHT AWAY!

Internationally-adopted children are unattached when they first meet their new parents: after all, they are total strangers! The child initially regards the new parent as a yet another caregiver. Children who were already attached to a caregiver will be distressed at being handed over. They will grieve for days, weeks and even months, acting withdrawn and passive, or endlessly crying, or furiously angry. A child who shows no feelings of loss but is happy and smiling from the start may actually have significant attachment problems. A baby who clings desperately to the new mom, and shrieks when separated for a moment, is not instantly bonded, but terrified. It is a trauma bond necessary for survival. Most internationally-adopted children resolve their grief, and gradually and successfully bond with their new parents. Within a few days, the baby or toddler usually shows a preference for mom and dad, has good eye contact, and accepts caresses and comfort. Even unattached babies often learn to love within a few weeks and months, with the care and attention of a loving family.

RECOGNIZING ATTACHMENT PROBLEMS

If a baby continues to refuses to make eye contact or interact with parents, and has no preference for them; dislikes being held and cuddled; does not hold on when held; never cries, even when soiled, hungry or in pain, or cries all the time and throws terrible tantrums; continues to be totally clingy (the velcro baby) and fearful of separation; has severe sleep problems; and self-injuring repetitive behaviors, the parents usually recognize that their child has attachment problems, and seek help. Parents who adopt older children also recognize attachment problems quickly, as they are generally educated beforehand about the known risks of attachment problems in older-child adoptions, and the symptoms of Reactive Attachment Disorder in school-age children are well-known.

The post-institutionalized children who do not get the help they need with attachment problems are those whose symptoms are not obvious from the start. They seem to attach well, but gradually show more and more symptoms as they grow older. When they are toddlers, many parents fail to recognize signs of Reactive Attachment Disorder, as the behaviors are often typical of normal toddlers. But when these children become preschoolers, and still misbehave like toddlers, their parents become concerned. Typically, parents have an instinctive gut feeling that something is very wrong with their child. Yet they, and the pediatricians, social workers, psychologists and counselors they consult, often misdiagnose the problem as Attention Deficient Hyperactivity Disorder, Oppositional-Defiant Disorder, autism etc. and turn to treatments and therapies that are not effective. One reason they do not consider Reactive Attachment Disorder is that children age two to five do not exhibit most of the symptoms recognized in school-age children. Another is that often the child appears well behaved and affectionate to others, reserving the misbehavior for Mom alone.

SYMPTOMS OF REACTIVE ATTACHMENT DISORDER

Symptoms of Reactive Attachment Disorder in toddlers and preschoolers include toddler behaviors that are more intense and persistent than in normal toddlers:

frequent, out-of-control tantrums. Unusually defiant and disobedient. Flies into a rage for the least little thing. Deliberately soils in inappropriate places. Destructive of property. Normal methods of discipline are ineffective.
the "velcro kid", unwilling to be separated from Mom for any time at all. Cries incessantly when parted, insists on keeping Mom in sight at all times. Scared to go to sleep alone at night, and wakes in the night to check on whether Mom is there.
needs to control Mom at all times. This can be achieved in many ways:

abnormally active toddler, constantly on the go. This risk-taking hyperactivity is intended to keep her constantly vigilant and at his side. A nightmare to take shopping, to a restaurant etc
disruptive when Mom is on the phone or talking to other adults, very jealous of attention to other siblings. Will whine, cling, hit, chatter, to monopolize Mom's attention - again, insecure or anxious attachment.
refuses to cooperate or excessively demanding with eating, going to the toilet, dressing etc. Refuses to eat meals or most foods. Demands food or drink frequently, wants Mom to accompany bathroom visits, wipe and wash hands, etc.
inability to play alone, insists that mother or other family member plays or interacts with him or her at all times
demands affection on his or her terms - asks repeatedly for hugs, tells Mom, "I love you" endlessly.
persistent nonsense chatter

All of these behaviors eventually result in the parents' limiting or curtailing any outings or social contact involving the child. Other behaviors that parents of normally-attached children would find worrisome are:

dislikes being cuddled and kissed, refuses to give eye contact, wriggles and gets down from Mom's lap when held
inappropriately affectionate and trusting behavior towards visitors and strangers.
excessive, intense hostility, jealousy and violence towards siblings and pets, especially when competing for Mom's attention.
lack of affect - remote and detached, with flat emotions.

WHY DO THESE CHILDREN BEHAVE LIKE THIS?

They feel shame, that they were unwanted by their birthmothers, and believe they must have been bad or defective to be rejected and abandoned. The lack of loving attention in the orphanage only reinforces that shame. They remain convinced that they will eventually be "thrown out" again, for being bad. These children usually feel anger towards their birthmother and birth family, for abandoning them. Their anger towards their adoptive mothers is actually directed at their birthmothers: they have not differentiated them. They may also feel anger towards the orphanage caregivers for the neglect and abuse they endured, and towards the adoptive parents for not rescuing them sooner. They may even feel anger about being removed from their country of origin. They are not convinced that they are really loved, and that they are permanently part of the family. To protect themselves from being hurt again by the loss of love, they may reject parents' attempts to attach, and use distancing behaviors, refusing to interact or communicate with parents. Children with insecure or anxious attachment often believe that if Mom did not give her full attention, she does not love them. If she is absent, or paying someone else attention, she has stopped loving them. Deprived in the orphanages of the constant care they needed, these children do not trust adults to meet their needs; they felt responsible for their own survival. So these children lack trust, and need to be in control at all times.

There are, of course, other causes of atypical behaviors, such as other mental illnesses, Post-Traumatic Stress Disorder, Sensory Processing Dysfunction etc -- many arising from the same early deprivation, neglect and abuse that causes attachment problems. But if a child does have Reactive Attachment Disorder, whether mild or serious, none of the therapies for other mental illnesses or learning disorders will be effective. The underlying cause remains, and behavior will very likely worsen. There are specific therapies which work for attachment disorder, both for the child and for the family. But they are most effective when the child is young. The sooner these hurt children get appropriate therapies, the more rapidly they will heal, developing the capacity to give and receive love, learning to trust, and coming to see themselves as loveable and worthwhile individuals.

Cultural Competence Scale

Tue, 31 Jul 2007 10:02:01 GMT

I developed this scale as a tool for group discussion, to raise awareness of the issue of parents' cultural competence.� It is based on the writings of Jane Brown, Beth Hall and Gail Steinberg, and all the adult adoptees from Korea and Vietnam writing online.�

�

Cultural competence scale

for Caucasian families with a transracial international adoption

�

negative�� Parent raises child in racist atmosphere, with racist comments and actions, normally against blacks, but also supports racist jokes and comments about child's own race.�

�

0�� Assumes child will "pass" as a white child.�� Ignores child's racial identity.� Believes racism will not affect his or her child.� Provides no toys, books, decor of the child's heritage or race.�

�

�� 5 �� Acknowledges the child's race, and provides minimal identifying materials in home, confined to child's bedroom.� Visitors see nothing of the child's heritage in the home.�

��

10�� Parents attempt to learn a little about their child's country; buy books, music and videos, to study at home, before they adopt their child, but stop after the adoption. Parent buys child same-race dolls, buys storybooks about child's country, plays ethnic music, incorporates it into home decor.� Parent attends festivals organized by Caucasian adoptive parents where child is dressed up in ethnic costume.� Parent socializes with adoptive families with children from the same country.�

�

�� 25�� Parents send child alone to language classes, and cultural classes, but do not participate themselves.

��

�� 50�� Parents are aware of the need to promote a positive racial identity. Whole family attempts to learn language, attend cultural classes, joins support group activities involving child's country, attends community events held by child's racial group.� Parents buy videos and books about successful Americans of child's race.� Parents take family to annual heritage camp.� Parents plan a homeland visit with child.� Parents teach children history of their homeland and their race in America. Family tries to befriend children and families of the same race as their child, especially in public places.

�

60�� Parents recognize importance of multi-cultural competence, fill home with toys, books and music of all races, not just child's race.� Children from Asia, for instance, get Black and Latino dolls, stories about black children, black music.� They encourage their child to see their specific country as part of a wider Asian, Hispanic, or South Asian culture.� Parents invite children of all races into the home for birthday parties, play dates.� They socialize with all kinds of transracial adoptive families, including African-American families. �They choose shopping malls, playgrounds, vacation locations, etc which are most multiracial. Parents take child to multicultural events, such as Dwali, Kwanzaa, Cinch de Mayo etc.��

�

�� 75�� Parents teach selves deliberately about race issues, attend seminars, read books on the issue, etc.� Parents actively seek positive role models for their children, the successful adults of their child's race in the community.� Parents choose professionals like doctors and dentists based on race.� They create genuine, personal friendships with same-race families, who are invited to the home, or stay in home as exchange students.�� They seek out adult adoptees from child's country as positive role models.� Parents actively teach child how to deal with racism.� They groom children and teach them manners to ensure approval in ethnic community.

�

90�� Parents take their child's race into account when making major life choices; they� deliberately select a multi-cultural neighborhood and schools (provided these meet other requirements such as safety and academic standards)�� They are willing to� move house, even change jobs to insure that their child's experiences growing up are as positive as possible.� May live in child's country for a time.

�

Harry Potter, Asian-American Living, and Raising Our Children with Culture(s)

Tue, 31 Jul 2007 10:02:30 GMT

In the second Harry Potter movie, Harry Potter and the Chamber of Secrets, there is a stark contrast between the home in which Harry grew up-the mainstream Muggle or non-magic home of orphaned Harry's aunt and uncle, in which Harry is locked in his room and punished for having magical powers-and the home of his best friend, Ron Weasley. �In Ron's home, magic is an integral part of the family's daily life. After Ron and his brothers rescue Harry from his aunt and uncle's home, the look on Harry's face is one of absolute wonder as he walks into the Weasley home for the first time and sees a pot washing itself magically in the sink, a sweater magically knitting itself, and a grandfather clock with magical moving pictures of all the Weasley children on its hands. The Weasleys do not take notice of these details, because magic is not a big deal for them. It is all around them. However, for Harry, it is the first time that he has ever seen a home in which the inherited attributes that make him different-the magical abilities that are his cultural and familial legacy-are incorporated into everyday life, displayed right out in the open without shame or embarrassment.

I experienced a similar moment when I was about the same age as Harry Potter and realized for the first time that my Chinese heritage and culture-which I downplayed in public-could be integrated with a holiday so intrinsically American as Thanksgiving. Before then, my mother had always tried to cook an American turkey dinner for us every Thanksgiving, but since she infrequently cooked American food, it was always miserable: frozen turkey meatloaf, mashed potatoes from a box, packet gravy, iceberg lettuce salad with Thousand Island dressing. Then one year we were invited to our neighbor's home for Thanksgiving. Third-generation Japanese Americans from Hawaii, the Shigematsus loaded their table with both Japanese and American food, side by side. There was a turkey glazed with teriyaki sauce right next to a big platter of sushi; there were mashed potatoes with garlic, sweet potato tempura, green beans with shiitake mushrooms, and many cakes and pies.

It had never before occurred to my family that we could serve Asian food on Thanksgiving, or combine our Chinese heritage or culture with our American lives. Previously, we had our Chinese home life and our American public life, our Chinese selves and our American selves. We had believed these were necessarily distinct, perhaps incompatible, even oppositional until that Thanksgiving - one of the best we have ever had.

It took many more years for this germ of an idea to mature, and even longer for me to believe in it enough to try to live it myself. Despite the mainstream's ignorance and bias and unrelenting brainwashing, I slowly came to realize that one could indeed be both Chinese and American without having to choose, that Chinese-American culture is actually an important part of American culture, and that people of Chinese ancestry - both here and abroad - have played an important part in the shaping of American and world history. We do not have to hide or apologize for our "Chinese-ness" or difference any more. Rather, we can incorporate "our magic" into our daily lives, and show our children what Asian-American Multicultural Living really is.

�

Where I'm Coming From

I was born and raised in California, which is now a no-majority state, but it was not always like that. My parents came to America in 1964-one year before immigration opened up to Asians-and I was born soon after. My dad was one of the first five Chinese students to attend Cal State Northridge-so special that they were all invited to the dean's house for Christmas. Los Angeles did not even have a Mandarin Chinese school, if you can imagine.

Most of my parents' friends also came on student visas and did not rush to have kids, so I knew few Chinese Americans my age (there was not really a sense of "Asian Americanness" yet). In school, I was always the only one. My friends were Cuban, Puerto Rican, Mexican, Thai, Brazilian, Italian, and Irish. Many were second-generation and bilingual like myself, but we rarely recognized these commonalities. Rather, we shared the "American culture" projected into our homes on television shows like "Happy Days" and "Welcome Back Kotter," and an understanding that that America was the real one and the America we lived every day was not. We played with blond Barbie and Ken dolls, and we knew that in order to be beautiful, one had to be blond, by definition, even though such beauty eluded and excluded all of us.

My family spoke Chinese at home, ate Chinese food, and our family friends were all Chinese, but I was not explicitly taught about Chinese culture and traditions. We never celebrated any Chinese holidays or festivals. At school, all I ever learned about China or Chinese Americans was that the Chinese built the Transcontinental Railroad in the 1800s, nothing to do with me. So although I knew that we weren't "American," I did not fully know what it meant to be Chinese, either, let alone Chinese American. Older folks complained that I was too Americanized-I talked too much, argued too much, was too tall, and would never find a Nice Chinese Boy willing to marry me.

Not "Chinese enough" for Chinese, not "American enough" for Americans, I could never figure out what I was doing wrong.

�

Goals of Asian-American Multicultural Living

I always knew that when I was a parent, I would raise my children someplace where they would not be minorities. I did not want them to have the same struggles that I did as "the only one."� They should not have to wrestle with confusions about who they are, what they are, and where they fit in, but should be able to move forward to more important things.

I expect progress.

However, despite my well-crafted plans, I ended up living in the Midwest. I live in Michigan, where I often find myself not only the sole Chinese person in the room, but also the only person of color, the only bilingual person, and the only person who has a sense of her family's immigration history. I live where people ask me questions "Where are you from?" and "Where did you learn to speak English so well?" I live a short distance from where Vincent Chin was killed.

Knowing from my own experience and from my work in Asian American media how difficult it can be growing up as a minority in America, I could not leave it to chance that my kids would make it through unscathed. Out of necessity, I began to work very hard to proactively create a multicultural community and environment around them. Because I have surrounded them with many types of people-Chinese, Indian, Vietnamese, Korean, African American, Native American, hapa, etc.-my girls do not yet know that they are minorities. Images of people like them are reflected in their books, dolls, videos, and television-watching. They think it is normal to be bilingual because everyone they know speaks another language-Italian, Hebrew, Korean, Vietnamese-not just the Chinese people. They comfortably switch back and forth between cultures and languages, and know the "real world" is larger than our small Michigan town. With a strong sense of self and ethnic pride, they are surprised rather than crushed to encounter racist stereotypes and discrimination. They laugh, "How come those people do not know what Chinese people are really like?" Most important, we talk about issues of culture, race, ethnicity, and difference so that they know these are questions they can discuss with me.

My goals in child-rearing, in writing, and myself are pretty much the same:

1.�� Provide a firm grounding in Chinese culture so they know where they came from, and can better understand and gain strength from our family, our culture, our history.

2.�� Help them develop a strong sense of identity and self-esteem as Chinese Americans and Asian Americans by teaching them about Asian-American culture and history so they know that they belong here; and by surrounding them with positive Asian and multiracial images so that they know that they are normal.

3.�� Extend that understanding and compassion to others because America is a multicultural place, and the world is vast with many interesting peoples and many different cultures. They will have a richer understanding of life if they can see the similarities among different peoples and learn from all people.

I hope to help my children develop what Dr. Purnima Mehta, an Indian American psychoanalyst with the Michigan Psychoanalytic Institute, calls a "Bicultural identity." She writes that second-generation Indian American children become "culture-wise" in the same way that poor urban children become "street-wise." They "learn to negotiate between the contrasting American and Indian worlds by calling upon different models of behavior in different settings," Dr. Mehta argues, and how to switch between these dual cultures in terms of language, mannerisms, cultural norms; and they become more flexible and able to adapt to both cultures. They are proud to be part of both cultures and do not feel constricted by them. For example, they understand that when an Indian person says dinner starts at 7, they really mean 8; but when an American says dinner starts at 7, they mean 7. The Indian person is not wrong or bad -- meaning just extends beyond words to include points of cultural understanding.

�

Asian-American Multicultural Living as a Lifestyle Choice

Asian-American Multicultural Living is a lifestyle choice of how we want to live our lives and raise our children. It is a way of thinking about our choices and our compromises with an eye to culture and ethnic identity.

As a lifestyle choice, this is similar to the way that recycling and being environmentally responsible becomes a lifestyle choice. It is a bother to wash out all the bottles and cans, and it takes time to sort the paper and the boxboard, but you do it because it is the right thing to do. Besides, after you get into the habit, it is not so bad. Then, once you start thinking about it, it begins to color more and more of your every day choices. You begin to reuse computer paper or grocery bags, buy the more expensive recycled paper, start a compost pile, buy organic produce, donate money to the Sierra Club, etc. Different people recycle to different degrees, depending on how important it is relative to other concerns.

Further, as more people begin to recycle, it begins to affect society as a whole. In the early days, when people had to drop off their recyclables at a special collection spot, only Boy Scouts and whole-grain college students would bother. Gradually, though, recycling became "normalized" to the point where society and government made it a priority, funded it, and now they come and pick up the recycling every week. Now even my parents recycle. The government incentivizes the lifestyle because they (or we) realize that it contributes to the broader social and community good. The same could be said of multiculturalism. The more children are full of self-esteem, and have respect for and knowledge about others, the better off society will be.

I do not believe that teaching children about their cultural heritage is something optional that we can do at the end of the day after we have finished teaching them all the "important things" like playing piano, math, science, buckling their seatbelts, and going to Girl Scouts. If you do that, either you will never get to it, or else it becomes compartmentalized into a once-a-year show-and-tell at Lunar New Year. Rather, it needs to be incorporated into daily life (like joining the Nikkei Girl Scout troop at the Buddhist Temple instead of the Girl Scout troop at school).

�

Don't Give in to Muggles

After the Weasleys rescue Harry Potter from his horrible Muggle relatives in Harry Potter and the Chamber of Secrets, they go to Diagon Alley to purchase school supplies. There, they run into classmate Hermione Granger and her parents, who we discover are both Muggles, or people without magical abilities. Nevertheless, her parents value and are proud of her magical abilities. Somehow, perhaps because of this sensitivity, they can even enter the magic realm themselves. They show Harry another way to participate in both worlds without having to deny a part of himself.

Similarly, there are many ways that we can incorporate the "magic" of our cultural heritage into our Asian American lives. We do not have to segregate our private and public lives anymore. We can instead meld them into true multicultural living, both for our children's sake and for our own.

�

�This article originally published at IMDiversity.com Asian American Village. Published here by permission of the author. Contact author for reprint requests.

On Raising Bilingual and Multilingual Children

Tue, 31 Jul 2007 10:14:16 GMT

When my first child was born, I spoke to her in Mandarin Chinese. It felt very natural-the language in which I had been mothered, so I knew how to talk to babies in Chinese. I was so proud when my daughter's first words were in Chinese. However, people had always generally regarded me with wonder, as an anomaly, upon discovering that I was American-born and Chinese-fluent. If that was already a miracle, what were the chances that my third-generation multiracial children would also be able to speak Chinese well? I figured the best that I could do was to hard-wire the language into their brains while they were young so that after they forgot everything, they would still be able to learn it later in college and not have an accent.

Then I read about a couple in Australia where the father had spoken to the child only in college-learned German. Amazingly, without any German community or television or relatives, the child grew up fluent. Certainly, then, I should be able to teach my child the language I learned from my parents. Right?

With renewed enthusiasm, I began to ask everyone I met what they were doing to teach their children their language. I asked Indian, Korean, Japanese, Chinese, Taiwanese, Filipino, Italian, Swiss, Spanish, Greek, and French friends. I asked parents of young and grown children as well as grown children themselves. I asked language teachers, read books and articles. I asked first, second, and third generation people. Here are some of the lessons I have gleaned from this research, along with some practical tricks to help those of us second-and third-generation Asian Americans with more limited language skills (despite years of language school and endless lectures from our parents).

Lesson 1: Just Talk that Talk

"The most important thing," says Mei Wu, a Chinese language teacher at the International School of the Penninsula in Palo Alto, "is to just talk to them." The kids need to hear the language on a daily basis. Relying on occasional visits to grandparents may not be enough (unless they live with you or babysit every day). Do not worry about how good or bad your command of the language is (it will improve as you use it), or if you have an accent. Just speak so that the children can hear it. You can always supplement with videos, cassettes, relatives, and friends to compensate for your shortcomings.

If your spouse does not already speak the language, make your spouse learn it. If your spouse insists that it is too hard, s/he should at least understand key baby words (milk, rice, potty, ouchie, smelly, etc.) in order to know what the children are saying and feeling (as well as when the in-laws are making fun of him/her). This prevents having to switch to English every time your spouse is present. My husband started learning Chinese alongside the children, but he has no talent for languages and they surpassed him within days of uttering their first words. He is, however, able to follow what a conversation is about without knowing exactly what each word means (especially when it is about him). The children also really enjoy teaching him new Chinese words, and they are thrilled (and very surprised) when he says a Chinese word correctly.

Make a point of finding other people to speak to them-grandparents, great grandparents, aunts and uncles, neighbors, daycare providers, housekeepers, teachers, classmates' parents, etc. The kids should hear many different accents and vocabulary choices to realize that the language has relevance and sub-contexts, as well as for conversational practice. My girls know that when they see a Chinese "auntie" they must say in Chinese "How are you, Auntie," and "Good-bye, Auntie." The aunties then invariably say, "Good girl," which is great for positive reinforcement. (One hitch is that they cannot always tell the different Asian ethnicities apart, so they sometimes speak Chinese to the Thai restaurant owner and the Japanese American Buddhist minister, who usually respond in the one or two Chinese words they know, or else teach the girls something new in Thai or Japanese.)

Be sure that these people know they should speak to your kids in the target language. Many people will defer to English, which they know the children understand, especially with multiracial children. Or they just forget. When my parents speak to my children in Chinese, the kids often respond in English, then my parents forget to switch back to Chinese and simply continue in English. So I tell the kids (loudly), "Remember to speak to your grandparents in Chinese." Hearing this subtly reminds my parents to switch back into Chinese.

Lesson 2: Start Young and Work on Your Own Skills

It is also important to start young. Early language development studies show that children need to hear the language by the time they are 6 months old to ever have the possibility of being able to speak it without an accent. Hearing multiple languages actually creates additional neural pathways in the brain. Other studies claim that two or three years is the age by which the hard-wiring of the brain is complete.

Another important reason to start young is that it gives you two years to practice and improve your language skills before the kids get a chance to talk back. At two years of age, they will start asking you 101 consecutive "Why" questions. At four years, those "Why" questions become really sophisticated and science-related. I often find I simply do not have the vocabulary to handle "Why is Pluto the farthest planet," or "How did the first chicken come," or "What happens when people die?" I can barely explain these things in English! Mabel Wai of Hillsborough, California, said that it was easy to talk to her daughter in Cantonese when she was a baby and did not talk back, but when her daughter turned four, the questions became so hard that she had trouble concentrating on her driving and answering in Cantonese at the same time and nearly crashed the car more than once.

Starting at birth also gives you time to make speaking your language to the children habitual. Before my children were born, I only ever spoke Chinese at my parents' home. At first it felt strange to speak Chinese all the time, especially in public, but it is a habit as much as anything else that needs to practice to become ingrained. Now it feels more natural to speak Chinese to the children than speaking English to them. In fact, I often speak to other people's children and the dog in Chinese, now, too, much to the amusement of any onlookers.

Lesson 3: School, Tutoring, Travel, and Other Training

Enroll them in language schools, or schools where the language is spoken, starting as young as day care. I used to send my children to the only Chinese day care in our town, even though it was on the opposite side of town, so that they would hear more Mandarin. It also gives them a space to play with other children like them and to learn cultural activities.

Language schooling can range from Saturday language schools to after-school language programs, from private tutorials to dual language immersion schools (both public and private) and summer camps. As these programs may not be listed in the yellow pages, ask people in your area about available resources (I always find out everything I need to know from the Chinese hairdresser and the Chinese grocery store owner). If local resources are limited, ask relatives around the country what is available in their area and if you can come visit for the summer. I spent this past summer living at my mother's house in California and commuting two hours a day, five days a week, so that my children could attend a dual language immersion summer school. It was hard, but their language improved significantly.

If you can, take the children to travel and study abroad. Kaori Ohara of Ann Arbor, Michigan, a Chinese woman from Taiwan raised in Japan, takes her children to Japan for two months every summer and enrolls them in the regular public school, and then goes to Taiwan for a month and enrolls them in the regular schools there. She started when they were daycare age, and now all three children are completely fluent in Chinese, Japanese, and English. The kids even speak to each other in Japanese-something I have never before seen in American-born siblings.

Remember, however, that language school alone will not be enough, especially if it meets only once a week. (How much of that high school French do you remember?) It is up to you to practice the songs, lessons, words, and homework throughout the week with your child (and not just the night before the homework is due). We have Chinese words written on Post-It notes all over our kitchen that we review at breakfast, and we sing the week's song or finger rhyme when we take walks and before bed every night.

One last note for now: As much as you may have dreaded language school when you were a child, and as hard as their homework may be for you now, try not to let it show. The children will pick up on any ambivalence you may have and will quickly start whining, "Chinese School homework is too hard." And you remember what that's like.

Favorite APA Heritage Books for Kids

Tue, 31 Jul 2007 10:19:14 GMT

For Asian Pacific American Heritage Month, I wanted to share my all-time favorite Asian Pacific American (APA) children's picture books. These books deal with a range of issues that face many of our APA children and their friends-celebrating Lunar New Year with our multicultural and multiracial families, celebrating Divali far away from family (and in the snow), encountering poverty and homelessness (and non-model minority) Asian Pacific Americans, embarrassment over grandparents who do not speak English and wear traditional clothing, and whether or not to Americanize our "weird" names that "nobody" can pronounce. Regardless of the specific ethnicities of the characters in the books, these issues can affect all our APA children. These books are great not only for our children, but also for our children's peers who may not have thought much about these issues before. Buy two today-one for you and one for your child's classroom or school library!

Dumpling Soup By Jama Kim Rattigan Illustrated by Lillian Hsu-Flanders Little, Brown and Company Boston, 1993 Ages 4-8 1990 New Voices New World Award

A delightful story about a (mostly) Korean-American family in Hawaii celebrating the Lunar New Year with a huge family reunion, fireworks at midnight, and an Asian Pacific American feast. Seven year old Marisa is finally old enough to help the Yang family women make dumplings or mandoo, but the dumplings she makes are a little lumpy and she worries about them not being good enough for the family. Grandma to the rescue. The family is enormous and multicultural, with Japanese, Chinese, Hawaiian, and haole cousins, all playing side by side. The food is mouthwatering and pan-Asian, including sushi, mochi-zuki, kimchi, roast pork, boiled tripe, octopus, spicy seaweed, and sticky new year's cake. Many Asian American families will be able to find themselves in this story of love, family, and food. At least two Chinese American children I know (mine, ages 2 and 3) have been inspired by this book to learn how to make dumplings.

Sam and the Lucky Money By Karen Chinn Illustrated by Cornelius Van Wright and Ying-Hwa Hu Lee and Low Books New York, 1995 Ages 4-8 American Book Seller Pick of Lists Award

A wonderful story with a socially conscious message that helps children realize the value of all that they have. Sam is excited to receive his red envelopes of money for Chinese New Year, until he goes to Chinatown with his mother to spend it. They go into a vegetable stand, a bakery, a toy store, and also see the fireworks and lion dance of the New Year. He becomes angry when he finds he cannot buy very much with four dollars. Then he meets a homeless Chinese man with no shoes in the middle of winter, and he gives away his red envelopes so that the man can at least buy some socks. The appearance of a homeless person in Chinatown makes this book uniquely Asian American, dealing with a theme not often found in children's books. Young children can easily relate to having cold hands and cold feet in the wintertime. It also puts the value of the much-treasured red envelopes into perspective. It opens up a discussion for how lucky our children are to have family, home, and basic necessities like socks and shoes.

Halmoni and the Picnic By Sook-Nyul Choi Karen Dugan (Illustrator) Houghton Mifflin, 1993 Ages 4-8

Yunmi's grandmother, Halmoni, has just come to New York City from Korea to help watch Yunmi while her parents are at work. When Yunmi's friends volunteer Halmoni to chaperone the class picnic, Yunmi worries that her other classmates may make fun of Halmoni's inability to speak English, her traditional hanbok and pointy shoes, or the kimbap she brings to the picnic to share. Many Asian Pacific American children will be able to relate to these worries of how the foreignness of their loved ones will be perceived by others. Halmoni also offers a fuller picture of immigrants (that some of our legislators could benefit from seeing, too)-Yunmi's grandmother is not just some old lady, she had a life before she came to America-she was a respected teacher in Korea-and her difficulties learning American culture and English language are not because she is not smart, but because they are complicated.

The Name Jar By Yangsook Choi (author and illustrator) Dragonfly Books, 2003 Ages 4-8

Unhei has just come to America from Korea, and on her first day of school, she is teased on the bus for her Korean name. She decides that she needs to find a more American sounding name, and her classmates try to help her by putting name suggestions into a big glass jar. In the end, she decides that her Korean name, which means "grace," fits her just fine, and she teaches her classmates how to pronounce it correctly. At the same time, a Caucasian classmate also decides to take on a Korean name, too, meaning "friend." This is a story that will resonate with many APA children (especially those not named David or Grace Lee) as well as their friends and classmates as they take pride in their unique names and heritage. As I tell my own children, "That's not a weird name, just one you're not used to. If you lived in Korea or India, 'Ashley' would be a weird name that no one could pronounce."

Lights for Gita By Rachna Gilmore Alice Priestley (Illustrator) Tilbury House Publishers, 2000 Ages 4-8

Gita and her family have just moved far away from all their family, from India to Canada. It is time for the Hindu festival, Divali, a harvest festival of light and family and best of all, fireworks. However, Divali in Canada (in November) is not the warm outdoor holiday it is in India, especially as a huge ice storm hits. Gita is disappointed as her friends cancel their visits and Papa cancels the fireworks, but Mummy shows her that the true meaning of the holiday lies beyond fireworks. This story shows how we can celebrate and adapt our Asian holidays in North America, even in the middle of an ice storm. Asian Pacific American families finding themselves in snow country will appreciate this book.

This article originally appeared at IMDiversity.com Asian American Village. Article is reprinted here by permission of the author. Please contact author for reprint information.

My Experiences with Lifebooks

Tue, 31 Jul 2007 10:31:02 GMT

What is a lifebook?
Lifebooks are a wonderful narrative tool that parents and children can use to discuss the child's story, from when they were born, not just from when they joined a family. A lifebook is a concrete tool for meaningful conversation. It is as fact based as you can make it, and an honest and loving biography. It makes adoption everyday conversation
and allows us parents a structure for working through difficult material, both for us and for our children. It allows parents to honor ALL of their children's lives.every minute and everyone who has played a role. Most importantly, it allows control of the story (what, when and where to share) to the adoptee.

A lifebook works for a child from any adoptive circumstance: domestic infant placement, international infant placement, fostercare placement, older child adoption either domestically or internationally. It is the place to tell the story with truth and love.

Lifebook vs. Scrapbook
Many people have created beautiful travelogues about an adoption trip either domestically or abroad. But we as parents need to be careful that the story in this book is that of our children, not of us. Think of it as the "Book About Me", the "me" being your child.

Beth O'Malley details some key lifebook vs scrapbook differences in her book "Lifebooks, Creating a Treasure for the Adopted Child" and they include:

*The Lifebook always starts with the child's birth
*Talks about the birth mother and birth father
*Discusses the reasons why the child was adopted
*Lifebook pages revolve around information, scrapbooks, around images
*Lifebook is private, scrapbooks are shared

It's a great tool in the adoption parent's toolbox. But what if you are creatively challenged? Keep in mind it's the facts and the feelings that are important. And Center Stage is your child, not you.

Why do I need to do one?
What if I told you that this book will help you to use the tough words and process the tough thoughts surrounding how your child came into your family. Most of this stuff is going to be harder for you as a parent to work through than it is for your children. For them, the facts are their story. They live it everyday in the questions at school and the dreams and fantasy at night. Allowing your child ownership and control of their own narrative is a huge foundational building block in identity formation. And any additional fact or detail is like gold. For those with an unknown beginning, we parents need to look for clues and use those to help us understand what our children were like before they came to us. For those children come with more known information, this book is a place to keep it all together. Who wouldn't want a special book just about them?

Once you have laid out the facts in this book, read the words a few times and let yourself work through feelings you might be having. This will give you an increased comfort level for those adoption conversations. Our children pick up on those subtle non-verbal cues and the practice you can get building this book will really help on that front.

A lifebook helps to promote attachment - children will build trust that their parent can tolerate their pain from the past and help them work through it. This book allows your child to connect to their "baby-self" and understand that all babies are made to be loved and cared for. This connection will help to create positive cultural and personal identity. Since the book is factual, it is a wonderful way to confront fantasy with the reality as we know it. And the biggest benefit? Front load the emotions and feelings for adolescence. It is much easier to do the work on emotions with your child before all the extra layers with hormones kick in.

What form should it take?
The choices are as varied as the people creating it. It's up to parent and child to decide. Each child will have different needs and the parent has different skills. The best thing you can do is to just get started, regardless of how you do it.

* Quality level can vary depending on your skills. You don't have to be a scrapbooker to make one of these. If you have a computer and a printer, you are in business.

* Have two sets for stains and anger (or save to a disk so you can reprint easily)

* Make sure that all the information is from the perspective of the child

* Make it flexible to be able to accommodate new information and a growing child.

* Allow lots of space for personalizing by your child, drawings, words and decorations.

(I have personally used a top loading presentation folder available at office supply stores. It allows for easy updating as our children's awareness and understanding grows around adoption issues. )

What I personally have done
In my seminars on lifebooks, I usually ask for a show of hands for these next questions. So how many of you know what a lifebook is? (usually everyone in the room holds up their hands) How many would like to create a lifebook for their child? (A few less hold up their hands) How many of you have actually made one for your children? That number is usually significantly lower. Generally I can count them on one hand. If you are one of those who didn't raise your hand on the last question, there is still hope for you, read on.

First a caveat, every family and child is different and will have different needs. This is what has worked for us. Your experience may be different.

We have used a "baby lifebook" one with just photos of caregivers, orphanage and early together family shots. There are no words, I can change them depending on the mood of the child or the topic we are working on at the time. My youngest daughter was big into her baby lifebook when she was 4 (it lived under her bed and she often browsed the photos before bed.)

Basically, I am a procrastinator. We talk adoption issues in our house, have dealt with loss and gain and still, I hadn't found the right time to sit down and put together "the book." It seemed too daunting a task. For some reason, the timing never seemed to be right. Until my older daughter learned to read and write. She came home from school one day and her teacher had told her that perhaps she should write books like her mom. Bingo. What better story than one about her?

I spent about 5 hours piecing together her "Just the Facts" story, with all the stuff I had tossed in what I like to call my lifebox. The place I toss all the stuff that I feel is important and related to the lifebook. I have discovered that lots of others use this box system as well.. I used a combination of Beth O'Malley, Cindy Probst and Jean MacLeod's book At Home in This World (hint, there are some great ideas in that book!) (Beth's book is a hands on, idea driven book. Cindy's is more introspective and a workbook for the parent, both were helpful to me.) Then I dug into the collection of clues I had been saving for the day I started the book. The weather on the day given to her as her birthday, notes from her foster family, photos of the orphanage and foster family, photos of the city she was from courtesy of Asia Threads, facts about her country of origin. As part of many of the pages, I put open ended questions ripe for discussion and my daughter's input. That is where we started. It all started in a page layout program on the computer.

Part B of her lifebook was entering her thoughts and feelings about the facts of her life as we know them. Each time we read her lifebook together, there are things she wants to add. The computer makes it so easy. I save the last file and modify a new one so at some time we can see how she evolved in her understanding. For us, this is an evolving tool that she has ownership and control over. Since she likes to write, I would guess that this might turn into a journal at some point. The evolution is in her control and has been wonderful to watch. For your family, one book might be the ticket. For us, the evolution has been so powerful. You as a parent know your child best.

To see the starting point (the "Just the Facts" story I wrote to get the ball rolling), I have saved it as a .pdf file available for downloading on our website. Head here http://www.emkpress.com/ugdownload.html. My daughter has graciously allowed others to see the beginning of her story so other moms and dads can make one for their children as well. Private information has been removed, as that is owned by her. She thinks that everyone needs a book about them and hopes that this will help moms and dads get started on a book for their child.

� 2005-2007 Carrie Kitze

For more information on lifebooks and using narratives to help your children navigate their feelings about adoption, visit http://www.emkpress.com/ugdownload.html
there is a section and examples of a baby lifebook and a lifebook with words.

'Adopting' an Agency

Tue, 31 Jul 2007 10:33:47 GMT

How does the average couple or single person find an agency to work with or a specialist who can help them on the path of building or enlarging a family through adoption? Are there good ways to find the best people to help you on this most important journey?� Does bringing a child into the family always entail risk?� How do you know if the people working in an agency are honest and ethical?� Anyone starting out on the adoption process might want to consider these and other important issues.

Finding an agency

At one time most people got the names of adoption agencies from friends, acquaintances and the Yellow Pages.� While word-of-mouth is still a popular way to find a good agency, the Internet is now the most widely used tool for exploring adoption. In the blink of an eye, search engines can lead you to information about hundreds of agencies all over the country.� Appealing websites with photos of beautiful babies attract those who are exploring. Websites are sometimes designed by high tech marketing specialists who know very little about adoption but who know how to sell.� Keep this in mind when you are browsing an agency site.� Read the content - there is a lot of excellent information that is easily accessible on websites.� For better and worse, the internet is here to stay and we need to concentrate on the things that will educate us and help us make good choices.�

Obtain information

When possible to do so, attend an agency information meeting or talk with the people who will be helping you through the process.� Don't be afraid to ask lots of questions.� Adopting a child is one of the most important decisions you will ever make and you don't want to look back and wish that you had asked more questions before starting the process.� Make sure that the agency you're thinking of using takes the time to explain things to you. If they don't take this time before you are a client, there's a pretty good chance that you'll be treated the same way once you've started the process with them.�

Adoptive parent references

Talk with several people who have adopted a child through an agency that you are considering.� Find out what their experience has been - the highlights as well as the low points in their process. The adoption process often has difficult challenges. A birth mother can change her mind about relinquishing her child, time frames can suddenly change in any given country, country fees can unexpectedly increase - and unforeseen legal and medical issues can arise.� In other words, although many people go through the process smoothly, you need to be prepared for the unexpected. Adoptive parents often encounter some bump in the road during their adoption journey. Although these difficulties are often minor, it is important to know if the agency they chose tried to help and were supportive during those times.

Ethics

How do you know if you are selecting an agency that is ethical and honest?� Check with people who have done an adoption through them. Read their mission statement.� Are they doing this work to help children or to find a child for you?� If the answer you get is the latter, be wary.� Such a motivation can easily lead to unethical practices and serious problems later on.� You want to work with an agency that is truly committed to the welfare of children.�

Fees

Make sure the fees charged are in the same ballpark range as other agencies.� There will be some differences between agencies regarding fees.� Overhead costs differ and some agencies have a larger staff and provide more services than other agencies.� But if the agency you are considering charges fees well under or well over what other agencies charge, be concerned. The work involved in adoption happens over time.� You should never be asked to pay the majority of the fees at the beginning of the process.

Knowing how you feel

Most importantly, listen to your instincts and take your time. Don't start the process because someone else is pressuring you to do it. If you are uncomfortable, do not proceed.� Keep exploring until you feel good about the choices you are making.� No one knows how you feel as well as you do. Adoption is a wonderful option for the right people, but it may simply be too difficult and risky for some.� Make sure that you are right for this process and that you have confidence in the people who will help you bring a child into your life.�

Using I Don't Have Your Eyes

Tue, 31 Jul 2007 10:59:23 GMT

While the children's book I Don't Have Your Eyes was written for parents and children to create a loving connection, it also allows children who look different from each other in a school setting to look at outside differences, inside sameness.

Teaching that looking different on the outside is okay because we all have the same kinds of inside feelings is a powerful lesson for younger children. This exercise has been used in PreSchool, Kindergarten, 1st and 2nd grades. Additional copies of this guide are available for download at the emkpress.com website, click the teacher resources tab on the home page.

A Great Way to Use this Book.....Skin Color activity:
This can be done as a small group or a larger classroom size group
Also great for Brownie Try-it Caring and Sharing (#4 Differences are OK)
with special thanks to Deb Buckingham

Part 1
Collect some paint chips from a paint store in various shades of browns, tans, and off-whites. (Try to get 2" square chips if you can, it will make Part 2 and 3 work better.) The idea is to get as many shades as there may be of skin tones. Make sure you get extras so there is lots of choice for all the children. Or you can visit the EMK Press site and download some pages of them.

Get a copy of "I Don't Have Your Eyes" by Carrie Kitze. You will need to download the activity off the EMK Press website so you have the child outline and the color swatches to use for faces and hands. Print out the child outline on page two on cardstock for as many children as you have participating in the activity.

You will need scissors, crayons or markers to decorate the child outline, glue stick. Also, a sheet of black, red, yellow and white construction paper.

Part 2
Read the book to the class. Talk about outside looks and inside feelings. Make a list of what makes people the same and what makes them different on a chalkboard. The things that will be similar regardless of what someone looks like are feelings. Have the children discover how everyone has the same feelings when things happen to them..How do you feel if a friend leaves you out of a game? If you get a present? In a dark room with no one else?

Next, put out the solid sheets of construction paper. Ask the children: Are you black or are you white? Are you red or yellow? Talk about the words adults use to describe people aren't always accurate. Now give the children the paint chips and have them select the color of their choosing. Children compare the paint chips with the colors of their own skin in order to find their colors. The neat thing with paint chips is that they have such cool names and the children get to say things like "My skin is vanilla cream but yours is applewood".

Now compare the paint chips with the construction paper. Talk about the fact that many people describe human beings in terms of being black or white or yellow or brown or red but it appears from looking at the paint chips that all kinds of skin are shades of brown/tan. Some of them are very light brown and some are very dark.

Part 3
Cut the paint chip the child has selected into a circle and place on the face of the child outline. Have the child decorate the outline to look like them.

Some teachers like to hang these up as the hands go together and look like they are holding hands.

To download the graphics that go with this guide, visit the EMK Press

EMK Press (The Toolbox Press) offers resources and books for parents and children in families formed through adoption.

Building Love with Language - PART 1

Tue, 31 Jul 2007 11:31:26 GMT

Part 1: Language and the child adopted from abroad Read Part 2, Read Part 3

Medical experts with a special interest in intercountry adoption (ICA) tell us that in terms of our children's development, around one month's loss is experienced by our children for every three they are institutionalized or placed in non-optimal 1:1 care. And so when we receive our children, we should expect that at least initially, in terms of language development, they will be 'behind' children who have never been institutionalized and who remain in the language environment of their birth and pre-birth. Experts call this developmental language delay. All other developmental skills, from the physical to the social, may also lag. It's our job to ensure that we have our children assessed for language delays and language disorders as soon as we can. Experts advise speech and hearing 'tests' should form part of the battery of tests run to evaluate the health of our children on arrival to our country and into our homes. It is only by learning how we may mitigate language losses that we can be fully empowered to create communicative gains.

In looking at our children's language skills (and which of these require assistance), we need also to look at their communicative needs and skills. Children who have been institutionalized, perhaps with less than optimal nutrition, physical care and attention, may be affected both in terms of cognitive and social development. A child raised with poor nutrition, doesn't have the energy or material to develop the neurology of communication and speech because the brain has not developed as it should. A child raised with no special caregiver attending to physical and social needs gives up trying to be heard. A child raised with the trauma of separation from birthmother locked within, lacks the capacity to communicate because fear is the key to this child's existence, not communication.

In assessing our children's needs we have to face their history:

1. Environmental factors (e.g. factory emissions, lead levels) in the sending country also affect physical and cognitive development and have a possible effect on speech and cognitive capacity. Standard of care can affect health; a child doesn't thrive with environmentally-linked illnesses such as gut and respiratory problems, and a child who doesn't thrive physically most likely doesn't thrive across the whole spectrum of development.

2. An orphanage is a place where learning either to speak age appropriately or to communicate (social interactive skills) is not likely. Noise levels in the corridors may be loud, and paradoxically staff may speak rarely to the children, more amongst themselves. The children are 'in a world of their own'. Their speech and communicative skills are not comparable with children in their birthcountry who are living outside orphanages.

Doctors and researchers specializing in ICA and speech/communicative development are beginning to see that communication skills-gestures, knowing how to play-are a significant predictor of catch-up in speech for our ICA children, and also predict how quickly our children will learn our language after whatever start they had in the language environment of their birth and care pre-adoption. It seems critical that as responsible parents we address both the speech and communicative environment of our children. We need to talk and sing and read to them, yes, but we also need to ensure that we are communicating with all the senses of touch, hearing, taste, smell, and sight. These underpin social communication and are the basis of rich communicative gains. For most children, development in the broader domain of communication skills, activity, movement and social roles has gains in language skills predicated upon it. And for those children for whom language skills can never be assisted back to a 'normal' age appropriate expectation, the teaching of the communicative skills helps them navigate our social world. Stanley Greenspan, in his book Building Healthy Minds, reminds us that parents don't pay enough attention to the skills that teach children how to relate, communicate and think. These include acceptance of sensory sensation, an ability to fall in love with parents, being a two way communicator, and being an interactive problem solver and creator of ideas, with the ability to connect between ideas and relationships. Greenspan holds that "These are the essential building blocks of higher-level skill".

There is no use in addressing any one of our children's issues; we need an umbrella approach, covering and supporting all. Communication is more than 'just' speech or language. It is fundamental interaction with our environment and the people in it. And communication ability which moves outward from the mother/child interaction and the secure bond that forms there-is the gateway to the world. Essentially, the ability to communicate is the fundament of building love.

Read Part 2, Read Part 3

Spiderman shoes- God knows your size and style

Tue, 31 Jul 2007 11:40:06 GMT

One of the highlights of my fall has been traveling to Russia leading short term mission teams. I always love leading team and this team had an exceptional blend of awesome people from around the country. Of course, going to St Petersburg meant I was able to see all of the children that had participated in the past summer hosting program. These children (and their caregivers) had become so precious to me during their visits to Dallas.

In addition to seeing Dasha and Sveta, the children we had hosted in our home, we had presents (and hugs) to distribute to all of the past "Angels" from their host families.

One of the "Angels" we would see is a 5 year old boy named Sasha who had stayed with a host family that were planning on adopting. Sasha became very bonded to his family while he visited and he did not enjoy the large group activities - he wanted to be home with HIS family. The thing everyone did know about Sasha is that he LOVED Spiderman. When I say LOVED I really mean it- he wanted to only wear clothes adorned by the "Spidy" logo, picture or graphics. His sweet family was happy to oblige him- he had a Spiderman t-shirt, shorts, hat and sandals (and I assume undies). I had a hard time ever getting a picture of him without his Spidy hat.

When the team arrived at Sasha's orphanage - I was not sure what Sasha's reaction would be to seeing familiar faces. In Dallas, he had been shy around people other than his host family. But when I walked in his room he was so excited and he ran to my arms and preceded to hug me fiercely around the neck. He buried his little head in my neck and hung on like his life depended on it. I started telling him (through a translator) how excited I was to see him and that I had come all the way from Dallas to give him a hug from his parents. That they wished they could be there instead of me and they hoped to be able to come get him soon. He broke out into a huge smile and did not stop smiling until we left the orphanage later that morning.

He proceeded to show myself and other trip participants his room and his locker- where he kept his prized procession- his Spiderman cap. I was so excited to spend time with this darling boy that it was hard to tear myself away and go down stairs to organize the shoes we were distributing to Sasha and all his friends.

Typically on a Russian shoe trip the shoes are released from customs in enough time to already be distributed to the individual orphanages. Those orphanages have then already sized the shoes and place a slip of paper in the shoes with the name of the child the team members need to place the shoes on. This day was different because the shoes had been help up in customs and just released 2 days before. We had loaded our tour bus with the actual boxes of shoes that had not been opened since they had been packed in the Dallas warehouse. The boxes were sorted by size and type so at Sasha's orphanage we were delivering large toddler athletic shoes sizes 10-13.5.

I arrived in the distribution room and we started opening each box so we could organize the shoes by size. As we cut open the 1st box, all of the staff was shocked to see a pair of boys Spiderman athletic shoes packed right on the top. I kept thinking- is it possible that these shoes are Sasha's size? And then I thought- how could they not be his size? They had to be his size! Someone in the US had purchased a pair of cool Spidy shoes, carefully packed and shipped it to our Dallas warehouse, then a volunteer had unpacked and taken off the tags and removed the paper from the inside. They had placed it in a bin of shoes all sized 10-13.5. Then another volunteer had packed those shoes in a shipping box along with other athletic shoes. A volunteer captain had counted the shoes and sealed the box. Our Dallas staff had placed a bar code label on the box and then stored the box by size. When it came time to ship the shoes to Russia, our staff had put the box on a palette. Those palettes were then loaded on a container that was trucked to Houston and then shipped via boat to St Petersburg. The container then waited weeks for the paperwork to be approved and then days to actually be released to the warehouse in St Petersburg. Then a Russian staff had unloaded the box and placed it under on our tour bus. Our team hand carried the box inside orphanage #47.

As Sasha ran excited into the room where the team was passing out shoes, I thought they just have to be the right size. And, of course, they were. And Sasha learned how special he is in God's eyes. And I was reminded that God knows each child's size (and style) and He loves His children and provides for them each day in a personal way that only He can orchestrate.

To Walk In His Works

Tue, 31 Jul 2007 11:45:57 GMT

This is by my boss Mike Douris:

I�walked up a narrow stairwell to a small two room office which was formerly a bordello and now housed a ministry giving light to an area full of darkness. As I entered the room, my eyes were immediately drawn to a very ill woman sitting under the sink wearing a surgical mask. Her eyes told her story - she was dying of aids. It was all I could do to hold my emotions together after all we had seen and experienced over the last couple of hours - ritualistic prostitution, enslavement, human trafficking, children abused, neglected and orphaned because of AIDS. Yet, in this small two room office you could see how the Lord was providing a way - a light through one faithful physician who was serving and loving unconditionally in the most difficult of circumstances.

We sat down with the director and I explained that we had prayed that as we traveled on our first trip to four countries that the Lord would guide us to the ministries and the people with which He want us to work. I told her it was not by accident that we were here in her office talking to her and as I finished that sentence she began to cry. Through her tears, she explained how difficult the ministry had been and that she had been praying the last couple of months for the Lord to send someone to walk with her in this work. Steve and I sat amazed - it was a story that was familiar - a constant reminder of God's faithfulness, provision and love for orphans.

Ephesians 2:8-10 has always been a wonderful verse to me,

"For it is by grace you have been saved through faith - and this not from yourselves, it is the gift of God - not by works, so that no one can boast. For we are God's workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do."

I will never forget the day I accepted Christ and felt the freedom and joy of this verse - finally understanding that salvation was a free gift of God, not of works. In Dallas Theological Seminary, I viewed these verses as the primary apologetic for the theological concept of salvation by grace through faith - but on this, our first ministry trip, the Lord in His grace and faithfulness demonstrated the richness of verse 10. We had prayed on this trip that the Lord would guide us to where He wanted Orphan Outreach to minister. We prayed that He would direct us to the geographic area, the children and to the ministry partners with which He desired us to work. Little did we know to what extent the Lord had prepared our way.

On our first day on the trip, several weeks prior to our experience in India, we rose at 5 a.m. to head into central Guatemala. All of us were tired and hungry. So about two hours into the trip, we saw a restaurant where we could get some breakfast. Here we were about 7 a.m. in the middle of nowhere at a small caf� when one of our party turns to me and says, "I cannot believe it - the first lady just walked in the door." I turned and sure enough there she was Wendy Berger with an entourage of ladies walking into the restaurant. I had become friends with the first lady over the years of ministry in Guatemala and had thought of setting up an appointment to talk about Orphan Outreach but had decided to wait until we had more definition of what we were going to do - but the Lord had other plans. When she saw me, she got up from her chair with surprise and excitement and hugged me. We had the opportunity to discuss the new ministry and she offered her assistance to set up appointments to assist us in anyway she could to develop ministries in Guatemala.

After our discussion with the first lady, we sat down in our booth and all looked at each other in amazement. What were the chances that we would meet the first lady in the middle of central Guatemala at 7 a.m. in the morning? We all felt it - confirmation that the Lord was preparing our way. He was confirming - "You are where I want you - when I want you to be there." He gave us confirmation on the first day of our three and a half week journey that this was His trip and He was going to answer our prayers.

This guidance happened time after time on our trip. In Honduras we were connected to a missionary couple through a good friend of mine. When she found out what the nature of our ministry was she called another potential partner ministry. In astonishment, the director of this ministry told her she and her colleagues had been praying that morning that the Lord would bring a ministry who could partner with them and help them start a group home for children who are HIV positive.

In Delhi we had lunch with a pastor and his family after the services. We had a wonderful time and I asked the pastor if he knew of anyone who we may interview as a potential director coordinating our ministries in India. He said he has two or three people who may be good but there was one person, named Uma, he thought would be great. His only reservation was that he was a very successful businessman who he had been mentoring for years and he did not think he could afford to do it. The pastor said he would call us the next day. We received a call the next morning and he said that he decided to Uma just to see what he would say and he had agreed to meet with us for coffee.

We arrived at the coffee shop and we explained to Uma about our ministry and that we would need someone to manage our programs in India. Uma listened intently and then told us that he had been feeling for the last couple of months that the Lord was leading him to be involved in full time ministry. He had been praying with his wife that very morning about it and they both felt the Lord was telling him to leave his job in faith and trust Him to direct him where He wanted Uma to serve. They both made the decision that morning to take that step of faith. An hour later the pastor called him and told him that there were two Americans who were looking for a director to coordinate a new ministry in India. He said when he told his wife, they looked just looked at each other in amazement.

God's grace is overwhelming! His love for orphans is uncompromising and his faithfulness to those who walk in faith to serve those He desires to reach with His love is unbending. As I sat in that small office in India - in a city I had never heard of - in a red light district that was as dark as any place I had ever been - talking to one who with faith and courage was providing light in the darkness - the profound truth of Ephesians 2:10 became my experience. This faithful physician was an answer to the prayers of the men, women and children in this horrible place and she saw us as the answer to her prayers to continue her work. The Lord had led us to this obscure place to walk in the works He had prepared for us in advance. There is not place on earth that the Lord cannot reach with the depth of His love and grace.

All I can do is echo the words of Paul in Romans 11:33-36. He just finished his description of the vastness of God's plan and finally being overwhelmed he breaks out in a doxology,

Oh, the depth of the riches of the wisdom and knowledge of God!
How unsearchable His judgments and His paths beyond tracing out!
Who has known the mind of the Lord?
Or who has been His counselor?
Who has ever given to God, that God should repay Him?
For from Him and through Him and to Him are all things.
To Him be the glory forever! Amen.

Saying good-bye to our Angel

Tue, 31 Jul 2007 11:58:36 GMT

Today was the day the Angels left. Honestly I am so torn up I have not been about to take pictures or write much. I want all of you to know that they left and they safely made it on the plane. I really think this is the most successful Angels programs. I was blessed to get to know many great children and great host families. Please join me for praying for all the children and the families that hosted them.

The good news is many of the children have host families that want to adopt them and many also have families that are applying for adoption. Of course many of you have asked about Dasha. Unfortunately we do not have any family who is applying to adopt Dasha and her brother. I think the biggest reason (besides them being siblings) is that Dima was not able to come so he is an "unknown". Brad and I prayed about it and we have decided that I need to travel to St Pete and meet Dima to learn more about him and confirm if he wants to be adopted too.

Thankfully with my job I volunteered to lead�a St Petersburg trip October 12-22. It made it so much easier to say goodbye today knowing I will see her and Natasha and the orphanage Directors in just a few months.

I want to clarify that we are not planning on adopting them both. Dima at age 9, would actually end up in between Misha (8) and Inna (10). I have also read and believed that it is not a good idea to break birth order. We also believe siblings need to stay together. Of course this breaks my heart more than any of you. I held Dasha as she cried for an hour last Friday when we reminded her she was leaving today. I wiped those tears and told her she would be ok. I KNOW God has a plan for her life and she will be ok-- of course I wish He would tell me the plan!

I was blessed by many friends who called to comfort me today. One of my dear best friends called to report on what happened at her house after her children came by last night to say goodbye. Her sweet children were just so upset about why their family could not adopt Dasha and Dima. She was explaining there are many reasons that go into making an adoption decision. As she talked about how hard it would be for a mommy to spread out her love to 2 more children. Her extremely bright son said "hey- that doesn't make any sense- they have NO mom at all- wouldn't they want a mom whose love was a bit spread out instead of no Mommy love at all?" . (added note- this is just one example of part of the conversations that were generated by our having Dasha in our home. I think it is great to have honest discussions with children about adoption and my friend and I would say that love is multiplied --not spread out ---when you add a child to your family thru adoption or biologically. I got an email from someone saying "Love is from God and His supply is limitless" and I think this is a great thought for anyone praying about adding to their family.)
I heard from the airport that as the boys (age 9-10) got on the van on the way to the airport their tough exterior degenerated and they started to cry and tell their orphanage director."Please let us stay-we loved being in an American home- the parents do not drink and yell at us here-they are so nice and happy-everything is so clean and beautiful here-I was NEVER alone and hungry in America. We feel so loved- don't make us go back to where it is so cold and lonely." The Director wanted to thank all the families for showing these children a glimpse of what a loving home could be like.

It's Hard to Write About Adoption

Tue, 31 Jul 2007 12:20:00 GMT

It gets harder as Madison gets older and I feel more protective about what I share and it's hard, too, because so much of what I feel about adoption is a fairly new paradigm shift in the world of adoption. And I'm very aware (because I'm reading about the history of adoption) that what feels very true to me is also the result of my cultural experience and surroundings.

Here's the thing. I feel that given this present template of what it means to be Family and it's emphasis on biology that there are things that Madison will experience as very much part of being an adoptee although in another time and another place maybe she wouldn't so much. If you read adoptee narratives there are so many similarities of feeling separate and different and lost. It seems pretty safe to say that many (if not all) adoptees share these feelings.

I know there's a tendency for folks to say, "But I felt alone, too. I felt different, too and I wasn't adopted."

I know. I felt like a black sheep for awhile. There were times I looked at my family and thought, "Where did you all come from?" I felt like a changeling sometimes. But I also always knew that like 'em or not (and during my teens I liked no one, least of all myself) they were indisputably my family. I was never afraid the way I've read some adoptees felt afraid. Trapped, yes. Unhappy, sure. Isolated, absolutely. Now I imagine having those not atypical feelings of adolescence and also having reason to think -- in a cellular way -- that I was alone. And that sounds like it's a lot harder.

I hate to paint a picture of miserable adoptee-ness. I don't think all adoptees are miserable or should be miserable or that something is wrong with adoptees who are happy. We all process things differently and we all have different needs. I do know, though, that we all have normal developmental paths we need to take and that there are parts of these paths that are made more challenging when a child is adopted. It is normal to be challenged by these. It's normal and healthy. Things that are hard, that are difficult, that make us unhappy -- sometimes it's normal to feel not so good about things and often I think that allowing and recognizing those yucky parts makes way for the joy or at least the acceptance and peace.

In any case, I think there are two issues for adoptees and I think they're inseparable. One of them is the primal wound -- the biological grieving of loss; the other is the emotional response created by our cultural biases. In other words, a baby who has lost his mother may grieve but the way we interpret that experience is filtered through our cultural understanding of loss, of motherhood, and of the importance of biological ties. When people start arguing about the primal wound they inevitably come down hard on the side of science saying it's proven or disproven and frankly, I don't think it matters. I think what matters is what adoptees themselves have to say about their experiences. I believe adoptees who say they are fine but I also absolutely believe adoptees who say they are not.

The hard part is knowing how to help my child given my biases, given my filters.

I believe Madison grieves her loss. I believe she is sometimes hurting for it. I believe that she is thinking a lot about how she does or does not fit into our family. There are many ways she is different than we are. She's braver, for one, and more out-going. She's brasher and more enthusiastic and more energetic. We could have given birth to a child like this, I know. And perhaps that child would have felt left-out or "other" but that child would not have been adopted and I have to believe that this imaginary child would experience and interpret that feeling of otherness differently. Maybe other kids feel like that in their bio families but those other kids are living another story. That feeling of aloneness in a bio family has got to be different than that feeling of aloneness in an adopted family because in our culture at this time it is different to be adopted than it is to be born into a bio family.

I don't know if Madison does feel otherness although she does think a lot about matching. She points out to us that her skin is brown a lot. She points out which of her dolls also have brown skin. She knows her skin is brown because Jessica's skin is brown. She knows in a 3-year old way that she inherited this skin from Jessica because she grew in Jessica's uterus and Jessica is her birth mother.

This is what I do: I point out ways she is like Jessica. I tell her that Jessica picked out her hair supplies because Jessica also has curly-curly hair and so she understands about braids and things. I tell her she makes funny faces like Jessica. We look at pictures and notice when they look alike.

This is also what I do: When she wants to wear a skirt like me, I find her one. I point out when we're wearing the same color. We talk about things we both like -- raspberry chocolate chip ice cream, for one happy example. I point out the ways that we match.

And this is what I do: I point out the ways we are not alike and how this is ok with me. She likes lemonade with meals and I like water. "We are the same about some things and we are different about others," I tell her. "That's how people are." And I hug her. (I did this with Noah, too, who tended to fret if I wanted things differently than he did. Like I get into later, his separation from me was in many ways much harder on him.)

I'm more explicit than I was with Noah. When Noah was sad because I was leaving to meet friends I would say, "I'll come back. I always come back. I love you." When Madison is sad because I'm leaving I say, "I'll come back. I always come back. I am your mommy and you are my child and I come back. I love you." I started doing this because she started asking. "You are my mommy? And I am your child?" In her mind "mommy" and "birth mommy" are coming to mean different things and last year at around this time (I believe -- checking my archives) she started wanting to understand the differences. I am her mommy and she lives with me. Jessica is her birth mommy and she visits. I tell her that she will always live with me until she is a great grown woman and then she can live where she wants to. "But I want to live with you," she says. "And daddy." That's fine, I tell her (the same way I told my 3-year old Noah), because she can stay forever if she wants. Kids live with their parents 'til the kids decide to go. We are her parents. She stays with us.

My point is that I meet her as she comes to me but I meet her with this preconceived idea that adoption means something (these particular things) and yes, I could be wrong. My filter could be off, sure. But the way I figure it, there's no harm in taking adoptee narratives to heart and but there could be a lot of harm to wait for her to be old enough to tell me her story (if she ever could).

If Noah ever cried for me while I held him, I'd think it was loss, too. If he did it at this age, I guess I'd think it had something to do with that great developmental leap of 2 or 3 when they know they are not of you anymore. (Noah used to be mad at me for not remembering his dreams; I was so central to his experience.) This could be part of it with Madison, absolutely. So why do I think it's not? Well, she is adopted and I do have those filters. And because she doesn't do it in times of high stress but sometimes on ordinary days for ordinary problems. And because she is testing the waters of mommies these days. She is very interested in other people's mommies and sometimes will insert herself into other families at the park.

"Is this your mommy?" she'll ask a kid. "Is that my mommy? No! This is my mommy!" she'll say, grabbing my leg, being typically three. But then, not quite typical, she looks up at me, "Right? You're my mommy?"

Then, a few months ago, "I want white skin like you and Noah!" Then, to Brett last week, "You know, I have brown skin, Daddy."

My filters, my experience but also my daughter telling me what she can about her experience. And this experience, I can't fix it or fill it or make it anything for her but what it is. But I can parent her through it by being present.

Our kids have their own lives to lead away from us. It just feels like Madison's started earlier than Noah's.

Noah, 3-years old, furious because I can't explain to Daddy what happened next in the dream he had last night ("Don't you remember?" he cried. "I know you do! Just tell him!"). And then Madison has never been surprised to discover that I'm separate from her. She has never thought I could read her mind the way Noah thought I could read his.

She is not every adoptee (I don't extrapolate what is happening in our family to what is happening in anyone else's) but she is indeed an adoptee.

(I gotta say that I have high hopes for her being able to process and integrate her story because she does seem to be processing so young. It makes me think/hope that she will have an easier time of it.)

(originally published here.)

Open Adoption: How Close is Too Close?

Tue, 31 Jul 2007 14:18:01 GMT

We just got back from visiting Jessica, our daughter's birth mom, at her job. We sat with her on her break and it was a nice visit if a short one. Driving back I was thinking that this is my main piece of advice if you're hoping for an open adoption: Be in the same city. Or at least the same state. At least in the beginning (I know people move).

We knew we would only say yes to an in-state adoption but originally my husband, Brett, was uncomfortable with the idea of living in the same city. I strongly disagreed with him about this so I worked on him but I also respected that this might be a boundary he couldn't cross. Then the first time we got a call that they wanted to share our profile with a woman in Columbus, he changed his mind and said yes to sharing our profile.

We aren't people who travel a lot. For one, we don't have the money. We knew that visits across states would be a hardship for us and that we wouldn't be able to arrange as many visits as we hoped to have. Now I think about the price of gas and realize that even if we'd matched with someone who lived in, say, Cleveland, there would be times -- like now -- when even that wouldn't have been in our budget.

The other thing about being local is that takes a lot of the pressure off of us all. Visits aren't special events, they take no special preparation, and they can happen on the spur of the moment. Madison sees Jessica about as much as she sees my mom -- they both have full-time jobs and busy lives and they both live across town (but in different directions). Actually now that I think of it, I think she sees Jessica more because we do more little visits like today.

I had stage-fright during Jessica's first visits. I worried that our house didn't look nice enough and I fretted over the muffins I was making and I, of course, wanted to be sure that Madison was clean and beautiful and wearing an incredibly adorable outfit. It was very stressful. (And of course, I really had the easier role.) But you have enough visits and you lighten up -- at least I did. At some point I sat Jessica down and said, "We're not going to make a big fuss over you because you're one of the family and to tell you the truth, I don't clean for my mom." And she laughed and it was fine. If we'd been doing visits less frequently, I don't think I would have let myself off the hook that way and I think that my continued worried preparation would have gotten in our way.

Today we went and saw Jessica because she called and asked us to come by. So after Madison's nap, we headed out there. Madison had on green "lipstick" (marker) and her pigtails were crooked from sleeping on them and her shorts were all twisted up because she put them on herself and that's the way she likes them so don't fix them, Mommy! We sat for awhile and the kids ate snacks and Madison teased Jessica (because she likes to tease her) and then Jessica's break was over and we came home. And while I was driving home I thought, man, I'm so glad we live in the same city so I decided to write this entry.

That's my first rule of building an open adoption: Live in the same city (or at least state). Obviously, your mileage may vary and proximity is not a predictor of anything but it sure has made our lives easier.

This article originally appearaed on my blog here.

Shame, blame and forgiveness

Tue, 31 Jul 2007 14:25:42 GMT

I've been thinking about my sexual history I always feel like infertility memoirs I've read so far don't talk much about the non-procreational kind of sex unless they're high-lighting the great irony of using birth control in the past and using birth encouragements in the infertile present. This seems so incomplete.

For me, my infertility experiences brought back a lot of my teen-age shame about being a sexually active 15-year old who was trying to be responsible and getting lectured every time she put her heels in stirrups. That is a bigger irony in my mind -- chastising the teenage girl for keeping her pap smear appointment and paying for her own birth control. No wonder most of my friends didn't bother.

There's this part of my history that I have never, ever, ever written on blog and I rarely talk about it because it's probably the thing that I feel most ashamed about and it's complicated and not something I've ever really figured out. But reading these entries made me feel like I knew what I wanted to say about it although I'm not sure how much I'm going to share. (I'll know when I've written it.)

When I was sixteen I hooked up with a guy who was twelve years older and had sex with him although I didn't want to. It wasn't date rape because I said yes but it left me feeling violated.

Part of the reason I allowed this to happen is that (as many of you have experienced for yourself), if you're a teenager and having sex then you're already a ruined kind of person and it seems unreasonable to say no to this guy since you have already said yes to that one. This is something huge I want to get across to my kids: You can say no even if you've said yes before. But in the teen world of the 80s (and one assumes in most other decades), once you're deflowered you kind of give up your right to play virgin. The best example of this I can think of is a male friend of mine who was a virgin and who said to me, "Why won't you have sex with me? What's the big deal when you've already done it?" And I thought, "Is he right? Should I just do it?" And this is really what happened with this guy who was 12 years older only his arguments were more complex and more flattering.

Afterwards, I felt like crap and I felt used and I was angry that I'd betrayed myself with this guy (and betrayed my friend who was dating that guy, which was a huge part of it all for me and profoundly changed my self-perception). But I also felt responsible and so I tried to pretend like it was ok and tried to pretend that maybe I even liked him and this was a further betrayal of myself. And it really wasn't until I met Brett and confessed all to him that I felt absolved because Brett helped me see that I was 16 and I was up against someone smarter and not very principled whether or not he realized how manipulative and underhanded his behavior was. I'm sure if I told this guy (if I could remember his last name because I've truly blocked it out) that I felt he took advantage of me that he would be totally surprised and that his version of events were that he met this randy little 16-year old and we enjoyed a fun evening together way back in the fall of '86.

Part of me really wanted to go with what was surely this guy's version and for a long, long time I tried to see it that way because the other option (to call myself a victim) seemed like a lie and also who wants to be a victim? But what I didn't see until my confession to Brett was that it was possible to find a middle-ground, which would acknowledge the complications of sexuality and personality and that this middle-ground also understood the limits of culpability.

There are many versions of truth. It's true that this man was much older than I was and that this gave him the upper-hand. It's also true that I pulled my tights off myself. It's true that I was responsible for my choices. It's also true that I was in over my head. (I'm trying to write this while Madison slurps mushy raisin bran and slams a metal car on the table next to me so I keep losing my train of thought.) These things are all true. I had to figure out how to reconcile truths that ran into each other and made a lot of confusion. How could I be responsible yet still feel so victimized? How could he be the bad guy when I walked willingly into that apartment with him? It seemed lose/lose. I couldn't figure out how to recognize his coercion unless I lied to myself. (He didn't hold me down or steal my clothes or force me to do anything.) But thinking about it made me want to throw up so surely something bad did happen?

That's how I managed to slip into shame and blame. It was my fault. I was a bad person. A bad slutty person, actually, so I may as well start wearing my skirts shorter and laugh it off, right? Only I wasn't laughing.

Jenny Garp fictionally wrote, "I wanted a job and I wanted to live alone. That made me a sexual suspect." She may as well had written, "I had a vagina. That made me a sexual suspect." The older I get the more I realize how complicated sexual roles are and how easily we fall into things and then twist ourselves up to make it all fit. I couldn't maintain the personal contortions it took to make sense of what had happened. When I told Brett (who somehow managed to see <em>me</em> inside the situation, unlike other boyfriends who couldn't see past the stereotypes anymore than I could) he helped me see that lots of things could be true; that I didn't have to succumb to any paradoxes.

I think of this when I think about first moms who don't know they have the right to grieve regardless of how complicit they were in their adoption decisions. Sometimes it seems like if we tell ourselves it's all right to cry, we have to give some of our power up first. But if we give that up in order to have the grieving privileges of being a "victim," we deny the truth of our experiences and then we can't find comfort.

I remember a friend of mine who had been raped when she was 13. The first time she told me about it, her story was that she'd been gang-raped and beat up. But as we became closer it turned out that what happened is that she was raped by her crush and that at first she was a willing participant. Why did she change her story? Because when she told people that she went with him, that she wanted him to kiss her, that she <em>liked</em> what was happening at first, who would care about what happened afterwards? The lie was her protection but it also betrayed her. It made her a liar and it made her a sneak and it made her feel guilty all of the time and it made her, ironically, feel more responsible and more complicit in the rape but what choice did she have? The world is not nice to women; she was already a sexual suspect just by showing up.

It's easy to get in so deep that we don't feel like we can turn around and go back. We have to learn how to forgive ourselves for making choices that lead us someplace we didn't want to go. Sometimes we say "yes" because we don't know how to say "maybe." And sometimes when we say "maybe" the world hears "yes" anyway. Sometimes we have no idea what we're getting ourselves into.

We don't have to accept the narrative that's thrust upon us because people assume a predictable trajectory. Saying yes to a man, saying yes to an agency, saying yes at the hospital or in a dark apartment doesn't mean we don't have a right to our regrets. We don't have to apologize to anyone (except perhaps -- lovingly -- to ourselves) for being too naive or too young or too ill-informed or too willing because we were doing the best we could.

Maybe that guy didn't victimize me but that doesn't mean that I knew what I was doing. He doesn't have to be a bad guy but I also don't have to be a slut. The truth is more complicated and ultimately it doesn't matter how the world sees it as long as I make sense of how I have to see it. I was in over my head. That's all there is to it. I wish it never happened but it did. No good things came out of it -- no great wisdom or great compassion or the kinds of things that make a trial worth it. Still, it happened. It's part of my story and I forgive myself for it. I acknowledge my responsibility but it doesn't take away from my acknowledgment that I was also an injured party. It's the big challenge, isn't it? To live with those paradoxes.�

This article originally appeared here.

Developmental Milestones for Children Ages Birth to Three Years Old

Tue, 31 Jul 2007 14:29:46 GMT

Every child grows differently and there are variations of what is considered developmentally "within normal limits".� However, there are specific milestones that all children should reach by certain ages. It is important to note that this outline is based on chronological ages. If a child is premature, the information can be applied to their adjusted age.� This article will briefly outline a typical child's development from birth to three years old, across all developmental domains:� cognitive, social-emotional, self help (adaptive skills), and motor development (both gross motor and fine motor).�

By three months, infants are consumed by adaptive skills.� At this age, babies should be able to turn their heads, move both eyes in the same direction, recognize the bottle/breast, react to sudden sounds and make cooing noises. Within this time, the infants start to grasp toys, hold fisted hands, kick arms/legs, lift their heads while on their stomachs, and smile.�

At six months, once they have passed the 0 - 3 month phase, babies will start interacting more with their environment.� They will follow moving objects, turn towards the source of sounds and reach for desired objects.� Infants between three and six months old can play with their toes, help hold the bottle during feedings, recognize familiar faces, and even babble. �

By nine months of age, babies become more physically active.� They can sit without support, crawl and pull themselves to a standing position.� Furthermore, babies at this age are able to drink from a cup, play interactive games (e.g. peek-a-boo), wave hi/bye, stack two blocks, and know approximately 5 words (e.g.. look at mom when someone says 'momma'; retrieve a bottle when requested).�

A one year old child has grown into pulling, pushing, and dumping things.� During this time, they should be reaching milestones such as: walking, feeding themselves, and assisting in getting themselves dressed/undressed.� By 12 months, children like to look at pictures, use crayons, and can follow simple directions (e.g. come here).�

At two years old, toddlers are assertive.� They become increasingly more verbal using two word sentences, labeling common objects, and using verbal requests (e.g. more juice).� They can identify body parts, build larger block towers, turn pages in a book, and show affection.� They also like to imitate the adults/peers around them. Two year-olds can be extremely determined to have things their way, thus making temper tantrums a very common occurrence.�

By three years old, children are completely independent.� They are able to walk up/down steps, put on their own shoes, use three-to-five word sentences, and are fully toilet trained.� Three year olds can play with other children, name at least one color correctly, and ride a tricycle.

Though exact times for reaching these milestones can vary slightly among children, these are good guidelines for tracking your child's developmental progress.�

If you believe your child is not meeting these milestones, you are entitled to have a free developmental evaluation.� Please call A Multilingual Development Agency, if you reside within Nassau County, at (516) 730 - 5001.� You may now visit us at www.multilingualdevelopment.com�
Written by: Lilya Popovetsky, MA Early Childhood Special Education, SDA, CAS

Birth Mamas

Tue, 31 Jul 2007 14:30:51 GMT

They are cropping up everywhere at our house. Yesterday Madison announced, "I'm Baby Baby's mommy mommy. She has a birth mommy, too." (Baby Baby is her favorite doll.)

"Just like you," I said.

"Yes, Jessica is her birth mommy, too!"

Then today while she was coloring, "This [marker] is the birth mommy and this one is the mommy mommy and this one is the baby!"

I'll tell you why this came up. When Jessica came over last time Madison had a great time with her and was very sorry when it was time for her to go.

"Don't go, mommy!" she said, and she meant Jessica. But then she got shy and hid behind me and pretended she meant me. "Don't go, mommy!" she said again, this time pulling on the leg of my pants. So later I wanted to make a point of saying that it was ok for her to call Jessica mommy, too. She can call Jessica whatever she wants (only don't call her late for dinner - haha!) and whatever Jessica wants to be called.

Anyway, I said, "I heard you call Jessica mommy today and that makes sense because you have two mommies, don't you?"

"You are my mommy mama and Jessica is my birth mama," she agreed.

"Some kids have one mommy, some kids have two and some kids have more. I know one little girl who has three mommies. Families are all different."

End of story except that now even the markers have many mamas.

I won't say this is easy. You hear your kid call another woman "mommy" and there's a wince to it, no doubt. Especially when she is also mommy. But you know, Jessica hears it all the time and it doesn't keep her from coming around and being a part of Madison's life so I'll keep her as my inspiration.

I wanted to say that part about it not being easy because it's not easy. And it's ok for it not to be easy - it's ok to wince. But it also feels good to know that Madison is growing up in all of this love and that she's clearly getting the message that it's normal to be adopted and to have two (or more) mommies and that any wincing by the grown-ups is done behind closed doors (or only on-blog).

This essay originally appeared here.

Writing it Out

Tue, 31 Jul 2007 14:35:11 GMT

Yesterday I ended up talking about Madison's adoption some without intending to. I need to figure out how I'm going to handle this. See, Jessica is an everyday part of our lives and she comes up in everyday conversation. Like someone might say, "Man the movie I saw the other day was incredible" and I'll say, "Oh Jessica was just telling us about that movie! She said the lead actor was amazing!" And they say, "Isn't Jessica Madison's" pause "birth mother? Do you see her that often then?" And ta-da! We're talking about Madison's adoption.

There's a lot to think about with this. I know some adoptees don't want to talk about their adoptions or have people know they're adopted and that there are parents who keep quiet until their child is old enough to say yea or nay to the discussion. That makes sense to me. But I also think it's about a billion times easier to do in a more closed adoption/less open because those families are living adoption differently than we do. It would be odd to keep Jessica set aside in a little corner of conversation marked "adoption" just like it would be odd to set aside my sister and only bring her up only if we were discussing "siblings." I talk to my sister all the time; she's a regular part of my life. Likewise Jessica is a regular part of my life. We talk about a lot of things besides Madison so it feels pretty natural to bring her up when I'm talking to someone about raw foods (because Jessica eats semi-raw) or when to pierce a kid's ears (because Jessica and I disagree on when to pierce Madison's).

These are some of the things people ask when Jessica comes up in conversation so you can get an idea of how things get complicated very quickly:

Do you see her often?
Does she lives around here?
How is that?
Does Madison know who she is?
So it's like she's an aunt to Madison/daughter to you (I get this a lot - I say, no like a sister to me like Madison's birth mother to Madison. I understand the need to find a simile to make sense of it but I strongly resist the "aunt" comparison.)

I don't mind answering most of these - they're pretty innocuous. I don't like answering specifics to why Jessica placed (heck, I don't pretend to be qualified to answer those questions) but usually those questions are so vague because people know it's personal and they want to give you room not to answer.

But then there's this other thing. I'm a huge proponent of open adoption, obviously. And I'm also a huge proponent of helping people make sense of open adoption because it's a mind-shift, you know? Like saying, "No, not like an aunt - she's Madison's birth mom." (Again, I'll say that this is the title Jessica chose so it's the one we use.) It's like I'm trying to physically shoehorn the reality of who Jessica is to us in someone else's conception of adoption. Why? Why do I want to do this? (I'm thinking as I type.) I guess when I sift through the feelings I have when I'm having these kinds of conversations is that I want to: counter some of the myths about birth moms and adoption; make it clear that this is a subject that is normal and comfortable for our family (that Jessica is a member of our family and not a special event). See, the more that people in our everyday lives understand how things are for us, the less we'll have to worry later. So if I'm sitting around with friendly homeschoolers explaining our adoption once, I won't have to again. And no one will be weird if Jessica shows up at a class with us (a distinct possibility).

For Madison, I really want to pave the way for normality when it comes to Jessica and people who are in our lives. It's not like the grocery check-out person needs to know, but for a mom who's going to circle our social and homeschool events, it just seems nice to put that out there.

It gets more slippery when people want to applaud our adoption; it feels uncomfortable. I mean, I'm proud of our family and I understand that it's interesting to people but you all know that my feelings about adoption are complicated and I haven't figured out how I want to react to statements like, "How great for Jessica! How wonderful of you! And she still gets to be a part of Madison's life! It's really working out for everybody!" I should just smile, right? But I'm always compelled to say, "Well, it's complicated. Well, credit really goes to Jessica. Well, we don't consider it a sacrifice. Well, it's been a blessing for the rest of us, too; we're so grateful to have Jessica in our lives. Well, I love Jessica for herself - not just because she's Madison's mother."

It gets people in too deep and I need to learn to shut up. It just bothers me (and maybe it shouldn't) when people think open adoption cures all adoption ills. I think open adoption is fabulous and all but but but . I guess I'm uncomfortable with the credit ("It's so good of you all to welcome her!") and I have to counter it ("It's not a sacrifice"). And I'm uncomfortable with people assuming that this is "the best of both worlds" (people say this) because Jessica doesn't have the burden of parenting but gets all the fun of visits. (That's the great myth of open adoption, isn't it? I used to believe it.)

And then there's Madison, of course, running in circles listening in. I'm not sharing personal secrets but still - it's her life and it's her life story. So when someone asks, "Does she know who Jessica is?" and I say, "Sure, she knows Jessica is her birth mommy and what that means" she's hearing that and I don't know if it bothers her. (I asked her yesterday and she said, "No, it doesn't bother me but when you use your whiny voice I say, 'Please use your grown-up voice, Mommy' because that bothers me." Gee, don't know where she heard that.) I mean, I talked a lot about Noah's birth when he was this age and we'd be trading birth stories but people generally just wanted me to finish blathering on about my birth story so they could get to telling about theirs. This is different because even if it's everyday to us, it's not to other people and really, it's the other reactions I worry about for her. But I don't want her to think that her beginnings are less valid and thus need to be hidden.

On the one hand I think, "This is her reality; she's adopted and people are curious about adoption." And "This is her reality; Jessica is a part of our lives and people are interested in that." And then I think we'll just continue on this way and I'll keep checking in and will alter the way we handle it as needed. But then I wonder if I should be more cautious. If we had a mostly closed adoption, it would be easier because it would come up a lot less - it would likely only come up in adoption context. Or I could censor mention of Jessica, (which would be hard for me and also my gut tells me would be wrong). Or I could somewhat censor (like when someone comments on Madison's height and I say her birth mom was also tall for her age - I could skip that) but again, to me that makes it seem like there's something secret or shameful because I wouldn't stop myself from saying, "Noah loved that toy at this age, too" although of course it's not the same because no one's head would swivel and no one would say, "So do you still keep in contact with Noah? How is that?"

I don't really want to "protect" Madison from people's assumptions about adoption as much as I want to model ways to handle it and I can only model it if we're talking about it. I'm just figuring out the boundaries and I guess I'll always be reevaluating them.

(This essay originally appeared here.)

Post Adoption Evaluations for Children from Birth

Tue, 31 Jul 2007 14:39:10 GMT

A Multilingual Development Agency is a New York State approved Early Intervention (EI) agency which provides Nassau County families free developmental evaluations for children from birth to three years old in the child's home environment. A Multilingual Development Agency specializes in working with families who have adopted a child, internationally and/or domestically. In accordance with NYS law, we conduct developmental evaluations in the child's dominant language. Some of the languages offered to families include, but are not limited to: Russian, Polish, Ukrainian, Armenian, Cantonese, Chinese, Korean and Vietnamese. All evaluations are sensitive to the cultural backgrounds of the children and take into consideration their histories. That knowledge, in conjunction with standardized assessment tools, provides the means with which to give your child the most accurate testing results possible.

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Early Intervention evaluations should be conducted shortly after arrival. All testing is conducted in the child's natural, home environment, with full parental participation. Our evaluators test children in a fun, play based manner using materials and tools that are appropriate for their ages. The parent is present throughout the entire assessment, contributing vital information to complement your child's performance.

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Evaluations will determine if there are any developmental delays in your child's growth. All evaluations are conducted by NY State licensed and certified professionals who are Department of Health approved service providers. The evaluations assess all areas of development including: cognitive, adaptive, social-emotional, physical and communicative. If there are additional concerns, families are entitled to supplemental evaluations that may address nutritional needs, audiological concerns, and/or family education.

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If significant developmental delays are found, all children are entitled to receive Early Intervention services conducted at their homes. Some of the services your child may receive include but are not limited to: speech/language therapy, special instruction, physical therapy, occupational therapy, sensory integration, nutritional consults, feeding therapy, and family counseling.

A Multilingual Development Agency is a multidisciplinary agency that works closely with your child's pediatrician, Nassau County service coordinator, and most importantly family members to meet all the developmental needs of your child.

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If you are a Nassau County resident and would like to learn more about receiving a free developmental evaluation for your child age birth to three years old, please call A Multilingual Developmental Agency at (516) 730 - 5001. You may now visit us at www.multilingualdevelopment.com

Written by: Lilya Popovetsky, MA Early Childhood Special Education, SDA, CAS

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Early Intervention Process: What should I Expect?

Tue, 31 Jul 2007 14:43:03 GMT

The process of receiving an Early Intervention (EI) Evaluation for children birth to three years old consists of four steps. They are as follows: 1. Refer your child.� 2.� Meet with your initial service coordinator (ISC). 3. Initial evaluation is conducted.� 4. Individualized Family Service Plan (IFSP) meeting, if your child is found to be eligible for services. The entire evaluation process takes 30 days from receipt of the initial referral until the evaluation must be completed.� The IFSP meeting, when applicable, must occur within 15 days after the evaluation.� Therefore, the entire evaluation process takes a total of 45 days.� �

In order to refer your child for an evaluation you must contact an Early Intervention provider such as A Multilingual Development Agency, in Nassau County.� Residents of other counties must contact their county's Early Intervention Program referral line.� At that time, a referral intake will be taken of the child's background information.�

After the intake is complete, your child is assigned a personal Initial Service Coordinator (ISC).� Your ISC will contact you within 7-10 days to schedule an initial home visit at your convenience.� At that time, the ISC will help you resolve any Early Intervention questions or concerns you will have.� At the end of the meeting, A Multilingual Development Agency will be authorized to conduct your child's evaluation.�

Next, an evaluator from A Multilingual Development Agency will contact you to schedule a day/time to conduct the evaluation, in your home, according to the optimal time for you and your child.� Depending on the needs of your child, there may be two or more evaluations conducted, within the 30 days.�

If your child is found eligible to receive Early Intervention services, an Individualized Family Service Plan (IFSP) meeting will be held with the family, Initial Service Coordinator (ISC), and evaluator representative, in your home.� At that time, services will be authorized for the next 6 months and developmental goals that are specifically tailored to the needs of your child will be set. .� The ISC will determine the frequency and duration of services.� IFSP meetings are held every 6 months to monitor your child's progress and growth.�

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If you are a Nassau County resident and would like to learn more about receiving a free developmental evaluation for your child age birth to three years old, please call A Multilingual Developmental Agency at (516) 730 - 5001. You may now visit us at www.multilingualdevelopment.com�

Written by: Lilya Popovetsky, MA Special Education, CAS, SDA�

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Preparing your Kids to Volunteer in an Orphanage

Tue, 31 Jul 2007 15:40:54 GMT

I've been thinking for some time about creating a handout on adopted kid(s) volunteering in China. It's necessary to discuss this topic because there are so many options and also because institutionalized children in China are not the same as children who have been raised abroad in modern households. Many families wish to bring their adopted kid(s) back to China on homeland visits that include a volunteer or community service component.

Note: for the purpose of this article - "kids" will refer to adopted children living abroad (as in your own child) and "children" will refer to children still living in an orphan care setting or institution in China.

The real questions:

How do you select the right environment and program at which to volunteer? How do you best prepare our kids for the conditions and realities of orphanage life? And how do you determine the options should be of concern as we prepare to engage our kids in what we believe to be a worthwhile effort - volunteerism? HOW?

Why worry or why prepare ? In my teens I volunteered at "The Trenton Center for Mentally Retarded Children" (yes, that really was the name at the time) , a center for special needs youth and adults. I can certainly recall the range of behaviors the program participants exhibited that were unfamiliar to me. They were "normal" for persons with their disabilities, but they were not behaviors I would commonly have seen at school or at home for the age I was at the time.

The situations that will cause our kids some discomfort may be within the range of "normal" for persons living in China but could be "strange/unfamiliar" to kids from abroad. For example, children with exposed body parts (such as older disabled persons with split pants showing their genitalia) or exposed organs (such as babies with spina bifida, where spines are exposed or children where they are not properly formed in the urinary/genital/rectal area). They are usually covered and diapered, but these will be children that will create questions for most returning kids.

�� The children with cleft lip /palate can also be surprising to our kids, but they tend to cope well with them knowing that they can easily be "repaired" and have normal lives subsequently.

�� Small babies and children with Downs syndrome or other common disabilities/issues such as cerebral palsy can usually be understood by our kids because they may have already seen affected kids at their school mainstreamed into classes. They don't see these kids as "hopeless" at home, yet in China such children may not have the kind of "hope" or future that they would have abroad.

�� I believe the "having hope" quotient is the important factor in helping our kids through a volunteer situation it's helping our kids know that it's their help and care that takes these children further toward their journey of having a life that is not totally wasted.

We have not had any� parents report that the sites we sent their families to for volunteering were not appropriate for their kids, and we've reviewed /visited around 30 locations thus far.� I can't speak� locations outside of the Beijing/Hebei region because, to be honest, we just don't want to send families to places we can't visit/review up-front before their volunteer program.

�� We also do not send families to the orphanage where their kid was institutionalized - for various reasons such

a. Orphanages that lack willingness by the local orphanage��officials to approve the visit because they aren't prepared to host foreigners overnight� or on a daily basis in contact with their operations. Those places mostly do not want to really risk the "judgment" of foreigners who often see what the orphanage personnel does as backward or inappropriate care for children;

b. The kid being "too close" to the situation to be able to gain�the distance and perspective to separate the "being returned" to the orphanage, or the "quilt factor" of being chosen, from the experience of giving back as a volunteer to children less fortunate than they are. After all, they were also once "less fortunate" and still are working through those issues as young persons.

c. The inability of local personnel to adjust to foreigners in��their institution due to language deficiencies on both sides, schedules, real needs of children to be met, etc.

This doesn't mean it's not possible to volunteer within your kid's institution, but it will require official approval from the Provincial Civil Affairs Office and planning in advance. Since there are government-approved volunteer programs for specific government orphanages through Half the Sky Foundation (HTS), this is a good option for volunteering in your kid's orphanage when a "build" is identified. HTS programs are serving wonderful purposes for those institutions.� Preparation of your kid and family will be even more necessary when returning to the kid's own orphanage or origin for an extended timeframe.

I am not sure I have magic answers, but I believe the following criteria are important for site selection when volunteering with an adopted kid from China and this is what we have been putting into place with our programs so far

1. Not too remote with regards to medical safety for families-placement should be around major cities. Within two-hour highway drive of a Western clinic.

2. Arrangements need to be made at places already checked out as kid-friendly - I'd suggest avoiding anything in poorer provinces, as conditions may not be good there at the orphanage, hotels, health/medicine, and sources of food.

�� What we consider kid-friendly are conditions where kids will not be traumatized by the children they see, the conditions they volunteer in, and that the length of time is short-enough that they are busy and engaged but not overwhelmed. I have heard of kids having "meltdowns" during orphanage build projects with HTS (according to Jenny in discussions we've had in Beijing about volunteer programs) where kids have come along with their parents. Mostly, I suspect that extended time on-site is not something kids can cope well with, as they become tired and easily bored. Of course some kids have done exceptionally well during the HTS projects because parents have prepared them in advance.

�� The time factor is why our original Volunteer-China program was half-day sightseeing and half-day volunteering and the volunteer locations are foster homes with good conditions, though some resident children will be in serious conditions. Kids can still see that they are lovingly being helped and cared for. We also have one to two� day pre-trip volunteering because it's a short time-frame.

3. Arrangements need to be at places accustomed to working with volunteers so that meaningful activities are assigned and age-appropriate activities planned. This is true for adults and kids who are volunteering. Sometimes people ask if they can go to an orphanage and play with the children but are interested in going in the afternoon-at the time when the children are napping. However, their routine can't be compromised for the sake of volunteers. Likewise, some institutionalized children do not know how to play, which is sad but true. Great patience and understanding is required in these situations. Be willing to volunteer and do what the organization/orphanage needs you to do to help them.

4. Arrangements need to be at places where conditions will not expose families to any illnesses/infections (such as lice, measles, scabies, etc.) and where the volunteering family will not expose the children in the orphanage to colds/flu, childhood illnesses that the children will not have immunity to.

5. Arrangements need to be at places with suitable on-site housing (provided by orphan care organization) or nearby hotel suitable for tourists with rooms and restaurants with kid-friendly conditions.

6. Arrangements need to be at places where the town/city is approved for foreigners to visit by the PSB. In China there are some 1600 cities, towns, villages approved for foreigners to visit, but still there are orphanages in locations that do not have local or regional government approval for foreign visitors.

Coping

Then there are the issues of the adopted kids themselves having been orphans/institutionalized and how they can easily put themselves in the place of the children with whom they are volunteering. I firmly believe this is the same as the trip back to the orphanage considerations.

It's a matter of how to walk your kid through the scenario before going there - what will they see, what will it feel like to see children who may not get adopted, will those sad feelings be "ok to feel" and how can we share with each other these sad feelings so that it's not a depressing situation but a learning opportunity and growth opportunity for kids?

�� I do think kids can cope well with volunteering because it takes away the "helpless" and "guilt" feelings about being chosen and not being left behind by empowering them to "give back" and to help in a way they are capable. I do believe the volunteering should not be a one-shot event but the culmination of a series of projects or planned giving. Create it as a project or long-term commitment-this year we will do this, next year we will collect clothes, the next year we will send vitamins, etc. Then the kid doesn't have this sense of needing to do it all at one time nor it being a quick fix. And, if the kids can get their classmates involved and friends involved or even the neighbors, it's not just one kid who "owns" the helping role-it takes a village. Rewarding for all!

�� As parents worry about overwhelming kids, they need to separate, out their own "being overwhelmed" feelings from their kids need to give something back. Focus on how the kids can connect positively before and after the experience, and design an experience suitable for the age levels of kids and emotional maturity.

�� Parents need to step out of the picture and think about the situations in China as different from the US. Also, I think families should sit down with the kids and examine the questions:

Why do we want to volunteer?

What will be good about us volunteering as a family?

What might not be good for us if we do volunteer?

What will make us happy/satisfied as volunteers?

What will make us sad/unhappy or dissatisfied as volunteers?

How long should we do this for (number of hours or days)?

�� Have a family pow wow to open up the issues up front and work through them prior to the final decision and prior to the volunteer trip. Then when expectations are created that are realistic, there's less chance of emotional fallout. We often think about culture shock when traveling to China but what's more likely to happen in a volunteer situation is "institution shock". Our kids are not exposed much to institutionalization or hospitalization or ill children, etc. by living abroad. Nor are they in contact with children with disabilities. So getting that out on the table is important whether or not you volunteer-it's reality in China.

Early Intervention Services

Tue, 31 Jul 2007 16:12:07 GMT

Early Intervention for children ages birth to three years old offers families free developmental evaluations, and therapeutic services to children who are found to be eligible.� Developmental evaluations assess all areas of development:� cognitive, social-emotional, physical development, and self-help/adaptive skills.� Each area of development is unique and plays a major role in the child's functional abilities.� All Early Intervention evaluations employ age appropriate standardized testing, materials/toys, and clinical opinion to determine a child's age equivalent.�

The cognitive domain, as assessed by a special educator, includes learning, remembering, thinking, perceiving, feeling emotions, and further experiencing their environment.� This also includes the development of a child's understanding of language.� A child's cognitive skills are reflected by the ways in which s/he plays and solves problems. The cognitive domain is assessed by a special education evaluator.�

The social-emotional component refers to a child's ability to interact and relate to other people including, parents, friends, and other family members.�� The evaluation of the social-emotional domain is a fundamental necessity that becomes particularly important when working with children who have been adopted.� Social-emotional assessment is conducted through the observation and analysis of the child's interaction with his or her family, caregivers, and the evaluators.� A special education evaluator evaluates the social-emotional development.�

Physical development allows children to manipulate their way around, giving them the opportunity to explore the world around them; this includes movement and posture, as well as muscle tone and strength.� The development of motor skills is the foundation of physical development.� These skills can be categorized as either gross or fine. Gross motor skills refer to those tasks that require use of the large muscles, e.g. crawling, walking and jumping and are evaluated by a physical therapist.� Fine motor skills are tasks such as making a fist, or using building blocks, that require the use of smaller muscles. Each area of development requires its own evaluation. Gross motor skills are assessed by a physical therapist and fine motor skills by an occupational therapist. �

The adaptive domain refers to self-help skills that we use for functional daily living such as, eating, drinking and getting dressed.� These skills can vary drastically based on differences of cultural background and past experiences.� For some children, this area of development could be the most vital as it could be the most delayed.� Both an occupational therapist and special education evaluator include the adaptive domain in their evaluations.�

Lastly, communication skills, which are evaluated by a speech-language pathologist measures how the child communicates his or her wants/needs.� The communication domain is classified by receptive language skills, which is what the child understands, and expressive language skills, which is what the child says (including non-verbal communication).� At times, there can be a great disparity between these two areas.� It is crucial to note that a language delay in a child who is adopted is due to a delay in the child's native tongue and not because s/he knows little to no English. A Multilingual Development Agency conducts evaluations, in accordance to New York State Department of Health guidelines in your child's dominant language.� Some of the languages we offer include, but are not limited to: Russian, Polish, Ukrainian, Armenian, Cantonese, Chinese, Korean and Vietnamese. �

If you are a Nassau County resident and believe your child(ren), ages birth to three, may be eligible to receive a free developmental evaluation please call A Multilingual Developmental Agency at (516) 730 - 5001.� You may now visit us at www.multilingualdevelopment.com�

Written by:� Lilya Popovetsky, MA Early Childhood Special Education, SDA, CAS�

Adopted Children that are emotioanlly younger than they really are

Tue, 31 Jul 2007 16:18:40 GMT

What Should I Know about Children whose Emotional Ages are Younger than their Chronological Ages

Children who are adopted typically develop with emotional ages that are significantly younger than their chronological counterparts. The reason for this comes as a direct result from being in hospitals and/or orphanages where the caregiver to child ratio is usually very low. The children did not receive a great amount of individualized attention where they were able to experience reciprocal interactions, affection, or emotional support. Therefore, children who are adopted are usually emotionally stunted because they never properly learned how to do such things as communicate and socialize with others. In this situation, it is important to meet the child's needs at the emotional level.

For example, a five year old whose emotional development is delayed, may need to engage in those activities normally done by a two year old such as testing boundaries (e.g. throwing temper tantrums), thumb sucking and attaching to a favorite toy or object. Emotional development occurs in a sequential manner. This means that children need to master each stage before they are able to mature to the next. There is no such thing as "skipping stages". All areas of development are interrelated. The emotional domain will affect the cognitive, adaptive, communicative and social domains.

Therefore a child's emotional well being must be secure for overall development to progress. Children must be able to understand their feelings before being able to communicate and socialize. For instance, children must be able to understand and accept the concept of sharing in order to successfully interact with their peers. It is essential to build an emotional rapport with children. Many professionals support the notion that emotional development is the foundation of how well a child will adapt to his/her new environment.

A child who is adopted, in particular, needs to build a strong level of attachment and trust with caregivers. It is crucial for the family to provide stability and most importantly, unconditional love and acceptance. One of the best ways to cultivate a solid emotional relationship is to spend quality time together doing emotionally age appropriate activities a child enjoys. This will build a strong common bond. Furthermore, allowing a child to choose the activity gives him/her control over the environment, which is an excellent strategy that fosters emotional empowerment. For example, you can offer the choice if they want to playing with playdough or using coloring utensils. Once the preference has been stated, it is important that the choice is honored and executed. In time, you and your child who is adopted will forge a lasting relationship. However, there is no formula that can ever determine how long that may take, as it varies for each child and family. Love, stability and above all else, patience will help to ensure the proper emotional development of your child.�

�Written by: Lilya Popovetsky, MA Special Education in Early Childhood, CAS SDA

Attachment disorder and no access to Therapist

Tue, 31 Jul 2007 16:35:50 GMT

Reactive Attachment Disorder (RAD) is a condition in which individuals exhibit markedly disturbed and developmentally inappropriate social relatedness. Children with RAD have considerable difficulty forming meaningful, affectionate relationships. Since prenatal experience (e.g., exposure to substances), birth trauma, inconsistent or inadequate day care, separation issues, abuse and neglect are often precipitating factors that may lead to RAD, internationally adopted children evidence this disorder at a significantly higher rate than the general population.??

�Since healthy attachment to a caregiver is necessary for cognitive, emotional, social and behavioral development, individuals with RAD often experience difficulties in these areas. The bottom line is that problems with attachment during the early years of life may compromise the quality of an individual's life-particularly when it comes to relating with others.??

What can a parent do if there isn't a specialist in RAD within 100 miles of their home?

�Because children with RAD have considerable difficulty or are unable to cultivate warm trusting relationships with others, traditional counseling or psychotherapy is often ineffective. These interventions rely upon the establishment of a "therapeutic relationship." In the same way that parents of children with medical conditions (e.g., asthma, allergies, diabetes, etc.) must become "experts" in addressing their child's condition, so too should parents of children with RAD. Read about attachment disorder and become involved in online support groups. Be willing to try different parenting strategies. For example, instead of explaining why your child should not do something, allow him/her to see the consequences of his behavior... for himself. Become consumed with behaviors that you are so desperately looking for in your child and lose interest in maladaptive, undesirable behaviors. Instead of looking to praise the attainment of goals, try reinforcing approximations of desirable behaviors-particularly those that involve social relatedness. Finally, seize every opportunity to model healthy social interactions for your child and make brief positive comments about these interactions, in the immediate aftermath, with your child.

Rather than trying to find a specialist who will "fix" your child, find a counselor or therapist whom you feel comfortable with. Someone who can provide support and guidance for you through your unique parenting journey.

Written by Dr. Mark Lerner of Adoptiondoctors.com

Visit Dr. Mark Lerner at www.DrMarkLerner.com�& www.ItsOKNotToBeOK.com

Generation 1.5 and Older Adopted Children from China

Tue, 31 Jul 2007 16:48:51 GMT

What is Generation 1.5?

They are immigrant children who arrived really early to their new home country, like age 2, 3, 4, 5, etc. and because they arrived so early, they are culturally in-between. They don't learn to read and write in their first language. But they don't have a good command of English, because they've learned it through interaction on the playground as they arrive and go right to day-care or school and learn language from other children. They're kind of dual non-native speakers.

What happens in school?

They show up. They do the work. The kids are obedient and dutiful, and the teachers don't really notice that there's a problem with their language skills because in public schools they can get by there with oral language skills and perhaps do not have many written assignments that assess their whole language learning.

According to Linda Harklau, author and Generation 1.5 expert, "familiar with U.S. culture and schooling, generation 1.5 students have different learning needs from other English language learners, such as immigrants with limited English proficiency and international students who travel to the United States for the express purpose of earning an American college degree."

Grasping the English Language

Equipped with social skills in English, generation 1. 5 students often appear in conversation to be native English speakers. However, they are usually less skilled in the academic language associated with school achievement, especially in the area of writing. Academic writing requires familiarity with complex linguistic structures and rhetorical styles that are not typically used in everyday social interactions.

Harklau reports that one of the most common traits among generation 1.5 students is limited or no literacy in their first language. Many of these students have lost or are in the process of losing their home languages without having learned their writing systems or academic registers. Unlike international students, generation 1.5 students lack a basis of comparison in fully developed oral, written, or both systems of a first language. In the case of older adoptees, that language is Chinese.

Acculturation-Assimulation

According to Kim� (from� "Development of Intercultural Identity" in Acculturation and Intercultural Identity in the Post Modern-World), a modern-day definition of acculturation is "the process in which immigrants comprehend the norms, values and take on some aspect of the new society-culture." The immigrant usually, but does not have to, develop an intercultural identity: an integration

of before arrival and after arrival cultures into a new culture. The older model of acculturation-assimilation paid much less attention to the individual cultural differences of each specific culture.

An immigrant can end up in 4 squares says authors Kim and Berry (in Acculturation Attitudes of Korean Immigrants): integration - maintenance of "heritage" cultureidentity and active participation in the new society, assimilation - loss of heritage culture and replacement by the new culture, separation - the dominant group formally excludes� them� from� mainstream� society ,� and marginalization - self imposed isolation from other cultural groups. See diagram on next page.

Homeland and Heritage Culture

The 1.5ers (and adoptees) do indeed "redevelop" their heritage culture, Chinese. They do not rediscover it (as in "rediscovering roots - they do not have roots in their mental framework to rediscover). The Chinese culture the 1.5ers know (or learn) is significantly different than adults who immigrated from China learned (not only in present day culture but in the way that they come to learn culture). Young immigrants (such as adopted children) experience Chinese culture as the malleability and metamorphization of their culture within the mental schema over time and space which is very different than what adults would experience as immigrants.

Cultural Identification

Depending on the person, she/he can answer in a variety of ways to her/his identification - race, ethnicity, culture, citizenship. Someone can identify with American

culture entirely and still be Chinese or Chinese-American. Likewise, one can decribe themselves as American (and be racially Chinese) and function within American Culture but not be seen by others as American, but instead be seen as being Chinese.

Older Child Adoption

When we bring into our family a child through a "waiting child" or "older child" adoption program, they will have an increased chance of becoming part of Generation 1.5.

Conclusion

While Generation 1.5 generally refers to those who immigrate to the US with their families (and their elders continue to speak their 1st language at home), there are characteristics of Generation 1.5 that solidly fit children adopted from their toddler years upward in terms of language development AND for all adoptees in terms of cultural identification.

ADHD and International Adoptees

Tue, 31 Jul 2007 16:54:54 GMT

I have heard that Attention Deficit/Hyperactivity Disorder (ADHD) is more common among adoptive children than the general population. Is this true? And, if so, why?

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Attention Deficit/Hyperactivity Disorder (ADHD) is the most frequently diagnosed psychiatric disorder of childhood. Children with ADHD have difficulty maintaining attention, are distractible, impulsive and, sometimes, hyperactive. Although these behaviors are observed among all children, the child with ADHD exhibits functional problems at home, with their friends and in school. It is important to note that not all children with ADHD are hyperactive.

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The incidence of ADHD is indeed higher among adoptive children than the general population. Why this is the case, is perhaps best understood by looking at the potential causes of ADHD. Although research has not identified a specific cause, ADHD seems to be related to both genetic and environmental factors. Approximately 40% of children with ADHD will have a parent with ADHD, generally the father. Beyond genetic factors, research has found that environmental variables such as prenatal alcohol or drug exposure, prenatal maternal smoking, low birth weight, and lead poisoning can place a child at greater risk.

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The adoptive child, who has been living in an orphanage, is potentially at greater risk for ADHD. Malnutrition and inadequate nurturing, in concert with other environmental factors (e.g., prematurity, prenatal alcohol exposure, etc.), contribute to this increased risk.

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It is important to refrain from hastily diagnosing, or labeling a young child with ADHD, prior to school age years. Other medical problems should be ruled-out (e.g., hearing and/or visual problems) as well as the presence of learning problems. I frequently explain to parents that traumatic exposure can cause symptoms that suggest the presence of ADHD. For example, institutionalized children who have been neglected, exposed to physical and sexual abuse, and various degrees of abandonment, often evidence problems with concentration, distractibility and impulsivity. These are normal reactions in the face of an abnormal event (e.g., sexual abuse).

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ADHD is best treated with a multimodal approach that has medical, behavioral, and educational components. Since approximately 70 to 80 percent of children with ADHD respond positively to medication, with an increase in attention and concentration and a decrease in problematic behavior (e.g., impulsivity and hyperactivity), the use psychotropic medications should be considered in consultation with a physician. Behavioral interventions are a major component to treatment. The utilization of behavioral plans, that emphasize positive reinforcement and consistency, are critical. Additionally, the child with ADHD may benefit from problem solving, communication and self-advocacy skills training. Finally, the child with ADHD can benefit from educational interventions. The Individuals with Disabilities Education Act mandates that children with ADHD be eligible for special services and the Americans with Disabilities Act stipulates that children with ADHD are entitled to educational accommodations, such as extended time for tests and preferential seating in the classroom setting.

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ADHD seems to be related to both genetic and environmental factors. The latter, in particular, may help to explain why ADHD is more common among adoptive children than the general population. Also, I hypothesize that due to nature of adoptive parents, there is a greater likelihood of an adoptive child being evaluated, diagnosed and, ultimately, treated for ADHD. It is important not to hastily diagnose children with an attentional disorder without first considering the potential of other medical problems or the effects of psychological variables, such as traumatic exposure. Most adoptive children will not have ADHD. For those who do, there are effective medical, behavioral and educational interventions that can make a difference in these children's' lives.

Written By Dr. Mark Lerner of Adoptiondoctors.com

Recommendations for parents with older child adoptions:

Tue, 31 Jul 2007 17:02:15 GMT

1. Interactive reading with your child will increase your understanding of how your child is progressing. That is, parent reads to child and child reads to parent, parent reads to child and let's child read portion of the words in the sentence (you create "fill in the blank" with grammar being an important part of the pattern).

2. Journal with your child in her/his first language and second language. It is possible for children to be bilingual from an early age as long as they learn the structure and patterns correct in both languages, where reading/writing is included in both languages. Allow child to journal from an early age using what they can write along with pictures they can draw. Again focus on making sure the structure of the sentences make sense as it's the structure of language that experts report being the most critical factor for success with the written language.

3. Make sure teachers are having your child write in school and checking their writing for correct patterns/structure. Also they should not drown your child's papers with criticism but rather give the child a chance to re-write or repeat until they have learned the pattern/structure/ grammar.

4. Remember that we ALL learn language first by interacting with others - children at home, at play, through our parents. Give your child the opportunity to interact with many people. Talk to your older adoptee in normal spoken English even if your child may not yet understand fully what you are saying. Speaking in simple English or "babytalk" does not allow children to learn the structure of language properly. Children who are spoken to with normal conversational English will have the patterns presented to them naturally. Young children who only hear parts of sentences only speak in parts of sentences and thus take longer to learn the structure/patterns of the language. 5. Use language tools with your older adoptee - such as labeling items in the house (stove, oven, sink, and bathroom) and making flashcards and tools that include complete sentences or fill-in the blanks where verbs, for example, can be changed.

6. Do not assume that your child is learning everything they should at school. Meet with her/his teacher to be sure that speaking, reading, writing are all on grade level or that progress is being made.

7. Use workbooks available from teacher supply stores to supplement schooling.

8. Computer programs such as Reader Rabbit or many of the Disney programs where interactively the child can read and learn whole sentences can prove helpful

Adoption Travel - Just adults or the whole family?

Tue, 31 Jul 2007 17:13:22 GMT

1. Should we bring our parents when we come to adopt our child from China?

2. Should we bring our biological children when we come to adopt from China?

3. Should we bring our toddler who was adopted from China when we return to adopt our second child?

4. What if I travel without my spouse to adopt our new child - can I do that? Will I be able to handle it?

5. Has a dad ever come to adopt without bringing his wife, the new mom?

6. What if I'm single, do I need to bring someone to help me? Can I hire someone to help me in China? (yes, through OCDF)

When I looked at the group photo for one of our 2006 adoption groups, I realized that the answers to many of the questions were within this one group. It was a very diverse group of people with varying backgrounds, interests, and ages yet they had a good adoption trip and they each approached it differently.

I don't believe there's one right answer to any of the questions. It really does depend on your family and your ability to manage diverse and challenging situations while juggling various relationships both new and old. Some people do well on their own and can manage change or uncertainty well, others do not. Adoption trips are filled with new experiences for most people. Even families returning to adopt the second time discover their return trip is rarely like their first trip, they know more but also China has changed or they are in a different Province or have a different agency or facilitator. Make sure if you do bring others that� they are "good help" and not people who will be an additional burden to you as your health and energy are needed throughout the adoption process. You need to be able to focus on your new child.

Factors to consider:

1.Luggage - can I travel light enough to carry my own luggage and handle my new child? Having two people can be better than one where luggage is concerned. If you are traveling single, make sure you pack light and that your luggage has wheels or you use a backpack and stroller. For those

traveling with many people, be sure everyone can handle their own luggage and still help the new Mom/Dad with their luggage.

2. Jet lag - can you travel where everyone in your family/ friends who accompany you will be able to handle the timechange and jet-lag? Remember your new child will not be experiencing jet lag while you are in China. Bringing small children such as toddlers or kids under age 6 may mean that they will sleep throughout the day while you need to be awake with your new child. Then they will be awake while you and your new child need to sleep at night. Expect to arrive in China a couple of days early if you plan to bring young children along and have a stroller for them. Your goal is to get over jet lag as quickly as possible so you can be at your best for handling the new child's needs

�3. Should siblings and grandparents be along? Some people believe they should experience the bonding of being a whole family. Some people believe that you (and your spouse) both need to bond to the new child independent of your other children.� The question then becomes one of family preference relative to bonding.

4. Meals and Medical issues for siblings and grandparents- If your children and grandparents can travel well in terms of their personal health, their medical conditions, ability and willingness to try new foods, then they should be able to handle the trip. If you have family members who are picky eaters, will not try or eat Chinese food, or have dietary restrictions due to medical conditions or allergies, then traveling along at the time of adoption may not be suitable.

5. Cost -the cost of adding a small child is basically their transportation and food. It's usually not much. But to add many people or to add children over the age of 12 who count as adults in China, the cost of your adoption trip soars as you add on international airfares, extra hotel rooms, meals and domestic transportation for a period of two weeks. This could cost more than the adoption itself if you have a large extended family.

What is the Adoption Psychological Evaluations?

Tue, 31 Jul 2007 19:17:47 GMT

I have heard that parents who seek to adopt children are often required to undergo extensive psychological evaluations? Is this true? And, if it is, what should my husband and I expect in this process?

It is becoming increasingly common for parents, who seek to adopt, to undergo psychological evaluation. Generally, these evaluations are not "extensive" in nature and are conducted in order to provide an overview of the psychosocial functioning of potential adoptive parents. Unlike comprehensive psychological evaluations, in which measures of various abilities are administered (e.g., IQ testing, Perceptual-Motor assessment, Achievement testing, etc.), pre-adoptive psychological evaluations generally center around interviews with the parents together and independently. Sometimes, an objective (i.e., paper and pencil) personality measure may be utilized in order to supplement self-report (i.e., interview) data.

In the psychologist's report, which is generally two to four pages in length, the reason for the evaluation should be stated. In this case, your desire to adopt a child (or children). The reasons and expectations centering around adopting are typically discussed, as well as your feelings toward the biological parent(s) and/or the child's present living situation. There should be a section that articulates relevant background information. Here, your history is addressed. Of particular concern will be pre-adoptive stressors such as fertility issues, miscarriages and other losses, relationship conflicts, etc. Beyond your respective individual adjustments, should be a discussion concerning your marital adjustment. Examples of conflicts, and the mechanism of resolution, by you and your husband may be offered. If psychological measures are utilized (e.g., a personality test), a thorough explanation of the data should be presented, as well as the impact of said findings on your potential to be suitable adoptive parents. Finally, the evaluator's conclusion regarding you and your husband's abilities in parenting an adoptive child will be offered.

As you move ahead, recognize that the psychological evaluation of potential adoptive parents is another of the many hurdles that you will face as you move through the journey of adoption. As I have discussed in my responses to previous queries, "Adoption Stress" will likely color all aspects of the adoption process. Know that this experience... your feelings, thoughts, actions and your physical and spiritual reactions are normal. If you are to undergo a psychological evaluation, just relax and be yourself. You're not expected to be free of anxiety, realistic fears and concerns. Rather than focusing on the review mirror, clouded by stresses of the past, focus on the road ahead... and clearly see your dream of having an adoptive child realized.

Written By Mark Lerner, Ph.D. of Adoptiondoctors.com

Disclaimer
The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Post-Adoption Depression?

Tue, 31 Jul 2007 19:28:12 GMT

The term "Post-Adoption Depression" has been used to explain the feelings of sadness that are experienced by many adoptive parents subsequent to the adoptive process. Unlike postpartum depression, which may be caused by significant physiological and hormonal changes (e.g., a sudden decrease in estrogen and progesterone in the bloodstream), Post-Adoption Depression cannot. Post-Adoption Depression focuses on the feelings of sadness that are experienced after the attainment of a long-term goal that has required time, money, effort, emotional strain and patience.

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New York Post-Adoption Depression is a symptom that falls under a much larger umbrella - what I have called "Adoption Stress." The latter refers to the feelings, thoughts, actions and the physical and spiritual reactions of all parties who are involved in the adoption process (e.g., a mother who surrenders her child for adoption, an adoptive child, an adoptive parent, a compassionate case worker, etc.).

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We can better understand and appreciate the depressive symptomatology experienced by many adoptive parents if we first consider 1) pre-adoption stressors, 2) stress associated with the acquisition of an adoptive child and 3) post-adoption stress. By focusing solely on Post-Adoption Depression, we miss the causative or related stressors that contribute to the adoptive parent's feelings of sadness. For example, the attainment of a long-term goal of having an adoptive child often opens the door to seemingly insensitive questions from others about infertility and prior losses. These questions will likely stimulate unresolved feelings, and may cause adoptive parents to revisit pre-adoption stress. The acquisition of an adoptive child is often colored by serious medical concerns, "misunderstandings" and heartbreaking disappointments. And, the post-adoption experience is often marked by tremendous life changes, new responsibilities and a future marked by uncertainty and fear.

�

During a recent therapeutic session with a group of adoptive parents, we explored a number of participants' feelings of sadness. Suddenly, one mother exclaimed, "I didn't sign-up for this!" Her comment was met by applause from several of the participants. Her statement underscores the complex continuum of "before, during and after stressors" that are faced by adoptive parents.

How can we prevent Post-Adoption Depression? First, we must educate all people involved in the adoptive process about Adoption Stress. If more people understood that the feelings, thoughts, actions and the physical and spiritual reactions were a normal response to a very stressful, multifaceted experience, fewer people would struggle with conflicted feelings. We must also focus our attention on parents who have been prone to feelings of depression and do not fare well when faced with considerable stress. We must encourage them to become involved in support groups or counseling. If we do this prior to parents entering into the adoptive process we can ultimately decrease the post-adoption stress that is experienced by many adoptive parents.

Written By Mark Lerner, Ph.D. of Adoptiondoctors.com

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Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Forever Fingerprints

Tue, 31 Jul 2007 19:29:25 GMT

I am more excited about the publication of FOREVER FINGERPRINTS than any book I have ever written! Why? Take a look at my nine-year old computer file, filled with rejection letters from publishers who couldn't understand why I would want to write a children's book about adoption. Take a closer look at my adult adoptee heart that is passionate about deepening relationships between parents and their adopted kids.

Here are some of the threads from the tapestry of my life that helped formulate the understanding and insight required to write this book for you and your kids.

Carried into my new home at ten days of age by my adoptive grandmother, Leah Cook, the social worker who handled my case, I believed as a young child in the miracle of adoption. Grandma ran the "County Home," or orphanage, a haven for abused and abandoned kids, where I played everyday with kids the world considered rejects. To me, they were my buddies who ate Wonder Bread with butter and sugar and swam with me at the city pool.

My dear parents, the late Mike and Retha Cook, from St. Johns, Michigan, always told me, "Out of all the babies in the world, we chose you!" They delighted in retelling my adoption story until their dying days, and I loved hearing it. Mike and Retha wanted nothing more than to be the best parents possible for me, but tools like this book weren't available in the 1940's to help parents understand how the loss of one's birth family impacts a child's ability to give and receive love.

Since the subject of my birth or birth parents wasn't discussed, curiosities and unspoken questions produced strong emotions that neither my devoted parents nor I understood. Why did I get so angry at mom? Was something wrong with me? I am sure she felt rejection, big time. Why did I sob hysterically at the funeral of my best friend's mom, when it wasn't my mom who died? Was I sad on a subconscious level for the loss of my birthmother, who provided a sacred place for me to live for nine months before birth? Why did I live a "double life" morally? Did I believe I was placed for adoption because I was a bad baby? If so, I lived out the fantasy. But to keep others from knowing how confused I was, I was also a high achiever.

Later in life, I began to see the big picture of adoption, the grand design. I discovered that the One who orchestrated the grand design loves me more than life itself and weaved me together in that sacred place before I was born. Since He did all that, I am fully convinced He made a way for my fingerprints to last forever.

Vietnam Adoption

Tue, 31 Jul 2007 20:00:34 GMT

Vietnam is once again gaining in popularity as the country of choice for American adoptions. In 2006 the number of American adoptions from Vietnam reached the highest point in 3 years and accounted for 163 orphan visas. It is expected that with passage of the U.S. Vietnam Bilateral Agreement on Intercountry Adoption of 2005 the numbers will vastly increase.

This article will outline Adoption Home Study requirements mandated by Vietnam. Before we begin a few words about the Adoption Home Study. It is a comprehensive report of the adoptive family's background and child-rearing philosophy. It is designed to assist the family in preparing for the arrival of a new family member into a nurturing environment. It is conducted by a Licensed Master Social Worker (LMSW) in the privacy of your home. Upon recommendation of the adoptive family the report is filed with (CIS) and becomes part of your dossier. Prospective adoptive parents are also urged to request additional information from their adoption agencies and adoption home study agencies.

ADOPTION HOME STUDY GUIDELINES FOR VIETNAMESE ADOPTION

. Prospective adoptive parents must be 20 years older than child they wish to adopt . Married heterosexual couples and heterosexual singles are eligible to adopt. Prospective adoptive families must have good ethical qualities and receive clearances from the FBI, Child Abuse Registers, local authorities. Prospective adoptive families must be in good health, free of mental impairments and contagious disease. Families wishing to adopt must have verifiable income and possess the resources to raise and educate an orphan. Children over 9 years of age must agree in writing to the adoption. Adoptive families may have the opportunity to review medical records prior to receiving their referral. This is an excellent opportunity for consultation with an pediatrician specializing in international adoptions and adoptions from Vietnam. Vietnamese law may disallow an adoption if it is not in the best interests of the child or if the adoption if illegal. Prospective adoptive families must agree to comply with requirements for post-placement supervision. Permission to adopt must be granted from an authorized American adoption agency in your state of residence�

Written by ROBERTA KALMAR LMSW of Adoptiondoctors.com� Roberta Kalmar, LMSW

Adopting from Vietnam

Tue, 31 Jul 2007 20:04:08 GMT

Adoption and bringing your new infant or toddler home from Vietnam are very exciting and memorable times. Once calmness descends upon your household however parents direct their full attention to their child's development and functioning in the new environment. Not only do they observe their child's recognition of them when they are near they also notice their child's interest in toys, ability to hold their bottle and their ability to physically maneuver. During these early months, parents tend to observe what other children the same age are doing and how their child measures up. There is also the inevitable comparison with developmental milestones as outlined by child-rearing experts. By one year of age many children have a small vocabulary, can grasp and hold small items and can crawl. Generally at two years of age they like to copy their parents, demonstrate affection, begin communicating in small sentences and enjoy feeding themselves.

For parents who have adopted from Vietnam the concern is heightened because the child may have lived in impoverishment in the countryside, may have suffered from life threatening medical problems and/or been neglected. The impact of these circumstances is immeasurable on fragile bodies and delicate brains. It is for these reasons adoptive parents of children through 3 years of age are urged to avail themselves of the Early Intervention program. The good news is parents can request these services themselves especially if they are worried their child is lagging in acquiring speech skills, experiencing difficulty crawling or walking or in responding to family members. Funded by the government and free to families, your infant or toddler is entitled to assessments by a clinical team of professionals who have considerable experience in observing and understanding young children. These specialists may include a psychologist who will assess you child's ability to perform tasks and ability to copy or learn new information. An early childhood specialist will meet with your child to understand your child's learning styles and areas which need strengthening. The speech therapist will study the child's style of forming words and self-expression, while the occupational therapist will measure the youngster's strategies for manipulating and hold small items. Too the physical therapist will assess crawling, standing, sitting and walking development. You will also become an active member of the team sharing medical reports from your international pediatrician, who will be readily available to consult with the team. Additionally you will provide background and observations on your youngster to the clinicians.

The assessment may take approximately one month or more depending on whether it is conducted by the Department of Education at a nearby school or in a private diagnostic center referred by your pediatrician. Once the evaluation is completed you and the members of the team will meet to discuss their conclusions and recommendations and you will receive a comprehensive written and oral report of their findings. You are then in the position to decide with the team what you feel is in the best interests of your child. If you are in agreement with the diagnostic team your child then stands to benefit from speech therapy, occupational therapy or physical therapy while you and the family can receive support counseling and family counseling. Many times these services are provided in your home giving you the opportunity to also reinforce the strategies you have observed. Other times appointments are scheduled at nearby Early Intervention offices. You may feel free to contact your local school for further information or consult with your pediatrician. It is suggested when you do receive referrals for programs you visit a number of them before committing to their services. You may want to meet with the Director to understand the program's philosophy, inquire how long the program has been in existence and understand what credentials the teachers possess who will work with your child. Too, see if you can meet with the professionals who will be working with your child. Be sure to ask how many sessions of therapy your child will receive weekly, how long the sessions will last and where the services will be provided-- in your home or in the agency's offices. Remember these are your child's formative years. Make every effort to ensure your child receives the evaluation and services s(he) needs to establish a good foundation for learning and realizing full potential.

Be sure to share information about your child's participation in the Early Intervention program with your social worker during your post-supervisory meetings. Your adoption agency and The Socialist Republic of Vietnam will be impressed your child has been availed of such individualized services designed to meet his/her specific needs.

Written By Roberta Kalmar LMSW of www.adoptiondoctors.com� Roberta Kalmar, LMSW

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Ethiopian Adoption

Tue, 31 Jul 2007 20:16:10 GMT

Ethiopia in 2006 has become one of the top 5 countries for American adoptions. This attraction is heightened by the beauty and appeal of the children, their ethnic diversity and their religions which encompass the Judaic, Christian and Muslim traditions. However as one of the highest ranking countries in the world for maternal mortality, malnutrition, poverty, AIDS and child abandonment a medical review of your child's referral packet is essential. Thus when you receive your youngster's photo, medical report and developmental history be sure to consult with a pediatrician knowledgeable about and experienced in international adoption. This is the professional who can provide you with the guidance and peace of mind to proceed with this referral or request another and who will be on call to you when you are in Ethiopia with pressing questions. He or she will also provide you with traveling suggestions and prescriptions for the long trip home to the states. It is this physician with whom you and your child will meet as soon as you return home.

Americans adopting from Ethiopia have the unique privilege of meeting and visiting with the biological family, if they are known, in their villages. It is an opportunity which should be eagerly accepted because in years to come it will give your child tangible information about his/her ancestry, photographs for your child's Life Book and yield important medical and psychological information about family genetics. This meeting will give a window into the circumstances for the adoption and provide the chance to obtain medical information from the birth family and officials and to take family pictures. These materials, as well as a few strands of hair from the birth mother, should be sent to your pediatrician while you are in Ethiopia or maintained for future genetic testing. In years to come DNA will provide a wealth of information to adoptive families and your doctor will be the repository of these materials and alert you to the latest findings. When in Ethiopia your child will be cared for in the orphanage by nannies, nurses and doctors. Your youngster will also receive check-ups from an outside physician in his/her office.

If you have questions and are uncomfortable with the answers feel free to ask for a team consultation, as I did, with all the professionals involved with you child. If you continue to be concerned contact your physician in America for clarification before bringing your child home. Most importantly know that your child will receive inoculations in Ethiopia and must be in good health to qualify for the America visa. Your child will receive a final check-up in Ethiopia to certify these requirements have been met. In addition to knowing your child's health and birth family you will meet the youngster you only "knew" from a photo within hours of your arrival in Ethiopia. Be aware that when you land in Addis Ababa you will be jetlagged from the long, exhausting trip. Therefore take the opportunity to get some rest, eat lightly and be refreshed when you meet your child. You want to feel your very best and be ready for one of the most joyous occasions you will experience. As you prepare to meet for the first time remember that your little one is not accustomed to many visitors or being held by newcomers. It will take both of you time to get acquainted. Enlist the assistance of the nannies who, although you may find them possessive in the beginning, will be a fund of information and full of helpful tips once you are assertive and they understand your good intentions. So spend as much time as you can during the first days in your child's care center observing your child's feeding schedule, appetite, sleep pattern and temperament. Get accustomed to feeding and bathing your child because in a few days the child you have been visiting daily will be placed in your custody. It will then be your decision to stay in the orphanage's guest house or a hotel of your choosing, while you await completion of your paperwork. And in a few more days you and your child will journey home to America to start a new life. One of the great advantages of Ethiopian adoption is the streamlined procedures and the abbreviated schedule, which is usually completed within 5-7 days of your arrival in Ethiopia.

A few words of wisdom when you return home: minimize the number of visitors during the first weeks. This is a major life change for your youngster and time is needed to rest from the long flight and to adjust to new formula/food and the immediate family. You and all those who love you and your new child will have a lifetime to celebrate.

� Roberta Kalmar, LMSW

Disclaimer:

Medical requirements for Adopted child with Tetrology of Fallot

Tue, 31 Jul 2007 20:28:19 GMT

Tetralogy of Fallot is an anatomic misalignment of the heart. The abnormality is quite complex and left untreated these children will do poorly. This condition requires open heart surgery for correction. Surgical mortality is now quite low in most centers in the United States which means that all things being equal most kids do well. At Children's Hospital of Philadelphia it is recommended to have surgery in infancy 3-6 mo for optimal outcome before the children become
cyanotic (blue).

Residual homodynamic abnormalities are commonly seen afterward as well as abnormalities in cardiac function. These children require follow up also by the cardiologist since they are at risk for arrhythmias (irregular heartbeats). They usually lead fairly normal lives but their hearts are never the same as a normal heart.

How well the children do is very dependent on factors which vary from child to child. It is therefore impossible to say with great assurity what someone's life will be like because a lot of times how someone does with a surgery depends on their personality and support.

I hope this has been helpful,

Dr James Reilly MD of www.adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made.
This website does not constitute a physician patient relationship.

Bedwetting in the Internationally Adopted Child.

Tue, 31 Jul 2007 20:37:48 GMT

Bedwetting in the Internationally Adopted Child.Bedwetting or Enuresis:

Enuresis is defined by involuntary urination after the age of expected bladder control it is generally reserved for children six years of age or older.

Epidemiology-20% of children at the age of 5 years wet the bed at night. 10% wet the bed at seven years, 5% at the age of ten years.

Nocturnal enuresis is more common in males than females. 70% of children with enuresis have a parent who has enuresis.

Enuresis again is not abnormal in a child who is four years old so expecting them to be dry through the night is unreasonable. If they are dry thru the night then you are merely lucky.

It is important to take a good history. If the child had been trained thru the night, has any abnormalities of the spine or there is any abnormalities in the stream then they need a further work-up.

Diagnosis-
Children who have this problem need to undergo a work up. Urinary tract infections, sugar in the urine, abnormalities of kidney/bladder function, and other more obscure reasons. Usually the urine is examined and perhaps cultured.

Therapy- education is important. The parents need to remain positive and to refrain from aggressive attempts at therapy until the child is around 6yrs. Alarm systems are the most effective of all interventions. They usually take time to work. There is drug therapy but all of the therapies have there side effects and are usually not used first line especially in younger children.

Prognosis- is excellent with 15% resolution rate every year without any treatment.

It is difficult to say what is normal when you are presented all of a sudden with a four year old child especially since sometimes friends or family may not remember what it is like to have children. This is a common situation for persons who adopt a child. The American Academy of Pediatrics puts out a definitive source on raising children. It talks about all the different things that parents usually will/may need to know such as what is the proper water temperature in your home? Does my child need vitamins? What car seats have been recalled because they are unsafe? Etc. "It is called caring for your young baby and child". It covers birth to age 5, I do not get any royalties and it does not pay for the pediatrician retirement home but it is an excellent source of information put out by pediatricians.

Written by James Reilly M.D. of www.adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical examination can a medical diagnosis and accurate treatment plan can be made.

A Mother's Touch

Tue, 31 Jul 2007 20:38:30 GMT

Children who are able to enjoy relationships were provided constant contact when in need as babies (and at many other times, simply because they were so cute and cuddly). Their mothers filled their hungry bellies while talking, smiling and interacting with them. Their mothers rocked, lifted and moved them, and provided stimulating environments in multiple ways, particularly through touch. Their mothers presented warm and loving faces to them, with a strong interest in eye contact. Their mothers connected with the babies' inner world, almost downloading their own inner experiences. This is illuminated by Dr. Daniel N. Sterns words "(as though watching before your eyes).the infant becoming the child of his particular mother" . Such moments not only create and shape the relationship but these "dyadic, reciprocal interactions that arise within a (parent/child) relationship are central to young children's neuro-psychological development" says Daniel A. Hughes, Ph.D. Such mother-child interactions are not only rich emotional experiences, but also rich sensorimotor experiences for developing babies.

Adoptive parents of children institutionalized from birth may find that their children resist comforting and show little interest in exploration. Some parents are concerned that their children do not seem to know when they are hungry or full. Other parents are saddened that their new child will not look at them and do not seem to know how to seek comfort or even safety. There are worries that their child does not "track" or heed a call of fear from a screaming mother who is seeing her child running toward a busy street! And, there are concerns over "affect regulation"� making an adoptive parent feel that the words "temper tantrum" do not aptly describe the intensity of the explosiveness and impulsivity their child displays. One of the most disturbing things for adoptive parents is to witness self-injurious behaviors, such as intense rocking or head banging. These are all poignant signs of not having been mothered.

Clinical research conducted by Neil W. Boris, M.D. and Charles H. Zeanah, M.D. and colleagues, has provided professionals with a set of emotional-behavioral symptoms for children who suffer from not having been mothered. Their findings indicate a spectrum of attachment disturbances, with the severe "Reactive Attachment Disorder" being but one type. Rather, they suggest a diagnostic scheme that includes children suffering from a "Disorder of Nonattachment"� because the etiology and symptomology differ between bad care versus no care. It is important to differentiate children who have not been mothered from those who have known uncaring, cruel or terrorizing mothers, because their plights differ. The children identified as "not having been mothered" are the children who have never experienced "her". They have no memories of "her" embedded deep within, and this is the basis of the sensorimotor issues that compound the emotional issues facing un-mothered children and their adoptive parents.

Institutionalized babies adopted within the first year of their lives seem, for the most part, to have a resiliency that allows them to flourish in a family setting [8]. However, children who are adopted later seem to be in need of relationship treatment at a higher rate, in my experiences, due to behavioral problems stemming from their inability to enjoy the sensations of their adoptive mother and/or father. Many of these families seek "attachment oriented psychotherapy" and engage in a treatment model called Dyadic Developmental Psychotherapy� (DDP) developed by Daniel A. Hughes, Ph.D. ^[2]. This treatment model, which can be found within the pages of Hughes' book, "Building the Bonds of Attachment"^[1], is designed to help a child feel emotionally safe so their energy can be spent enjoyably engaging others, especially their primary attachment figure.� It is also designed to create the experiences of "affect attunement," the emotional sharing that occurs between a child and his/her parent, which may not have been experienced prior to adoption.� This treatment model focuses on the relationship, providing a model for occupational therapy as well - the sensorimotor-mothering piece that is sorely needed in many cases.�

�� The deprived infant/child, the one not held, fed, cuddled and "claimed," (the children identified by Drs. Boris and Zeanah as having a "Disorder of Non-Attachment") needs to be given the opportunity to experience missed sensations.� This is most often accomplished through occupational therapy, but in the past, the missing component has usually been the parent.� Most naturally, the un-mothered child will have issues of praxis^{^[2]}but treatment also needs to be experienced within the context of a meaningful relationship.� If the child does not have a relationship with his/her parent, there is the likelihood that there will not be one with the occupational therapist.� In addition, having a parent in the occupational therapy treatment room, versus watching a therapist with the child through a one-way mirror (or sitting in a waiting room), can take advantage of the developing parent and child relationship that psychotherapeutic treatments, such as DDP, are working to create.� Further, it is suggested that the treatment be performed through the parent. �This means the occupational therapist must work with the parent to teach them to do the interventions.� "When a child is in attachment-oriented therapy the occupational treatment plan will always include the parent in the treatment room," says Sandra Glovak, owner of Sensory Systems Clinic in St Clair Shores, Michigan^[3].� Having occupational therapy mirror attachment-oriented psychotherapy creates more opportunities for the child's sensory issues to heal, and more opportunities for the developing parent-child relationship to flourish.

# # #

References

1.� Daniel N. Stern, M.D.� The Interpersonal World of the Infant: A View from Psychoanalysis & Developmental Psychology.� Basic Books.� 1985.��

2.� Daniel A. Hughes, Ph.D.� An Attachment Based Treatment of Maltreated Children and Young People.� Attachment and Human Development, 6:263-278, September 2004.

3.� Allan N. Schore, M.D.� Affect Regulation and the Origin of the Self.� Lawrence Erlbaum Associates.� 1994.

4.� Jan Moren and Christian Balkenius.� A Computational Model of Emotional Learning in the Amygdala. Proceedings of the 6th International Conference on the Simulation of Adaptive Behavior, Cambridge, Mass., 2000.� The MIT Press.

5.� Neil W. Boris, M.D. and Charles N. Zeanah.� Attachment Disorders in Infancy and Early childhood: A Preliminary Investigation of Diagnostic Criteria.� American Journal of Psychiatry 155:295-297, February 1998.��

6. Diagnostic and Statistical Manual of Mental Disorders DSM-IV by American Psychiatric Association.

7.� Charles N. Zeanah, M.D. and Alicia F. Lieberman, Ph.D.� Disorders of Attachment in Infancy.� Infant Psychiatry: Child Psychiatric Clinics of North America. VOL 4, 571-588.� 1995.

8.� Rutter, Michael. Developmental Catch-up, and Deficiency, Following Adoption After Severe Global Early Privation: English and Romanian Adoptees (ERA) Study Team.� Journal of Child Psychology & Psychiatry, 39 (465-476).� 1998.

^[1] Daniel A. Hughes, Ph.D.� Building the Bonds of Attachment.� Jason Aronson.� September 1998

^[2] Self-determination as opposed to coercion, intentionality as opposed to reaction, creativity as opposed to homogeneity, and rationality as opposed to chance

^[3] www.sensorysystemsclinic.com

�

��

�

Adopting a child whose birthmom used Marijuanna during pregnancy

Tue, 31 Jul 2007 20:46:03 GMT

In general doctors are not too crazy about the idea of pregnant ladies taking any drug when they are pregnant either legal or illegal unless it has been rigorously studied to have no harm to the developing child. The main active ingredient of marijuana, tetrahydrocannabinol, can cross the placenta and thus may affect the fetus. Marijuana is the most widely used illegal drug in the USA among women of reproductive age despite this fact there is a relative lack of literature dealing with this problem.�

How Marijuana works in the brain is thru the receptors in our brain which respond to our natural chemicals. When it binds to our brain it gives the "high feeling" the user is looking for. The worry is that when it binds in a developing brain can this change the way the brain develops requiring more natural chemicals or making the brain resistant to these chemicals.� �

�

There are some studies that seem to show that marijuana can effect the development of the nervous system in a baby as evidenced by the increased nervousness/tremulousness and irritability that is seen after a child is born whose mother abused marijuana.

When these children enter school they are noted to have more behavioral problems and seem to have problems paying attention in school. The also appear to have more problems with memory at four years of age when compared to other children. They also have deficits in problem solving skills. Exposed children do not appear to have a decrease in IQ.�

�

Later in life the outcomes are less clear what exactly happens. There seem to be no good data on what kind of "citizens" these children become.�

The problem with marijuana is that it is usually not abused in isolation and that it is usually found in someone who at the same time is smoking cigarettes and perhaps drinking alcohol. These co-drug exposures make it difficult for researchers to say definitely what causes damage in a developing child's brain

�

Written by James Reilly of Adoptiondoctors.com

How Do You Mend A Broken Heart?

Tue, 31 Jul 2007 20:47:59 GMT

I knew how to treat Eastern European adoptees and American foster children.� Actually, by 1996 I was considered an expert with quite a few years of clinical practice under my belt.� But, the new little ones I was beginning to treat, the ones from across the other ocean, were giving me pause.� Each toddler or young child from China that walked or was carried into my office had incredible anxiety.� It was pervasive.� I had a sense that behavioral treatments were not going to fix the symptoms and most certainly not the problem, whatever it was.� Even the usual relaxing effects of play seemed ineffective, provoking more stress in some cases.�

Anxiety, of course, is a part of life.� At one end it can be performance enhancing, at the other incapacitating.� The anxiety of adoption is also a normal part of every adoptee's life; the "wondering" itself causes anxiety.� But, the children from China that I treated seemed to be anxious far beyond those proportions, and at times it was heartbreakingly debilitating.� The need to control, the need to check and recheck on mom and/or dad, difficulties with sleep initiation, night terrors and painful separations were the usual worries and complaints that led parents to my office.

I wrongly concluded that a child who was brought to treatment automatically fell into a special group, the 10 percent of adoptees that do not adjust to their new homes and are in need of psychotherapeutic interventions.� (The therapeutic world now knows this number is inaccurate since the study was based on abused and neglected children who entered foster care.)� But the children I was seeing fit into their own classification. There was something different, something that was "normal" for them.� About this time, as fortune would have it, my husband had a business opportunity that required travel to China.� I jumped at the idea of joining him in Beijing.� I knew I wouldn't find any therapeutic answers or be able to visit an orphanage, but being the "feelings doctor" that I was, I also knew that the experience would be invaluable.�

I didn't make the connection until sometime later as I reflected on the sunny day I stood in Tiananmen Square in 1997.� We were watching children and their parents fly kites while marveling at the ominous structures all around us.� Then, with no warning, soldiers came to clear the area-- many, many soldiers!� Everyone obediently followed the soldiers' lead.� The masses moved in unison and we followed, searching for someone who spoke English.� We wanted to know the problem as well as just how fast we should find transportation back to our hotel. We discovered it was simply a visiting dignitary and safety precautions were being made, but the anxiety level around us was incredible.� I wondered if it was like this all the time?� Was there always such a quick response to authority?� Did everyone always feel so tense and alert?� Is it some sort of cultural anxiety, maybe built into one's neurological makeup over years and generations?� Could this be so?� Perhaps this was the thread of commonality in every child from China that I had met!� Clinically I could testify to it.��

Upon my return from China I took on several new child clients.� These little girls were very special and taught me much.� Each, in her own way, confirmed my theory about their underlying cultural anxiety, the one I experienced in Tiananmen Square, the one that permeates the pages of Life & Death In Shanghai, for example.� It was becoming clear that this "cultural anxiety" was passed along from one generation to the next and was being disguised, here in the USA, as "common" adoption anxiety.

I was also underestimating a second factor, real abandonment. These children didn't just "perceive" abandonment; they had lived abandonment.� In the United States we are not accustomed to "finding" babies on street corners or in parks, a tiny baby, a newborn, left alone in the elements.� It seemed a different kind of abandonment, one I call real.� Each child was living in her new, loving family with this deep-seated fear.� And their anxieties were thought to be common adoption adjustments, not fear!� There was a notion that the Chinese adopted baby girls didn't know or remember anything of their past, since many had been adopted before the age of one.� Not many adults, prior to the 90s, had yet come to see that a baby could have a broken heart, let alone experience an underlying fear that it would be broken again.� Parent-talk of forever families and "I will love you forever" didn't seem to "fix" the problem for these children.

One day, out of compassion for all the tears I saw at work, I sat down and wrote a story about a baby that was abandoned, describing how I thought she might feel.� It was raw.� It was graphic.� It was heartfelt.� It gave reason for the tears, for the anxiety, for the fear.� I then discussed this story with each of my little clients' parents and talked with them about their child's own story.� I asked that they tell their child's story, confront the anxiety and address the fear.� After processing this request with horrified parents (remember this was over five years ago) they agreed it was worth a try.�

It was unearthed that one child believed her birthfamily lived in a nearby city.� When told her story of abandonment she was so relieved that she was indeed in her "forever" family that she never experienced night terrors again.� Another child who needed to play act her abandonment did so with her mom, using the story as a springboard to the whole truth. a piece this child didn't know, that there was a second mother, a foster mother, who cared and loved her.� And then there was a toddler who stopped the rages to listen to this story.� It must have felt so true to her experience that she grieved, along with her mother, giving closure to all those angry days and nights.� There were others and the effects were the same.

The anxiety needed to be addressed with words and with truthfulness for the children from China.� The anxiety needed a name and the name needed a story.� The story explained the purpose for some of the behaviors, as the past seemed to drive the present, which certainly now made sense.

My story circulated and one evening Jean MacLeod of FCC-Metro Detroit called to ask if I would consider writing a book using the ideas I had put to words.� I never thought beyond my office, my clinical practice, or the children I treated, so I had to give this idea some time.� Eventually I said yes with lots of provisions, in particular her assistance.� Later, as fate would have it I had contact with an artist on a personal project.� While working together I asked if she might be interested in a charitable project?� She was.� After two years of word and picture changes and learning more about publishing than I ever wanted to know, I finally had a book.� It began as a story I wrote for one child and matured into a book for many.�

Now my story can help more parents understand the reason for their child's behaviors.� Now, perhaps it can help create empathy rather than frustration.� Before I Met You can be used as a prescription for an illness called cultural anxiety, complicated by fear of abandonment, mixed with common adoption anxiety.� it can help to mend a broken heart.�

�� Order a signed copy of

�� Before I Met You

�� http://www.adoptionparenting.net/page35.html

Alcoholism: From Russia to You & Here in the USA

Tue, 31 Jul 2007 20:53:40 GMT

In America the skyrocketing use of drugs and alcohol has been targeted as the primary factor in children placed in out-of-home care according to the National Adoption Information Clearinghouse. If statistics were available would it be the same in Russia? Likely. In 1996 reports indicate that the average Russian man drinks about four gallons of pure alcohol a year, or about a pint of vodka every other day, nearly twice what Americans drink. Excessive drinking has become the leading cause of death in Russia. The life style includes alcohol. Social custom is a major contributing factor to alcoholism, as drinking has no negative connotations at any age or at any social standing in Russia. except, loosing one's children due to alcoholism! The termination of parental rights documentation for many of the children adopted from Russia refers to "alcoholism" somewhere in their papers. Does this fact place a Russian-American adopted child at risk for alcoholism? Yes.

Every child in America, regardless of heritage, is at risk for alcoholism. Research indicates that 26% of 8^th graders reported drinking alcohol in any given month, 40% of 10^th graders and 51% of 12^th graders! All kids are at very high risk AND their genetics play a role in their level of risk.

Many studies of twins and adoptees have clearly found and demonstrated that genetic factors influence an individual's vulnerability to alcoholism. No conclusive evidence has been found to explain precisely what is inherited, or the overall importance of this inherited material, but most think it is likely numerous genes as opposed to one. There isn't a genetic marker, as yet, but every study indicates there is a connection. a fact that adoptive parents of children from alcoholic birthparents must take seriously.

The level of influence the environment has in alcoholism vs. genetics has yet to be determined but we know when both exist it can be lethal. This has major implications for children adopted from Russia just as it does for children adopted from American families with alcoholism in their history. For example, sons of alcoholics were more likely to be alcoholic than were sons of nonalcoholic, whether they were raised by their biological parents or by nonalcoholic adoptive parents. In the same study, a more detailed analysis found that there was a correlation between alcoholism in biological mothers and alcoholism in the adopted daughters.

Other studies show that a parent's drinking behavior and attitudes about drinking have been positively associated with a child's initiating drinking. We know that children reared in alcoholic families are more likely to engage in alcoholic behaviors if they have been exposed to drug seeking/taking behaviors. The risks increase if they have tasted drugs or alcohol (as abhorrent as the thought might be) and engaged or witnessed stealing, lying and cheating behaviors to obtain alcohol or drugs. These are facts that adoptive parents cannot ignore when the adoption documentation reveals some connection to alcoholism and their child spent any significant time living with alcoholic birth parents.

A Few More Facts.

� Impulsive, restless and distractible 3 year olds seem to be twice as likely as those who are "inhibited" or "well-adjusted" to be diagnosed with alcohol dependence at age 21.

� Aggressiveness in children as young as ages 5-10 has been found to predict alcohol or other drug use in adolescence.

� Childhood antisocial behavior is associated with alcohol-related problems in adolescence and alcohol abuse or dependence in adulthood.

� 6 to 17 year old boys with attention deficit hyperactivity disorder who were also found to have weak social relationships had significantly higher rates of alcohol abuse and dependence 4 years later when compared with ADHD boys without social deficiencies and also to boys without ADHD.

� In a study of college freshmen, alcohol abuse or dependence was twice as likely among those with anxiety disorders as those without the disorder. The same study yielded that alcoholism is four times as likely in kids with major depression. the depression came first.

� Children who have been abused or experienced other traumas are at increased risk for alcohol problems.

� Adolescents in treatment for alcohol abuse reported higher rates of past physical abuse, sexual abuse, violent victimization and witnessing violence when compared to kids who have no problems with alcohol.

The Good News.

Children who are warned about alcohol by their parents AND children who reported being closer to their parents are less likely to start drinking. The person-environment interactions help shape patterns of alcohol/drug abuse or non-abuse. How kids behave with their peers and other reference groups come from you, the parent! Parents are the role models. How you cope, how you handle stress, how you use alcohol, how you view yourself within the family and your community are all relevant to your child's development of their alcohol and drug attitude.

Early initiation of drinking has been identified as an important risk factor for later alcohol related problems. Believe in your own power to help your child - avoid alcohol use. You have more influence on your child's values and decisions about drinking before he or she ever begins to even think about drinking. Seek out an alcohol and drug prevention/education program in your community.One of the most powerful tools you have is YOU!

Never forget the kids are watching!

Action Checklist for Prevention of Alcohol and Drug Use

National Council on Alcohol & Drug Abuse National Association for Children of Alcoholics

For young children: Establish a loving, trusting relationship with your child. Make it easy for your child to talk honestly with you. Set a good example regarding your own alcohol use and your response to drinking. Talk with your child about alcohol facts and reasons not to drink.

For pre-teens: All the above plus. Know the signs of a drinking problem. Keep tabs on activities. Join with other parents in making common policies about alcohol use. Develop family rules about drinking and establish consequences early. Encourage your child to develop healthy friendships and fun alternatives to drinking. Know whether your child is at high risk for drinking problems. Take steps to lessen that risk.

For teens: All the above plus. Know the warning signs of a drinking problem and act promptly to get help for your child. Create a plan for peer pressures and role-play how to get out of difficult and high-pressure situations.

Thank you to the staff at Maplegrove, West Bloomfield, MI, for their efforts in this educational process.

(Orinigally "Make the Connection" - Condensed & Revised: February, 2004 upon Publication)

Smoke Signals

Tue, 31 Jul 2007 21:49:15 GMT

"Oh, what a cute game!" We exclaimed as our new daughter threw herself backwards over and over again while we held her. Some of the other babies in our adoption group were playing the same repetitive game, and we all laughed at their antics. When we were home with our daughter, she continued to play the game with anyone who held her. The rules were the same. Someone would pick her up and she would arch her back, roll her eyes upward, and then thrust her body away hard enough that you had to quickly throw your arm behind her to keep her from falling. As time wore on and experience set in, we eventually learned this common body language from a young adopted child is not a game at all, but a silent message sent by a child who is desperately trying to get away from the arms that are holding her.

Adoptive parents often overlook, misinterpret, ignore or miss early signs their child is struggling to attach. Even parents that have other children, as we did, often miss the signs for various reasons. Perhaps their other children were biological without attachment issues, or their previous adopted children displayed different behaviors, or they simply never received the education necessary to recognize the signs at all. Though each child with their own distinctive personality and experiences will show various behaviors to signal their attachment difficulties, perhaps sharing some of the specific signals our children sent to us will help you recognize similar behaviors in your child who is trying desperately to send you a message.

Early Smoke Signals of Attachment Issues in Our Adopted Infant (12 months-24 months)

~Extreme arching of the back when held, thrusting her backward. Early on, this happened with no crying or facial expression at all. Later it included full-blown wailing and thrashing.

~Crying was often not comforted by being held, but would increase sharply anyway if you ceased to try to comfort.

~Did not seek out the comfort of a parent when injured or frightened but would either stare blankly or cry alone with a "glazed over" appearance.

~Was almost "too easy" to care for: would play alone for long periods without seeking attention, cried little, demanded little.

~Inability to differentiate between adoptive parents and any other men or women. Our daughter would call any man "Dada" and any woman "Mama" and sometimes even seek their attention to meet her needs.

(This happens at some level with biological children, too, at a certain developmental stage, but it can be much more significant in a child who is not forging appropriate bonds with a parent.)

~Did not want to be fussed over, especially at bedtime. She wanted to just be placed in the bed and left alone, not rocked or held or cuddled.

~Would not look at you in the eyes if you tried to make close or extended eye contact.

~Would let anyone hold her without complaint or seeming discomfort, even strangers.

~Did not "mold" herself to parent when being held. Kept her body somewhat rigid and resisted being pulled in closer.

~Would seem to intentionally call others "Mama" when her needs were not being met (if she was hungry or sleepy she would go to someone else, hold her arms out to be held and say "Mama")

~Seemed often to be somber. Her laughs and smiles seemed much more muted than our bio children's had been. We rarely saw her just loose herself in joy the way kids do.

~Seemed unusually independent for her age.

~Emotionally withdrew after we returned from an absence instead of immediately trying to reconnect.

Smoke Signals of Attachment Issues in our Adopted Toddler (3-4 years)

~Would "fake" affection to get to a desired object. For example, she would climb up into the lap of a relative that she was not very familiar with and act like she was really wanting their attention, only to try to get to a piece of cake that was sitting in front of the person.

~Copied off the affections and loving actions of siblings instead of initiating any herself.

~Seemed to disassociate when cuddled. She would tolerate the holding and was not reactive the way our first daughter had been, but she didn't react at all to the attention and seemed to have a glassy and disinterested look.

~Attached to objects and articles more than people. The loss of a piece of candy or toy caused her far more distress than the absence of a parent or sibling.

~Was overly driven to get to school or for a babysitter to arrive and was noticeably disappointed when we were reunited.

~Cried often and for inappropriate events that would not usually trigger crying in a child.

~Would return to small but inappropriate behaviors over and over again even after repeated attempts to intervene and train her in appropriate behaviors.

~Lied frequently even over very small things.

~Hid objects or behaviors obsessively; seemed to be very comfortable in a secretive life.

Many of the issues we faced with both of our daughters could be categorized into some general areas even though our daughters' expressions of those issues varied greatly. The basic categories which were often the most significant measures for how our daughters were adjusting and attaching could be summed up as follows:

More interest in and attachment to objects, food or places (such as a crib, a toy or a particular room) than family members.
Inability to engage in intimate interactions with others such as close eye contact or close physical contact.
Exaggerated reactions to the stimulus of being out in public, around crowds or groups of people, or to extended travel and changes in routine. The reactions often did not surface, however, until we returned home.
Tendency to disassociate and emotionally either withdraw or the converse, meltdown or rage, after the absence of parents.
A frequent and uneasy sense that the child was relating to the parent and others on a very surface level and not forging deep and intimate interactions with the parents.

While symptoms and signs of difficulties in your child can vary widely, it is simply important that adoptive parents learn to recognize general clues that something is not connecting in their child so that they can seek the help needed and help their child heal and bond as fully as possible. As in so many other areas as parents, we often allow our own love and feelings of attachment to our child to blind us to any difficulties they may be having, finding it hard to acknowledge our children may not feel as close to us as we do to them. It is not just important that we as parents are comfortable with their progress and our level of bonding to them. We also need to diligently educate ourselves to the sometimes subtle signs that our children are not grasping the great, complex web of interactions that forge the bonds of attachment with us. Perhaps the basic experiences shared here will be one step in the process to bring you closer to understanding the depth of your child's struggle to come out into the light and participate fully in the intimate relationships of family.

Dawn G. Choate and her husband are the parents of 5 children, including 2 born in China and 1 in Guatemala. A writer, speaker and advocate for adoption-related issues, Dawn is the founder of Healing Hannah Ministries (www.healinghannah.com). Please visit www.youtube.com/user/fisherdawn to view her videos.

Healing Hannah

Tue, 31 Jul 2007 21:59:54 GMT

The moment was exactly as I had imagined it. They called our names as a blur of a person walked into the room holding her. I don't even know who held her, because all I could see was that beautiful face from the picture, now come to life. She looked exactly the same, and I could have spotted her on the streets of Beijing after the hours I had studied her sweet face from the referral picture. Our Hannah Li was finally in my arms! There was a brief moment of concern when we noticed the large bruise on her head, an indentation created from the hours she must have spent banging her head against her crib. But this was quickly brushed aside while we played with her (she wasn't even crying!) and even got our first smile! Now I feel rather na�ve as I think back on that precious day. How many clues did I miss? How many subtle, yet clear, signs was she trying to send us that this road we were about to travel was going to be a little more bumpy than we had expected or prepared for?

The first month with Hannah Li continued as the first day.a breezy, honeymoon-like entrance into parenting our new daughter. After having raised 2 boys through the baby years, Hannah seemed like a piece of cake. We even frequently remarked to others this was almost "too easy". She would play quietly on the floor for sometimes a couple of hours without demanding anything. She ate well and wanted to go to sleep without us fussing over her at all (which was really a blessing when you have 3 kids to put to sleep!). Then, one day after a traumatic visit to a doctor, the shock wore off and the reality of a year of life in an institution came exploding out of Hannah like a volcano.

What I can only describe as "emotional meltdowns" began to emerge once, then twice, then up to 5 or 6 times a day. The reason I don't really think "tantrum" is the appropriate word is because it was clear that her emotional explosions were much more complex, much more deeply rooted, and much more agonizingly traumatic than your normal run-of-the-mill toddler fit. Believe me, I have seen my boys throw themselves in the floor and scream because I took a toy away. I had never, however, seen a child (much less a baby) kick, scream, and rage until her whole body shook just because I wanted to rock her to sleep. I had never seen a child cry in absolute panic if I stopped feeding her for one minute to get something in another room. I had never had a child who desperately pulled her hand away every time I tried to hold it, pulled her face away every time my cheek touched hers, and pushed at me with both arms every time I tried to pull her to my chest.

Crawling into my closet in the dark one night after I laid her in her crib, I sobbed over my daughter's losses and grief and inability to trust me as her mother, my own grief over the loss of "natural" attachment that I had shared with my biological children, and my ignorance at the great sacrifice and cost it is to take a broken, wounded child and somehow help them find healing. I cried on that floor and asked God to help me find a way to wake up that next morning and refuse to let the kicks, the rejection and the cries cause me to fail Hannah's test.her test to see just how much I am willing to love her; just how determined I am to not abandon her; just how sure I am that I was meant to be her mother.

We spent the next year trying, and failing, then trying again to help Hannah heal. Each time we would think we were through the healing, another wound would seem to appear in Hannah. Layer after layer melted, slowly but surely. We did a great deal of holding therapy with Hannah, though we did not know there was a clinical term for it at the time. But our instincts just told us that if she pushed us away and screamed when we tried to hold her that the worst thing we could do was to not hold her. So we would cradle her in our arms and hold her even if she screamed her way through it! I also spent a great deal of time on the internet and phone trying to track down anyone I could who could help us. I talked to several social workers, adoptive parents, agencies and therapists trying to glean as much information as I could. Sometimes we received undue criticism or judgments from those who didn't understand. But it was worth it to keep seeking help whenever we would stumble across even a small bit of information that we could use. We also tried very hard to keep Hannah in routines that were predictable and peaceful. Large amounts of time spent at the mall, the school or church or other places in public were often detrimental to her well-being. We limited her time spent in over-stimulating environments and being cared for by others, making sure we did the vast majority of her care. At the same time, we tried to also balance our own emotional well-being by taking time for ourselves and as a couple to decompress and replenish.

Hannah is a child now, over a year later that, in many ways, barely resembles the child that was first placed in our arms. I often am in awe when she is laying across my lap, completely relaxed and snuggled up next to me of how much she has healed and how far we have come. She has truly become bonded in a way with us that I wasn't sure at times was even going to be possible. I still don't know why God called a na�ve, inexperienced, impatient mom like me to help Him heal Hannah. I can only surmise that He enjoys the beauty of teaching a broken, imperfect, helpless mother how to lay down her life to help love a broken, imperfect, helpless child. At least I know I'm not alone. And now, neither is little Hannah Li.

Dawn G. Choate and her husband are the parents of 5 children, including 2 born in China and 1 in Guatemala. A writer, speaker and advocate for adoption-related issues, Dawn is the founder of Healing Hannah Ministries (www.healinghannah.com). Please visit www.youtube.com/user/fisherdawn to view her videos.��

Confessions of an Adoptive Parent with Attachment Issues

Tue, 31 Jul 2007 22:08:37 GMT

Maybe I should have left my name off this one. Perhaps I could have been one of the anonymous writers who change their name to protect their identity. I will probably open my inbox to find I've been booted off a Yahoo adoption group or two after this confession. I'm sure I won't be invited to the next LifeBook creation group or called up by the Discovery Channel to cover my next adoption. But, I'm not really confessing this to win any popularity contests anyway. The truth is, I am quite certain that what I am about to confess is a dark, deeply held secret of other adoptive parents out there and I am just the one with the big enough mouth to say it. Okay, here I go..

I have attachment issues. Yes, me. Not my daughter (our second adoption), although she has her own set of attachment issues, too. But I am talking about me. After a year and a half, my heart still struggles to latch on firmly, to feel free and open with her, to feel the wonderful bonded feeling of being completely attached in heart and spirit to another person. I still catch myself looking blankly at her, wondering if I even know her yet. I am still more easily frustrated by her, less patient, slower to forgive and recover after she misbehaves. I still have to fight feelings of wanting to pay more attention to the children with whom it is "easier" to feel close. And sometimes I am the one who can go without contact with her and not feel like I even miss her absence.

Before you lynch me, before you throw me to the Yahoo group trash bin, before you black list my name to every agency on planet earth and turn me in to Dr. Phil and his evil message boards..

Let me leave you with some thoughts just in case this strange phenomenon ever lurks its way into your adoption fantasy and threatens to turn it into a nightmare.

Why Adoptive Parents Face Difficulties in Bonding

There are many reasons an adoptive parent may experience difficulty in bonding with their new child. Post-adoption depression is actually a term used now by many therapists and experts in the field. Below are some possible reasons a parent might struggle with bonding:

Unresolved grief over a previous child-related issue (such as miscarriages, inability to conceive, previous adoptions that fell through or previous difficulties with an adoption)
Previous experiences with attachment issues with an adopted child
Adopting an older child who no longer exhibits the natural baby/toddler development stages that promote bonding with a parent
Adopting out of birth order (this can make navigating the "baby of the family" developmental stage tricky)
Attachment issues in the child that cause the parent to feel rejected
Inability to communicate adequately with the child (language difficulties, speech issues, special needs issues)

This is, of course, only a partial list of the myriad of possible reasons a parent may feel that "block" that prevents the free-flow of emotion from parent to child. It is a list that we could mark off multiple items that relate to our experience. When we adopted our daughter, she was 3.5 years old. While she still had much of the "baby" look to her rounded cheeks and pixie face, her behaviors were not in any way like a baby. When I tried to follow the advice of re-parenting her (treating the new child like a baby in certain ways), it only became a source of frustration for us both. She would bite the bottles or pacifiers until she chewed them off, she would regress and wet her pants since she thought that was what I wanted her to do (behave like her little sister), and all the effort didn't produce any real feelings of change in either one of us because she seemed to grasp that she was really not a baby and didn't particularly want to be treated like one.

Another issue we faced was that it was an out-of-birth-order adoption. Although there are many successful cases of this type of adoption and we do not regret having done it ourselves, it certainly presented us with challenges. Our younger daughter still needed to be babied in some ways, and it was tough to make sure that our new daughter was receiving the amount of attention she needed. In addition, you really can't trick your mind into seeing a child who is not the baby as a baby. We were learning firsthand how those critical baby years form that soft foundation of bonding before you have to face the more difficult toddler years with a child. Yet we had missed all of that with her and were thrown head-first into the tougher toddler years.

Communication was also a great hurdle for us as our daughter came to us not only as an older child who had learned over 3 years of Mandarin, but as a child with cleft lip and palate that severely impaired her ability to speak at all. Once again, I was startled to realize something we take for granted in parenting other children that is such a vital key to successful bonding was missing in our relationship with her. Even now, if you ask her why she is crying, she can rarely answer you. All you get is, "Um...um...I'm crying!" Language and communication are the cornerstones of relationships and it is very tough to find alternate ways of communicating with a child who is impaired in a way that truly brings understanding and the ability to form bonds and attachments.

Perhaps the most critical key to understanding my struggle to bond to my daughter, however, is to understand the struggle we had to get our first daughter to attach to us and how that struggle impacted and scarred my parental psyche. Over time, I have learned and recognized that the awesome weight I bore in the journey to help our first daughter through her struggles left me far more emotionally exhausted and wounded than I had realized at the time we completed our second adoption. After all, Hannah was doing great by the time we adopted again and was getting better everyday. The battle was over (for the most part) and now our new daughter was quiet, gentle and much easier to care for than Hannah had been. How could I not be okay and bond instantly with her? Yet when the first crying jags started, even though they were not nearly as wild and uncontrollable as had been Hannah's, I found myself holding my new daughter up by her shoulders as she wailed and shrieked, looking her straight in the eyes, and pleading with her, "I'M NOT GOING TO DO THIS AGAIN!!! I CAN'T DO THIS AGAIN!!!" Red flags should go off at that point. Someone with a megaphone might as well have been screaming at me, "SECONDARY POST-TRAUMATIC SYNDROME!!!" Of course, I had no idea what that even was at the time. It took a few late nights of internet searching before I recognized it several months after it began to surface. My heart had been greatly wounded before, and now my emotions and spirit were struggling to bear up under another child's journey through grief.

Strategies for Navigating the Journey to Attach with Your Child

After months of agonizing over the lack of attachment I felt towards my daughter, we slowly began to piece together some strategies that we hoped would eventually build the necessary bonds between us. Over time, we noticed small changes that eventually led to even more significant changes. Though the process is slow, the effort and energy we have expended has always eventually paid off. Here are some of the strategies we used that have contributed to the growing bonds between us:

If your child is out of birth order, separate time out specifically for that child away from the children who are younger. Find an activity that suits the new child's age and personality and make it a special event between you. For example, my daughter is very domestic (unlike her wild, Harley-riding sister). So, when I bake an apple pie (okay, this is a rare activity), I bring her alongside of me to help instead of Hannah (distracting Hannah by telling her she can go swing from the trees with her brothers, an activity she would prefer anyway).
Do not feel like you have to follow all of the tips of "re-parenting" if you adopt an older child. When we tried many of the suggestions (giving a bottle, pacifier, etc.), we found it just frustrated us and did not build any connections with her. Those methods may work well with some children, but our daughter did not respond to them, so we had to move on and treat her like the age that she is instead of trying to "regress" her. She was happier when we did and we found connections with her easier when we did not try to treat her like something she wasn't.
Work hard to find skills, personality traits, and talents unique to your new child. We tried many things until we discovered what a great swimmer our new daughter was. So we spent extra time developing that in her, praising her for that skill, and used the time in the water as a way to attach to her. Some of my best interactions with her and most affectionate times are in the water.
Give yourself permission to not have to feel all gushy about your new child. It is okay if it is not a fairytale. It does not make you a bad parent or evil. It is what it is. Many days I told myself that I was just going to be a good "babysitter" that day and gave myself permission to not have to force myself to feel anything else.
Work through any unresolved emotional issues you may have that are blocking your ability to bond. If you have issues of grief, resentment of previous failed adoptions or attempts to bond, or secondary post-traumatic issues, it can really impede your ability to connect with a new child. Get help if necessary.
Find at least one person other than your spouse that you can be completely honest with about your struggles. You might need to air some feelings that can cause some to judge you. But if you don't have at least one safe, outside place to vent, the pressure can build and cause further damage to your relationship with your child.

Finally, and perhaps most importantly, no matter how you feel, no matter what your emotions tell you, after all is said and done and you have done everything you can to change your feelings...just keep moving forward anyway. This may sound simple, trite or ignorant of your needs. I certainly stress the need for you to have time away, time for yourself and time to vent to others. But in the midst of all that, there are many days you have to just realize that you made a choice to bring this child in and whatever you do or do not feel towards that child, love is a choice. Choosing to love your child mentally even when you do not feel it emotionally is a powerful step in the journey to bonding with your child. The rewards for that choice may not surface immediately. The process may be very slow and lacking in immediate gratification. But every day that my daughter laughs a full belly laugh instead of a weak giggle, every time she spontaneously comes to me with arms open for a kiss and says, "I love you, Mommy", every time she comes running to see me when I return home with a giant yell, "MOMMY'S HOOOOME!!!", I realize that though the journey is long, we will get there. Though I have doubted at times, I know it is true. What you reap, you will sow and one day I know there will be a bountiful harvest in my relationship with my daughter.

This is not an adoption that was microwavable. I could not create "insta-attachment" for her or for me. No, this is a relationship that is in a long, long simmer. Every once in awhile I get a whiff of what it will eventually be. I cannot wait to taste it fully, but until then, I will keep kissing her good-night, brushing her long, beautiful hair, biting my tongue when I'm frustrated, and hugging her just as fully as I do my other children. She's worth the wait. I hope she thinks I am, too.

P.S. I intentionally left my daughter's name out of this article. It may sound silly as I'm sure I've used her name in other articles. But I felt I at least owed her a little privacy in this particular article considering the candor with which I am expressing our struggles.

Dawn G. Choate and her husband are the parents of 5 children, including 2 born in China and 1 in Guatemala. A writer, speaker and advocate for adoption-related issues, Dawn is the founder of Healing Hannah Ministries (www.healinghannah.com). Please visit www.youtube.com/user/fisherdawn to view her videos.

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Hepatitis A disease and the Adopted Child

Wed, 01 Aug 2007 06:35:35 GMT

Is Hepatitis A infection something that I should worry about in my internationally adopted child?

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Like the other forms of hepatitis B & C, hepatitis A is a viral infection affecting the liver, and it generally results in lifelong immunity to the virus. In many developing countries, most children are exposed to the hepatitis A virus early in life. In overt cases of hepatitis A infections, the condition is easily recognized by it signs and symptoms. In the pediatric population however, a good proportion of children can have the anicteric for (without yellowing of the skin) and can go unrecognized. The majority of children affected with the Hepatitis A virus will recover completely, and only a small proportion will go on to develop a more aggressive for of hepatitis.

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In children that live in orphanages or day care like setting, the primary means of person-to-person transmission is via the fecal-oral-route. The second method of transmission is by the ingestion of contaminated food or water that has been contaminated with the Hepatitis A virus. The major reason why this is a communicable disease is that fact that the virus will shed in an infected child stool for 1 to 2 weeks before the child even presents with any signs or symptoms of disease. Once the signs and symptoms of Hepatitis A appear and an accurate diagnosis is made, the viral transmission through the stool decreases. In an orphanage or institution, hepatitis A infection can run rampant, infecting a majority of the cases in a short period of time. Since an majority of the children have asymptomatic disease, during the first two weeks if the illnesses, these children act as a vector to spread the virus to other children and to those who care for the children and change the diapers.

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Signs and symptoms of Hepatitis A infection are pretty easy to recognize if they are there:

Gastrointestinal Upset (Poor appetite, vomiting, diarrhea)
Slight fever
Jaundice (yellow skin)
Pain in the region of the liver, right upper quadrant, right below the right rib cage.
Enlarged liver
Dark urine
Stool become light and clay colored
Knowledge of local epidemic in the orphanage.
Laboratory studies generally not performed in orphanage

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An attempt to isolate the infected child during the initial phases is indicated in order to reduce the possibility of widespread orphanage epidemic. Unfortunately, by the time the child is diagnosed with the Hepatitis A virus, he may already be in the noninfectious phases. For the caregivers, it is imperative to handle diapers; stool and soiled clothing with care in order to not become infected also.

For those exposed and were in direct contact with an infected child immunization with Hepatitis A immunoglobulin can be administered if it is available.

Once a child is infected with Hepatitis A, there are no specific therapeutic measures. Generally a very light diet is prescribed, low in fates. This help to lower some of the gastro-intestinal symptoms, but it does nothing to cure the disease. The overall prognosis for children is excellent. There is the very rare instance when a child may have fulminant hepatitis and expire.

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Currently in the U.S.A. there is a new Hepatitis A vaccine. The current recommendations are to begin immunization for all children between the ages of 12 and 23 months. Older children should receive a primary dose followed by a booster dose of Hepatitis A 6 months later. The primary role of any vaccine is to provide immunity to the person that was immunized. A secondary goal is to provide what is called herd immunity or the fact that others in the herd or population have been vaccinated provides protection to all others, whether or not vaccinated themselves.

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Unfortunately, hepatitis A vaccine is not given in a majority of the countries that place children for International Adoption. By the time that your adoptive child reaches the United States, he/she will more than likely have already contracted hepatitis A disease and already have immunity to it.

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Written By George Rogu M.D. of� Adoptiondoctors

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Lazy Eye Vision Problems in adopted children

Wed, 01 Aug 2007 06:49:06 GMT

Are eye problems and other visual disturbances more prevalent in the internationally adopted child when compared to the general population?

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Poor visual acuity is one of the most important medical factors that can contribute to poor behavioral, developmental and academic achievement in a child if left untreated.

The actual country of birth of the child is irrelevant, but there has been a documented increased prevalence of eye problems such as Strabismus and ambyopia in the internationally adopted child, especially the ones that were adopted from Eastern European countries.

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In infants and children, in order for visual development to proceed normally, visual experiences must occur with well aligned eyes that are free from eye pathology and other visual acuity errors. One of the consequences of not fulfilling theses visual requirements during the early years of life could lead to disorders like strabismus, ambyopia, and decreased visual acuity. In the general population, the aforementioned visual disturbances are reported to occur in 2%-3% of the general pediatric population. In the United States, physicians and school nurses are very good at screening for such problems. In the case of the institutionalized child, one would speculate that because of the lack of general medical care, conditions such as "Lazy Eye" or "Cross Eyed" would go undiagnosed and untreated for an extended period of time.

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Basic medical care is generally considered a luxury for those unfortunate enough to reside in an Institution. Routine vaccinations, correctable surgical conditions and basic medications such as antibiotics are often lacking, so why should we expect these children to have an annual vision screen. It therefore should not come as a surprise that many orphan children have amblyopia and strabismus.

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Amblyopia is reduced vision in an eye that has not received adequate stimulation or usage during early childhood. It basically means "without sight."�Amblyopia has many causes, among�them being a "lazy" eye.�Amblyopia most often results from this "lazy" or�misalignment of the child's eyes.�A "lazy" eye is seen by an observer�as crossed eyes, or divergent eyes.�Amblyopia also results from a�difference in image quality between the two eyes (one focusing better�than the other).�In both cases, (misalignment and weaker focusing),�one eye becomes stronger than the other.�If this condition persists,�the weaker eye may become useless.

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Visual acuity tests and newer technology such as the Visual evoked potentials are some of the best ways to screen for these visual disturbances. These screening tests are generally performed at the routine well child visits, vision screen performed by an ophthalmologist or by the school nurse. The test may pick up abnormalities if they are present at the time of the examination. A child may have normal vision on today's examination, and over the course of the following year, visual disturbances occur and it is picked up at the next check-up examination. This is why annual vision screens are performed in children.

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Strabismus is a misalignment of the visual axes of the two eyes. The eyes can turn inwards or outwards Children appear to be cross eyed. Strabismus may cause or may be due to amblyopia.

With early diagnosis and treatment, the vision in the "lazy eye"�may�be restored.��

The earlier the treatment, the better the opportunity to reverse the vision loss. Before treating Amblyoia, it may be necessary to first treat the�underlying cause.� Glasses are commonly prescribed to improve focusing or misalignment�of the eyes.�In extreme cases, surgery may be required to allow both eyes to work together.

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Eye exercises are a limited form of treatment. The correction may be followed by:� Patching or covering one eye may be required for a period of time�ranging from a few weeks to as long as a year.�The better-seeing eye�is patched, forcing the "lazy" one to work, thereby strengthening its�vision.� Medication - in the form or eye drops or ointment - may be used to�blur the vision of the good eye in order to force the weaker one to�work.�This is generally a less successful approach.

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I am not sure of the exact percentages of Strabismus or Amblyopia for children that resided in institutions. In my own personal experience I have found that there is an increased incidence of referrals that I make to the pediatric ophthalmologist in my International adoption cases, especially for those children from Eastern European countries.

Written By George Rogu M.D. of www.Adoptiondoctors.com

Newborn screening in children from Guatemala

Wed, 01 Aug 2007 06:58:03 GMT

Why is the newborn screening program important for babies being adopted internationally from Guatemala?

As a general rule of thumb, medical information and testing of children that are being placed for international adoption is limited. While the newborn screening is not an essential test in order to make a decision about accepting a referral, it is another piece of medical information that can make the decision process a little bit easier. The newborn screen is a routine test performed in the United States on all newborn infants.

The purpose of the newborn screening is to provide important information about the child's health that you were even your doctor may not otherwise know about. The screening programs identify different rare medical disorders such as rare metabolic conditions, endocrine problems like congenital adrenal hyperplasia, thyroid conditions. The newborn screening is also suitable to screen for blood disorders such as sickle cell disease and other hemoglobinopathies as well as some infectious conditions like HIV infection.

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From all the countries which I do pre-adoption medical evaluations for, Guatemala is the only country where the newborn screening tests seems to be routine. In the United States every state has a newborn screening program but at each state screens for different conditions. The New York State screening program can check for more than 40 different disorders. Some of these conditions may be life-threatening and others may slow down the baby's development. Most infants that have one of these underlying conditions show no signs or symptoms of the conditions and they may seem very healthy in the immediate period after their birth. Please be aware that the conditions that are checked during newborn screening are very rare and a majority of the babies have negative results.

The testing process is relatively simple. The tests are performed on a tiny sample of blood obtained by prick in the baby heal and applying the blood specimen to a special transport paper. The sample is then sent to a reference lab for testing. The reference lab that I have seen performing newborn screening tests on babies adopted from Guatemala is a company called Pediatrix Screening. Your adoption agency should be able to help you to have this test performed. If that is not possible you as a parent may visit the website pediatricx.org and purchase the newborn screening kit and have it sent to a medical professional caring for this infant.

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If on a newborn screen the results return requiring a retest, this does not necessarily mean that the child has a disorder. Retesting may be needed for a number of reasons. The most common being at this first sample contained too little blood to complete all the tests, in this does not necessarily mean that there is anything wrong with your child. When one of the preliminary tests indicate the problem these results cannot be considered confirmatory until they are redone this would require a new specimen and you will need to have a physician evaluate the results. This physician contact is important in order to determine whether the child needs immediate medical management while waiting for the retesting results.

Fortunately in my own general pediatric practice I have seen very few abnormal newborn screenings that had real medical conditions. The vast extensive majorities were all false positive tests and when they were repeated they were normal. In my international medical practice, obviously the volume of newborn screenings results that I receive are considerably less than in my general practice but fortunately I have only witnessed normal newborn screening results.

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Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Transitioning the Adopted Child

Wed, 01 Aug 2007 07:09:00 GMT

After arriving home how can I help ease the transition from orphanage life to family life?

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After an adoption the stress that a child can experience is difficult to describe. Just imagine, this child is taken out of his usual environment by complete strangers, forced to go on a terrifying plane, and now live in a completely unfamiliar home setting with people that he can not even understand. This type of experience can certainly causes severe psychological and emotional turmoil in any one.

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The transition between the orphanage and the child's new home can be eased if the parents are aware of a few simple measures.

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Post-institutionalized children do best in a highly structured environment. By starting out with a highly organized home life; this will minimize regressive behavior in the child. Children vary in their ability to tolerate change and uncertainty and when it occurs, it needs to be structured.

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Another important situation is over stimulation. Where not enough love is definitely in the detriment of the child's emotional health, too much love right away can lead to emotional turmoil and stress. Post institutionalized children have a limited ability auto regulate themselves or their behavior. Activities which can be viewed as a normal family routine (example: a trip to the mall, Toys R' Us or Disneyland) can lead to total decompensation and meltdown in a internationally adopted child, especially during the first six months post placement.

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It is imperative during the first few months to maximize parent child interactions. This can be done by reading, holding, and playing with the child. Constant reassurance that the parent will always be there must be made. The child should also be encouraged to have interactions with other children, but only when the parent is present. This helps to foster appropriate attachment between the child and the mother.

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Unfortunately, many children exhibit bizarre behaviors such as rocking, and head banging. These behaviors are self stimulating and soothing activities that help the child to auto regulate himself. These behaviors may appear disturbing to the parents, but as long as they do not pose a safety issue to the child, parents should learn to tolerate them. Most of these behaviors will diminish what time but may reemerge only when the child is tired or stressed.

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The final piece of advice that I have is for easing the transition to family life is for parents to seek help early if needed. Parents have a tremendous emotional investment in their child and often have a strong need normalize abnormal development or destructive and dangerous behaviors. Parent should avoid making excuses to explain delays or problems. I encourage parents to seek help early because prompt intervention usually results in a better outcome.

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Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

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Additional information and references: 1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC. 2) Federici, R. (2001) Raising the post institutionalized child: Risks, Challenges, and Innovative Treatment.

Building Love with Language - PART 2

Wed, 01 Aug 2007 07:17:57 GMT

Part 2: Understanding Language Losses in children adopted from abroad

The Nuts, Bolts, and Cracks in Language�� Read Part� 1,� Read Part 3

Understanding what language losses our children may have-beyond developmental language delay- takes away the fear of the unknown, and assists in knowing when to ask for help. specialized help should always be sought if a parent has a gut feeling that something is wrong. We parents need to learn to listen very carefully to other experts our children may encounter, as teachers and day-care workers may pick up on problems as fast as we do.

Speech, Language, and Auditory Disorders

There are many speech, language and auditory disorders that have roots in genetics, trauma and environment. If our children have functional difficulties in making sounds, with voice tone and in sequencing language structures, we may need to consider the possibility of speech, language or auditory disorders-or a combination of all three.

Speech Disorders are where the speaker has difficulty producing sounds or has problems with voice quality. Problems include stuttering, difficulty in articulating sounds or with pitch and voice quality. Sufferers often suffer from a bundle of problems. Those listening to a speaker with a speech disorder may find it hard to understand what is being said.

Language Disorders are where there is breakdown in capacity to understand and use words in context. Typically speakers use words inappropriately; sometimes the capacity to form grammatical sentences is lost, and vocabulary is limited. Sufferers sometimes find it hard following directions. Sometimes language disorders are found in speakers who also have language learning problems and/or developmental language delay.

From The National Institute for Deafness and other Communication Disorders (NIDCD) comes a brief definition of auditory processing disorder:

Auditory Processing Disorder(s) Auditory processing is a term used to describe what
happens when your brain recognizes and interprets the sounds around you. Humans hear
when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The 'disorder' part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.

We are not sure what causes APD (also referred to as Central Auditory Processing Disorder, or CAPD). Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to 'hear normally', he or she may have difficulty using those sounds for speech and language. While the cause of APD is often unknown, auditory processing difficulty in children may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning. Undiagnosed and untreated, children with auditory processing disorders find it difficult to follow the 'social rules' of school and making friends. They can not sequence and hear (the bones of social interaction), and they may act out in frustration. We need therapeutic help with such children, both in ensuring vestibular (inner ear) stability and in ensuring they learn the rules of 'how to hear' in complex auditory environments (such as in a classroom). Many children with ADD and ADHD are possibly misdiagnosed; they simply may be too stressed to hear.

Cognitive Loss

Cognitive loss is a highly emotional subject for parents of adopted children whose development has been arrested by poor conditions prior to adoption. Under-stimulation and lack of a supportive, creative daily environment can cause a child's communicative brain to
atrophy, out of lack of interest, and out of lack of care.

Children placed into adoptive homes with rich communicative environments may be able make up losses. There are experts who assert that a child's brain is 'plastic' (it can take
on board new experiences and use them to develop previous developmental gaps). So, although a child's development has points where the brain hardwires available experience,
the brain permits 're-tries' with new experiences at later dates. For us this means hope within the richer communicative environment of the adoptive family.

However, not all loss can be made up or restored by loving care. Some families have children whose poor environmental pre-adoption care, compounded with a predisposition for language learning disorders, mean that the child is left, for example, unable to process differences in color, size, or hot versus cold. These children need specialist help, and some families report that their children will need help in understanding 'daily living' all their lives. Families in these circumstances suggest that their children were severely neglected, spending days in cribs without interaction or communication.

Boris Gindis, PhD a licensed psychologist and a certified bilingual school psychologist
also reports on a different type of cognitive loss which can occur as our children transit
from being primary speakers of their birth language to primary speakers of English, and
move from the language skills required at home to the language skills required in the classroom. This aspect of cognitive loss is related to subtractive bilingualism. Gindis notes that language is used both for communication, but also at school and work for reasoning.

Dr. Gindis calls this difference 'communicative language' (also known as BICS, Basic
Interpersonal Communicative Skills) and 'cognitive language' (or CALP, Cognitive
Academic Language Proficiency). Gindis suggests that children adopted between the ages of four and eight are most vulnerable in not being able to make the leap from home to
school, from communicative to cognitive language.

The reason? Children adopted under the age of four have a longer time at home before
they go to school, and that time allows English to take root as the foundation for both
communication and reasoning. Children adopted after age eight have their birth language
in place, may be able to read and write, and may well be able to reason. While these older
children may have developmental delays, or other learning difficulties and speech/language
disorders, Gindis asserts that these are more easily recognized in the older child and more evident for treatment. The four to eight year-olds fall between the cracks. Their primary language was lost before their new primary of English was learned, so the foundation for English is shaky.

Families who have reported with pleasure how 'quickly' their children learned (communicative) English are shocked to find that when their children are in school, end of school reports note the children's difficulty in using language for reasoning, which of course affects academic study across the whole curriculum.

Subtractive Bilingualism

Subtractive bilingualism needs to be considered as part of an international adoptee's developmental language delay. Receptive language (being able to understand speech) typically precedes communicative language. So a child will act on an instruction long before there is any verbal response. For those of us who have adopted children old enough to have developed receptive language skills in their first language, we need to consider what it means for them to be removed from their first linguistic environment and be transplanted to ours. We need to remember that receptive language acquisition may well begin in the womb, as the child listens to its birthmother talking as she goes about her everyday life. Our children, even at only months old, will have begun to internalize and understand their spoken birth language.

Coming from the environment of their first language to us, our children are lost on a sea of unanchored sounds and unfamiliar structures. Even gestures, which children use to augment their understanding, may well change from one culture to another.

Boris Gindis notes that our adopted children have linguistic challenges quite unlike children who come as immigrants and who also must learn English in order to communicate. The difference is that our children's home language, upon adoption, also becomes English. We don't support the continuation of their first language, because we can't. We are not native speakers. Our child effectively is deemed to have English as his or her primary language from the minute s/he enters the adoptive home. What does this mean for the adopted child? It means that the child can not use a primary language (the language of home) in order to scaffold learning English. There is no use for the child's first language, and the focus of the family is probably to have the child learn English. Compare this with the immigrant child. A rich interaction in the primary language is available in the home, and the child can use the primary language's underlying structures to test and compare with the underlying rules of English. Learning a language when a primary language remains 'live' is termed additive bilingualism. Subtractive bilingualism is where the new language replaces the old-before the child has full grasp of the first. When this happens, there is limited potential for the child 'to check' the underlying systems that support his new language.

English as a Second Language (ESL) or English for Speakers of Other Languages (ESOL) programs, which are in place in schools to assist new learners of English become fluent, are built on the assumption of additive bilingualism, and may not meet the learning challenges of our adopted children. Children need a particularly rich linguistic and communicative environment in their new homes if we are to truly assist them take English as their primary (but second) language. We can help them. Taking things beyond simply looking at the development of language into the realms of the development of communication means that we look at language along with all the senses and systems of body management, in interaction with the world.

Read Part� 1,� Read Part 3

� Sheena Macrae 2005; first printed in EMK Press "Adoption Parenting: Creating a Toolbox, Building Connections" 2006

How to choose your Pediatrician for your adopted child ?

Wed, 01 Aug 2007 07:18:24 GMT

Good health is very important, and other than you as the parent, no one will be more involved in ensuring good health than your pediatrician. Most families develop a long lasting relationship with their pediatrician. If you choose a pediatrician who matches your personality and needs, both of you could work together to ensure your child's health care needs are met, while making it a enjoyable process at the same time. This generalized statement holds true for all parents, whether they have a biological or adopted child. For the Internationally adopted child, there are some special nuances that need to be considered prior to choosing a physician. Depending on where in the United States you live, you may need to have two different physicians who help with the medical problems of your Internationally adopted child. If your pre-adoption consultant also practices pediatric medicine in your hometown you are very fortunate, otherwise you will need two doctors.

During the pre-adoption medical record evaluation, the physician does not need to practice near you in order to help your family. With the advent of the Internet and technology, you could live clear across the America and still be provided with a pre-adoption medical records evaluation. Services provided by Adoption Medical specialist are geared towards medical record interpretations, video and photo analysis and family support. The pre-adoption consultation is designed to be an educational and family support service and not a medical practice. Your adoption consultant will help to explain your child's medical record, educate the parents in regards to perspective problems found on the reports, and to prepare a follow-up to help your physician investigate suspicious condition found on the record. The most important role that your Adoption doctor has is to educate and guide an adoptive family with their decision. A pre-adoption physician cannot pick out or reject an adoption referral. The adoption decision is the sole responsibility of the adoptive parents. International Adoption is a leap of faith, but with proper education and knowledge, parents can be empowered to make this a calculated leap of faith.

Things that adoptive parent needs to consider when beginning the selection process of their child's doctor:

Do you want to take your child to a International Adoption Clinic which is usually attached to a hospital environment or would you prefer a International Adoption friendly private practice?

Would you prefer a male versus a female physician?
It is important to have the doctor's office in close proximity to your home. Traveling one hour for an ear infection is not plausible?
Is your physician listed within your health insurance network?
Do you feel more comfortable dealing with a younger or older physician?
Does your doctor have any experience in treating internationally adopted children?

Inernational adoption clinics are often staffed by pediatric subspecialists such as Infectious Disease, Developmental and Endocrinological services. Each of these pediatric specialties are capable of handling the Post-Adoption Medical Evaluation, but I personally feel that a General Pediatrician should be the one to control the case. Because of the mere fact that they practice general pediatric medicine, they will look at the patient as a whole and are not limited by a specialty care point of view.

If your general pediatrician discovers a problem that he can not handle and requires specialty care (ex. active pulmonary tuberculosis) a prompt referral to a Pediatric Infectious disease specialist is warranted.

While there are many general pediatricians around the country who care for Internationally adopted children within their general pediatric practice, there are many more that do not. The reason why some Pediatricians do not offer this service range from lack of time, to lack of experience and training. Some pediatricians may not be attune to the special problems that is unique to this population of children. If you are lucky enough to live in a community where your general pediatrician also cares for Internationally adopted children within the scope of hi general medical practice, then you are very fortunate.

Before you decide on a physician who will care for your child either in an adoption clinic or private practice, you should schedule an introductory "get to know you" appointment with this doctor. This visit should be completed before you travel overseas to pickup your child. This visit will help you to determine whether you feel conformable with this doctor and whether his answers to your questions make sense. It is also of important to make you physician aware of any concerns discovered on the pre-adoption evaluation that may need to be taken care of immediately upon arrival. While you are there visiting the doctor's office, please take advantage of the office staff as well. Speak to them and ask questions. You may be dealing with them almost as much as the physician himself.

�Questions that you should ask of the office staff:

How long do patients usually wait to see the doctor?
What are the office hours?
How does the office handle routine questions?
How does the office handle emergency calls and after hour calls?
Does the office have evening and weekend appointments?
How does the office handle Sunday and holiday emergencies?
Is your physician listed within the health insurance network?
How much lead-time do you need in order to make an appointment for a physical examination?.
Does the office see children urgently on the same day for sick visits?
How much lead time do you need in order to schedule a Post-Adoption Medical Examination?

Adoptive as well as biological parents both have many questions pertaining to the health and development of their child. Pediatricians in general are accustomed to such questions and most of them enjoy sharing their knowledge and experience you. Your physician should be kind, caring and by all means he should never intimidate you. He should be considered your allay in the health of your adoptive child.

Here are some important questions to ask your pediatrician himself during the "get to know you" visit:

Does your doctor have experience in dealing with the complex issues of the internationally adopted child?
Will s/he perform the Post-Adoption Medical examination or will he refer you to a specialty clinic.
Where did s/he go to medical school and more importantly where did s/he do her/his Pediatric residency training?
Are the physicians in the office board certified?
5. If a hospitalization of your child become necessary, does the office admit to a local community hospital or do they admit to a hospital that is geared towards the care of children?
6. How long does the Post-Adoption medical examination take to perform?
7. Does your doctor feel that the Post-Adoption examination is just another check-up?
8. How many of the physicians within the group actively see Internationally adopted children?
9. What are you doctor's views on well childcare and early childhood development.
10. During the Post-Adoption Medical examination period will a primary Adoption doctor handle the entire case or is the care shared amongst the entire medical staff?

Having a child can be one of the most exhilarating moments in life, but having an Internationally adopted child can make this a frightening experience at the same time. The reason for this is the stress created because of the possibility of unknown medical conditions, extensive laboratory tests performed, and the multitude of vaccines that need to be administered.

Your Pediatrician is your ally in the health care of your child. He is also your support service during these very stressful times. It has been my personal experience that many of the problems discovered during the pre-adoption evaluation are not true. While there are many families with children that have problems, your doctor will be the one to turn to, to resolve them. He will be there to diagnose a medical condition and treat it accordingly. Pick your pediatrician wisely; he is not just a name in an insurance directory.

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Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

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Cleft lip/palate deformity in the adopted child

Wed, 01 Aug 2007 07:27:39 GMT

Cleft lip or palate is a facial defect causing a cleft that is either unilateral or bilateral. It is easily corrected surgically, and with special services like speech therapy, occupational therapy and a team approach these children do very well with complete recovery.

A facial cleft can occur in many different circumstances. It can be an isolated abnormality or part of a more generalized syndrome. It is imperative that a physician evaluates this child and determines if this cleft is nonsyndromic or syndromic and is associated with something more serious.

In the past the nonsyndromic cleft was considered the classic form with a genetic inheritance. Because genes are involved, the chance for a cleft lip and/or cleft palate to happen again in a family is increased, depending on how many people in the family have a cleft lip and/or cleft palate.

The syndromic form may occur in a wide array of syndromes associated with (environmental, chromosomal, single-gene or unknown reasons.) These children usually have many other medical conditions associated with the cleft.

Environmental

Maternal seizures with anti-seizure medication usage (CL/CP)
Fetal alcohol syndrome (CP)
Amniotic band syndrome (CL/CP)
Chromosomal
Trisomies (CL/CP)
Single Gene disorders
Treacher Collins syndrome (CP)
Unknown
Cornelia de Lange Syndrome (CP)

Facial clefts are usually associated with the following problems

Early feeding difficulties
Recurrent ear infections
Hearing and language delay
Speech problems
Hypernasality and articulation errors
Dental and orthodontic complications

There may be many people involved in the team approach to the management of a cleft abnormality in children. The skills of many different areas are needed to help with the problems that can occur with cleft abnormalities. The following are some of the members of the team:

Plastic/craniofacial surgeon - a surgeon with specialized in the treatment of skeletal abnormalities of the skull, facial bones, and soft tissue. He will be the one who actually performs the surgery and coordinate a surgical plan.

Pediatrician - a physician who will follow the child as he/she grows and help coordinate the multiple specialists involved.

Orthodontist - a dentist who evaluates the position and alignment of your child's teeth

Pediatric dentist - a dentist who evaluates and cares for your child's teeth.

Speech and language specialist - a professional who will perform a comprehensive speech evaluation to assess communicative abilities and who will closely monitor your child throughout all developmental stages.

Otolaryngologist (ear-nose-throat specialist) - a physician who will assist in the evaluation and management of ear infections and hearing loss that may be side effects of your child's cleft abnormality.

Audiologist (hearing specialist) - a professional who will assist in the evaluation and management of hearing difficulties your child may have.

Genetic counselor - a professional who reviews the medical and family history, as well as examines your child to help in diagnosis. A genetic counselor also counsels your family regarding risk for recurrence in future pregnancies.

Nurse team coordinator - a registered nurse who combines experience in pediatric nursing with specialization in the care of your child and acts as liaison between your family and the cleft team.

Social worker - a professional who provides guidance and counseling for your child and your family in dealing with the social and emotional aspects of a cleft abnormality and assists your family with community resources and referrals (e.g., support groups).

Treatment for cleft lip and cleft palate:

Treatment for these abnormalities includes surgery and a complete team approach to help with the multiple complications that can occur. Specific treatment will be determined by your child's age, overall health, and medical history specific qualities of your child's abnormality your child's tolerance for specific medications, procedures, or therapies involvement of other body parts or systems your opinion or preference

For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds. The goal of this surgery is to correct the separation of the lip. Sometimes, a second operation is needed.

Cleft palate repairs are usually done between the ages of 9 and 18 months but before the age of 2. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The goal of this surgery is to repair the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.

After the surgery for cleft lip:

Your child may be irritable following surgery. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.

Stitches either will dissolve on their own or will be removed in approximately five to seven days. Specific instructions will be given to you regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.

After the surgery for cleft palate:

This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. The child may require intravenous fluids until he/she can drink adequately.

Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days.

There may be some bloody drainage coming from the nose and mouth.
There will be some swelling at the surgery site.
For two to three days, your child will feel mild pain that can be relieved by a non-aspirin pain medication.
Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite.
Your child will be on antibiotics to prevent infection while in the hospital.
Your child may be in the hospital for one to three days,

Diet after surgery:

The child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes, and gelatin. Note: your child should not use a straw or pacifier, as both could damage the surgical repair.

Activity after surgery:

Your child can walk or play calmly after surgery. He/she should not run or engage in rough play (wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery.

Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

Building Love with Language - PART 3

Wed, 01 Aug 2007 07:32:13 GMT

Part 3: Creating Communication Gains
The Language of Love � Read Part 1, Read Part 2

Speech is human. It's perhaps the pinnacle of the processes that support human communication and connection. It is accompanied by and builds on the systems of gesture, touch, movement, hearing, and smell; which make it possible for us to 'know our loved ones' and connect. All are vital for the nurture and sustenance of babies. But perhaps voice, the precursor of speech, is critical to the mother/child bond. A newborn turns to the voice of the birthmother-because that voice has become known from the time within the womb. The baby knows that this is his mother, and so expects to be held and kept secure. Babies are secure simply in knowing their mothers. Destroy that intimate knowing and a baby is lost. Without mother, there is no communication and no love.

Communication
We are story-tellers and historians. Our cultures the world over reflect events re-told in song, in drawings, in books, papers, diaries, and in everyday speech. Why is this narrative history so important to us? The success of humankind probably rests on developed ability to 'share the load', learn and teach again how best to protect ourselves and our children. We don't have to re-invent the wheel.

The immense success of the internet is just the latest tool we've developed to support our basic need to communicate. Do we communicate because we are basically a vulnerable species? Looked at in terms of physiological strength, we are weak. Looked at in terms of how we can communicate, we are powerful. Our communication skills are crucial in bringing up our children. Of all creatures, we humans have the most vulnerable babies.

Experts note that our children are, in fact, born 'too soon', physically immature but with a head large enough to contain the brainworks that makes us the best communicators in the world. Our vulnerable children need help to find themselves in space and in loving arms. This primes our brains for everything else. Walking, talking, math, and reading-all derive from the first senses of being held, attentively, by mom. Senses underlie understanding of them-which is all that math and reading are, an extension via thinking of walking and talking! And because our children are so physically vulnerable, our human bonds of love for our children depend heavily on the senses that underpin communication. Voice, touch, and playful movement all conspire to make a child and his mother a pair.

So, speech (and the development of the language process) requires to be securely based on all other forms of communication in order for use as a social tool. Some experts suggest that speech delays-and perhaps even cognitive disorders-may be linked to a child's not having access to a fully enriched communicative environment at critical points in his or her development. Research also predicts that a child who 'gets' social cues develops language skills more easily. Speech is far more than the naming of parts. It's about claiming a place in a discussion- and that's how it is from the first gaze of a mother and baby to the last handclasp of a grownup child and a dying mother.

Separation: Voices Lost
For our adopted children, what does being separate mean? Separated from mother, placed in care, with multiple caregivers and multiple placements? How does this affect speech and language development? How does it affect social development, and communication skills? How does it affect capacity to love and accept love?

Children who've become separated from their mother in the first six to nine months of life have not just lost their mother; they have lost part of themselves. We noted that the human child is born immature, and has no 'self' other than the mother. It's only when the child finds 'self' reflected in the communicative gestures that are the foundation of normal mother/child relationships that allow healthy baby separation. The game, the dance, the sweet eye-contact and the kisses-with-baby-words tell the baby that someone else (and she is an important else) thinks 'this baby' is a wonderful partner. It's an invitation to dance, and psychologists Dan Hughes and Dan Siegal endorse this. We learn our worth and how to navigate the world from the reciprocal bow, and the act of 'dancing' with our mothers.

What does it do to a baby to find that voice gone? Quite simply, experts believe it is the end of the world as that baby thought the world was. And more, what does it do to a baby to find her mother 'there' but angry and depressed? If the mother is 'there' but unable to meet the child's needs (food and eye contact, nutrition of the body and the soul), the child will inevitably become depressed (because she is still part of the mother), and communication between them regarding the baby's needs will fail. This is essentially the basis of 'failure to thrive' in children where communication systems fail, and the child cannot get needs met, neither emotionally nor physically. Without eye-contact, without interactive play, without food, smell from the expected mother, the child's interest in developing communication wanes.

How many of us 'know' our adoptive children in this description? We adoptive parents often parent children who have lost or never known the joy of communication. How do we repair this gap? Can we? We do it by 'learning' our children as we would have if we were their birthparents. Our difference? We learn our kids, we learn their loss and we parent the combination. We reach out with all the senses that underpin communication and ask our children into our arms. We ask them if they'll let us help them belong.

Claiming the right to parent a child with profound loss (which all adoptive children have), doesn't mean we are there to remove their loss or right to grieve it. We are there to help our children bear it, which they can do through the security of knowing us, being held by us, and communicating with us. And we can give them back a sense of understanding of their past, by talking and sharing our thoughts on their loss, and listening to their thoughts right back.

Creating a Communication Environment
Many of us have wonderful adoption video and pictures. When we re-watch them later how many of us are forced to rethink what is happening there, and how our child is feeling and reacting to us? For many children, the handover or first meeting is fearful. The child meets us. He peeps from behind known caregivers (perhaps the care isn't good, but it's the familiar, and the norm for our child). We are happy, we smile, and we out-stretch our arms. Yet, the child's gaze may avert from us, or lock gaze with the caregiver. Our kids are using their whole body to say no, I am not yours. And that's where we must start our work as parents.

Whether our child becomes ours as a baby, a small child or a school-age child, it's a new start. We are, parent and child, born to each other that day. It's our job as responsible adoptive parents, to begin again the Dance of Attunement that might have/should have begun at birth, with mother and child together. Except we are dancing our child to a broken tune, and it's our job to take that on and make our dance positively swing. It's only through this new dance, say psychologists Dan Hughes and Dan Siegal, that adoptive parents can link to their child. It's only by learning how our child feels that we can gently reconnect the damaged connections our child brings to us from abandonment, loss of first family, and first mother.

Playing together, reading together, talking together is powerful. It allows us precious time and space in which to play and come to know each other. Later on it allows us to open the dialogue more comfortably about the tough topics of adoption, race, and feelings. We need to learn how and when our child likes to talk, play, learn, and communicate. Different children have different styles, and so do parents. This learning curve is the basis of attunement to the child's communicative needs. It's our job to appreciate how our child needs parenting, and to get out of our comfort zone and accommodate them.

. Buy them great art materials, and sit with them as they draw-even if we can't draw.

. Listen to tapes while walking together, or simply talk when walking if you are a bookworm and your child loves to move!

. Sit with your child if they are a couch potato and love TV: don't condemn it all of the time, instead discuss it. Buy books associated with programs, buy music, do drawings.

. Practice being the animals in films which is great fun for budding actors! As your
child grows up, make films together. Or sit and watch theirs!

. Make journals; bind your children's drawings and stories. Work on it together.

. Work on your child's Lifebook together.

. Create a family history and include your child's 'notable deeds'. Funny words, funny stories, and achievements become the fabric of your family.

When Communication is Difficult.
What of the child who resists contact? Who won't allow touch, who doesn't 'hear' voice and who certainly doesn't permit eye contact? A sector within attachment theory and therapy is predicated in the fact that certain children who have suffered loss and trauma may often use standard modes of communication as barriers against being cared for by a new person. They may defy, avert from eye-contact, may not hear, and every attempt at touch is resisted as if we are abusing them. They may have sensory problems as well as attachment problems. These children may have been neglected children and they have resisted being social because they trust only themselves. How do we give them the essential help to become social? We work to understand what caused their withdrawal from sociability and work to engage via all communications channels-from a handclap to a hug and onto words...until our child responds.

And what of the traumatized, inward turning child?
The child for whom the transition to our family triggers fear based in the changes and loss in their short lives before us? How do we help these children communicate with us? What of the child whose language is delayed beyond the developmental delay expected in post-institutionalized children? Or a child whose history includes multiple caregivers? And what of the child who hugs too hard, or falls up the stairs or hates to swing or swim? We work to understand what may underpin these delays, and work to engage the child in 'just' the appropriate but ever-changing load of sensory input from the external world. We-as responsible parents need to discover how our child is able to process this. It's what we do with the finding that makes the difference!

New and exciting research suggests that trauma impacts on a child across all the senses, not just the emotional plane of feeling. A hurt child, quite literally, withdraws inside himself and is unable to communicate or make her body work in space. To restore the child to a level closer to age-appropriate capacity for communication and movement, it's thought the child must be re-stepped through all the stages of motor (physical) and emotional development that were halted with the onset of trauma. A child trapped in a trauma bond at under a year old may sometimes behave and move as a baby, even at age five or six or seven or eight. It is our job as parents to help our child know the world via their senses-otherwise they cannot know it with their minds.

So, what do we do to help, reach and comfort a traumatized child, the child with attachment bonds that are broken?
Research suggests that a child (pre-birth and post-birth for up to nine months) is regulated totally by its mother. Sensory experiences are modulated by her. The bond that is formed post birth between them through the senses (touch, voice, smell, balance, and gaze) is also modulated hormonally, via the hormone oxytocin, the hormone of 'love'. The bond is based on trust. Take that essential contact and bonding away, and a child cannot move from the neurologically primed response which freezes a child in the face of fear. They have no capacity to do anything other than feel the fear. They have no fear reflex, which alerts, and gives capacity to move, seek and check the fearful stimulus.

How many of us see our children stuck, unable to do other than feel the fear when they first come home? Can we adoptive parents remedy this? Can our being available and close, work for our hurt kids? Yes, because we don't aim to replace people, but simply become the loving hands that will hold our child safely, the loving voice that will help our children rest. We are not usurping a place, but simply filling a void with feeling, words, and touch.

Communication: Building Love
The way forward is to recreate for the child the comfort and closeness of the mother and child that was their birthright as children born into this world. That's love, basically. We can attempt to re-modulate these hurt children by recreating the bonding movements. Some of us may use various forms of therapy, some of us may not, but we all need to get close to our children to 'reach them'. To achieve this balanced mix of love we'll use: eye-contact, voice contact, touch, smell, and movement. Find these in rocking, cradling, lifting, swinging, gazing, talking, singing, touching, and listening to our children. Therapists may suggest very specific techniques to achieve this (even for older children) by using slings, ball ponds, womb-like spaces and more to create closeness between mother and child.

We can learn interventions that re-create a close and rich sensory bond for our children. For little kids, peek-a-boo games introduce eye contact, the fact that mom is still there and the notion of permanence. Mom holding a kid trying to walk/ride a bike is the model for the child who is not quite built for a task yet!

Board games are communication tools and involve turn taking, a prerequisite of social dialogue. Ball games are a dance of partners. Team sport is an extension of board games; kids learn that dependency is a worthy tool and makes us humans stronger. Camp fire songs draw together soul-mates. We can do all of these interventions in some way or other from babyhood to teens. We become the mothers and parents of our children, parenting the child and all the losses they bring with them.

Using these tools, we balance the child and permit real and psychological movement out from mother, as our child checks back with us for regulation and approval, that's communication. And when we smile and they smile back.that is love.

Read Part 1, Read Part 2

China Medical Issues in Adopted Children

Wed, 01 Aug 2007 07:33:51 GMT

China is the number one country that places children for international adoption in the U.S.

Virtually all children adopted from China are girls. The reasons for this discrepancy are the government's one-child policy and the cultural preference for male born children. These selective properties have caused abandonment, infanticide, and failure to register countless numbers of female infants yearly. Most of theses infants come from rural villages. The decision to abandon a child is determined by the family composition of siblings. Usually the 2nd or 3rd female is abandoned. The health of these infants is usually very good. Boys are rarely abandoned, but when it does occur, they may be handicapped, ill, or born to unwed mothers.

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When a child is abandoned in China, the event generally takes place a great distance from the family's home. The reason for abandoning children far away from their home is because, the incentive by the authorities for investigation is lessened if the child was removed from local jurisdiction. Children are often left in a crowded market or transportation station. Leaving the child in a crowded facility makes the probability of finding this infant better, and this lessens the possibility for the child to suffer from health issues.

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In China abandonment or endangering the welfare of an minor is not considered a criminal offense as in the U.S. Fines and penalties for abandonment of a infant are similar to those imposed for an "over-quota" child. The lack of criminal prosecution and additional fines make abandonment of an infant a tolerable risk.

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While the overall general health of Chinese adoptees is very good, many of the same medical problems exist as in other countries with some country specific issues. While not a major epidemic in China, the illicit use of drugs and alcohol has been expanding. Infectious diseases found in China include Dengue fever, plague, Japanese encephalitis, and malaria. The more recently publicized epidemic of SARS brought a temporary halt adoptions from China in order to reduce international transmission of the disease.

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Some children who are slated for adoption are placed in a foster care environment. Other children are placed in a modified institutional care setting in which, during the day, the child spends time in a group setting and later returns to the foster family at night. While there is no perfect replacement for a loving parent, these minimal interventions can help to enhance child development. Chinese adoptees tend to be healthier medically and have better developmental milestones. The risk for Fetal Alcohol Syndrome and Effect is considerably lower in Chinese children when compared to Eastern European children, but the risk is always there.

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Other problems found in Chinese children have a similar prevalence to other countries. These problems are as follows:

1.�� Growth and developmental delays.

2.�� Intestinal parasites such as Giardia

3.�� Latent tuberculosis (+PPD)

4.�� Lead intoxication

5.�� Hepatitis B surface antigen positive

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These conditions are not country specific; they occur in environments where children live in overcrowded and poor hygienic living conditions.

China has become a desirable country for international adoption for a variety of reasons.

1.�� Availability of infant children

2.�� Possibility of adopting a child with better health conditions.

3.�� Placement in a foster care environment as opposed to institutional care living

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Even though Chinese children have a better medical outcomes when compared to other countries, this does not preclude families for having a pre-adoption medical consultation performed. Health records, pictures and if available video recording should always be evaluated by a adoption medical records specialist.

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These consultations can enlighten families about unsuspected medical concerns that are not easily recognizable by their agencies. I have heard many parents and adoption agencies make the following statement: "There are no medical problems in children adopted internationally from China, therefore we do not need to consult with a physician." While I do agree that I have seen fewer issues with children adopted from China, they are still at risk for being neglected, malnourished, and having untreated medical conditions. All of these similar issues can be found in all internationally adopted children, regardless of their of country of origin. Parents need to educate themselves by consulting with a professional, and not just follow the statements found on the Internet, given by agencies and/or other parents.

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International adoption is a leap of faith, but with proper education and knowledge obtained with the help of your adoption consultant, it can become a calculated leap of faith.

Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

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Disclaimer

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Medical Issues in Guatemalan adopted children

Wed, 01 Aug 2007 07:42:08 GMT

Guatemala is one among one of the top five countries that place children for International adoption.It has become a desirable country from which to adopt because of the availability of infant children with better developmental milestones because they are placed in foster care as opposed to an orphanage.

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The placement of abandoned children into a foster care environment helps to decrease the developmental delays that these children are at higher risk for and it makes for the Post Institutionalization syndrome encountered in the former Eastern European countries to be almost nonexistent.

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Guatemala is also the only country that provides the signed relinquishment and the results of DNA testing, that shows the relationship of the mother to the child to the adoptive parents. The purpose of this policy is to reduce the adoption of children that be obtained by illegal means such as kidnapping, baby buying, coercion. Prior to the DNA testing policy, unscrupulous woman would pose as the child's birth mother and release the child for adoption for financial motives. Other tests performed upon the birth mother are HIV, syphilis and hepatitis screening.

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As with all countries where financial constraints and poverty force desperate mothers to place their children for International adoption, the health concerns for Guatemala are similar as with other countries with some minor differences.

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Many of the mothers are smokers, and the use of alcohol varies widely across the country. Drug abuse is also becoming an increasing problem especially among the young birth mothers. Some of the more common drugs of abuse are cocaine, marijuana, and tranquilizers.

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Other health concerns found in the Guatemala population that may be country specific are parasitic infestations (such as Dengue, Filariasis, leishmanaiasis and malaria). Such conditions are almost never seen in the U.S.A and are generally caused by poor hygienic living conditions.

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There are some special social issues that an adoptive parent needs to consider prior to choosing to adopt a child from Guatemala. Once a child is slated for international adoption, they are generally placed in the foster care system. Families should be aware that while foster care is superior to living in an institution, not all foster homes are loving or attentive to the child's needs. Foster parents will all vary in their ability to care for the child and each one has their own motivation to become a foster parent.

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In terms of the availability of the pre-adoptive medical information, some medical data, monthly updates of and pictures of the adoptive child are usually available for review. While it is not the norm, I have seen a few cases where an actual video tape of the child was given to the parents.

For Guatemala. This is not the rule but the expectation.

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There are no particular medical concerns that are specific to Guatemala. Problems encountered are similar to all internationally adopted children, and they stem from being neglected in early infancy. Fortunately because of the foster care programs, developmental delays are not as serious as in other countries. Other medical concerns found in children from Guatemala vary from, anemia, parasitic infections and tuberculosis. Unrecognized medical concerns such as fetal alcohol syndrome, hearing impairment, and various degrees of developmental delays have also been discovered, but they are rather uncommon. These conditions are problems encountered in many of the Internationally adopted children, regardless of their country of origin.

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While living with a foster family during the early months of life is beneficial to the overall health and development of a orphan child, foster care is not a substitute for a loving parent.

Even though Guatemala has a better infrastructure for caring for the countries abandoned children, this does not, this should not preclude anyone from not having the medical data evaluated by an adoption specialist. Health records, pictures and if available video recording should always be evaluated. A through and in-depth dialog with the prospective parents can help them to become aware of unsuspecting medical concerns.

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I have heard many parents and agencies say the following statement: "There are no medical problems in children from Guatemala, and we do not need to consult with a physician." While I do agree, and I have personally seen far fewer medical issues with this particular population of children, they are still at risk from being neglected, malnourished, and having untreated medical concerns. Parents must educate themselves and consult with a professional and together you can decide whether this child is for you. Do not follow internet statements and lines given by your agencies or other adoptive parents.

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Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

Gardia infection in Adopted Children

Wed, 01 Aug 2007 07:53:19 GMT

Giardia is an intestinal parasite that uses the human being as the primary host for infection. Giardia organisms also infect dogs, cats and beavers as well as other animals. These animals contaminate water with feces that contain cysts and it is these cysts that are infectious to other humans.

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Persons usually become infected either directly via hand to mouth transmission of cysts from the feces of infected persons, or indirectly by drinking contaminated food or water.

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Children who lived in orphanages, especially those who are not toilet trained or are mentally retarded, are more prone to these infections because of stool handling when changing soiled diapers. Close quarters, poor living conditions, poor hygiene and infection control measures amongst the caregivers are the main causes of widespread mini-epidemics within child care environments. Many times staff and family members in close contact with these children also become infected.

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This disease is communicable for as long as the person excretes the cysts, which can go on for many months. The incubation period is generally about 1 - 4 weeks.

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Clinical manifestations of this disease are generally localized to the intestinal system. These children tend to elicit many or all of the following symptoms:

1. acute watery diarrhea with abdominal pain

2. foul smelling stools with flatulence (gas and bloating)

3. abdominal distention and anorexia

Sometimes with more protracted disease, malabsorption of nutrients and anorexia ensue thus causing significant weight loss, failure to thrive, and anemia in untreated individuals.

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Testing

Testing for this organism is very easy to perform and it is routine testing for all internationally adopted children from any country. The actual trophozites (parasitic organisms) or cyst can be identified by a direct microscopic smear examination of the stool and by testing for the giardia antigen with a test called the Giardia EIA enzyme immunoassay. The Giardia EIA is more sensitive than the direct microscopic examination. A single stool specimen microscopic examination can detect 50% - 75% of the infections; these numbers can be increased to approximately 95% when testing 3 different stool specimens.

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Treatment

Treatment of this intestinal parasite is with a drug called Metronidazole and Furazolidone.

Metronidazole is 90% effective in eradicating the parasite but it not available in a liquid preparation.. It can however be compounded by special pharmacies but this usually takes time and therefore delays treatment for a couple of days.Some of my patients had luck with a pharmacy called RX-express, they compound medications on site. Furazolidone is 80% effective, but it is the only drug in the USA that comes in a liquid preparation. If therapy fails a repeated course of therapy is indicated with any of these drugs.

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While children who come from an international adoption are at higher risk for a multitude of diseases, intestinal giardia infections can be easily treated. Once eradicated, these children should thrive, gain weight and any nutritional deficiencies that may have occurred because of the malnutrition syndrome should resolve

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Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

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Early Attachment and Food Insecurity

Wed, 01 Aug 2007 21:44:48 GMT

Cracker crumbs found under a pillow.� Moldy food rotting under the bed. A stash of food hidden in a backpack. A child who sits at a table and eats - and eats - and eats, until you are afraid their stomach can handle no more.

Sound familiar?

Do you blame yourself?�� Do you hear your mother's voice in your head telling you not to waste food? Are you tempted to put a lock on the refrigerator door?

Please don't.� Don't lock the child out of the bedroom or put locks on the kitchen cabinets. Don't yell, threaten, punish or cajole. Don't try to shame a child or make them feel guilty for what they are doing. Food hoarding behaviors will not diminish under threat of consequence.

Children communicate needs through behavior. On a deeper level, this issue is not about food but about control. The child is not yet ready to trust the adults in his or her life to provide a secure, safe environment. That trust cannot be won by threats, punishments or shaming behaviors.

This behavior does not come out of a vacuum. Rather, it is an adaptive response to deprivation. It often stems from years of food insecurity.

This behavior is telling you a story: "Once upon a time, my biological parents traded food stamps for drugs and I didn't have enough to eat... Once there was a time when I lived on the streets and had to beg for food from strangers... When my younger brothers and sisters were hungry it was up to me to feed them... In the orphanage, I had to fight for food..."

Listen carefully and be patient. Try to hear the story of your child. You know why you made this decision, to take a child into your heart, into your life. It hurts sometimes� -- you wonder why this child cannot trust you.

But, the larger truth is that you are the adult -- and you made the decision to make this child a permanent part of your life. Please have faith that�you possess�mental and emotional resources to handle this challenge. Patience is a virtue that nobody really wants to learn, but life has a way of teaching it to us.

Steps to take:

1.) Acceptance: Convey, in your daily actions, that you love the child. You are not disappointed in them. You have not lost patience with them. You are not so frustrated with their behavior that you are about to trade them in for a better model.

These are their fears: That you won't love them anymore. That no one will take care of them. That deep down, they aren't worthy, aren't loveable, and that's why they ended up in harmful situations in the first place.�

2.) Empowerment: Consider giving the child his or her own "food cabinet" in the kitchen, to store goodies that are theirs and theirs alone. Allow them to keep an air-tight plastic container of food in their room at night when they sleep, in case they wake up hungry. Let them carry a plastic bag of munchies in their backpack -- it will give them security just to know it's there.

3.) Teamwork: Confer with other adoptive/foster parents. Encourage one another to be patient. Share ideas that help -- and don't be afraid to�gently confront�another parent if you feel that their approach might be more harmful than healing to their child. Sometimes being a friend means being honest with one another.

4.) Consultation: If you feel that the problem is threatening your child's health, such as binging-and-purging,�please consult a professional. It is wise to�do your homework about which�professional counselor that you choose.�Make sure that the professional you choose demonstrates the ability to view child behavior within its context, rather than overmedicating or pathologizing the child.

5.) Realistic Expectations: Recovery takes time. You are not being judged or graded by your child's progress and the time it takes for your adopted/foster child to heal. If your adoptive or foster child's hoarding behaviors lessen but do not disappear completely, that is a success.�

* Please note that this blog entry refers specifically to hoarding behaviors that stem from childhood trauma, attachment, anxiety and abandonment issues�(not OCD).

Circumcision and the Internationally Adopted Child

Thu, 02 Aug 2007 09:31:16 GMT

Upon arrival to your home, it is always recommended to schedule an introductory medical evaluation with your pediatrician within the first week. This is to ensure there are no acute medical conditions that may require immediate care. A full post adoption evaluation is usually performed at a later date, once the child has become situated in his or her new environment. A frequent topic of discussion that may arise at one of these visits is the issue of circumcision and when to have it performed.

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Like most internationally adopted boys, the majority may not have been circumcised in their country of origin. Although the procedure itself is quite simple, the social, emotional, and religious aspects of circumcision can be often complex.

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It is commonly performed in American boys and in those from traditional Jewish and Muslim families in other countries. The procedure usually takes place at the hospital, within a few days of birth.

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Reasons for infant circumcision generally fall into one of three categories:

To address an immediate medical condition
prevention of future disease or
as an act of religious dedication

Currently, approximately 80 percent of US males have been circumcised, mostly for non-religious reasons. Recent data shows that frequency of newborn circumcision has fallen in the USA from roughly 90 percent in the 1950s to about 55 percent today. Prevention of disease is the second most commonly given reason for circumcision after religious reasons, although the evidence that it has any beneficial effect on future health is uncertain.

Potential medical benefits of newborn male circumcision are a reduced incidence of urinary tract infections in the first year of life, reduced risk of penile infection, and possibly reduced incidence of penile cancer (all rare conditions, even in the uncircumcised male). Possible risks and complications of the surgery are those of other minor procedures; bleeding, infection, and scarring. Circumcision performed after the newborn period typically requires a general anesthetic and involves the risks of anesthesia. The greatest considerations for the adoptive family are the potential effect of a traumatic experience, the actual surgery, as well as the the child's ability to bond to his adoptive family.

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In general, elective surgery should wait until your child is settled in your home. It is suggested that adoptive parents who are interested in circumcision consider the timing of such a procedure. It may be prudent to delay the operation for six to nine months after adoption, perhaps even longer. This waiting period encourages the adoptive family to work on attachment and bonding. It allows the child, in some cases, to develop the cognitive and language skills to understand what is happening to him. Furthermore, the risks associated with general anesthesia are somewhat decreased after a child's first birthday.

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To children, hospitals can be quite intimidating. Doctors perform blood tests and procedures which can be uncomfortable and sometimes painful. The adopted child may also become separated from his parents at times during the hospital stay. These stressful situations can negatively influence the newly adopted child and raise concerns over whether such non-essential procedures should be performed in the first place.

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Many families choose to combine circumcision with other surgical procedures that their new child may require, for example; ear tubes, hernia repair or removal of tonsils and adenoids. Their patience may result in a safer and less stressful surgical experience for both adoptive parents and child. Whatever is decided it is important for each adoptive family to weigh carefully the potential for negative emotional effects on the child with the benefits the surgery may bestow.

Tell the World You're Adopting

Mon, 06 Aug 2007 22:00:45 GMT

Once you've decided to adopt, you'll want to share the news. Try these four creative methods for conveying your excitement to family and friends:

1. Write it.
Compose an upbeat letter that explains why you chose adoption and expresses your hopes and dreams for the child you're expecting. Anticipate the questions people will ask, and include a list of Frequently Asked Questions about adoption. A letter gives your loved ones time to absorb your news without the pressure of responding instantly.
2. Blog it.
Journal your feelings and experiences on a Web log (better known as a blog). Blogging is an inexpensive, interactive way to share your latest updates, post pictures, address hot-button issues, and educate your supporters about adoption.
3. Shout it.
Plan a festive gathering, complete with balloons and banners. If you anticipate opposition to your announcement, invite a confidante who completely supports your adoption plan.
4. Gift it.
Prepare a box or basket that contains items from the country or region from which you plan to adopt. If you're adopting from China, for instance, include chopsticks, tea, fortune cookies. Let your imagination run wild!

Lifebooks: Tips for Dealing with Secrets

Wed, 08 Aug 2007 16:30:10 GMT

Accidental Secrets

Secrets.we all have them. Adoptive families have too many, it seems. I'm tired of keeping secrets. They're too much work. They clutter up the relationship section of my soul. Who knows what pieces; how much do they know?

I am a child of the 1950s-a dark time for adoption. Social workers instructed adoptive parents not to discuss adoption. I was raised on 'secrets,' which made it hard to feel real and 'a part of.' Today, things are different. Aren't they?

Secrets once again came into my life when I began helping families create Lifebooks. People complained that insufficient time was the bane of Lifebook creation. Often, what was really holding things up was a fact-an uncomfortable or overwhelming fact-which they didn't want to share or didn't know how to share. The Lifebook went on the back burner because of the secret.

A secret for one family is dinner table discussion for another; much of how you communicate is learned from your family of origin. No one starts off parenting with a plan to deceive a child. Families fall into these dark spots by accident. It's that age-old parental desire to 'protect' that is a prime motivator.

Who wants their child to feel pain? To feel different, or somehow 'less than'? There is never a good time to disclose many difficult facts. But waiting can turn information into a secret. Suddenly, what was innocently tucked away is now under lock and key.

Here are a few questions to help you assess your child's history and whether or not to hold back: The proactive approach, often via a Lifebook, typically works best to solve this problem. Get free tips on lifebook creation on my website.

1. Who else has this information? What is the likelihood that it can be discovered or disclosed accidentally?

2. If your child finds out later, how will s/he feel? Will s/he still be able to trust you?

3. Is this a custom common to all adoptions in the country where your child was born? For example, in China, most babies are 'found' somewhere.but this does not change the fact that adopted children of Chinese origin will eventually ask, "Where was I found?" And whether you use the word 'abandoned' is another article!

4. How well can you lie? An innocent cover story eventually becomes a lie. Will your child sense this? How will you feel? Will this affect respect and communication?

5. Is this something your child may figure out alone, without your support? This danger exists around such realities as the existence of birth mothers and birth fathers, the fact that only girls seem to be adopted from China, and that sometimes birth mothers later have, and try to parent, additional children.

6. Might the information be damaging to your child's self esteem right now? Do you plan to discuss it later? Plant a seed. Try saying, "This is something we will talk about when you're older." But ask yourself; is it too hard for you or for your child?

7. Is this something you think the outside world will judge? Try to evaluate which is more important, your child's ability to trust in and attach to you, or the potential fallout from the outside world.

8. Is the birth fact something that other children will know about? For example, many school-age children are told that internationally adopted children come from orphanages. Who can protect your child from racial jeers or insults about Orphan Annie? Be pro-active.

9. Is it possible that a child might hear this information differently? Adults have years of experiential input and developed values, whereas a child might simply take in the information without judgment.

10. Is it a secret through omission? What we don't talk about is sometimes more emotionally charged than what is said. The silence says, "This must be so bad that it's unspeakable." Often the adopted child fills in the blank with stories much scarier than reality.

As an adoptee, the older I became, the more important finding out the pieces to my story became. Those found facts filled in the grief-ache, and the missing facts eventually became 'just the way it is.' Some of my story is not pretty. But it is my story. I would not have wanted one person to have lied or protected me 'for my own good.'

It is so valuable to let children hear the pride in our voices as we discuss their birth countries and caretakers from early years. They too, will feel proud of their heritage.

Copyright �2005-2008 Beth O'Malley M.Ed, Adoptive Mom and adoptee, Author of LifeBooks:Creating a Treasure for the Adopted Child ; Sign up for lifebook lessons at www.adoptionlifebooks.com/signup.htm ( no charge)

Picture Books With African American Characters

Thu, 09 Aug 2007 12:35:12 GMT

There is a place in children's literature for the issue-driven books. African American authors like Jacqueline Woodson rise to the challenge of tackling issues like parental imprisonment and sharing historical events such as the Underground Railroad.

However, there is also a place for Picture Books featuring African American characters that focus solely on encouragement, affirmation and family love. These are the books that parents might read to a child before bedtime.

Here are some of my favorites, arranged by category.

Welcome to Our Home.

Adoptive parents can welcome their child with Welcome Precious by Nikki Grimes. In this book, everything celebrates the child's presence, from the glistening mystery of soap bubbles to the swish of leaves in the breeze.

Books That Teach Simple Vocabulary

Cooke, Trish. So Much. One by one, family members ring the doorbell and make a grand entrance by expressing their love for the new baby.

Isadora, Rachel. Peekaboo Morning. A baby plays peek-a-boo while learning the names for members of her family.

Johnson, Kelly. Look At the Baby. For babies and toddlers, this is a good introduction to the names of body parts, such as eyes, ears, nose.

Williams, Vera. More More More Said the Baby. Babies and toddlers enjoy this book, although the text might prove confusing to grownups when they first read it aloud.

Celebrating Children's Abilities

Baicker, Karen. I Can Do It, Too! A young child celebrates her growing capabilities, naming a succession of things that grown-ups can do, and adding, "I can do it, too!"

Jabar, Cynthia. Wow! It Sure is Good to Be You! This celebration of personal empowerment is custom-made to build a child's self-esteem.

Johnson, Angela. Daddy Calls Me Man. A series of vignettes about a little boy whose father recognizes his growing capabilities.

Pinkey, Sandra. Read And Rise. Photographs and poetic text celebrate reading as a means of encouraging African American children to pursue their dreams.

Price, Hope Lynne. These Hands. A little girl celebrates all the things her hands can do!

Food as Nurturing

Cooke, Trish. Full, Full, Full of Love. Sunday dinner at Grandma's house is full of tasty dishes, all kinds of fishes, hugs and kisses, and lots of love!

Duncan, Alice Faye. Honey Baby Sugar Child. A celebration of the love shared between a mother and her child.

Falwell, Cathryn. Feast for 10. Numbers from one to ten are used to share how members of a family shop and work together to prepare a meal.

Smalls, Irene. My Pop Pop and Me. A young boy sniffs the lemon whiff and clinks the dishes in the sink, while helping his Pop Pop bake a cake.

Love That is Not Dependent Upon Perfection

Hooks, Bell. Homemade Love. A girl savors the warmth and love of her family. No one can be "all the time right," but her parents provide her with protection and acceptance.

Lee, Spike. Please Baby Please. Spike Lee and his wife have written the perfect Picture Book! It has rhyming words, repeated phrases and the predictable storyline. A young child is overflowing with energy while enjoying daily activities.

Routines that Cement a Family

Bang, Molly. Ten, Nine, Eight. Numbers from ten to one are part of this lullaby which observes the room of a little girl going to bed.

Bunting, Eve. Flower Garden. A little girl helps her father plan a birthday surprise for her mother.

Greenfield, Eloise. Honey I Love. A celebration of the love that a little girl has for her cousin, her family and the world around her.

McQuinn, Anna. Lola at the Library. Every Tuesday Lola and her mother visit their local library to return and check out books, attend preschool storytime, and share a special treat.

Macken, JoAnn Early. Sing-Along Song. A child sings along with all the wonderful sounds in his everyday world.

Medearis, Angela Shelf. Snug in Mama's Arms. A little girl falls asleep after her mother reads her a story, tucks her in bed and turns off the light.

Nikola-Lisa, W. Summer Sun Risin.' A young man enjoys a summer day on his family's farm, milking the cows, fishing, and having fun.

What Type of Toys Should I Take to the Orphanage?

Sat, 11 Aug 2007 09:12:09 GMT

Are you getting ready to make your first (or second) trip to the orphanage to visit your new child? Are you wondering what types of toys might be best for you to take to play and interact with him or her? Tatyana Komarova, native speaker and Russian language instructor, recently provided some great advice on this topic I'd like to share with you during her ThinkingOfAdopting.com webinar, "Russian for the Adoption Traveler I".

Tatyana recommends you take toys that are both fun for the child and help you play and interact with them. After all, what you want more than anything at this point is to get to know him or her! One such toy is a book with big pictures and little (or few) words. "You don't have to read any of the words," says Tatyana, "you can just say, 'This is a bear, this is a duck, etc.' while you point to the pictures." If you say "this is" in Russian (Eta bear; eta duck), you've created a little game in which you are starting to teach English! Of course, the game could be turned around. By pointing to the pictures and asking "What is that?" in Russian (Shto Eto?), they can help teach you Russian!

Another very nice present is a little coloring book & fun pencils. Tatyana believes they have a shortage of pencils in Russian orphanages and certainly do not have as many fancy ones as we have here in the United States -- fun ones with bright colors, designs, and/or sparkles on them. Tatyana says, "They would really be amazing for them." You can draw pictures for them, they can draw pictures for you, and you can draw pictures together. Stickers are also a good present. Says Tatyana, "They would love them."

Bubbles are another good toy - universally fun - and easy to carry. However, if you're afraid that they might somehow spill or leak in your suitcase on your trip, Tatyana advises that you can probably buy your bubbles in Russia instead.

Of course, what child doesn't like to play with what's in a purse? Therefore, Tatyana recommends that you make sure that you have a lot of "little things" that they can play with in your purse. Like all children, they do like "real" things (they always seem to be more attractive than the toy version). "Whatever is in a woman's purse they would like. Everything you have in there - keys, cosmetics, credit cards, they will play with them" says Tatyana.

Speaking of "real things", cell phones make a great toy. Tatyana says, "If you don't want them to use your phone, have another one to give them. I even bought a toy cell phone that was the same color as mine." Tatyana also mentioned that your old cell phone could make a very good toy . "They don't need anything else".

When visiting the orphanage Tatyana recommend that you first allow them to play with their own toys, and try to interact with them using whatever they are playing with. Do not give them your gift right away. One game you might try is saying (in Russian) "Show me your toys". When he or she loses interest in their toys you can say, "I have this for you!" Make it like a surprise.

While it's so tempting for any parent, Tatyana recommends against taking stuffed animals such as teddy bears. "Yes they are cute, but there is not really anything to do with them compared to a book, pushing buttons, or coloring. [It's better to] take something you can do with them."

Or course, being able to communicate with your new child during your visit to the orphanage in their native language is a big help. The fourth session of Tatyana's webinar, "Russian for the Adoption Traveler"�was all about child's talk to�help the parents prepare for that visit.��Tatyana says, "The whole session is your scenario for your 1st and 2nd visit - the scenario for you to meet your child and interact with him or her."

On Faith, On Culture

Tue, 14 Aug 2007 11:11:33 GMT

Both my kids are being raised in the Jewish faith, as in their formal religious education is happening at our synagogue. They are also being raised less formally with some understanding of Christianity because their father is a Christian. Because it's easier for me to talk about my beliefs than it is for their dad to talk about his, when our bio son, Noah, asks big questions I answer from a Jewish perspective as I understand it.

We're not so great at the trappings of either of our religions. Judaism - even Reform - has a lot of trappings and this is one of several reasons that our kids are at temple instead of at church. (The other major reason being that churches are not comfortable places for me and Brett enjoys services at synagogue.) It's pretty easy to embrace Christianity - you just become Christian. But Judaism has a lot of formal rites that can be confusing and off-putting and to learn them now will make it easier for them to live Jewish later, if they choose to.

That's our immediate family: non-denominational, liberal Christian and very Reform Jew. Our extended families are everything from Christian Scientist to Athiest to Catholic to Pagan. They have some exposure to all of that but their faith teachings spring from my Judaism and Brett's Christianity.

Now to explain why I feel it's important that our daughter by adoption, Madison, has exposure to Christianity:

1. Her birth family is African-American and French-Catholic. Her grandparents met in Catholic high school (Jessica's last name is french). Her history on both her maternal and her paternal grandparent's side is Creole way, way back. She should have a cultural understanding of that because it's a rich part of her birth heritage. (Noah, as an aside, is jealous that Madison has a busier family tree than he does because we've talked about this.)

2. Also her birth family, even when they don't practice Catholicism do practice Christianity. It's a big, huge part of their lives and the emails and things we get from them reflect this. She needs to understand this so she has a shared language or at the very least understands their point of view. (Also as an aside, her adoption into a Jewish-identifying family was a concern for some of her first family and we've made a point of letting them know that they don't need to censor their faith with us.)

3. Likewise, Christianity is a very important part of the African American community at large. Open up a copy of Essence if you don't believe me. Christianity is assumed in a way that Islam is not. "Church clothes," gospel music, biblical teachings - they are important cultural touchstones. Madison is going to miss out on a lot of cultural touchstones by virtue of growing up in our white family and I can't try to replicate them for her. What I can do is offer her an understanding of them by actively seeking out members of the community who are willing to educate her about them. (Our babysitter is one person who is helping us with that.)

While some folks I know have argued otherwise, I don't think that Madison has a "true" religion that I can ferret out by looking at the color of her skin or her family tree. I certainly don't have the hubris to enter into the debate happening in the black community about the relevance of Christianity - what do I know? I'm a white Jew! I'm not talking about faith, I'm talking about the cultural experience of religion. So teaching Islam does not seem as important to me as teaching Christianity in a casual cultural context. We're all for formal and informal multicultural religious education and the informal part is, to me, about addressing the immediacy of a shared cultural experience. This is also why I haven't gone out of my way to expose my children to Buddhists - we don't know any. (We know some people who are casually interested in Buddhism but no one who is a practicing Buddhist.) Likewise, in my need-to-happen-more forays into local African American community, I'm seeing a default to Christianity. I have also been explicitly told by several black people that I need to expose Madison to Christianity. (Two people have brought up Islam and both were white people.)

A woman wrote me awhile back about being a Jewish woman with a child from Guatamala and she said that her son's birth religion is Catholic but she can't teach him Catholicsm because she's Jewish. I understand the dilemma - but I'm NOT talking about raising our children in their birth faith. I'm talking about giving our children an understanding of their birth culture.

Here's something of an example - one reason I think people assume I'm Christian is that I understand some Christian language. I understand what "the world" means. I understand what it means when someone says, "I was convicted on that." One of the guys who assumed I was Christian used some of that language and I didn't ask him what he meant and now I realize that by knowing his language, he was able to more comfortably (and surely unconsciously) make an assumption about me. I was welcome in a discussion we went on to have that I might not have been otherwise. (Sometimes I'm troubled by this because I worry that I'm lying by omission but he never asked so there didn't seem to be a proper way to back up and explain. Anyway.) I want Madison to grok the language.

It goes back to some old posts (too lazy to dig them up) I had about American-Family and math camp. To be Chinese, her husband quite clearly says, means to go to math camp. So should all white parents of adopted Chinese children sign up for math camp? Well, maybe. If math camp has the opportunity to be a shared touchstone that will make it easier for said child to enter into his/her birth community, then math camp has way more importance than just, you know, math camp. It's a cultural experience that can give a child options.

There are black kids at our synagogue (not many but they're there). The difference between them and Madison is that they all have at least one black parent. Those children may have to struggle to define what their blackness means to them (or what other people's assumptions about their blackness means to them) but it will be a different struggle than Madison's and I think I need to be more proactive than those other parents need to be.

I don't want to dictate Madison's experience by telling her that there is one more legitimate way to be black than another (that it is more legitimate to be Christian or Muslim or to embrace the example of Ethiopian Jews). Her experience as a child of African American heritage is legitimate because she is legitimate. BUT I do want her to know what the world at large is talking about. Even if she never has a chummy time in someone's kitchen getting her hair done, she needs to know that lots of other black women do and that sometimes people will look at her skin and think she shares an experience that she doesn't. I don't want her to be broadsided by this - I want her to be prepared, at the very least to be prepared to know that she doesn't know things but also where to find out. I want her to feel comfortable finding out. Having some shared language will, I know, make her search easier.

The reason I know how painful it is to be ignorant of things that feel like they should have been a birth right is that I'm a second generation interfaith Jew who converted at 30-something. It's hard sometimes to participate in temple activities and I can't help but wish my parents had given me an idea of what was going on even if they didn't want to teach me the faith of Judaism. (It's a relief to be able to talk about grandmother's hamantaschen even though I didn't even know that's what they were until I went to my first Purim celebration as an adult.) Sometimes I don't mind being ignorant but lots of times I want to (irony alert) pass as a regular old Jew. Sometimes Madison will want to be able to blend in, too, and I will do my best to open doors so she can craft her own identity instead of being stuck with the one we're foisting on her.

What Madison's faith will be is entirely up to her - she may end up feeling strong ties to her French-Catholic ancestry, or her dad's mom's Christian Science history, or she may say to heck with all that and become Mormon. Being a second-generation interfaith family, I feel that religion has way more to do with following your heart than with following familial dictates. But I also know that sometimes we look for - and find - truth by following our roots. Madison has a lot of roots. She has those that came to her by adoption, she has those that come from her first family and she has those that are part of the shared history of African Americans. It's easy for me to share my faith and to share my family's faith (including her dad's family) but it will take special effort on my part to share the religious culture that she lost by being adopted. My post was about making that special effort because I want her to have access, should she choose to exercise it.

I'm not sure what that will look like but I imagine I will follow the lead of our local (i.e, Columbus) African American community and seeing where it leads us. Also it comes from studying black history, reading books with black protaganists, and yes, from reading Essence. (I don't subscribe anymore but I did and I learned a lot - about hair and about religion to start.)

(originally published at my journal here)

The Second First Child

Tue, 14 Aug 2007 11:17:27 GMT

Many adoptive families wonder how to handle it when their child's birth parent has another child. Joyce Maguire Pavao, Ed.D., LCSW is the founder and CEO of the Center for Family Connections in Boston. She says "the second first child" is a critical time in any adoption.

"Although this arrival of a sibling or half sibling is momentous in so many ways for the adults, it is the children on whom we should be centered," said Dr. Pavao in an email interview. "The earlier and more normalized the explanation of the new baby is to the adopted child, the more ability there will be to process this and to talk about it in a developmentally correct way."

It's typical, says Dr. Pavao, for birth parents to pull back as they focus attention on their growing family. Adoptive parents who understand this can help their children process the natural ebb and flow in their birth family relationship.

"The more we normalize and make clear and simple the realities," she says. "The easier it is to keep good and honest communication with all of the children involved."

(Originally published at Open Adoption Support)

Back to School with Confidence

Wed, 15 Aug 2007 13:57:25 GMT

Although the calendar and thermometer say it's summer, the back-to-school ads on TV prove that summer's days are numbered. Our thoughts are turning to school, and we parents are undoubtedly starting to wonder what this new school year has in store for our children.

Like all parents, we adoptive parents want our children to have the best possible school experience. We work to find good schools, we ensure that their teachers are giving them a quality education, and we monitor their friendships to ensure that they're healthy. We do all we can to make sure our children's educational, social and emotional needs are met. But making sure that schools meet their adoption needs is a different challenge altogether.

Our children's educators may have had no formal training in adoption, and may themselves not understand adoption process, relationships, and emotional impacts correctly. Worse still, teachers and classmates alike may have formed their impressions of adoption from what they see in the media or in TV sitcoms. And although we like to believe that TV is catching up, I assure you it's not. Just the other day, sitting in the kitchen watching a sitcom with my 16-year-old daughter, we heard one character insult another this way: "You're adopted and Mom and Dad don't love you!" I immediately turned to Mara, who feigned indifference. But her body language told me otherwise. It hurt.

We'll never be able to control everything the world dishes out to our kids. But we can look ahead to the possible experiences they may encounter to smooth their paths. School gives us an excellent opportunity to do that. Our children will spend in the neighborhood of 17,000 hours of their young lives in school. The time we spend educating our children's educators will be well worth the effort.

There's no single right way to do this, but I can share some ideas taken from my family's experience.

Know your child's school Before our children ever set foot in their schools, we should visit to get to know the environment. Are the administrators and teachers welcoming? Do they show you around with pride? Are they willing to share test scores and demographic information, the latter of particular importance to transracial adoptive families? Will they be open to understanding the importance of adoption in our children's lives? In short, do you get good vibes?

Know your child's teachers Make an appointment to visit your child's new teachers before the school year begins, even if it's only for a few minutes to introduce yourself. Having been a teacher myself back in the day, I know the power of a visit from parents, and the great help it was to talk directly to them, one-on-one, about their children's specific needs. The time for that discussion isn't back-to-school night, it's before the school year even begins, or as close to it as possible.

Be an educator Because we can't presume to know a teacher's perspective on adoption, it's best for us to assume the role of adoption educator. My approach was to put a packet of adoption information together at the beginning of each school year for each of my children's base teachers. I labeled it with the names of all of the teachers and counselors on that year's team, and included a note asking them to read the material, pass it on, and to call me if they had any questions. This packet always came back to me with thank-yous, which told me that the information was helping raise awareness among the teachers. C.A.S.E.'s S.A.F.E. at School would be a great resource to include in such a packet.

Be vigilant Almost every adopted adult I know has told me that they never told their adoptive parents about instances of teasing or uncomfortable assignments for fear of hurting them - and that's all the more reason for us to ask. Knowing about difficult projects well before they're due will allow us to help our kids and their teachers adjust the projects or to find alternatives. Recognizing that teasing has occurred, even when our children want to handle the situations themselves, keeps the lines of communication open, and this alone may be enough to help our children through the inevitable rough patches.

Be creative Teachers work hard. A full day of teaching followed by an evening of grading papers and planning lessons can be exhausting. When we come to our children's teachers looking for alternatives to emotionally-challenging assignments (like family trees or histories) we should bring along a few ideas. They'll help our children and those who follow, too. If you can't think of any idea to bring, take the time to meet with your child's teacher to discuss your concerns and brainstorm alternatives together.

All of these really speak to being committed and involved. There's really no way to predict exactly what adoption issues might or might not arise at school. Being ready to actively address them is the best support we can give our children.

I'm approaching this year's return to school with a little more nostalgia than usual. Our son leaves for college in two weeks. Just as his thoughts are all in the future, mine are much in the past. I remember that first day of kindergarten so clearly - walking down the street to school with Paul in his new sneakers and backpack. Without question, the teachers and counselors who appreciated the educational importance of understanding adoption have helped him develop the confidence that will take him through college and into adult life.

Originally printed in the summer 2007 issue of in C.A.S.E., the newsletter of the Center for Adoption Support and Education.

Time to Grieve

Sun, 19 Aug 2007 17:36:30 GMT

Even within the context of a loving home, with healthy meals, stimulating activities, support and resources, an adopted child does not�enter that home with a "blank slate."

Paradoxically, the more safe and secure the adoptive home is, the more likely the child is to grieve their losses. Grieving is a process. Children can only begin to grieve within a safe and secure relationship.

Only within a safe, secure environment can a child:

- Face their losses
- Confront their anger
- Move past denial
- Emerge from behind a shield of detachment
- Recognize and resign themselves to the fact that any fantasies that they might have had about a reunion will not come true

This painful work usually takes place after a child enters a permanent home -- and at the very time that the social services often terminates services. This is the very reason that post-adoptive services are so important.

Loss of�the Biological Parent

When�parental custody is severed and the child is adopted, the child will still need time to grieve the loss of biological parents (and siblings!)

Loss of�the Foster Parent
Because parental rights are prioritized, attachments between children and their foster parents are often ignored. The presumption is that the child can and will reunite with biological parents if at all possible.

Unfortunately, the bond between foster parent and child is often minimalized. It is important to recognize that children who have found sanctuary and built trust in a foster home�might at first resist placement in an adoptive home,�with new "parents" who�are strangers to them.

Loss of Other Adults in the Child's Life

In a recent survey, teens who didn't want to be adopted, said that the single most important person they would miss would be their social worker, lawyer, and/or CASA. All the people they've come to depend upon are lost, leaving behind yet another loss in their life.

These losses stand between children and attaching to a new family.

Madeleine Krebs, Clinical Coordinator for the Center for Adoption Support and Education points out, "Grief is not an easy thing to live with. Because it looks like anger. It looks like, I don't give a ****, get out of my face, and all those other things that teenagers�say."�

For this reason, and many others, post-adoptive services are immeasurably valuable. To quote again from Krebs, "We're there when everyone else leaves."

To learn more about the Center for Adoption Support and Education, please visit: http://www.adoptionsupport.org/

A good place to start is by reading Marilyn Schoettle's "Healing Loss in the Traumatized Child," a publication which is available to download free of charge on the site.

The Fetal Alcohol Spectrum

Mon, 20 Aug 2007 13:27:54 GMT

Since prenatal alcohol exposure is a concern that arises so frequently in our preadoption consultations, we created this article as a resource for families grappling with the alcohol issue. Our experience in this field comes from working at the FAS clinic at the University of Washington, evaluating and following many alcohol-exposed internationally adopted children, and volunteering with older orphanage-raised children in Moscow.

Unfortunately, a recent study found that 60% of pregnant women in Russia reported drinking during pregnancy, with 8% reporting at least one binge drinking episode during pregnancy. Since these were women that were actually receiving prenatal care, the rates and amounts of prenatal alcohol exposures for children in orphanages are likely to be significantly higher, as those pregnancies do not tend to be supervised. The rate of FAS in Russian orphanages have been estimated at 1-10 per 100, and the rate of alcohol-affected kids is even worse. That's a lot higher than in this country, where it's thought to be 1-3 per 1000. Alcohol is also a major concern in other former Soviet Union countries, and is an emerging issue in many other countries.

So . what is fetal alcohol syndrome?

FAS is a permanent birth defect syndrome caused by maternal alcohol consumption during pregnancy. The full FAS diagnosis requires all of the following: growth problems before or after birth, a pattern of minor facial anomalies, evidence of altered brain structure or function, and prenatal alcohol exposure. There is an associated increased risk of eye, hearing, heart, and other associated defects, but those aren't part of the diagnostic criteria.

What about PFAS, AFAS, FAE, ARBD, ARND, etc etc etc? Partial FAS, atypical FAS, fetal alcohol effect, alcohol-related birth defects, alcohol-related neuro-developmental disorder, and other names have been used to describe children that seem to be affected by prenatal alcohol exposure but are missing one or more of the four FAS criteria. An emerging term is fetal alcohol spectrum disorders (FASD), including children with FAS as the "tip of the iceberg", but also alcohol-affected children with fewer or less severe features of FAS.

We know that alcohol can damage the developing fetus, but the effects of alcohol are quite unpredictable - we've seen fraternal twins where, given the same mother and alcohol exposure, one has FAS and the other seems fine. There seem to be unidentified protective and risk factors for mom and babies that make predicting the effects of alcohol exposure very hard to do. No amount of alcohol exposure has been proven to be safe, but heavy and repeated binge drinking is highest risk. We also worry more about older moms and later pregnancies, because they seem to produce kids more affected by alcohol, perhaps because alcoholism is further along in those pregnancies. Involuntary termination of parental rights can also be a clue to social dysfunction and alcohol abuse.

Growth

Let's look at those 4 FAS criteria, starting with growth. This is probably the least important, and a lot of us in the field would like to see it dropped from the "must-have" criteria. FAS was first described in children from a growth failure clinic, so of course they were all small at birth or thereafter. But in the FAS clinic where I work, we've seen plenty of children that we believe have FAS that don't have growth failure. In the international adoptee population we see lots of growth failure that's more likely to be due to institutional deprivation anyway, which makes growth even less of a reliable FAS measure for our kids.

Facial Features of FAS

What about the facial features? An overly long list of features associated with FAS has piled up over the years, but there are only three features that really count - a thin upper lip, a smooth or absent philtrum (vertical groove between the nose and lip), and small eyes. The face of FAS requires all three of these to be abnormal, and the diagnosis of full-blown FAS requires the face. Unfortunately, since that face seems to get "created" on only 2-3 days in early pregnancy, there are moms who drink heavily whose kids can be quite alcohol-affected but don't have the face of FAS. Not having "the face" does not rule out alcohol exposure and effects. But having "the face" dramatically increases your risk for FAS and its associated disabilities.

The other things you'll hear about - big cupped ears, "clown eyebrows", wide-spaced eyes, epicanthal folds ("asian" eye appearance), flat nasal bridge, short upturned nose, flat midface, small chin, etc - are not necessarily caused by alcohol exposure. They can be developmental (most babies have short upturned noses), ethnic, or just minor anomalies unrelated to alcohol. We do see them more often in alcohol-affected children but the thin lip, smooth philtrum, and small eyes combination is much more reliable and specific for alcohol damage.

We can often get a decent look at the lip and philtrum from referral photos and videos. That's two of the three features, and if both are abnormal then we get concerned. If you have a thin lip and smooth philtrum, plus microcephaly (small head), and strong suspicion of alcohol exposure then I'm usually quite worried about damage from alcohol. We do have software that is able to analyze facial features more accurately, but it requires a specialized "sticker" photograph.

How Alcohol Affects Brain Structure and Function

Enough about the face . what about the brain? That's what we really care about, after all. In fact, young kids with the face of FAS can be really cute. We can look at the brain structurally by plotting the head circumferences on a growth chart. You should measure the head circumference yourself if there has been any concern - bring a non-stretchable measuring tape, and practice a bit first. Wrap the tape snugly around the widest possible circumference - from the most prominent part of the forehead (often 1-2 fingers above the eyebrow) around to the widest part of the back of the head. Remeasure it 3 times, and take the largest number.

Microcephaly (head circumference less than 3%, or "below the growth chart") can be evidence of brain damage from alcohol. It's one of the few things we have to predict later brain function in infants and young toddlers, because meeting early motor milestones does not rule out difficulties later on with learning and behavior. In fact, a lot of the functional disabilities from alcohol damage aren't apparent before school-age. The lack of concrete predictions about alcohol effects is a constant frustration in this process ... it really is a "time will tell" issue, unfortunately.

"Typical" (in quotes because the outcomes are so variable) functional impacts of prenatal alcohol exposure include problems with inattention and impulsivity (ADHD-like behaviors, sometimes not as responsive to medications), lower IQ scores or mental retardation, math and other specific learning impairments, "executive function" difficulties (the higher-order brain functions that plan and organize how you solve problems), trouble with cause/effect, social and communication challenges, coordination problems, sleep difficulties, and so on. Alcohol commonly affects multiple domains of brain functioning. Teasing this out can require wide-ranging testing by professionals familiar with alcohol effects. Many kids aren't identified early enough, and are labeled as "difficult", or "just doesn't get it", or other labels that don't help. Accurate diagnosis as early as possible helps children impacted by alcohol.

Raising Children Affected by Alcohol

While these difficulties are usually lifelong, this is not a hopeless diagnosis. Consistent, patient, loving, "industrial-strength" parenting with tons of structure, and appropriate expectations and supports in school can really help kids affected by alcohol reach their full potential. That potential may be limited by alcohol-related brain damage but setting the bar at the right height, and identifying what they CAN'T versus WON'T do can really help them have success in their life, and hopefully prevent some of the "secondary disabilities" of depression, acting out and aggression, victimization, troubles with the law, and especially their own substance abuse potential.

Additional Resources

We have an FASD Resource List with internet and book references that will help give you a better sense of the range of alcohol effects, and what it's like to parent a child affected by alcohol. A wonderful parenting resource is available for free download that has a lot of great ideas on how to manage various behavioral and cognitive challenges. Also highly recommended is a downloadable guide for teachers and caregivers of child with FASD. Our website also has a collection of helpful FAS links.

The most up-to-date version of this article is on www.adoptmed.org. Some rights reserved.

Sleep and Adoption

Mon, 20 Aug 2007 13:45:23 GMT

"People who say they sleep like a baby usually don't have one." - Leo J. Burke

The Problem ...

Dr. Sears: "Thou shalt cosleep, unless you don't really want that special bond we like to call attachment."
Dr. Ferber: "Thou shalt let them cry, unless you don't really want that thing we like to call a good night's sleep."
Dr. Dobson: "Good night's sleep? Have you considered a good night's spanking?"
Dr. Weissbluth: "If you don't sleep train them now, there's a 90% chance they'll be huffing paint behind the Quik-E-Mart by age 16."
That neighbor whose kid would have slept well even if raised by wolves: "Really? Our precious Tyler slept through the night since he was 2 months old ..."
Attachment therapist: "Never let their feet touch the ground ..."
Movement therapist: "But if she doesn't learn to crawl soon, her left brain will never talk to her right brain!"
Mother-in-law: "You're spoiling that child - she needs to cry it out."
APmom on your 4am chat group: "Cherish these magical middle-of-the-night bonding opportunities - not ever sleeping is a glorious gift!"
Dad: "Honey, the baby's crying ..."
Mom: "Honey, why don't you go cherish this particular magical moment ..."

Too many experts, not enough left brains talking to right brains. Too much opinion, not enough research. Too much crying, not enough sleeping. What's an adoptive parent to do? Read on, my sleepless friend, as we tiptoe through the too-often tendentious topic of SLEEP.

What is this thing you call sleep?

So much depends on adequate, restful sleep. We've got important work to do at night, from physical growth (80% of growth hormone is secreted while we sleep), to mental growth (integrating themes and memories of the day), to recharging cellular batteries, and other functions that we just haven't understood yet.

We all sleep in cycles, but children have unique sleep patterns. As infants, they have many sleep periods through a day, and a greater proportion of active (REM) sleep - about 50%, with the other half being "quiet sleep", a precursor to more developed Stages 1-4 of non-REM sleep. By 3-4 months, melatonin turns on, and infants organize their sleep into more of a day/night pattern. This is why it's silly to expect children to sleep through the night before 4 months.

By 6 months, the full cycle of non-REM and REM sleep is happening, but infants can get into Stages 3 and 4 (deep sleep) much faster than adults, and still spend more time in REM sleep. Deep non-REM sleep is important, since it's the most restorative phase of sleep, and is also when growth hormone is released. REM sleep seems to process and organize new memories and events, and is crucial to mental wellbeing.

By 3-4 years of age, children's sleep finally resembles adult sleep in quality, with 4-6 sleep cycles. The first half of the night has more non-REM sleep, with more REM sleep in the second half.

You'd think with something this important we'd be born good at it ... but we're not. Not even close. Just like walking and talking, the ability to fall asleep and stay asleep is something that is learned at developmentally appropriate times. How and when to help your child learn is the hard part.

Why bother? Sleep deprivation is being increasingly linked to emotional and behavioral problems, poor concentration, impulsivity, ADHD misdiagnoses, impaired learning, reduced physical performance, poor growth, headaches and bellyaches, and decreased immune function, not to mention family stress.

Sleeping through the night?

As for "sleeping through the night" ... nobody does. We all wake up to some degree several times a night, often when our sleep cycles from deep to lighter sleep. Arousals after REM sleep also occur, and tend to leave you more awake and alert. You may not be up long enough to remember it (that takes 3-5 minutes), but you do wake up, even without the "help" of your less sleep-skilled child. Our goal, thus, is not to "sleep through the night", but to promote healthy sleep associations and self-soothing skills so that your kids will fall back asleep when they wake 5 times every night.

How common are night wakings that you'll notice? By 4-6 months, babies are physiologically capable of sleeping through without feeding, but according to the 2004 Sleep in America poll, 70% of these infants still wake up and need help or attention, with 47% of toddlers, 36% of preschoolers, and 14% of school-age children also with notable wakenings. The numbers seem considerably higher in new adoptees, for reasons we'll address below. As far as other sleep difficulties go, the same poll revealed that 69% of all children experience one or more sleep problems, including stalling, bedtime resistance, and daytime sleepiness.

How much sleep does my child need?

The following table is based on sleep surveys and recommendations from the National Sleep Foundation:

Age	Total Sleep Hours	Hours at Night	Number of Naps
0-2 mo	10.5-18	What night?	It's all naps .
2-12 mo	14-15	9-10	3->2
1-2yo	12-14	11-12	2->1
2-3yo	12-14	11-12	1
3-5yo	11-13	11-11.5	1->0
5-12yo	10-11	10-11	You wish
13-18yo	8.5-9.5	8.5-9.5	They wish?

While each child is unique, it's rare for kids to genuinely need less sleep than these recommendations. As for the naps, children who nap are happier, have better attention spans, may learn better, and arrive at bedtime without being overly tired. Good naps lead to good night-time sleep, and vice-versa. "Sleep begets sleep." Just try to keep naps from lasting into the later afternoon. For a great discussion of the how and why of naps for one and all, see Sleepless in America.

Special Concerns in New Adoptees

Sleep disturbances are far and away the biggest initial concern for the new adoptive families that come to our clinic. Most new international adoptees sleep well enough on the trip home - quite possibly because they're thoroughly overwhelmed and emotionally exhausted by this transition. When you arrive home, 1-2 days of jet lag per time zone crossed is typical, but children often recover before grownups.

Learning as much as possible about the prior sleep environment and bedtime routines can be very helpful. But since orphanages can have unnaturally long naps and early bedtimes (often aided by medication, sadly), you may not want to follow their timetable precisely. Remember that children from orphanages may never have been alone in a room, and will need a prolonged transition to sleeping by themselves. Children in foster care may have quite evolved bedtime routines, transitional objects, and sleep habits ... such as cosleeping, which is common in Korea and many other countries. Even the clothes they came in have reassuring smells and associations, so keep them around ...

If the "cry-it-out" methods work as advertised, then why do kids from orphanages who've unfortunately been crying-it-out their whole lives sleep so poorly at first? Well, since almost every aspect of bedtime and your child's new sleep environment is different and thus "wrong" at first, it's natural that new adoptees have difficulty falling asleep and falling back asleep during night arousals. Your child's grief at the loss of familiar caregivers may erupt at night, and when you come to console them they may be expecting someone else.

New adoptees are usually so overstimulated (we call it "Disneyland syndrome") that they may blow right through sleepytime into an adrenaline-addled second or third wind. Also, your child is experiencing dramatically more love and stimulation, is having rapid catchup development, and we know that children working on new skills often obsessively practice or at least cogitate upon these new milestones. Nightime is no exception, and it's not unusual to find children happily or unhappily attempting new feats in the crib.

Children experiencing parental love and attention for the first time are understandably reluctant to give it up because someone says it's "bedtime". The early stages of a new attachment have an insecure, "velcro" quality, so it's normal for new adoptees to be anxious and insecure around bedtime. If they won't even let you have a bathroom break, how are they suppose to handle the big kahuna of daily separations - bedtime in their own crib? Add to that the fact that it's developmentally normal for kids to have a flareup of separation anxiety at around 18 months, and you got quite an anxious child on your hands.

Plus ... it's scary in the dark, even for many "home-grown" kids. On top of that, think of all the negative associations with nighttime your adoptive child may have had. Being cold, soaked through the rags that served as diapers, in a hard metal crib, with no one answering your cries, and waking up to a different shift of caregivers is not a good memory. Neither is hearing your first parents yell and hurt each other late at night.

Finally, children with histories of prematurity, prenatal substance exposures, lack of early responsive, regulating caregiving, and stressful/traumatic experiences can literally be wired differently, with real neurologic differences in sensory processing and self-regulation. Children with oversensitivities to sound, light, or touch are more likely have difficulty filtering these inputs out at night. Children with poor emotional and self-regulation experience their emotions more intensely, and have difficulty self-soothing. The process of "attunement" (a powerful emotional connection in which the caregiver recognizes, connects with, and shares the child's inner states) with a responsive caregiver is necessary to help your child identify, organize, and work through their emotions. That attunement, more than "crying-it-out", is what will rewire your child so that they develop genuine self-soothing skills. Try to see initial nightime wakenings with empathy for where they're coming from and what they're now experiencing.

For all of these reasons, most adoption professionals do not recommend sleep training that involves prolonged crying in the first few months home. You may have brought home an 18-month-old, but he/she may be emotionally younger in many ways, and your relationship itself is a bouncing brand new baby ... one that will keep you up more than you might like in the first few months. Plan on being more emotionally and physically available at night, and try to think of these nightime interactions as an opportunity for bonding, and a way to repeatedly show your new arrival that she is loved, safe, and well-cared for.

But keep your eyes on the prize - restful restorative sleep for all. It's never too early to set up good sleep habits, and help build self-soothing skills. You'll probably want to have both a transitional sleeping plan, and a longterm plan. Get the The No-Cry Sleep Solution for Toddlers and Preschoolers or Sleepless in America, and one of the "sleep training" books (Sleeping Through the Night is my favorite, but see our list of recommended Sleep Books), and get down to learning and soul-searching about what's going to work for your family in the short and long-term. Pantley's sleep logs, sleep association list, and sleep plan worksheet can help guide the discussion ...

While the transitional plan should probably involve some parental presence during sleep onset and night arousals, the longterm plan is up to you. It's a emotionally loaded powder-keg of competing sleep philosophies out there, and I'm not going to light the fuse. If you are loving, attentive, and attuned during the day, and have been responsive to transitional sleep issues in the first months home, you do have my permission to move into some modified "gentle" sleep training if that's what you need to do (prolonged hysterical crying does feel traumatizing to many of us, though). You also have my blessing to cosleep 'til the cows come home, as long as you're all cosleeping and not cosleepless.

Bottom line - know thyself, and know thy children. If they have histories of trauma or neglect, you don't want to reinforce those stress-forged neuro-endocrine pathways by retraumatizing them. If a method feels like torture, or just isn't helping your child, then try something else. Sleep training is not a one-size-fits-all solution; some children may settle quickly after a brief fuss that blows off some of the stresses of the day. Some will cry for HOURS and devolve into a sweaty, snot-smeared, how-dare-you-do-this-to-me, too-frantic-to-sleep zombie. And they'll do this every time the routine gets off and you have to "re-sleep-train". Weigh the risks and benefits for your family. What's worse, lonely frantic crying and loss of loving, attuned care at night, or having a dangerously sleep-deprived, depressed, not-so-attuned parent during the day? There's no right answer to that ... you need to trust your instincts here. That said, I do think Mary Sheedy Kurcinka's Sleepless in America is the closest I've read to "the right answer", since she skillfully walks you down the path of what underlies your child's sleep issues, and helps you adjust your approach to your child's temperament. Very very highly recommended.

Let's get practical ...

After all this sleep theory, I know that you wanna get practical, so let's get into practical:

Zeitgebers

But first, more theory. Ha. Just kidding. Zeitgebers are the "time-givers", the environmental cues that set or reset our biological clocks. Because we run on a 25-hour clock, and the world runs on a 24-hour clock, we need daily cues to continually set our circadian rhythms. And trust me, you need these right now, especially if you just got off the plane.

Light is the major zeitgeber - keep things dim in the hour before bedtime, dark at night except for a dim nightlight if necessary, and brightly lit through the day. A sunny breakfast first thing in the morning is ideal.
Physical handling and eye contact are potent stimuli that can boost adrenaline levels. Keep the physical play and long intense gazes for daytime ... but soothing contact like rocking and gentle backrubs work well at night.
Food routines can help maintain circadian rhythms, so try for consistency in your meal/snack/bottle schedule.
Vigorous physical activity during the afternoon can make a big difference at night as well. Go for a big hike or playground session - your new arrival may have more energy than you think.

Bedtime Routines

Even if you're a free spontaneous spirit, your child is gonna need a bedtime routine. Young children thrive on predicability and routine, and that goes double for post-institutionalized children. How long should it be? How about 30-60 minutes ... sound too long? Well, how long does your child take to actually fall asleep after you "put them to bed"? Either you've just found some time that could be better spent on a cozy, bonding bedtime ritual, or you've won the sleep jackpot (don't tell the other parents). Here are some ideas for your bedtime routine ...

The whole hour before bedtime should be free of TV, computer games, vigorous play, or other stimulating activities.
Sleepy-time snacks. Preempt the "I'm still huuuungry" calls with a healthy and even sleep-inducing bedtime snack. Complex carbohydrates, as well as turkey, peanut butter, bananas, soy and dairy products (which all contain tryptophan) can help you get your sleep on. Best eaten half an hour before bed.
Review a pictorial sleep routine story that you wrote/drew together to reinforce the prebed ritual, and to confidently anticipate sleep successes. These sorts of personalized picture stories can really help in any anxious situation.
Baths. Who doesn't love a bath? Well, the kids who got stuck under a cold faucet during diaper changes don't love the bath so much at first, but usually quickly warm up to the concept. Try not to make it a wet 'n wild play session, though. Remember - "you're getting sleeeeepy ..."
Brush the teeth. Battery-powered toothbrushes are fun. So are tasty toothpastes. "Should I brush your teeth ... or your bellybutton?" Riff on your routine with absurd suggestions - they like it, and it builds language in the younger child or new English speaker. My niece likes to "teach the cat how to brush".
Change into PJs ... and don't forget to change out of PJs in the morning - helps them be a more powerful sleep association.
Bedtime bottle? The dentists just can't seem to win on this one ... but certainly no caloric beverages in the crib/bed, and it's nice to finish feeding 15 minutes before sleep to let saliva wash out some of those sugars, and to avoid setting up drinking as a sleep association that won't be there in the night. Milk, formula, and breastmilk are all soporrrific!
Take a tour of the room, saying goodnight to all the favorite toys. Doubles as a language lesson for the English learners.
A bedtime prayer is part of many bedtime rituals ... think about the content though. "If I die before I wake" might not be your best sleepytime thought.
Put your child in his bed or crib and take up your station next to him. Oh look, was there a nice little not-too-stimulating surprise waiting in bed? Maybe a sticker? Or a new book? Isn't going to bed dandy?
Do consider a gentle, soothing back massage or foot rub. Massage can work magic at bedtime, unless your child overly sensitive to touch or ticklish ...
Bookreading. Let your child choose 2-3 books. The lights should be really dim by now, so it's not about the pictures, it's about your soothing voice. If your voice needs a rest, try a tape of you reading, or an audiobook.
"Goodnight, you princes of Maine, you Kings of New England ..." What will you leave your child with each night?

Bedtime Itself

It's earlier than you think. In fact the ideal toddler bedtime is often somewhere between 6:30 to 8pm.

Use your sleep logs to keep track of when your child shows signs of sleepyness, and when he actually falls asleep.
If you miss it, poof goes the easy sleepy bedtime - tired cranky adrenaline-addled children don't fall asleep well.
If you get home from work late, you may need to rejigger that or make early mornings your quality time.
If you're having sleep issues, you're well advised to keep sleep schedules the same 7 days a week.
That said, sometimes your child's current circadian rhythms has him going to bed later than you think. Try letting the bedtime start out later but inch it backwards by 10-15 minutes per night.

Falling Asleep

This here is the key, folks ... the associations your child has with that golden moment of falling asleep will be the ones she needs each time she wakes in the middle of the night. Do everything in your power to let that moment be on her own. No feeding, no rocking at that moment, if you can. Stay in the room at first, by all means, stay next to the bed or even in it if you must ... you can wean that later if you want. Falling asleep is hard to do if you are anxious and having difficulty letting go ... Here are some ideas to help with the weaning process, which may take weeks to months.

Does your child have a "lovey", or transitional object, that can represent the emotional security she's building with you? If she didn't arrive with one, have an array of dolls, stuffed animals, and blankies around for a few days and see if she gravitates to one. Several of my patients swear by the Slumber Bear that plays womb sounds when jostled.
When she settles on one, experienced parents keep backup loveys on hand, and even rotate them so they're equally worn and stinky.
Maybe there are a few nonsense "errands" you need to do, in the room or out of it? But you'll be right back.
In fact, you can set a silent timer like an hourglass egg timer or visual timer and tell her that you'll be back in 3 minutes when the timer is done. Come back, check on her briefly, and repeat. Make sure you do come back.
Even if you're not doing the timer thing, coming back in for brief checkins when your child is not screaming for you is reassuring and rewards good bedtime behavior.
Successes with independent falling asleep are often followed by fewer night wakings in 1-2 weeks.

Night Wakings

Remember the sleep study statistics - 70% of infants, 47% of toddlers, 36% of preschoolers, and 14% of school-age children wake and need help at least once per night - these are normal, folks.

What's going on? Illness, teething, soaked diapers, recent stresses, new developmental milestones, night fears, night terrors, nightmares?
Again, be more responsive at first than you might eventually plan to be ...
But be as brief, boring, and minimalist in your interventions as possible.
And give brief fussing a chance to subside on it's own - your child may be having one of those night arousals that doesn't involve fully waking up.
Before you approach your wide-awake-and-screaming-at-4am child, take several slow, deep breaths, in through nose, out through mouth, focussing on a happier parenting moment or image of your child. Then go in.
Keep the "deep cleansing breath/find your happiness" thing going while you're in there. Seriously - breathing and a calm, affectionate approach is SO helpful, day or night; HeartMath's "Quick Coherence technique" is one way to get there.
Review your child's sleep associations - is there anything he falls asleep to that isn't there in the night?
Is there something your child could do for himself that's self-soothing? Some of my older adoptees have cassette/CD players in bed with calming stories or music. If you played music at bedtime, can your child turn it back on easily?
Pantley has several great suggestions - giving your older child one or two Get-Out-Of-Bed-Free cards, a "Sleep Fairy" that leaves stickers under the pillow when children have had a successful night (depending on what they're working on - reward incremental successes), and even wrapped prizes in the morning for kids that have a good quiet night.

Cozy Sleep Nooks

First things first - if there's a TV or computer in your child's room, banish it forthwith. They are the anti-sleep.

Ideally the sleep area is for sleeping and quiet resting ONLY, and perhaps separated by curtains or other dividers from the rest of the room.
Lots of stuffed friends can be reassuring, as are pictures of loved ones.
Climb in and spend some time in it yourself. Is the mattress comfortable enough? Audible household or outdoor noises? Lights shining in from the hallway or street?
Is there a place for you? Because that's the ultimate safe, secure "cozy sleep nook", at first. I think the ideal transitional solution is with one parent sacked out next to the child, since that will maintain a consistent sleep environment for the child when you eventually wean the parental presence.
If you're not there during the night, something that explicitly reminds her of you is also very important - since smell is one of the most powerful shortcuts to our primitive brain, where our senses of anxiety and security come from, perhaps an aromatic worn t-shirt or pillowcase of yours? And some photographs of you together in a loving, calm moment can be reassuring in the night.
Other options are having the crib or for an older child, a futon, next to your bed.
Cosleeping is also a popular option at first. Some adoptive parents report that their child was easily weaned after a few months to their "big girl bed", but in general, once you start cosleeping it's the hardest to wean.

Light

Seattle in the summer is brutal for sleep. Try creative window treatments like "blackout curtains", cardboard, aluminum foil (also adds a certain "blocking the alien mind control rays" touch to your decor) or whatever it takes to get that room dark.
If you do use a nightlight, keep it as dim as possible to avoid vernichten das zeitgeber, ja? If you know what I mean ...

Sound

White noise can be a godsend for sleep, and is one of the first things I recommend for light sleepers.
A fan or aquarium pump running all night long can help drown out other intrusive noises.
Ocean wave noise generators, womb noises, and heartbeat lullabies are other favorites.

Smell

That lovey smells funky for a reason. Wash it at your peril.
Something that smells like you can be soothing too. See above ...
Aromatherapy - lavender and chamomile scents are felt to be relaxing as well. Try some "Badger Sleep Balm" ...

Touch

Being wet in the night is trouble, so limit fluids in the 1-2 hours before bed, use diaper doublers, and consider a nice layer of protective diaper paste before bedtime.
For children that seem to crave that snug-as-a-bug-in-a-rug sensation, often winding up wedged in the corner, perhaps a smallish sleeping bag or sleepsac would feel good. Grembo, LittleBigFoot, and others make zipup sleep bags for infants and toddlers. Tucking in the the sheets extra-tight may help at first, but they come undone; some parents have used a lycra sleeve around the mattress that the child slips into. Weighted blankets are available for older children with sensory issues as well.
Many orphanage-raised children will have pronounced self-stim/self-soothing habits like rocking, head shaking or banging, ear fiddling, or sucking on lips or fingers. These do fade with time, but may still show up in time of stress.

Temperature

The body tends to cool off at night, and people sleep better in a cooler environment.
Warm baths followed by cool bedroom may help this process along.

Does my child have a sleep disorder?

Courtesy of Dr Mindell, the following list of sleep problems may indicate that your child has a sleep disorder. If these issues are present, if sleep issues are getting worse not better, or if you're at the end of your rope, please talk to your health care provider.

Loud snoring, noisy breathing, or breathing pauses while sleeping
Breathing through his mouth while sleeping
Appearing confused or looking terrified when he awakens during the night
Frequent sleepwalking
Rocking to sleep or head banging when falling asleep or during the night (ed: actually very common in orphanage raised children, and thus only a problem for them if severe or persistent)
Complaining of leg pains, "growing pains", or restless legs when trying to fall asleep at night
Kicking his legs in a rhythmic fashion while sleeping
Sleeping restlessly
Frequent difficulty falling asleep or staying asleep
Sleep difficulties leading to daytime behavior problems or irritability

You can also use a validated Children's Sleep Habits Questionnaire by Dr. Judith Owens to help you and your providers determine if your 4-12yo child's sleep needs further evaluation.

Additional Sleep Resources

Our favorite Sleep Books
Our collection of Sleep Links

Acknowledgements

Thanks to New Hope Child and Family Agency for the impetus, Elizabeth Pantley for many fab ideas, Drs. Mindell and Weissbluth for others, Dr. Greene for the zeitgebers, and our sleepless families for the inspiration.

The most up-to-date version of this article is on www.adoptmed.org. Some rights reserved.

Circle of Love

Tue, 04 Sep 2007 14:18:44 GMT

Some days I am Janis Joplin, Tracy Chapman, or my own bluesy folksinger with a soulful groove. Of course, on these days I am driving in my car and, luckily, no one hears me. My late grandmother was a singer and pianist, but her musical talents are lost on me.

Yet, there's hope. Not only does my 19-month-old daughter Maeve love to sing in toddler dialect Twinkle, Twinkle, Little Star and Row Your Boat, she boasts an impressive dance repertoire. Her great-grandmother would be proud.

Maeve bops, sways and claps to music in the house, whether children's sing-a-longs, blues, reggae, rock or jazz. With a spark in her eyes and a beaming smile, Maeve shakes jingly bells, her daddy taps drumsticks, and I, wannabe bluesy songstress, take tambourine in hand. We laugh and dance, laugh and dance - our own wonderful rhythm.

While these moments of familial bliss make treasured memories, they also are a stark reminder of another woman's loss in an arrangement so bittersweet.

Although ours is an open adoption with letters, photos and an annual reunion picnic, my husband and I want more contact and hope our relationship with Maeve's first mother, B., continues to grow.

Some folks are incredulous. Their faces scrunch as they ask: "How could you want Maeve to know her birth mother?" I try not to bristle, and simply answer, "How could I not?" They ask if I'm threatened when B. plays with her, kisses her. They tell me in a protective tone, "You're her mom now," implying there should be no interference with the mother-child relationship.

I agree. So I ask them to consider the mother that created and carried Maeve, and loved her enough to admit she couldn't provide all her daughter deserved. I ask them to consider the woman who pushed Maeve from her loving womb, and held her close before letting her go in an act of love many couldn't muster. She is the mother that lawyer, judge and adoption agency had no hand in making.

What they don't see is that this doesn't take away from me, it only adds to me. It makes my daughter more complete which makes me more complete.

And, at the end of the day, is it so terrible that Maeve has another person in her life to love her?

There are bonds in our lives that are so fundamental they simply are the core of our being. B. is Maeve's biological mother, the woman who chose life for her. The woman brave enough to acknowledge when she couldn't be everything Maeve would need. She loves Maeve that much. That's a bigger love than many are capable of. Maeve and B. shared an existence, months of moments together. They are part of each other. Biology cannot be altered. (And, by the way, if there was some bizarre scientific way to do that, I wouldn't. Ever. She wouldn't be the same little girl I adore if she were biologically mine. Irony again, you naysayers, you.)

It's simple: I can be many, many things for Maeve. And don't get me wrong, being her mom means more to me than - well, than I can adequately express via keyboard.

But I can never be the woman who brought her into this world.

No, instead I am the one lucky enough to love her in person each day. Every uh-oh and sad tear, every milestone, every hug and nose kiss, even every tantrum, are mine to receive, to witness - indelible marks on my heart.

Unlike B., I am here, within arms reach, to feel her love at any moment, to hear the raucous of her jingly bells. I am sad that B. is several hours away, the next state over, unable to feel this Maeve Love anytime she wants. I do not pretend to know B.'s pain, her thoughts, her fears. When I try to imagine these things, I fear how large that cloud of pain and sadness could be. I fear the shadows it may cast for her. I only have my own experiences as a mother within which to craft some idea of what choosing someone else to raise my child feels like. I will never adequately know.

But I do try to understand. I try to understand the complexity of emotions involved. I feel connected to B. in a way that brings me 1) humility at her selecting me as Maeve's everyday mom and 2) promise - promise to do right by her. Promise to be the best mother I can be to a little girl that forever binds us.

Every morning I wake and embrace the commitment I made to B. to raise a giving, loving child with a heart so big that no one and no creature be excluded from its myriad gifts.I re-commit to do right by B. and - pardon the rewrite, Ms. Joplin - the baby that takes yet another little piece of my heart. The daughter that makes us both a mother.

I share these dreams and aspirations for Maeve as honestly and fully as B. chose to share this beloved little girl Maeve with us.

Although miles away from us, B., I send you my love. And know that it is love from Maeve too; it's the love you first shared many months ago coming back to you. Like a full circle, your love for Maeve gave us the chance to love her and to receive her love, and we share it with you now and always. We are all forever entwined in this circle of love.

A circle of Maeve Love.

Gretchen Boger-O'Bryan was placed with her infant daughter in July 2005. An editor in legal publishing, she also is a freelance writer and currently writes about adoption and first-time parenthood on her blog, musings:mamahood&more, at www.mamagigi.wordpress.com.
This post is excerpted in part from her blog post, Circle of Love.
(c) Gretchen Boger-O'Bryan

Catching A Song: The Older Child's Adoption

Wed, 05 Sep 2007 16:06:45 GMT

Catching A Song: The Older Child's Adoption

Wed, 05 Sep 2007 16:07:45 GMT

The blue dress reminded me of the kind of silk my great grandmother used to trim her blankets. My oldest daughter stood at the edge of the dressing room drowsy with possibilities. I bury the thoughts about the sensible clothes we were "suppose" to buy. The results of sensibility, I reminded myself, were the white bermuda shorts purchased two summers ago, which were never worn.

"Can I buy this dress and save it for the Prom?" Poncahontas hair fell folded into the small of Kyeong Sook's back, the Morning Glory blue material rippled like wind walking across grass. "But what if something happens and I do something bad, will I still get to keep the dress?"

"Honey, there is nothing you could ever do that would cause me to take this dress away from you. It will be yours no matter what." Unlike her brother who needed to be held lightly, this daughter needed to test the strength of my grip. Perhaps there is no adequate description for some older child adoptions, which happen with such a full-on force. This kind of love will need to stay molten. In its lifetime it will often need to be thrown back into the fire and reshaped.

When we arrive home Kyeong Sook puts the dress on again. She leans hard into the mirror's reflection, pushing aside all that thick black hair. The mail arrives bringing the latest issue of an adoption newsletter. I glance at the photos of waiting children. Lisa's high-cheeked face stares at me. She is 9 and has experienced extreme neglect in her birth family. And athletic girl, Lisa enjoys sports, and she also likes to cook and bake, but she can be bossy, and stubborn. It says a two-parent family, where at least one parent is ative American is needed; that she'd dod best in a family experienced in parenting children who have been abused and neglected.

Five minutes later I scatter handfuls of birdseed on the porch railing. I add an extra handful of sunflower seeds for the nuisance birds, the Scrub Jays who send the smaller birdseed to the grown like rain while searching for their favorite treats. I'm an instinctive mother, not a book-read one, and my heart tells me they're looking for another mom like me, for I know what it is to bend a bow almost too massive for my strength. I remember when I used to think that all a troubled child needed was to be brought into a loving family. Now I know better.

Kyeong Sook became my daughter when she was 10. She was a smart child, with unresolved emotional and behavioral problems stemming from abuse, deprivation and rejection in early and middle childhood. We had four years of what I thought of at the time as getting-no-where counseling. Never one to waste money or admit defeat, I spent those sessions discovering my own thorns, we all have them.

The adoption of an older child requires a different education, and a much stronger support system throughout the parenting years. You've got to teach yourself to work at creating positive memories. Learn to think of parenting your child as a relationship waiting to be build rather than a wall needing to be torn down. It's important to find a therapist and begin family counseling before you need it. Loss and abandonment issues often surface at holidays, on anniversaries, and at other times when we least expect it. Marker events bring out an old sadness, ones that we usually do not even know about, and it gets mixed up in our current family life. What many people don't realize is that masked sadness often surfaces as anger.

Still, there are those of us bound for the older child adoption trail. We saddle up, and get ready to ride. Violet water bathes our thoughts of what "could be." Lisa, the child in my mind's eye, learning to accept the consequences of her behavior, tenderly loved, dancing near me in a beam of sunlight, with a billow of fringed jersey shall around her. This time I know the dream giver comes to me not with a child, but instead with this story.

Catching A Song: The Older Child's Adoption

Wed, 05 Sep 2007 16:08:56 GMT

Catching A Song: The Older Child's Adoption

Wed, 05 Sep 2007 16:10:42 GMT

TenThings to Think About When Adopting An Older Child

Thu, 06 Sep 2007 17:07:17 GMT

I adopted my daughter from Russia when she was 13 years old, and my son came home from Kazakhstan this past May, at age 10. Over the last few years I've gained a lot of valuable parenting experience in a "hands on" way. I have also educated myself about issues with older children, by belonging to a number of adoptive parent forums in the internet, reading, and just talking and visiting with other parents of older kids. I don't hold myself out to be an "expert," but I can tell you what I know, from my experience.

ONE Can you learn some of the child's language?

In any adoption of a child over the age of 2 or 3 years old, I think the most crucial thing is to learn the child's language, at least a few key "mommy" words and phrases. Your child will not learn English overnight. You will need to communicate for several weeks or months before the child will be able to function in English. I took a formal class in Russian, but even though I have a facility for languages and speak French and Italian, the Russian was really difficult. I finally just told my teacher that I really just wanted to memorize parent words and phrases, and she gave me a handy list. She also made me a CD, at my request, so I could pronounce things correctly. Additionally, I listened to CD's in my car, although they were of limited value because they were aimed at travelers. Despite all my preparations, communication was a big issue with my daughter, at first.

TWO Are you willing to educate yourself on the issues your child may have emotionally?

Everyone knows the horror stories of older adopted children with severe emotional behaviors - I can't address that. However, most older adopted children I know of are not severely dysfunctional. They are good kids who just need extra help.

THREE Are you willing to keep things in your child's life low key for several months after they come home?

Adopted children need to be at home, in a calm, safe environment, as much as possible after they come home. It's not a good idea to immediately stick the child in school. The child needs to bond to you and your spouse and other family members. The child needs to adjust to a whole new life - new country, new family, new tastes, smells, etc. It can be really overwhelming, at first. You will need to avoid parties and big social events, and keep things very low-key for a while. You may have to severely curtail your social life and normal activities, for the sake of your child.

You need to take FMLA leave if you work full time, just like you would with a baby. I could only take 2 weeks with my daughter, and her attachment was slowed a lot. With my son, I took 6 weeks, and had much better attachment.

FOUR Are you willing to be flexible about your eating habits when the child gets home?

FIVE Are you able to take the time to educate yourself about adoption issues?

The most important tip I can give you is this: Educate yourself. Read everything you can about kids adopted from orphanages, the customs of the country your child is from, other parents' experiences, etc. I regularly check out a number of online forums for discussion of adoption issues, and read adoption magazines. Talk to other parents. If you are in a large metropolitan area, find a FRUA chapter in your area. Ask your agency about other parents in your area that you could speak with about your child. If necessary, form your own support group. I formed a very informal support group here in Atlanta for parents of kids adopted from Russia and Eastern Europe, and we meet occasionally and let the kids play while we visit. It's great to be able to exchange ideas.

I have read numerous books about how to handle the behaviors of an adopted child, although there are few resources for parents of older children. Dr. Ronald Federici's book Help for the Hopeless Child, was quite helpful. I also liked Beyond Consequences, Love and Logic, by Bryan Post and Heather Forbes. They offered very different perspectives, yet I gleaned valuable information from both of them. I've also heard good things about Deborah Gray's Attaching in Adoption.

SIX Can you develop a thick skin?

I had several close friends tell me I was crazy when I was in the process of adopting my daughter. My own brother was very resistant to the idea. I was told my child wouldn't bond to me, would have huge emotional problems, probably would have terrible FAS [fetal alcohol syndrome] etc. etc. I had to just say "Look, all kids have issues. I can figure out how to handle whatever issues come up!"

I've also had plenty of thoughtless and ignorant questions thrown my way. Examples: Where's her real mother? What does she call you? Why did you give her your last name?

If naysayers and ignorant folk are going to freak you out, don't adopt an older child.

SEVEN Can you accept that your child will likely not look or act like you?

For some parents, this can be a daunting issue. Neither of my kids look like me. I'm OK with that. I'm open about them being adopted. Not everyone is comfortable with that.

EIGHT Are you willing to become an educational advocate for your child?

With an older adopted child, they are usually 2-3 years behind academically. Most school systems will want to stick them in the appropriate class by age, regardless of their true academic level. You will need to get your child the help they need. My daughter was poorly educated in Russia and has a learning disability. I had to pay for her testing and finally home school her for a year because the local school kept telling me all her problems in school were language based, which I knew wasn't true. I've spent over $12,000 helping her educationally.

NINE Can you handle a child who is emotionally behind his or her peers?

My daughter is 16 and acts 13. My son is 10 and acts about 7. They never got the love and emotional security they needed when they were young. It's a documented fact that institutionalized children fall behind their peers emotionally. They aren't bad kids, they are just not the same as American kids in normal middle class households. You have to be willing to baby your kids a bit, and accept that they are different.

TEN Are you willing to adopt a sibling, if there is one out there?

A lot of kids in orphanage have siblings. Some still live in the birth families. Some are in different orphanages. Many times, siblings are located for older children, and the families are asked if they are willing to adopt them. There is no right or wrong answer to that question, but you need to think about it. If you cannot possibly adopt more than one child, think about how you can keep the kids in contact with each other. Losing a sibling can be devastating emotionally to a child, even a sibling they aren't close to.

One question you might be afraid to ask an adoptive parent of older kids is this: Can I love an older adopted child the same as a bio child? The resounding answer is YES! I would do anything in the world for my kids. I would give up my life, if necessary. They are so sweet, and so very loving. They are grateful to have a mommy who loves them. It's impossible not to love them with all my heart. I know so many adoptive parents of older kids [both bio and adopted] who say this same thing - your heart can expand exponentially, if you take a chance.

I have so many handmade cards and letters from my daughter telling me how much she loves me and how thrilled she is to be part of a family. My son spent the first few weeks he was home hugging me around the waist 10 times a day and smiling up at me and saying with mingled awe and delight "My MOM!" It's those moments that I know I did the right thing.

If you'd like to know more, please feel free to check out my blog. I update almost daily. It's a good picture of day-to-day life with older adopted kids:

deescribbler.typepad.com/jacks_new_family/

[Note: I have written a children's book called Jack's New Family, to help Russian speaking children know what it's like to be adopted. It's also in English. It's available on Amazon.]

Dee Thompson

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Do adoptive parents frequently experience Posttraumatic Stress Disorder (PTSD)?

Wed, 12 Sep 2007 10:20:33 GMT

Certainly a provocative question! Unfortunately, far too many people confuse Posttraumatic Stress Disorder (PTSD) with Traumatic Stress. The former is a psychiatric disorder that is applied to a relatively small percentage of individuals who have experienced, witnessed, or have been confronted with an event (or events) that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The individual's response involves intense fear, helplessness and/or horror. Traumatic Stress, on the other hand, refers to the normal reactions that we experience in the face of abnormal events. I often say to people that, "It's okay not to be okay" during challenging times in our lives (www.ItsOKNotToBeOK.com).

I have used the term "Adoption Stress" to refer to the unique experience of people who are involved in the adoptive process. I believe that it more appropriately describes the impact of adoption on all parties involved (e.g., birth mother, adoptive parents, etc.) than the term, Traumatic Stress (www.AdoptionPsychologist.com).

I am profoundly committed to the belief that people who have experienced adversity can learn to harness the energy from a painful experience and use it to propel them to cultivate a mission and purpose. I often refer to this as the "Oprah Factor!" However, it is critical for people to understand and resolve their own conflicts prior to becoming an "expert" in helping others. Those who do not address their own issues often become sympathetic listeners, rather than empathic listeners. The sympathetic listener is often all too eager to try to solve someone else's problem and runs the risk of becoming a part of the problem-the "self-proclaimed expert" (e.g., "When I adopted my first child from Russia, I....") rather than the empathic individual (e.g., "I see that you're scared of what will happen when you begin to integrate your adoptive child into your family.").

This question taps into the enormity of stress that is experienced by many people who are involved in the adoptive process. It also points to the need for those who have been emotionally scared by the adoptive experience to address their own feelings, rather than running the risk of projecting those feelings onto others who are beginning to walk down the exciting, but often challenging, road of adoption.

AdoptionPsychologist.com & Adoptiondoctors.com

Written by Dr. Mark Lerner

Thalasemia and International adoption

Wed, 12 Sep 2007 10:40:07 GMT

Reader's Question on Thalasemia...

By: George Rogu M.D. of Adoptiondoctors.com

Hemoglobinopties are disorders of blood cell structure and they may occur in many different ethnic groups, such as African, Asian, Mediterranean or Middle Eastern decent. There are two major types of Hemoglobinopaties:

1) Thalassemias : which are caused by quantitative deficiencies in the in the production of globulin chains which are used to produce hemoglobin. These defects generally produce anemia of varying degrees depending on severity.

2) Structural abnormalities of globin chain production causing a defect in the shape of the blood cells. Examples of this type of anemia would be an illness called Sickle Cell disease.

In this article we will talk about the Thalsemia syndromes and in particular about Hemoglobin H disease. In order for the human body to make normal hemoglobin, which is required to transport oxygen to all our vital organs, normal cells must have 4 alpha globin genes. In the Thalasemia disorders, there is a genetic defect or deletion in one to four of these alpha-globin genes on a chromosome #16. The severity of the syndrome is related to the number of gene deletions.

A) Silent Carrier: has one gene deletion. They are asymptomatic and have normal blood findings.

B) Alpha-Thalsemia Trait: 2 gene deletions, they have normal or slightly decreased hemoglobin (blood levels) causing a mild anemia.

C) Hemoglobin H disease: 3 gene deletions. They have mild to moderately severe anemia.

D) Hydrops fetalis: 4 gene deletions. They have severe intrauterine anemia, asphyxia, and usually expire shortly after birth.

blood In-patients with Hemoglobin H disease, or 3 gene deletions, these patents may be symptomatic and have secondary complications of hemolytic anemia. Patients with HbH disease can generally have moderate to severe anemia, with low hemoglobin levels of 7-10g/dl. Other common medical finding would be paleness, jaundice (or yellowness) large liver and spleen, increased susceptibility to infections, leg ulcers and pigment gallstones which occur after prolonged breakdown of red blood cells, can cause recurrent abdominal pain and may require surgery. Deficiency in Folic acid may also occur.

Complications that can occur in children with HbH disease are generally the result of intermittent exacerbation of their anemia, which may require repeated blood transfusions. These episodes of hemolytic anemia generally are precipitated by certain drugs or by a parvovirus infection. Usually patients with HbH disease can lead fairly normal lives with relatively few blood transfusions. Transfusion therapy is usually reserved for patients with severe anemia (usually less than 7g/dl) and with symptomatic anemia.

Another complication of this disease is the enlargement of the spleen with worsening of the anemia. Many times this requires the removal of the spleen itself, and then you have all the complications other than just that of surgery, which is the susceptibility to bacterial infections. Usually removal of the spleen is reserved for patients with symptoms of large spleen, as reflected by leukopenia (decreased white blood cell levels) thrombocytopenia (decreased platelet count) and worsening anemia or, in-patients who were previously stable and develop blood transfusion requirement.

What does the medical future of this child have in store for this adoptive family?

1) Usually patients with HbH disease can lead relatively normal lives.

2) They may require repeated blood transfusions, and after many years of therapy may result in a complication of iron overload.

3) Large spleen which may require its removal.

4) Susceptibility to bacterial infection after the removal of the spleen.

5) Many children are kept on prophylactic penicillin therapy to ward off infection.

6) Severe hemolytic anemia episodes which may easily be triggered in times of stress, infections with viral illness or may even by certain types of medications such as sulfur.

7) Gallstones and abdominal pain all secondary to pigment stone collection caused by prolonged destruction of red blood cells. Surgical removal of gallstones to alleviate the abdominal pain.

Now back to the original question that the parents say they are not carriers and are not ill. I believe that they are not ill but are more than likely both silent carriers of the disease or have the thalsemia trait or some combination of this. Because of the rules in genetics, it is possible to have three other children that are not ill with the severe form of the disease, but they may also be silent carriers or have the thalasemia trait. From the clinical description of this child's medical scenario, the diagnosis may be accurate. Good follow-up with a Pediatric Hematologist is essential to the management of this disease

Written By George Rogu M.D.

For Pre-adoption Medical Evaluations and Post-Adoption General care on Long Island New York, Visit us at our International Adoption Private Medical Clinic.

Adoptiondoctors.com and Adoptioneducationclasses.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made.
This website does not constitute a physician patient relationship

Insta-Attachment and Other Adoption Myths

Wed, 12 Sep 2007 15:46:13 GMT

I let out a long, deep sigh as I re-read the words in my inbox again and again. It's not that it was the first time I had heard those very same words. It's not that I judged the family who spoke them, knowing I would have written the same a few short years ago. But the pang I felt in the back of my heart and the lump in my throat was for the little girl they were describing. Despite the words of bliss, despite their descriptions of a perfect adjustment, my heart sank as I could envision her face before me. I knew what her eyes would look like if only I could see them. I knew what expression she would have on her face. I knew because I have seen it before. And now I know what it means.

I had received the glowing report in my inbox from a friend of a relative who had just come home with their beautiful new daughter only 7 weeks prior. "She is bonding with everyone! Family, friends, neighbors, people at church! She is just adjusting so quickly and bonding to everyone she meets!" This particular report was really quite similar to many I hear early on. She was doing "so well", "adjusting great", and was "better than they could have ever expected". It is the report our families, friends, co-workers, and even agencies hope and expect to hear from us. Everyone is waiting for the "he/she is all we ever dreamed of" and "it is as if he/she has always been with us". These are the words everyone waiting to bring a child home reads on the blogs of families who have gone before and prays they will be able to write.

Insta-Attachment. Psychologists and anthropologists have noted for decades that our society is especially vulnerable to the temptations of insta-everything. We are used to it, after all. Everything is fast, easy, convenient. We hate waiting in lines, despise slow drivers, and adore our internet as long as it comes in high speed. We think we are immune to that constant drive for speed and convenience in the adoption world because we wait so long through endless paperwork to bring our children home. We herald the "lesson we have learned in patience" as we agonize through the trials of the paper pregnancy. But that is where so many draw the line. Once our child is home, that is the end of the waiting, right? They are going to be placed in our arms and our waiting is over! Hurray!! The end of our trials and tribulations and now our joy can begin!

The problem is that for your child, they are not in the joyous epilogue of a long novel finally reaching the glorious conclusion as you think you are. They are still in the introduction of a brand new book, one that includes chapters they have never heard of called "Living with a Family", "Welcome to a Mom and Dad that Look Nothing Like You!", "A Few Strangers in Your Life Would Now Like to Kiss and Hold You Endlessly" and "So This is America??". In the midst of all of this is the greatest myth of all. Insta-attachment.

Children do not bond in a week. People do not learn to trust in a day, a week, or even a month. A child who is living in a strange land with strange looking people who speak an even stranger language cannot possibly learn in a short period of time what it means to be loved by a family, what a mom and a dad even are there for, what it means to be a sister or brother, and that all of these strange people can be trusted to never leave them again, never harm them, and navigate them through the twists and turns of life. We want so much to believe in Insta-Attachment because, truthfully, it makes us feel better. The wait has already been so long for us, we sacrificed so much to get here, and the last thing we want to face is the possibility that our work is not done once we reach what we thought was the end of the road, the fulfillment of the goal. Sometimes we are willing to accept a few hours of grief, a few days of the child's emotional walls, a few weeks of sleepless nights. But we certainly don't want to face the chance that perhaps those few tears, a night terror or two, and the struggles with sibling relationships might last longer than a week or two. Or, even harder to face, is the possibility that even though our child seems to be doing well, their actions may be masking the true grief and trauma that so many adopted children hide deep in their hearts.

And this is where the temptation to ignore the unspoken signs of trauma and grief in our children steps in. We want so much to believe they are adjusting quickly that we interpret signs that actually are warning signs something is not right as signs that our child is doing really well. When our daughter reaches her hands out and lets anyone hold her, we beam with pride that she is so social. When our son falls apart on the floor because we asked him to do a simple task, we say he must be really opinionated. When our kids run around at an event, wandering in and out of strangers without concern for the location of a parent, we say they must really like parties. When our child plays alone on the floor for long periods of time without a need to be entertained, we are grateful we got one of the "easy kids".

Attachment is not instant. Bonding takes time.a long time. And even if your child is pleasant and calm with you from day one, plays with you and hugs you, lets you hold her and seems to get along with everyone, it is simply a matter of common sense that what the child is experiencing in those early months is not and cannot possibly be attachment to you. Even if the child has the opposite reaction and cries every time you leave the room, it is still not defined as true attachment. When we were in China picking up our second daughter, she cried the first time I tried to hold her but by the next day she screamed if I was not in her sight. This was not because she somehow miraculously attached to me overnight (though that would have been nice to believe!). She simply had figured out a major change was about to happen in her life and that I somehow was the next person in line to provide her some tiny amount of security so she was going to latch on and not let go! This does not mean she suddenly loved me, trusted me, or even liked me for that matter. It was a matter of survival. Her instincts kicked in and she knew that her safety and future depended on clinging to me.

We are now weeks away from bringing home our 5^th child, our 3^rd adopted child. We have had the privilege of visiting him twice. Though by week's end on both visits he was clinging to me and watching my every move, I am not fooled. My heart would love to believe this baby has decided I am his mother, thrown himself in my arms and shunned all others to choose me. But I have seen his eyes. I know what his eyes say that his actions sometimes belie. He does not trust me yet. He does not love me yet. How could he possibly? Though my heart wants to believe I can spend the months and years to bring a child home that will run into my arms and realize I am their family forever now, I am now a little more cognizant of the impossibility of that expectation on a child.

So how do you create attachment in a child if it is not instant? You build it, one brick at a time. Sometimes you even have to break down the faulty foundation that was created before you ever received your child, and then build a new foundation one brick at a time. If your child seems content, seems "okay", seems social, seems to "fit right in", look past the surface behaviors and do not let the survival instincts of children fool you into thinking their past has not affected them and that they are rubber balls who can be bounced around yet simply bounce right back. Do not just move on with your life as if your work is done. Stay with your child. Give some things up. Spend time playing, holding and talking to your child. Do not let your child push you away, manipulate you with shallow behaviors or place any other friend, relative or caregiver above you. You have the right as the parent to ask questions, challenge your child emotionally, and insist on being the first love of their life.

You are not a failure as a parent to admit your child home for even a year still does not show preference for you. Your child is not "less than" other adopted children because he does not appear as adjusted as other adopted children whose parents glowed, "This was a perfect adoption!" Do not believe in Insta-Attachment. It is a fairytale that ultimately prevents you from really seeking out the deepest part of your child's heart and searching for true healing instead of proper behaviors. It is worth the search. It may take much longer than you had hoped for, your emails to family and friends may be lacking in the instant gratification. But the long, slow simmer of true attachment in the end is stronger, more deeply satisfying, and more healing. Do not look for the easy path. Look for the road less traveled. Be willing to take another journey of patience even after the paperwork is done and your child is home. Do not close the book. Begin a new one. It is worth the effort. It is worth the wait. Your child is waiting for someone who is willing to take the time and energy to write it for them. Insta-Attachment is one fairytale your child can do without.

Dawn Greer Choate and her husband are the parents of 5 children, including 2 daughters born in China and one son born in Guatemala. In 2005, the Choates launched Healing Hannah, a resource to educate parents on issues related to attachment and emotional healing in the adopted child. Dawn is an ordained minister, author, speaker, and a co-owner with her husband of a computer/software business. For more information, please visit www.healinghannah.com and www.fishersofwomen.com

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Institutional Autism, secondary to orphanage living conditions.

Wed, 12 Sep 2007 20:26:51 GMT

Many children who are available for international adoption have either been placed in hospital-run orphanage or a classic institutional care setting for a multitude of reasons. These reasons range can from illness or untimely deaths of biological parents, to the parents' inability to care for the child's basic needs necessary for survival. Over the past 15 years there has been a dramatic rise in the number of children who are internationally adopted and a majority of these children have been raised in an institutional care facility.

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In countries from the Eastern European block such as Russia, Romania, Ukraine and Moldova, children are still being placed into orphanages at an alarming rate. Reasons for abandonment stem from the fact that since the fall of the Communism, democracy and freedom have left many people poverty stricken and homeless. The lower socioeconomic class no longer has the social support of the government to help with their survival. Because of the poor economic situations of these people, families are no longer able to care for the medical, physical and psychological needs of their young. Families that are condemned to a life of poverty find orphanages to be the only viable alternative that their children have for survival and maybe even a future. Strange as this may sound it does occur all too frequently.

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Hospital-based institutions are still state-run facilities with little or no resources. Children who have any type of medical condition (even minor problems) are placed in institutions, which also house patients with the more severe and sometimes neuropsychiatric conditions that no child should ever be exposed to. Children with more complicated or chronic medical conditions (such as blood disorders; infectious disease, congenital malformations and classic autism) are doomed to a forgotten life behind closed cold walls of the institutions.

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The biggest problem that I personally have with the institutional setting is medical diagnoses that are given to these children. These diagnoses often are false, exaggerated and unfortunately sometimes very real. The disparity to the severity of the medical problems found in these children is is sometimes incomprehensible. They mix the severely mentally retarded, autistic, and handicapped patients with the relatively normal child who is abandoned, with mild developmental delay or the child who required minor surgery that is unable to acquire the procedure in order to lead a normal and healthy life.

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Unfortunately, once a child was placed in a orphanage, that label follows the child for years, especially in countries like communist Romania during the 1980s. These children were fated to remain there for a life without appropriate medical care or even the possibility of having a family to care for their needs.

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Developmental delays are frequently found in many of the orphanage children, even before they are placed in the institution. This is usually a direct result of poor pre-natal and post-natal factors, nutritional inadequacies and medical neglect. Once placed in an institutional care setting, these minor delays are often misconstrued as a metal deficiency or mental retardation.

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During the critical years of neurobiological development of the child's brain, orphanages are notorious for being deficient in providing the social, emotional and cognitive stimulation required for normal development of the child. Many children are starved, neglected, and forced to stay in their cribs in order to follow safety protocols.

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Children are frequently and repetitively moved from one age group to another. As the child ages out, he can no longer learn anything new for the younger children in the group and often regresses to a more immature behavior.

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All of these factors, combined with profound medical, nutritional, and physical neglect cause these children to revert back to a more primitive state in the child's mental development. Speech, language, and intellectual abilities languish, and over time developmental milestones deteriorate to levels where the child may appear to be truly mentally delayed or retarded.

As a defense mechanism, in order to maintain the child's own inner well being, neglected children generally shut out all environmental and interpersonal contact that could cause them harm. There is sometimes a component of learned helplessness. It is this type of behavior that often gets labeled as Institutional Autism. Once this pattern of regression occurs, it tends to be insidious and progressive.

The following is a list of characteristics that children with Instititutional Autism exhibit:

Loss of physical height and weight. These children look much younger than their chronological age.

Severe language delay which can regress to infant babbling

Lack of eye contact, aloofness

Failure to orient to child's name

Lack of interactive play

Lack of interest in peers

Failure to use gestures to point or show

Sometimes there are severe issues with bedwetting and soiling

Behavioral control issues and lack of social development

Attention and concentration problems. Example: ADHD-like behavior

Deficient in learning and memory

Institution-acquired autistic behaviors

Some of the most worrisome and disturbing characteristics of children afflicted with Institutional Autism are that when they have complete regression, they resort to self-stimulating behaviors in order to fill the lapses regarding loneliness, deprivation and despair.

Examples of these behaviors are:

Rocking and head banging

Uncontrollable outbursts of rage and aggression

Body thrusting into inanimate objects such as walls

Self-mutilating behaviors such as hair pulling and picking at the body

During the adoption process many parents are faced with the dilemma of acquiring a child who exhibits some or all of the above mentioned characteristics. Parents become saddened when the child does not come running or show any type of emotion towards them when they arrive to meet the child. During the first hours to days for these children to be withdrawn, exhibit lack eye contact and lack of communication with the families. Observation over time is the best means to differentiate adjustment problems versus more severe conditions.

After the adoption process is complete and the child returns to the United States, some of these children continue to display some quasi-autistic behaviors learned from in the institution for a period of time after the adoption is completed.

It must be remembered that all orphan children have significant impairment in both communication and their social skills. These children cannot be expected to come home, put on a pair of blue jeans and function immediately in our society. There is a great deal of work that is required to rehabilitate these children. In contrast to true Autism, Institutional Autism tends to improve with time and proper interventional services. It has also been found that some children who arrive with severe mental impairment upon arrival have a dramatic improvement in their IQ points in the first years post-adoption.

I must once again stress the importance of rehabilitation, education and a great deal of work on behalf of the parents in order to obtain these results.

*Institutional Autism is not a term found in your everyday Pediatric Textbook. It is a term described by Ronald Federici, Psy.D who has done extensive research and was the first to write about this subject in his book "Help for the Hopeless Child: A Guide for Families (With Special Discussion for Assessing and Treating the Post-Institutionalized Child), Second Edition, by Dr. Ronald S. Federici*

*More information and research on the topic of Institutional autism can be found at www.Drfederici.com** *

by George Rogu M.D.

Medical director for Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

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Goldenhar Syndrome, is this an adoption issue?

Wed, 12 Sep 2007 21:32:41 GMT

The main features of this condition are a unilateral under development of one ear associated with under development of the jaw and cheek on the same side of the face. When this is the only problem it is normally referred to as hemi-facial microsomia but when it is associated with other abnormalities, particularly under development of the spinal column it is referred to as Goldenhar syndrome. It is likely however, that these are two ends of the spectrum of the same condition.

Facial muscles of the affected side are also under developed and there are often skin tags or pits in front of the ear, or in a line between the ear and the corner of the mouth. There are often abnormalities of the middle ear and the ear canal may be completely absent and unilateral deafness is extremely common. Children with the Goldenhar may also have a variety of heart and kidney problems. Most children with Goldenhar syndrome are of normal intelligence although learning difficulties can occur. These learning difficulties are secondary to language problems caused as a result of deafness. As infants because of swallowing problems, many of these babies have poor weight gain in the first year or two of life.

Causes:
The origin of this syndrome is thought to be a vascular accident in the fetus during pregnancy. This accident causes the blood supply to be cut off and production of blood clots in the area of those tissues which will develop into the structures of the ear and lower jaw. Since it is not genetically linked, most cases of Goldenhar syndrome are sporadic and the risk of an effected individual to have an affected child is minimal.

Diagnosis of Goldenhar syndrome is made clinically and no DNA abnormality has been identified.

Expectations:
Due to the delayed growth and development of the effected areas, the effects of this syndrome will be more evident as the child grows. The lack of the development of the upper and lower jaws can cause breathing problems as well as a dental malocclusion which will need to be addressed surgically and orthodontically

Treatment:
For these patients, treatment generally requires the expertise of both a craniofacial surgeon and an orthodontist with experience with these problems. The jaw deformity is addressed as early as 3 years of age if the mandible anomaly is severe enough to cause airway difficulty. The best approach to reconstructing the jaw is determined by the surgeon and is specific for each patient. If it is needed, ear reconstruction is performed in four stages and usually begins at the age of six years. Throughout life, these patients must maintain adequate dental occlusion through ongoing orthodontic treatment.

Written By George Rogu and Yekaterina Ryzova M.D.

For Pre-adoption Medical Evaluations and Post-Adoption General care on Long Island New York, Visit us at our International Adoption Private Medical Clinic.

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made.
This website does not constitute a physician patient relationship

Small head size problem

Wed, 12 Sep 2007 21:41:26 GMT

Microcephaly: Small Head size

Plotting head growth is the standard of care in all offices that provide medical care for infants and children. While there are numerous medical factors that can adversely affect a child's head size, living in an institution itself can cause of global growth delay. It is a well known fact that children that live in orphanages tend to have a syndrome called Institutional growth delay. For every three months that a child lives in an orphanage, one could expect approximately 1 month of delay in both growth parameters (height, weight, and head circumference) as well as developmental delays in milestones.

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Unfortunately, a small head can not be dismissed just because the child lived in an orphanage or that the measurements were wrong. It is imperative to analyze the entire medical record for any medical risk factors, view the video tape to look for any significant delays in development. It is also important to view pictures of the child in order to determine if there is any concern for genetic syndromes, birth defects or fetal alcohol syndrome. It is only after this that an limited educated determination can be assessed.

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The growth charts that are used in the USA today are developed from data merged from two studies performed in 1948 and 1965. In the data collection children measured were well nourished and ethnically diverse. Unfortunately, neither or the two studies incorporates data from any country in the world that places children for International adoption today. One should not dismiss growth parameters because they do not pertain to these children. They do provide an arsenal of information. They must however be used with the understanding that there are some short comings to the data. If a growth chart is available for the child's country of origin it should be used in order to determine the individuals head size in relation to its peers. It is also very important to realize that growth parameters over time are much more informative than individual points.

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Microcephaly: is defined as a head circumference of less than 2 standard deviations below the mean for age and sex. Growth parameter over a prolonged period of time is more important that single measurements. Head circumferences that progressively drop to lower percentiles with the increasing age are indicative of a medical condition or process that has impaired the brain development. A very small head size at birth is a red flag that there was some type of intrauterine insult.

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Causes of Microcephaly (small head circumference)

1) Genetic Disorders or syndromes

2) Toxin Ingestions during pregnancy: (alcohol, anticonvulsants)

3) Infections during pregnancy: (TORCHES: toxoplasmosis, rubella, cytomegalovirus, herpes simplex, syphilis)

4) Perinatal trauma or hypoxia (birth injury)

5) Perinatal Infections: (bacterial meningitis or viral encephalitis)

6) Metabolic and degenerative disorders (very rare types of disorders). In the USA these disorders are check for during the state mandated universal newborn screening test.

7) Familial trait: small heads in the family

8) Growth failure seen in orphanages secondary to psychosocial growth retardation. There is generally a lag in height and weight as well.

9) Severe protein energy malnutrition: during times of acute malnutrition, these children tend to demonstrate developmental delays in all milestones (speech, motor and social), they have abnormal crying patterns as well as social interactions and apathy. When taken out of the hostile environment and are recovering from malnutrition, there is a dramatic reversal in the apathy, improved motor and exploratory skills. There may be even after adequate correction of the malnutrition some reduced developmental quotients in the future.

As you can see an exact explanation for a small head can not be determined with just a few growth parameters. An adequate history and physical examination is a must. We as health care providers are often faced with the task of determining the overall well being of an internationally adopted child, and we are asked to determine if a child brain is neurologically intact. Head and other growth parameters are extremely important in making and generalized assumption of the child health status; but they can not be used as the sole factor in making an overall decision. It is imperative to evaluate the medical record and determine if there are any underlying medical, genetic, or other biological or pregnancy related risk factors. Any specific medical diagnosis will obviously increase the overall risk and prognosis. A careful evaluation of the video can give us incite as to the developmental milestones attained by this child, and close up pictures can help to determine if any types of genetic syndromes or fetal alcohol syndrome.

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Unfortunately, consistent and progressively decreasing head size markedly increases the risk of developmental delays and the smaller the head the more profound the deficit.

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While the ultimate decision making power resides solely within the adoptive parents. No one Doctor can tell you to adopt or not adopt a particular child. All that we as physicians can do is adequately educate and inform the family of all foreseen and unforeseen risk factors, and then prepare them for all possible scenarios both with good and bad outcomes.

Written by George Rogu M.D. of Adoptiondoctors.com & Adoptioneducationclasses.com

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Signs that a Child Has Been Sexually Abused?

Wed, 12 Sep 2007 22:06:15 GMT

What are some of the signs and behavioral presentations exhibited by a sexually abused child?

1) Many times the sexually abused child is old enough to verbally make direct statements about the abuse and his/her perpetrator.

2) Inappropriate sexual behavior or play in an immature child.

3) Sexual abuse of other victims

4) Chronic medical conditions :

a) Recurrent abdominal pain without medical diagnosis

b) Bedwetting or soiling

c) Genital or anal trauma

d) Sexually transmitted disease

e) Pregnancy

f) Genital bleeding or discharge

5) Emotional and behavioral manifestations:

a) Sleep disturbances (recurrent nightmares)

b) Depression and social withdrawal

c) Aggression, temper tantrums, impulsiveness

d) Guilt and low self esteem

e) Feelings of helplessness

f) Hysterical reactions

g) Excessive masturbation

h) Suicidal threats

j) Runaway behavior

6) Fear of intimacy and sexual dysfunction

7) School problems and truancy

8) Substance abuse

Many of these characteristics can be exhibited at different times in a child's life from early childhood to later adolescence. Usually, sexual abuse is not a one-time event. It is generally a chronic and ongoing problem. Abused children often find themselves helpless in the situation. Unless the child is taken out of the environment, the abuse will continue. Sexual abuse of any child or adolescent is a vile thought but it does occur. Professionals and everyday people need be on heightened alert to such cases, and when they are suspected, an immediate report to the authorities is mandated. In some internationally adopted cases, the sexual abuse did not occur in the new environment but it occurred in the old orphanage. Institutions are magnets for child sexual predators. Abuse can be at the hands of the caregiver or at the hands of some of the older children within the orphanage. Sometimes adoptive parents are left to deal with the scars of sexual abuse created in the orphanage.

Written by George Rogu M.D. of Adoptiondoctors.com and Adoptioneducationclasses.com

Post Adoption Peculiar Behaviors

Wed, 12 Sep 2007 22:10:28 GMT

I have heard that many Institutionalized children exhibit many peculiar behaviors shortly after arriving home. Can you described some of these behaviors and what does a new adoptive parent need to do to help over come these behaviors?

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Many peculiar behaviors can be observed immediately post-adoption in many internationally adopted children. These behaviors provide self-soothing, self-stimulation and often times are used to attract the attention of the adult caregiver.

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For the socially neglected orphan child, the lacks toys, limited human interactions and the lack of loving parent; are the primary reason for this type of behavior. While these behaviors appear to be very peculiar, they are basically a normal response to an abnormal environment in which these children are raised. Some of these self-stimulating behaviors are so disturbing that they mimic the some of the behaviors of the "Autistic child".

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Some of the Autistic like behaviors exhibited by orphan children is:

1) Head banging

2) Rocking

3) Head shaking

4) Swaying back and forth

5) Staring at the hands

6) Hand flapping

7) Biting and hitting others

8) Twirling and pulling hair

9) Smelling object

10) Fascination with spinning objects

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In an orphanage environment, getting the attention of the adult caregiver often time is extremely difficult. A well-behaved, disciplined child who does not disturb or bother anyone would never get any adult interaction. Many times, orphan children resort to attention seeking behaviors such as biting, hitting and various other types of tantrums in order to earn some extra adult attention. To a socially neglected and isolated child, even negative attention like discipline is better than no attention at all.

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To the new adoptive parent, any of these behaviors can be very disturbing and heartbreaking. I recall a case of a 2-year-old girl from Russia. The parents at the Post-Adoption evaluation described to me a peculiar rocking and swaying behaviors exhibited by their newly adopted girl. I tried to explain that this is a normal response to an abnormal environment. At our next visit, the parent's video recorded the event. The rocking and banging was so severe, that I as a physician was moved by it. Movements were so violent that it mimicked seizure like activity. The only thing that went against the diagnosis of a seizure disorder was the mere fact that the child was completely alert during this entire event. After a few minutes of this rocking and banging, the child settles down a falls asleep, and the rocking disappeared. This ritual occurred for many weeks. As the child settled into her new family, the intensity of the episode decreased dramatically to the point where it disappeared. The mother did report however that, there are times when the child is under stress or being excessively tired, that the episode does resurface.

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While I really do understand hoe disturbing this could be to the new parent's, I would like to assure you that these behaviors really do go away with time. As new adoptive parents, we must concentrate and reward the good behaviors while ignoring the disturbing behaviors. As parents, it is our responsibility to make certain that the child is always safe, and that the behaviors in no way injure the child. If the child exhibits head bagging as a self soothing ritual, instead of allowing the child to hit his head against a hard wall, place a pillow or something soft to lessen the blow.

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These behaviors generally take weeks to months to self extinguish, but eventually they do after the child settles into his new environment. It should also be noted that many times in moments of stress, these behaviors might reappear temporarily until the stress resolves. A particular case come to mind of a 20 month old child that had resolved his head bagging only to reappear after being involved in a car accident. During the care accident, the mother was rendered unconscious while the child was safe in his care seat. He was strapped in and was completely helpless, while his mother was not able to soothe him in the time of need. Lots of lights, sound and commotion just overwhelmed this child. His body rocking and head banging reappeared for a few weeks, but after resettling into his normal family routine, his head banging and rocking have once again disappeared.

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To date, the head bagging ritual has not resurfaced.

By Dr. George Rogu of www.adoptiondoctor.com and Adoptioneducationclasses.com

Additional information and references:

1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC

2)William W. Hay M.D. Current Pediatric Diagnosis and Treatment. McGraw-Hill Medical Publishing.

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Post-Adoption Medical Examination

Wed, 12 Sep 2007 22:18:48 GMT

In the USA, generalized routine laboratory screening of healthy children is not standard of care. In children that are internationally adopted, extensive screening tests are performed because of a multitude of reasons. These screening tests are recommended by the Pediatric Red Book of Infectious disease and the Academy of Pediatrics.

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It is only through extensive laboratory testing that a physician may:

1) Uncover a medical condition that has not yet presented itself clinically

2) Rule out a diagnosis or condition that was reported on the pre-adoption evaluation

3) Help to confirm the adequacy of treatment of a particular ailment and/or document cure.

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Some parents feel that maybe they do not need to test their children because they had some blood work performed by the orphanage, and that the child was already seen by a physician in order to qualify for a visa. While these are all good thing to have done for your child, they are not enough. The Visa medical examination focuses primarily on detecting if there are certain serious contagious diseases that would make the child ineligible for entry in the USA. The procedure usually consists of a very brief physical examination and medical history. A chest x-ray is performed to look for active tuberculosis, and blood test are performed to screen for HIV infection and syphilis. These tests are performed only if the child is older than 15 years or age and in those younger than 15 years, they are only performed if there is a suspicion of medical illness. Chances are that since the child really has no available history and there is little or no testing performed, that the Visa examination consisted of documenting that the child is breathing at the moment of the examination and is not terribly ill with any contagious disease.

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As for testing by the orphanage, caution should be used when interpreting the results. While these tests are important in the Pre-Adoption evaluation process in order to help the family in making their decision, the validity of these tests needs to be confirmed and they should only be considered as a screening tool. Confirmation of a medical diagnosis should never be made solely on these test results.

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Because there is a wide variation in the geographic regions where children are placed for International adoption, different medical problems can be encountered in different regions. Screening is also important because of the unknown medical background of the child, inadequacy of health care and poor living conditions encountered in the institutional care setting.

A Physician should see an internationally adopted child within 2 weeks of arrival to the United States. A child who is ill upon arrival with either an acute or chronic medical condition should be evaluated for that problem immediately.

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After the arrival of the child, this is a very good time for parents and child to get to know one another. The process of attachment and bonding needs to progress. Some parents may feel the need to have large family gathering and parties, go on elaborate vacations to Disney Land, and buy everything at Toy R Us for the child. While their intentions are good, this will only over stimulate the child and stress them out. Just like these painless examples, an immediate visit to a doctors office, and multiple visits to the blood laboratory is another type of excursion that does not need to be made immediately unless the child is acutely ill. Too much love is also no good.

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The initial Post-Adoption evaluation will include the following:

1) Thorough review of the child's medical history and concerns discovered on the pre-adoption evaluation

2) Complete physical examination

3) Evaluation of developmental milestones (Denver developmental screen)

4) Immunization status needs to be evaluated and confirmed with vaccine titers. There is no harm to a child receive an extra vaccine, but there may be harm if the child remains susceptible to these childhood illnesses. The doctor will use the same catch-up schedule that would be used if the child was born in the USA and was behind in the vaccines.

5) Laboratory screening for a multitude of medical concerns.

I would like to try to explain what each test generally screens for.

A) CBC: complete blood count It gives us information on the health status of the child's blood cell, pertaining to anemia, which can be caused by a multitude of reasons. Sickle cell disease, Thalasemia, anemia of chronic illness or just iron deficiency anemia.

B) Lead screen: can cause anemia and developmental delay if untreated. Lead can be found in old institution walls, water supply (pipes) and the overall environment as a pollutant.

C) G6PD deficiency: an enzyme deficiency that is common in Asia, Africa, and the Mediterranean region. Screening from these areas needs to be performed prior to prescribing medications that may cause hemolytic (blood cell breakdown) anemia in persons lacking this enzyme.

D) Hemoglobin Electrophoresis : in Asian children to look for Thalasemia Anemia.

E) HIV Elisa: test for the AIDS or HIV virus.

F) VDRL: test for syphilis. Frequently transmitted from the mother to child.

G) Hepatitis B panel: should be performed prior to hepatitis B vaccination. It tests for acute, chronic illness as well as vaccine status.

H) Hepatitis C: for Hepatitis C.

I) Calcium, Phosphorous, Alkaline Phosphatase: screens for Rickets.

J) Urinalysis: check the overall kidney function.

K) Stool sample: for intestinal parasites, Giardia is common in Institutions.

L) Stool cultures : intestinal bacteria.

M) Comprehensive metabolic panel SMA-20: check on overall body function, liver, kidney.

N) TFT: thyroid disease.

O) PPD: tuberculosis status.

P) Immunization Titers: to see if the child mounted an immune response in order to continue with the current vaccine schedule or restart all vaccine from the beginning.

Q) State Newborn Screen: only in children less than 12 months. To check for metabolic disorders routinely tested at birth (PKU, Biotinidase, Sickle cell)

R) Hearing and vision tests

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As you can see that there is going to be a lot of blood drawn in order to perform these test. It is a stressful time for both child and parent. I generally recommend that the parents to perform these tests on two visits spread out 1 week apart.

Written by George Rogu M.D. of www. Adoptioneducationclasses.com

& www. Adoptiondoctors.com

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Lactose Intolerance in Asian Children

Wed, 12 Sep 2007 22:23:56 GMT

Lactose intolerance is defined as the body's inability to digest and absorb the milk sugar called lactose. This occurs secondary to a deficiency in a necessary enzyme essential in the digestion process of milk products. This enzyme is named lactase.

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In many children who are internationally adopted this medical entity is incorrectly blamed for many intestinal symptoms these children experience.

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Lactose intolerance is more prevalent among adult Asian, African, Native American and Mediterranean populations. Although many internationally adopted children come from the above-mentioned ethnic groups, this condition is relatively rare in infants and very young children. It does occur however under pathological conditions such as when a child has some sort of intestinal infection. In infants and very young children, the enzyme lactase remains active during the first few years in order to enable these children to absorb and digest breast milk or formula.

Clinical signs and symptoms

Abdominal pain and cramps

Abdominal distention

Nausea and vomiting

Diarrhea and flatulence

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Lactose intolerance sometimes may occur as a temporary condition if it is secondary to an intestinal infection. Secondary lactose intolerance usually occurs because there is some damage to the mucus lining of the intestinal tract. Reasons for this could be secondary to an intestinal infection with parasites, viruses or bacteria.

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Internationally adopted children, especially those of Asian descent, should have lactose intolerance high on the differential diagnosis radar, but other medical conditions need to be ruled out. Such medical causes are as follows:

Parasitic intestinal infections with Giardia or cryptosporidium

Viral gastroenteritis, with the routine stomach virus caused by Rotavirus

Bacterial enteritis: salmonella and shigellosis

Severe protein malnutrition

Celiac disease

Cystic fibrosis

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Toddler's diarrhea secondary to excessive juice intake

A very good dietary history needs to be obtained and appropriate medical examination and laboratory tests need to be ordered before a diagnosis is made or excluded. General clinical suspicion of lactose intolerance can be confirmed by a favorable response to withdrawal of lactose from the diet. There is also more sophisticated laboratory testing such as hydrogen breath test that can help in confirming the diagnosis. Intestinal biopsies and lactose tolerance tests are rarely indicated in the Pediatric population.

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Overall management of lactose intolerance is very simple: avoid milk products. Exclusion of milk from the diet should also be done even if the condition is a temporary one such a secondary to intestinal infections with Giardia. If the child is an infant, than Lacto-free formula should be prescribed. Older children may self-treat themselves by selectively eating foods that they can tolerate.

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All newly arrived children who complain of intestinal symptoms should have a work-up for intestinal, viral, and bacterial organisms before the diagnosis of lactose intolerance can be used to explain their symptoms. This is especially important if the child comes from an ethnic background where lactose intolerance in more prevalent in the adult population.

by George Rogu M.D. of Adoptiondoctors.com & Adoptioneducationclasses.com

Disclaimer

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Role of institutions and orphanages in child's overall health and development

Wed, 12 Sep 2007 22:32:10 GMT

Adverse effects of institutional care living is not new information, it has been recognized as a problem for many years. The healthiest living condition for a child is obviously with a family who will love and nurture as well as providing food, shelter and clothing that will ensure this child's survival.

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Unfortunately, this is not reality for many of the world's children.

By definition, the word orphan: means a child that was left without parents to care for him because they are deceased. Today's international orphans usually have parents but they have abandoned them or their parental rights have been terminated. There are numerous reasons why people abandon their children; reasons seem to be similar worldwide.

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Below is a list of the most common reasons why children are placed for adoption worldwide.

1) Poor economic situation, poverty

2) Parental illness, mental and or physical

3) Drug or alcohol abuse by the parents

4) Mental retardation

5) Incarceration

6) Termination of parental rights because of neglect or abuse

7) Political and economic policies of different countries (one child policy)

8) Complicated medical conditions that the family can not care for.

Orphanages are part of every societal culture. How good or how bad an orphanage is depends on the particular country outlook on abandoned children and obviously the financial situation of these countries.

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The most devastating effects on orphan children were seen in the orphanages of Romania during the 1980's when abandoned children were basically warehoused in large buildings with little qualified staff to care for them.

Delays in developmental health are common in many of the post-institutionalized children, the degree and severity of problems is directly proportional to the length of time of institutional care living.

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Many of these children suffer from physical neglect, poor hygiene and a lack of a nurturing environment is all too common even in today's more modern orphanages.

The practice of bottle propping is still practiced even today. This results from the need to feed many children within a short period of time with little nursing staff. This practice continues to place these children at increased risk of developing recurrent ear infections, hearing loss and severe dental caries. More importantly, these children miss out on experiences encountered from maternal child interactions during feeding. This early human interaction is critical in early emotional development.

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The general lack of a lack of a stimulating environment leads to bizarre self-stimulating behavior such as unusual posturing, head banging and rocking. This also results from a lack of a primary mother figure that would love, nurture and soothe the infant. This is a normal reaction to an abnormal environment. This behavior occurs because of the child's need to restore the sensory requirements that is necessary for their brain development.

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Sometimes the old building that these children are cared for may be laden with environmental toxins such as lead, which can cause developmental delays.

Cognitive development in young children is critically dependent on their experiences during early infancy and childhood. The more hostile the environment the more detrimental are the developmental delays. Even in today's more modern orphanages that are cleaner, full of toys and other stimulating activities, there is still no substitute for a mother child relationship.

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It is extremely difficult to care for many children in a group setting no matter what country you are in. Many children that live in orphanages suffer from lack of experiences with the outside world. Many of these children have not left the orphanage grounds; they lack the experience in going to the park, stores or even some other child's home for a play date. These are simple daily experiences that we all take for granted and part of growing up.

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Another devastating effects of institutionalization is the emotional neglect experienced by these children. In order to prevent the spread of infectious disease in young infants, many of the caregivers wear mask that cover the face during feeding, changing and other daily activities of the infants routine. This well-intentioned activity deprives the infant of having a human contact. Sometimes a bed sheet is also hung on the side of a crib, once again in order to reduce the spread of illness, but limiting the child field of vision with the environmental surroundings. With this type of medical behavior, many of these infants never even see a human face or other child until they begin to move around on their own.

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I feel that the most important detrimental effect that institutional care living provides is the lack of a one-to-one primary care giver relationship. This is still seen in almost every orphanage around the world. While these harmful effects are well know to cause developmental and emotional delays in children, world wide efforts are being made to reduce the care-giver child ratio from 30 to 1 to as little as realistically and financially feasible. Because of shit work by the caregivers, a child may experience many different nannies during the day, afternoon and then the night shift. Shift work from within the caregivers will have detrimental effects on the emotional well being of the child. With this kind of arrangement, the child is faced with different caregiver styles to feeding, bathing and emotion queues. With many different caregivers all providing the same care, the child will experience inconsistent responses to their basic needs, and as a result the child may not learn how to react to a common situation.

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Worldwide, poverty remains as the most common reason for abandonment of children. In some countries with extreme poverty, sometimes an institution is the only viable alternative for this child's survival. At least in an orphanage the child will receive the minimal daily life requirements as food, shelter and clothing. While medical care is somewhat limited it is available. In an orphanage the child should be protected from abuse and neglect and may even be offered formal education.

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I can not even begin to imagine at how hard it must be for a parent to abandon their child. Circumstances of desperation and poverty must be pretty significant for them to resort to such extreme measures. Sometimes an institution is the only alternative for some of these unfortunate children.

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By Dr. George Rogu of www.adoptiondoctor.com

Additional information and references:

1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC.

2) Federici, R. (2001) Raising the post institutionalized child: Risks, Challenges, and Innovative Treatment.

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical examination can a medical diagnosis and accurate treatment plan can be made.

� George Rogu, M.D.

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Persistent diarrhea in orphan child.

Wed, 12 Sep 2007 22:35:56 GMT

My child who is 20 months old has a problem with persistent diarrhea. H e had the post-adoption medial workup and nothing came back positive. I just do not understand why his bowels are so loose if there is nothing medically going on with him?

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Unfortunately, chronic diarrhea is a very common problem found in many post-institutionalized children. Causes can vary from medical concerns, dietary intolerances to psychological situations. In pediatric medicine in general, children have usually one medical problem at a time. In the orphan child that had lived many years in an institution, several different medical conditions can occur concurrently.

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The normal stooling pattern for all children in general for children are 1-2 times per day. When this frequency increases to multiple times per day, large amounts, foul smelling with little consistency, diarrhea would be a diagnosis of concern in an Internationally adopted child, regardless of the fact that the initial evaluation was determined

to be negative.

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Some of the common things that may cause recurrent diarrhea in the internationally adopted child can be multifold. If a diagnosis is made appropriately, then the proper medical therapy can be implemented subsequently resolving the chronic diarrhea symptoms.

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Overeating is the most common reason for recurrent diarrhea. Adopted children are known to be fixated with food post arrival. Sometimes they seem to be bottomless pits. One must remember that food for these children was scarce in the orphanage. When it was available, it did not taste good at all. Now these children have an endless amount of food available, and most of the time it taste good, they do not know if they will have this meal again, so they just eat. Catch up growth in these children is always very dramatic. Growth parameters tend to take a vertical pattern on the growth chart. Diarrhea secondary to overeating can only be made once all medical concerns are ruled out. Sometimes, probiotics such as a product called Florastar, this may help the children overcome their complaints caused by dietary changes.

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Toddlers Diarrhea is another common cause of recurrent loose bowel movement in the general pediatric world. It is even more common in the adopted child because, like with food, they tend to drink large amounts of juice. Apple juice, a common drink given to the pediatric population is a notorious cause of Toddler's diarrhea. The recommend therapy of choice is to limit the amount of juice.

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The diarrhea caused from dietary intake is called osmotic diarrhea. Both of the above mentioned cause of diarrhea could only be made once other medical concerns are ruled out.

Medical concerns that need to be looked into are mentioned below:

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Giardia Enteritis: A parasitic infection of the bowel common place in children that live in orphanages. Infected children in the developing parts of the world are generally not treated for this organism because of the high recurrence rate. Once a child is diagnosed with positive stool specimens for ova and parasitic infection, as well as a positive Giardia antigen, therapy is started with either metronidazole or the newer drug called Alinia. Metronidazole is a complicated and not so easily attainable medication. The medication must be specially compounded by the pharmacist, foul tasting and needs to be administered four times daily. A newer and better tasting medication is called Alina. The company states that a child needs to be treated once a day for a total of three days. Personal experience with this medical is that a longer course of therapy in required. I had spoken with the medical director of the company who stated that, especially children adopted form Russia, they seem to carry a resistant type of Giardia. They require longer therapy from the very beginning.

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Milk protein allergy is another common cause for recurrent diarrhea. In children under 2 years of age, cow's milk protein allergy is more common. Adopted children in the orphanages are given different types of milk products, such as Kefir, soymilk, and sometimes goat milk. It is only until they arrive to the U.S.A. and the new adoptive parents introduce whole milk to their diets that intolerance to milk protein is discovered.

Eliminating cow's milk from their diet and supplementing it with soy or rice milk can easily manage children with this condition.

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Lactose intolerance can occur temporarily in children following a course of antibiotic therapy, intestinal infection. This condition is found sometimes in children adopted from China. There is a deficiency in the enzyme called lactase that is used to in the process of digesting milk products. A lactose free diet and the use of lactate supplements when enjoying a milk product should be sufficient to control the symptoms of the child.

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Sorbitol found in a medication called Isoniazide used to treat a positive PPD reaction is another common cause of explosive diarrhea in the internationally adopted child. I have had cases where we were treating the child's positive tuberculosis screen and caused explosive, foul smelling diarrhea, with a negative stool workup. A simple remedy to this problem is to have the pharmacist compound the Isonizide using a sorbitol free preservative.

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More serious conditions such as Celiac disease, Cystic Fibrosis, malabsorbtion syndrome usually present with chronic diarrhea in a child that does not thrive at all. The one thing that many internationally adopted children do is thriving well post adoption. When they do not, it should be a red flag for your physician.

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Once a qualified pediatrician determines the cause for the child's recurrent diarrhea, only then can appropriate therapy be implemented.

One should try to stay away from food products that may upset the child's bowels:

1) Raw fruits and vegetables

2) Juice, soda and milk

3) Greasy and fried fast food products

4) Spicy foods

5) Sauces and sweets.

Things that can help to alleviate the upset stomach

1) Small frequent meals

2) Pasta, Rice and hot cereal without milk

3) The Brat diet is routinely used in the Pediatric Medicine community. It stands for products made from, Bananas, rice, applesauce and toast.

4) Plenty of fluids such as electrolyte solution (pedialyte) are good to help ward off acute dehydration cause by prolonged diarrhea with poor liquid intake. It is not the treatment for diarrhea however.

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Again, the exact cause of the chronic diarrhea needs to be investigated before an appropriate course of therapy can begin. The above examples are just some simple common cause for recurrent diarrhea in the internationally adopted child. If one was to look into a pediatric medical textbook under the differential diagnosis of chronic diarrhea you will find a list that has 30 - 40 different medical conditions associated with diarrhea.

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Written by George Rogu M.D., Medical Director and founder of Adoptiondoctors.com and adoptioneducationclasses.com

Disclaimer: The information provided is intended for educational purposes only. It is not intended to be medical advice on how to deal with a particular situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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International travel tips

Wed, 12 Sep 2007 22:41:32 GMT

I am journeying overseas to adopt Internationally. I will hopefully be taking my toddler and adolescent on this trip. What can I do to ensure a healthy and enjoyable trip for my family?

International travel, with the entire family unit has become a growing trend among potentially adoptive families. Some see this trip as a means to create a new family while bringing the old family unit closer together. While International travel can be a very stressful endeavor, it can also prove to be a life-enriching experience that you may never have had the occasion to encounter if it was not for International Adoption.

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People travel great lengths to Russia, China, Africa, Guatemala, and Columbia to formally adopt a child. Some families are fortunate to be assigned industrialized cities like Moscow, while others need to go the periphery of Russia to finalize their adoption. More concerning are the groups that voyage to developing nations. In developing countries, there is a shortage of health care, poor sanitary conditions; and where infectious diseases run rampant should be of significant concern to any educated traveler.

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Parents need to plan their International travel accordingly. It would be wise to have a conference a local authority on International travel at least two months before the anticipated travel date. Time is needed to attain an immune response to the advocated vaccinations. Sometimes prophylactic medications may also be required during the trip.

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As a group, young children have significant difficulty tolerating extreme heat, dehydration and reduced nutritional intake. It is because of the child's decrease in reserve, why parents need to carefully prepare in order to be able to identify the signs of medical problem should they arise, and understand how to deal with it accordingly.

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Infants in general are more prone to become ill during their trip because of their immature immune system and sometimes-deficient primary vaccination series. From the aspect of adolescents and teenagers, other health and social concerns appear. Because parents may be very busy with their International adoption proceedings, appropriate, consistent and continuous supervision of the teenager may unintentionally be reduced. Adolescents may have opportunities to participate in potentially risky activities such as drug, alcohol, sex and travel in unsafe motor vehicles. As a parent, it is imperative to be knowledgeable of these hazardous behaviors and speak to your youngster frankly with regard to how to deal with them should the event invariably arise.

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In order to virtually guarantee a healthy trip for you and you household, good weekend plans on behalf of the parent is strongly suggested. Below is a list of appropriate things to you should thoroughly review prior to embarking on an International trip, particularly if journeying to a developing country.

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Tips before you travel:.

1) Review health insurance benefits. Investigate if your plan furnishes coverage to you while you are overseas. Sometimes it may be in your families best interests to obtain supplemental health coverage while traveling should a medical need arise.

2) Evacuation insurance should a medical emergency appear and a family member needs to be airlifted to another country for medical management.

3) Locate the names and telephone numbers of travel clinics in the country that you will be visiting.

4) Parents need to record the telephone numbers of all the household members physicians and pediatricians.

5) Make sure that you children's vaccine status is up-to-date and obtain any special vaccines as indicated by the particular country. A brief visit to a travel Clinic will aid to determine if you require any particular country specific vaccines, such as Typhoid, Hepatitis A, Rabies, Encephalitis.

Tips for preventative care of children while traveling:.

1) Provide sufficient entertainment and distractions to effectively keep your child occupied for the duration of the entire plane flight. A portables DVD player, game boy, books, puzzles or their favorite toy are sufficient to keep even the most mischievous youngster busy.

2) Sedation in most instances is not required for overnight travel, but for children greater than 2 years of age, a parent may choose to administer Benadryl to help the child sleep. It is very important you try a trial dose a few days prior. All children are different, and can metabolize the medicine differently. Some children may have a paradoxical response, and instead of becoming sleepy, become hyperactive and restless.

3) Changes in cabin pressure can have a painful impact on a child's inner ear. Generally, the act of swallowing, drinking from a bottle can aid with pressure equalization.

4) Make sure that the child is adequately hydrated during the air travel. Insensible fluid loss happens in flight and can cause dryness of the child's mucous membranes. They are not dehydrated however.

5) Try not to overfeed infants because the higher altitudes occasionally cause the stomach gasses to increase and children may encounter tummy distention and physical pain.

During your international trip abroad:

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While traveling, particularly to a developing country, the prevention of infectious disease is of the utmost importance. The most common intestinal problem encountered in tourists can be avoided if simple hygiene procedures are followed. Simple hand washing and the avoidance of unsafe foods can avert clinical illness.

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Good hygiene is essential to the avoidance of gastrointestinal infections, which are in most cases transmitted via the fecal-oral route. Washing with soap and water, or the appropriate use of antibacterial hand wash is sufficient to furnish protection. When traveling abroad, especially after visiting the orphanages, siblings may find themselves playing with some of the children, on the ground, with dirty toys. Special attention before eating in regards to hand washing before meals is now imperative.

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Choosing safe foods for you and your children during your voyage can become a full time job. Getting children to eat in general is a difficult task, introducing a different cuisine to their diet can make it even more challenging. Water is the most common vector for the transmission of illness. Travelers, particularly to developing nations should effectively avoid the consumption of the local tap water. When dealing with children, parents should be on the lookout for juices mixed with tap water, ice cubes, and even when brushing your child's teeth with water should be avoided.

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Families should automatically make it a practice of consuming only bottled water. Make sure that the bottle is sealed because sometimes-unscrupulous vendors might recycle old bottles and stock them with tap water, and successfully sell it to the unknowing traveler. If bottled water is not available, then boiling the water is regarded safe before consumption.

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Often foods that are unsafe for consumption can be detected without too much difficulty.

Below is a list of unsafe food and drinks.

1) Uncooked fruits or vegetables from which the outer skin have not been removed.

2) Undercooked meats or seafood.

3) Fruit drinks and frozen popsicles

4) Any food washed with water should be cooked before consumption. Milk should be avoided unless it is pasteurized.

Unsafe foods can come in mysterious packages:.

1) Sandwiches that have been topped with lettuce or tomatoes

2) Fruits that have been skinned at outdoor markets (mangos, pineapples, papaya) are often dipped in water to retain them moist.

Food and snacks at the local market can seem appealing to your children. Parents should be prepared by traveling with know safe snacks in order to prevent purchasing contaminated snacks for your children.

Safety and injury prevention :

Advise about safety and injury prevention during your adoption journey, is along the lines of the anticipatory guidance that one would receive during your well childcare visits with your pediatrician. Accidental injury is the leading cause or death in children that travel internationally. Standard safety measures and extra common sense during your voyage can aid to reduce the potential risk of accidental injury.

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Seat belt safety while traveling in vehicles is still the most important means of preventing accidental death in children. Unfortunately, seat belts may not consistently be available in the automobiles that they will be traveling in during their adoption journey. In cases when there is no seatbelt in the automobile, carefully positioning the child traveler in the rear seat is safer than in the front seat.

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Unless you are staying at the local Hilton 5 star hotel, the physical environment can be more dangerous than some families realize. Children are explores by nature and are guaranteed to detect potential dangers before the parents do. Unfortunately, when this happens, it is generally too late. Parents should inspect the child's environment during their travel continuously. They should watch for exposed electrical wires and outlets, and broken glass. Some of the building that you may visit may be older type, with decaying construction, inadequate guardrails and lack of window guards.

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The most devastating feeling that a parent can experience is when they turn around and they no longer see their child. Children can become accidentally separated from their families during their adoption journey. The commotion of visiting the orphanage, conversing with facilitators doctors and successfully completing millions of forms, can lessen the parents supervision of their other children. It takes just a split second for your naive child to get lost. Personal information, containing the child's name, address where the child's family are staying and contact telephone numbers should be put into the child's pocket. It should never be displayed in plain view.

Protection against insects pertains to traveler to developing countries. Mosquitoes can frequently transport life-threatening illness such as Malaria, dengue, Filariasis and Japanese encephalitis. Barrier protection with sufficient clothing cover-up, protective nets and personal insecticides are essential to preventing exposures to such diseases.

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Your adoption journey should be a memorable experience for you and your family. Careful preparation and extensive guidance before you travel can effectively make this trip an enjoyable event, and not a remembrance laden with medical illness, hospitals and physicians.

Resources:

Contemporary Pediatrics, March 2006 "Hitting the dirt road: How to prep families for travel to developing countries" By Miriam K. Laufer M.D.

Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

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Preparing for International Travel to pick up adoptive child

Thu, 13 Sep 2007 06:24:56 GMT

Traveling to another country can have its own hazards. Your own health changes all the time and it is a good idea to get a checkup before you go on a long trip where it will be difficult to get medical care.

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It is also important to consult the centers for disease control website www.cdc.gov for information on infections that may be ongoing in your destination country. It will also provide you up to date information on any vaccines you may need and also things you may need to bring with you.

If you do get sick abroad personal physicians worldwide 1-888-657-8114 & international association for assistance to travelers 1-716-754-4883 are resources you can use as well as your adoption agency.

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There are clinics available in most large cities, which specialize in persons traveling abroad, and they can be a valuable resource to you and you physician about what you can expect. Also speaking with the adoption agency and with other people who have made the same trip is useful.

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Preparation for travel with children

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Antibiotics and respiratory infections

In this country, with ready access to quality healthcare it is not advisable to treat overly simple colds and coughs. Being abroad with a child who is malnourished, living in an institution without thorough knowledge of their recent health however it is advisable to bring with you antibiotics for illnesses, which seems to be overly affecting the child.

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Consulting with your child's future pediatrician is the ideal way to handle this situation before giving any antibiotic but because of time delay sometimes this is not possible. Many experts suggest bringing with you an antibiotic such as zithromax in a powdered form with sterile water premeasured by the pharmacist so that all you have to do is mix them together. The dose is 10mg for every kilogram given once a day for three days for most simple infections.

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Bacitracin/Topical Antibiotics

It is useful to bring with you an antibiotic ointment and bandages because having a child means having bumps bruises and cuts. Any decent first aid kit is invaluable.>

Conjunctivitis

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(contemporary pediatrics 1997 Wagner)

If you are confronted with a child whose eyes look like these, an antibiotic drop such as polytrim placed in the affected eye(s) three times a day for seven days usually effects cure.

These drops should be acquired ahead of time and require a prescription.

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Atopic dermatitis

This is a common condition among children who are being internationally adopted it appears and is treated as the pictures/table below. Normally Dove unscented is the soap most recommended by pediatricians for all children, but especially for children with sensitive skin.

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TABLE I

Treating atopic eczema

Keep the skin at a high, even level of humidity

Apply 1% hydrocortisone cream as needed

Apply liberal amounts of a topical moisturizer such as Vaseline many times a day<

Sources: Bigby M: A thorough systematic review of treatments for atopic eczema.

Arch Dermatol 2001;137:1635; Oranje AP, De Waard-Van Der Spek FB:

Atopic dermatitis: Review 2000 to January 2001.

Curr Opin Pediatr 2002;14:410

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Cradle Cap

Cradle cap is a normal finding in infants and is easily treated with nizoral shampoo, which is available over the counter.

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Care should be taken not to get the shampoo into the eyes but otherwise it is fairly safe to use. It appears here in its worse form, normally it is not so terrible but it can get as bad as this.

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Diaper Care

Diaper rash commonly appears as below but it can be erosive with bleeding or with small bumps or pimple, which usually means superinfection with either a fungus or a bacteria. Normally most diaper rashes can be taken care of as outlined in the table below.

(Source Shwayder July 2003 contemporary pediatrics)

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TABLE 2

Preventing and treating diaper rash

Keep the child's bottom clean and dry; change the diaper frequently

Clean the perineum gently when changing the diaper

If the skin is red, use 1% hydrocortisone cream twice a day mixed with lotrimin cream, which is an antifungal foot cream available over the counter. Cover the cream and the diaper area with zinc oxide paste or desitin ointment.

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Scabies

Scabies are caused by a round mite that is 0.4mm long has four legs and is spread by direct contact. It is incredibly itchy with pustules and burrows on the skin. Treatment is with elimite commonly and needs to be prescribed by your pediatrician.

(Source Shwayder July 2003 contemporary pediatrics)

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Allergic reactions

Use of benadryl liquid 12.5mg/5ml(one teaspoon) usually is a safe medicine to use for acute allergic reactions associated with hives.

The dose is approximately 1mg/kg. It is not used in infants, follow the package directions.

Some kids respond to benadryl by becoming extremely active. It should not be used to provide sedation.

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(Schmitt cont peds 2003)

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Lice

Sometimes with lice there can be no signs or symptoms and they are discovered when cleaning the child's hair.

As with scabies this is commonly found in institutionalized children and is treated with an over the counter preparation called nix most commonly/effectively.

Follow the package directions.

(Source Shwayder July 2003 contemporary pediatrics - picture)

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Tylenol/Motrin

Tylenol or Motrin is invaluable when the child has fever or sick and appears off. The dose for Tylenol and Motrin is 10mg/kg; both can be given every 6 hours. It is easier to travel with the children's formulation and if dosed appropriately can be given at any age.

It is a good idea to bring a dosing syringe available at any pharmacy so you can dispense these medicines.

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Nasal congestion

Plain nasal decongestants are usually all that are needed if a child has a stuffy nose and cannot sleep. Plain pedicure nasal decongestant for kids 3 months to one year and plain Sudafed for children are commonly used.

Dosages depend on the formulation and can be obtained from your pediatrician.

Diarrhea

Diarrhea and vomiting can occur at any time in children and it is advisable to be prepared. Pedialyte or powdered electrolyte solutions, which can be reconstituted with boiled water as needed, are usually brought. These are usuallly given if the child is having excessive vomiting or diarrhea. Normally most pediatricians try to feed through bouts of diarrhea in infants with small amounts of formula given more frequently. However if there is decreased tears/urine output or saliva and oral rehydration solution and consultation with a professional is advisable.

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Constipation

The opposite end of the spectrum is constipation and certainly with a change of diet this can be seen. Most constipation is treated effectively by increasing fruit intake especially prunes/prune sauce. Instant relief can nearly be provided through the use of glycerin suppositories although regular use is not advisable it is very helpful in a pinch.

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Feeding

What to feed and bring with you depends on the health background and age of the child you are adopting and it is advisable to consult your pediatrician.

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You may also ask the adoption agency to provide information as to what the child is currently eating and use this as a guideline for what types of foods your child will accept. For example if the child is not eating from a spoon then the time to start will be back in the states.

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The Academy of Pediatrics puts out a book called "Caring for Your Young Infant and Child." It has almost everything that you ever wanted to know and perhaps things you do not want to know about children. If you want a definitive source for childcare, this is it. It goes into great depth about how to feed children and to take care of them.

Written By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com

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Disclaimer

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Microophthalmia in the adopted child

Thu, 13 Sep 2007 06:31:14 GMT

Microophthalmia

There is an orphan available with a condition called MICROOPHTHALMIA. She is 18mos old and is blind in one eye. Can you tell me more about this condition? Can anything be done to regain her vision? Is this condition linked with a syndrome that may not be showing yet?

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Is a disorder of the development of the eye which is akin to not having

developed an eye at all ? �Midline defects such as this are often associated

with other abnormalities since the development of the eye begins very early

in development. In other words something that effects the development of the

eye seems to effect the development of a lot of other things in the body.

This disorder can be seen as part of fetal alcohol syndrome but in my

review of the literature it seems it may be most commonly associated with

some genetic/prenatal insult.

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Without other information it is impossible to say what is the prognosis

for this unfortunate child because this may depend on other factors that may

only be known with time. It may or may not be associated with other

abnormalities, some of which are severe.

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Her capacity for normal vision also depends on what exactly is the cause

of her blindness this can best be told to you after an exam by an

ophthalmologist.

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Thank you for your questions, sorry I could not be more informative but

unfortunately without more information we cannot give you more than a

general view.

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Written By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com

For Pre-adoption Medical Evaluations and Post-Adoption General care on Long Island New York, Visit us at our International Adoption Private Medical Practice.

This website does not constitute a physician patient relationship

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Reader's Question of Tethered Cord

Thu, 13 Sep 2007 06:41:59 GMT

During fetal development the spinal cord occupies the entire length of the vertebral column, this cannot persist because when the child or the adult bends this may cause a kink in the blood supply though the spinal cord.

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Surgical transaction to the thickened cord tends to halt the progression of neurological signs and prevents the development of dysfunction in asymptomatic patients.

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Surgery prognosis is a very difficult area to analyze. In a recent review of three different neurosurgeons with commonly done neurosurgical procedures the outcomes varied greatly. It did seem however that there was a very low rate of poor neurological outcome after the first surgery for tethered cord. The best way to evaluate the prognosis of any surgery is to look at the history of your surgeon what are his/her outcomes like. Is the surgery more complicated than other patients( many times tethered cord may be associated with other abnormalities which can effect the outcome of the surgery).

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If the patient needs a second or third procedure the risk for an adverse outcome is improved. If there is solely a tethered cord release it seems however that 97% of the kids are ok 25 years out from surgery.

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As always however 97% is fine unless you are one of the three percent. What I try to get my patients to focus on is what is happening now and how can we maximize what we are doing now instead of looking ahead to possibilities which in the future may not apply to us.

I hope this has been helpful

Written By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com

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Reader's Question on Streptodermia

Thu, 13 Sep 2007 06:48:27 GMT

I have a video and medical on a 10 year old little girl from Russia. She appears very normal and healthy. Her medical history says she has had streptodermia and acute glomerulonephritis (hematuria type). Chronic glomerulonephritis in remission. What is this medical problem?

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Glomerulonephritis is both a generic term for several diseases and a histopathologic term signifying inflammation of the glomerular capillaries in the kidney. Outbreaks are known where "nephritis" strains of group A strep germs are circulating in the blood stream, it is usually is sporadic.

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Since there are many different forms of glomerulonephritis there are many different ways it can present. Post streptococcal glomerulonephritis usually presents after an illness with the strep germ either through strep throat or classically from a skin infection such as impetigo. It is most common in children aged 5-12 yr and uncommon before the age of 3 yr. The typical patient develops an acute nephritic syndrome 1-2 wk after an antecedent streptococcal pharyngitis or 3-6 wk after a streptococcal pyoderma, or skin infection.

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The patient usually can present with coca cola colored urine or it can be found incidentally on examination of the urine. There can be increases in blood pressure if the kidneys are significantly damaged along with edema (swelling of the extremities).

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Urinalysis demonstrates red blood cells, RBC casts, proteinuria, and polymorphonuclear leukocytes. Anemia may be present from low-grade hemolysis and retention of fluid. The serum C3 level is usually decreased in the acute phase and returns to normal 6-8 wk after onset.

A positive throat culture report may support the diagnosis or may simply represent the carrier state. The best single antibody titer to document coetaneous streptococcal infection is the deoxyribonuclease (DNase) B antigen. An ASLO may be done but it notoriously does not rise after skin infections with strep.

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The diagnosis of poststreptococcal glomerulonephritis is quite likely in a child presenting with acute nephritic picture, evidence of recent streptococcal infection, and a low C3 level. It is important to consider other diagnoses however.

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Treatment of the infection which caused the post streptococcal glomerulonephritis is done first, and then treatment is supportive. Management is directed at treating the acute effects of renal insufficiency and hypertension .A 10-day course of systemic antibiotic therapy with penicillin is recommended. However it does not affect the natural history of glomerulonephritis. The acute phase generally resolves within 6-8 wk. Although urinary protein excretion and hypertension usually normalize by 4-6 wk after onset, persistent microscopic hematuria may persist for 1-2 yr after the initial presentation.

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Complete recovery occurs in more than 95% of children with acute poststreptococcal glomerulonephritis.

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Mortality in the acute stage can be avoided by appropriate management of acute renal failure, cardiac failure, and hypertension.

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Infrequently, the acute phase may be severe. However, the diagnosis of acute poststreptococcal glomerulonephritis must be questioned in patients with chronic renal dysfunction because other diagnoses such as membranoproliferative glomerulonephritis may be present. Recurrences are extremely rare.

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By James Reilly M.D. of www.adoptiondoctor.com

This website does not constitute a physician patient relationship

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Sponge kidney on medical reports

Thu, 13 Sep 2007 06:55:36 GMT

Most patients discovered incidentally to have medullary sponge kidney can

be advised that the disorder is benign and that they can anticipate no

serious morbity or mortality from the disorder.

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On the other hand, kidney stone formation can occur in some patients and

can be a difficult problem. Its incidence is approximately 1 in 5000 in the

general population.

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The only associated abnormality that occurs is growth of one side of the

body but this would be fairly evident on physical exam.

�

Written By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com

For Pre-adoption Medical Evaluations and Post-Adoption General care on Long Island New York, Visit us at our International Adoption Private Medical Clinic.

This website does not constitute a physician patient relationship

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Oligophrenia in the Biological mother

Fri, 14 Sep 2007 23:25:41 GMT

The little girl my husband and I may be adopting from Kazakhstan was taken away from her mother because her mother was dx with oligophrenia and was unable to care for her. This scares me because I teach mentally handicapped children and I know many of them have low IQ parents. I also know that environment is a factor. The little girl is almost 2 and she is described as normal development. What are the chances of oligophrenia being hereditary?

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Oligophrenia usually is used to mean mentally deficient. It is an unfortunate term because it is very broad and prone to misuse. Mental retardation has a number of etiologic factors. unfortunately in about 40 percent of cases we never find out the etiology after a thorough investigation. Mental retardation occurs in about 2-3% of the general population but will be higher in less developed nations. The chances of whether there is a genetic cause for mental retardation are therefore very hard to say. It would be reasonable to assume perhaps that if someone suffered some perinatal insult that their retardation would be secondary to that insult.

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A number of single gene disorders can result in mental retardation. Many of these are associated with atypical or dysmorphic physical characteristics. Such conditions include fragile X syndrome, neurofibromatosis, tuberous sclerosis, Noonan's syndrome and Cornelia de Lange's syndrome.

As many as one fourth of persons with mental retardation will have a detectable chromosome abnormality. Children with Down syndrome usually are very recognizable but others such as Klinefelters may not be as noticeable. Other children may have a small deletion that is usually not reported. Some chromosome abnormalities can be inherited but most occur de novo meaning that the pop up in that individual but that they would not pass it on to there offspring.

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As with many things in life there are no simple answers, knowing the increased incidence problems that happen to young children in that part of the world it is likely to say that the mothers problem was probable the result of some perinatal insult or confluence of many factors. No one will be able to give you a very reliable odds estimate.

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On the bright side a knowledgeable examiner should be able to give an idea about this individual child. The statement "normal development" means little to me unless it placed in the proper context. What is the child's head circumference? Was there any delayed milestones? Does the child have imaginative play? When did she enter the institution/how long has she been there? In reality every child put up for adoption has a risk. It is the job of the doctor to give you report of what the risks are. Unfortunately, to do a good job we try to review as much information as we can possibly get.

By James Reilly M.D. of Adoptiondoctors.com & Adoptioneducationclasses.com

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If Arthrogryposis is indicated in adoptive child's medical record?

Fri, 14 Sep 2007 23:31:08 GMT

Arthrogryposis refers to a symptom complex characterized by multiple joint contractures present at birth. This is a description of what we see when the child is born. It is usually caused by decreased fetal movement of whatever etiology.

This is merely a description of a symptom however because there are approximately 150 different syndromes occurring with multiple congenital contractures that are characterized as arthrogryposis.

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The major syndrome (amyoplasia) accounts for approximately 50% of children who have multiple congenital contractures. The cause of this syndrome is unknown but it can affect all of the muscles in the body and can even lead to respiratory failure.

The classic presentation of arthrogryposis is contractures of all four extremities but it is possible to carry this diagnosis and have only contractures of one extremity but this is rare.

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X-rays need to be taken to rule out underlying spinal deformities and hip dysplasia

To understand how difficult and complex the diagnosis can be, imagine that the syndrome can start anywhere from the brain to spinal cord to peripheral nerves to the muscles. Therefore they need a thorough evaluation. . Laboratories might be able to rule out congenital muscular dystrophies and chromosome abnormalities these can be done at birth to help elucidate the etiology.

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Every child with these syndromes should have a complete musculoskeletal evaluation and genetics evaluation.

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Most of the children who have this diagnosis at birth survive to adulthood and need different medical interventions depending on their diagnosis.

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Surgery is needed usually in all of these children and extensive splinting and physical therapy to help improve and get some function.

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These children can be very intelligent (as long as the arthrogryposis is not secondary to a syndrome) so that they can make significant adaptations to their disability and lead productive lives.

By James Reilly M.D. of Adoptiondoctors.com

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"""" Internationally adopted child, carrier of Hepatitis C antibodies""""

Fri, 14 Sep 2007 23:35:57 GMT

Your question is not as easy a question to answer as it may appear. Hepatitis C is a virus which before we used to screen blood for it, was predominantly spread through blood transfusion. Someone who has hepatitis c can spread it sexually and it has been shown to be spread to family members (although this incidence is very low).

However having antibodies does not mean that you have hepatitis C virus in you currently, it could mean that you had it in the past and have already killed it. To know if someone is still potentially infectious you need to do a PCR test to look for the virus itself.

It is also possible that the mom had hepatitis C and merely passed on her antibodies to an infant without passing on the virus itself. PCR tells us if the child could pose a risk and that is the test you need to search out.

I hope this has been helpful.

Written by James Reilly M.D.

Salmonella infection in the Internationally adopted child

Fri, 14 Sep 2007 23:42:30 GMT

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They are both salmonella infections. Normally however when we say salmonella infection it is nontyphoidal salmonellosis.

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Without knowing the clinical context it is hard to know exactly what is going on with your child, for example was this in the blood, stool, or spinal fluid ?

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I will quickly summarize what happens with salmonella infections.

It can present in 5 ways. 1. Acute or chronic asymptomatic infection- salmonella has an ability to hide in the gut and to be shed it the stool for a prolonged time. This ability seems to be facilitated through the early use of antibiotics. This is why in this country we do not jump to treat all cases of salmonella. We do treat however if we feel the child is at risk for a severe illness. A child may be hospitalized to isolate him/her from the other children so that they do not start an outbreak.

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2. Gastroenteritis- an illness of vomiting and diarrhea with fever. This can be recurrent if they are exposed more than once.

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3. Focal infection- salmonella can spread about the body after an enteric illness but then the salmonella would not necessarily be found in the stool after treatment, but it can be found recurrently in the blood.

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4. Bacteremia- salmonella in the blood, normally once it is treated it is gone unless it finds a home in the bone for example.

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5. Enteric fever- a prolonged bacteremic illness where the child appears very ill usually needing hospitalization. The factors that determine if a child gets really ill are young age, virulent organism, hemoglobinopathy (such as sickle cell), leukemia/lymphoma(rare so young and ruled out by a blood test), immunosuppressive drugs, problems of the immune system either they are born with (scid) or acquired (HIV).

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Without a more thorough history it is impossible to say with any certainty what is going on with this child and unfortunately this is the risk that we are faced with many times in international adoption.

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A child should not have serious long term effects from an uncomplicated infection from salmonella in general, But it is important to know therefore was the illness a normal gastroenteritis or was it something else.

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By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com

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Worries about HIV infection in the orphan child

Fri, 14 Sep 2007 23:46:31 GMT

This question is not so simple as it would appear. First we never say whether someone should or should not adopt someone, because children can be adopted with HIV infection to avail the child of the myriad opportunities for treatment that are available in the United States.

HIV is an infection caused by a virus which is known to be transmitted from mother to child. The transmission of the virus can be decreased from approximately 30 percent to eight percent with the perinatal treatment with antiretrovirals.

The HIV antibody test can be positive in an infant just because they are the infant of an infected mother and the antibodies are able to cross the placenta.

If the mother has antibodies then the child could have antibodies. What was the medical condition of the mother? This could effect the way that we interpret these results. This child is reported to be "negative" at birth although at birth tests such as PCR, HIV culture, detection of HIV RNA or detection of p24 antigen are usually done because of what we previously stated.

A child over the age of 6 months we can follow the HIV antibodies because they start to wane. A child is considered negative if two consecutive HIV antibody tests are negative and the child has no other clinical or immunologic abnormalities. This of course assumes that the tests are being done correctly. It is recommended that all children who come to the United States be screened for HIV at least once.

The good news is that in recent studies that children from international adoptions seem not to be initially negative and then become positive. This is something that we always worry about but, our experience with this issue is very positive.

The other part of this question is that we know about the HIV infection but are there any other infections that could have been transmitted to the child by the mother. Hepatitis C,B, and syphilis should be tested. These infections should be checked in all international adoptees but information about the mother could effect the way we investigate a child.

As usual the lack of information puts us at risk because we cannot say anything with a great degree of certainty. Ideally another test could be done and sent to an American reference laboratory for the appropriate testing if this is something that is considered to be vitally important.

By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com

For Pre-adoption Medical Evaluations and Post-Adoption General care on Long Island New York, Visit us at our International Adoption Private Medical Clinic.

Psychological evaluations of the adoptive parent.

Sun, 16 Sep 2007 10:09:23 GMT

I have heard that parents who seek to adopt children are often required to undergo extensive psychological evaluations? Is this true? And, if it is, what should my husband and I expect in this process?

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It is becoming increasingly common for parents, who seek to adopt, to undergo psychological evaluation. Generally, these evaluations are not "extensive" in nature and are conducted in order to provide an overview of the psychosocial functioning of potential adoptive parents. Unlike comprehensive psychological evaluations, in which measures of various abilities are administered (e.g., IQ testing, Perceptual-Motor assessment, Achievement testing, etc.), pre-adoptive psychological evaluations generally center around interviews with the parents together and independently. Sometimes, an objective (i.e., paper and pencil) personality measure may be utilized in order to supplement self-report (i.e., interview) data.

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In the psychologist's report, which is generally two to four pages in length, the reason for the evaluation should be stated. In this case, your desire to adopt a child (or children). The reasons and expectations centering around adopting are typically discussed, as well as your feelings toward the biological parent(s) and/or the child's present living situation. There should be a section that articulates relevant background information. Here, your history is addressed. Of particular concern will be pre-adoptive stressors such as fertility issues, miscarriages and other losses, relationship conflicts, etc. Beyond your respective individual adjustments, should be a discussion concerning your marital adjustment. Examples of conflicts, and the mechanism of resolution, by you and your husband may be offered. If psychological measures are utilized (e.g., a personality test), a thorough explanation of the data should be presented, as well as the impact of said findings on your potential to be suitable adoptive parents. Finally, the evaluator's conclusion regarding you and your husband's abilities in parenting an adoptive child will be offered.

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As you move ahead, recognize that the psychological evaluation of potential adoptive parents is another of the many hurdles that you will face as you move through the journey of adoption. As I have discussed in my responses to previous queries, "Adoption Stress" will likely color all aspects of the adoption process. Know that this experience... your feelings, thoughts, actions and your physical and spiritual reactions are normal. If you are to undergo a psychological evaluation, just relax and be yourself. You're not expected to be free of anxiety, realistic fears and concerns. Rather than focusing on the review mirror, clouded by stresses of the past, focus on the road ahead... and clearly see your dream of having an adoptive child realized.

By Dr. Mark Lerner. Of Adoptiondoctors.com & Adoptioneducationclasses.com

Disclaimer

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Impact of Traumatic Stress on Adoptive Parents

Sun, 16 Sep 2007 10:20:59 GMT

You write frequently about the impact of traumatic stress with adoptive children. Could you address the impact of traumatic stress experienced by the parents of adoptive children?

As I have indicated previously, a significant number of adoptive children have been exposed to traumatic events including, but not limited to, neglect, physical and sexual abuse and various degrees of abandonment. I have emphasized the importance of recognizing and addressing traumatic stress early-potentially preventing acute stress reactions from becoming chronic stress disorders.

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New York Your question is a good one. It reflects an appreciation of the stress associated with the entire adoption process. The reality is, when we look closely at adoption, we realize that traumatic stress is pervasive-often impacting several, if not all, of the parties involved. Unfortunately, this traumatic stress is generally not recognized and its impact is misunderstood.

Traumatic stress refers to the feelings, thoughts, actions and physical reactions of individuals who are exposed to, or who witness, specific events that overwhelm their coping and problem-solving abilities. This experience is not limited to the adoptive child, nor is it limited to the adoption process per se. When considering traumatic stress experienced by parents of adoptive children, we must realize that there is pre-adoption stress, stress associated with the acquisition of an adoptive child, and post-adoption stress.

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Adoptive parents often bring to the table a history of traumatic stress. For example, pre-adoption stressors may include fertility problems, losses and significant relationship conflicts. Once engaged in the adoption process, there are often serious medical concerns, "misunderstandings," and heartbreaking disappointments. After adopting a child, additional traumatic stressors come into play, centering around the realization of a dream, tremendous life changes with new responsibilities, and a future marked by uncertainty and fear.

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Once parents recognize and understand the potential of traumatic stress impacting their own lives before, during and after adopting a child, they may begin to address the host of feelings that may negatively color a truly priceless opportunity.

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By Mark Lerner, Ph.D. President of the American Academy of Experts in Traumatic Stress, and Member of Adoptiondoctors.com & Adoptioneducationclasses.com

Disclaimer

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Risk for Reactive Attachment Disorder in Adopted children.

Sun, 16 Sep 2007 10:29:47 GMT

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Reactive Attachment Disorder (RAD) is a condition in which individuals exhibit markedly disturbed and developmentally inappropriate social relatedness. Children with RAD have considerable difficulty forming meaningful, affectionate relationships. Since prenatal experience (e.g., exposure to substances), birth trauma, inconsistent or inadequate day care, separation issues, abuse and neglect are precipitating factors that may lead to RAD, internationally adopted children evidence this disorder at a significantly higher rate than the general population.

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New York Since healthy attachment to a caregiver is necessary for cognitive, emotional, social and behavioral development, individuals with RAD often experience difficulties in these areas. The bottom line is that problems with attachment during the early years of life may compromise the quality of an individual's life-particularly when it comes to relating with others.

What are some of the signs that parents should look for?

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In infants, we see a general lack of connectedness. There is an indifference to others, including the parents, a resistance to physical contact, a lack of cuddling (e.g., the infant may appear stiff), poor eye contact, a lack of reciprocal smiles and, oftentimes, a delay in reaching developmental milestones. With children, we see a continuation of these behaviors, as well as a host of other problematic behaviors including poor peer relationships, poor impulse control, depression, aggression, a lack of conscience, abnormal speech patterns, and what seems like a preoccupation with control issues.

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What can parents do?

Structure and consistency are critical for healthy development in all children. Additionally, modeling and reinforcement for successive approximations of appropriate social relatedness are critical. However, these variables are even more important for the child with attachment problems. Children with RAD will often require professional intervention in order to work through traumatic experiences that compromised early developmental bonding. However, it is important to recognize that not all mental health practitioners are trained or willing to address the challenge of a child with RAD. Speak with your pediatrician and find a child psychiatrist, psychologist or social worker with experience in working with attachment problems and childhood trauma. With early intervention, children with RAD can become respectful, resourceful, responsible members of society.

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By Mark Lerner, Ph.D. President of the American Academy of Experts in Traumatic Stress, and

Member of Adoptiondoctors.com & Adoptioneducationclasses.com

Disclaimer

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What is post-traumatic stress and how does it manifest in the young institutionalized child?

Sun, 16 Sep 2007 10:38:49 GMT

Unfortunately, a significant number of young institutionalized children are exposed to traumatic events. These include, but are certainly not limited to, neglect, physical and sexual abuse and various degrees of abandonment. By having an understanding of traumatic stress and how it impacts young children, we can identify posttraumatic stress reactions and address the unique emotional and behavioral needs of these children.

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New York It's important to understand that traumatic stress, and posttraumatic stress, are not synonymous with Posttraumatic Stress Disorder (PTSD). The former are very normal human reactions that are experienced in the face of abnormal events. The latter, PTSD, it a mental disorder marked by a significant disruption in functioning over time (e.g., recurrent and intrusive distressing recollections of the event, distressing dreams, flashbacks, difficulty concentrating, hypervigilance, an exaggerated startle response, and a host of avoidance behaviors).

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Traumatic stress typically refers to the emotional, cognitive, behavioral and physiological experience of individuals who are exposed to, or who witness, events that overwhelm their coping and problem-solving abilities. These events are often unexpected and uncontrollable. They compromise an individual's sense of safety and security and leave people feeling insecure and vulnerable. Traumatic stress disables people, causes disease, precipitates mental disorders, leads to substance abuse, and destroys relationships and families. In the case of the young institutionalized child, immature behaviors, behaviors that were typically abandoned in the past, are often manifested (e.g., thumbs sucking, bed wetting, fear of the dark, loss of bladder control, speech difficulties, decreases in appetite, clinging and whining, and separation difficulties). As these children become older, they may manifest periods of sadness and crying, poor concentration, fears of personal harm, aggressive behaviors, withdrawal/social isolation, attention-seeking behavior, anxiety and fears, etc.

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Since preschool-age children do not yet possess the cognitive skills to understand a traumatic experience and since they lack the coping strategies to deal effectively with it, they look to adults in their environment for support and comfort. Unfortunately, the young institutionalized child may not find that comfort in their facility. They may not be exposed to adult figures who model an adaptive response in the face of adversity and who appropriately address their fears of abandonment. This experience only serves to reinforce feelings of aloneness.

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It is critical to look beyond the physical and safety needs of young institutionalized children, and understand and address their emotional and behavioral needs. A mental health professional who is knowledgeable about traumatic stress, and how traumatic events impact young children, can be an invaluable resource in addressing the unique needs of the young institutionalized child.

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By Mark Lerner, Ph.D. President of the American Academy of Experts in Traumatic Stress, and

Member of Adoptiondoctors.com & Adoptioneducationclasses.com

Disclaimer

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Symptoms of Traumatic Stress in Adopted Children.

Sun, 16 Sep 2007 10:54:08 GMT

Many adoptive children have, unfortunately, faced traumatic events. Having an understanding of the symptoms suggestive of traumatic exposure can aid in identifying children who may be experiencing traumatic stress reactions. Ultimately, by identifying symptoms early, we can keep adoptive children functioning and mitigate long-term emotional suffering.

First, it's important to understand what traumatic stress is. Traumatic stress refers to the emotional, cognitive, behavioral and physiological experience of individuals who are exposed to, or who witness, events that overwhelm their coping and problem-solving abilities. More simply stated, traumatic stress refers to the feelings, thoughts, actions and physical reactions of people who experience seemingly overwhelming events in their lives.

In the case of young children, immature and regressive behaviors, behaviors that have been abandoned in the past, are often manifested again (e.g., thumb sucking, bed wetting, fear of the dark, loss of bladder control, speech difficulties, decreases in appetite, clinging and whining, and separation difficulties). Older children may manifest periods of sadness and crying, poor concentration, fears of personal harm, aggressive behaviors, withdrawal/social isolation, attention-seeking behavior, anxiety and fears, etc.

Children who are quite verbal may discuss the nature of their exposure to a traumatic event if they are asked. Caregivers can specifically ask the child to talk about a "happy time" in their life-something that made them feel good. Following such a discussion, the conversation could shift to a discussion of a "sad time"-a time when the child was hurt or had something bad happened to them. Many children who are not particularly verbal will act-out their thoughts and feelings concerning prior traumatic exposure in their play. Look for aggressive play-play that provides a window into the conflicted mind of a traumatized child.

In the same way that we respond to the physical needs of the adoptive child, we must also address psychological needs. Emotional, social and behavioral problems, precipitated by a significant traumatic event, are all too common among people who were adopted. By understanding traumatic stress and knowing the symptoms that are manifested in young children, we can intervene early and ultimately make a difference in the life of the adoptive child.

By Mark Lerner, Ph.D. President of the American Academy of Experts in Traumatic Stress, and

Member of Adoptiondoctors.com & Adoptioneducationclasses.com

Adoption Stress and International Adoption

Sun, 16 Sep 2007 10:59:12 GMT

By: Dr. MArk Lerner of Adoptiondoctors.com

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Unfortunately, far too many adoptive children have faced traumatic events including, but not limited to, neglect, physical and sexual abuse and various degrees of abandonment. In recent months, I have accompanied Dr. George Rogu on a speaking tour with AdoptionDoctors.com. As the "Adoption Psychologist," I regularly explain to adoptive parents that by having an understanding of the symptoms suggestive of traumatic exposure, we can identify children who may be experiencing traumatic stress reactions. Ultimately, by identifying symptoms early, we can address emotional, social, behavioral and educational needs. As I often say to parents, we certainly don't wait to address physical trauma. And, in the same way, we must not wait to address traumatic stress.

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New York How is traumatic stress manifested in adoptive children?

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In the young adopted child, we see immature and regressive behaviors-behaviors that have been abandoned in the past are often observed again (e.g., thumb sucking, bed wetting, fear of the dark, loss of bladder control, speech difficulties, decreases in appetite, clinging and whining, and separation difficulties). Older children may manifest periods of sadness and crying, poor concentration, fears of personal harm, aggressive behaviors, withdrawal/social isolation, attention-seeking behavior, anxiety and fears, etc.

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So, what is "Adoption Stress"? Does it refer solely to the experience of so many adoptive children?

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The reality is, when we look closely at adoption, we realize that traumatic stress is pervasive - often impacting several, if not all, of the parties involved. Unfortunately, this traumatic stress, "adoption stress," is generally not recognized and its impact is misunderstood. Consider the following..

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Birth parents, who surrender a child for adoption, typically experience a great deal of stress. Oftentimes, due to their circumstance, they have little choice or control and must surrender their child for adoption.

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Adoptive parents often bring to the table a history of stress. For example, pre-adoption stressors, which may include fertility problems, losses and significant relationship conflicts. There is also stress associated with the acquisition of an adoptive child. For example, there may be serious medical concerns, "misunderstandings," and heartbreaking disappointments. Finally, post-adoption stress may center around the realization of a dream, tremendous life changes with new responsibilities, and a future marked by uncertainty and fear.

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Adoption stress is manifested in the feelings, thoughts, actions and physical reactions of all parties associated with the adoption process-by birth parents, adoptive parents and certainly, adoptive children. By understanding adoption stress and recognizing the symptoms, we can intervene early, educate and empower victims, and prevent acute difficulties from becoming chronic problem

�

By� Mark Lerner, Ph.D. President of the American Academy of Experts in Traumatic Stress, and

Member of Adoptiondoctors.com & Adoptioneducationclasses.com

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Disclaimer

Psycho-medical and social effects of natural disasters

Sun, 16 Sep 2007 11:22:40 GMT

What are some of the psycho-medical and social effects of natural disasters such as Hurricane Katrina on children living through this traumatic event?

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Natural disasters like hurricane Katrina and other events like the 9/11 terrorists attacks have grave implications on all persons that live through these traumatic events. The effects on our most fragile population sometimes go unrecognized in our youngest patients,

The effects of a disaster are medicated by personal experience, parental reaction and the child's developmental competency at the time of the disaster. It must be stressed that like adults who experience traumatic stress so do children. The only difference is that the symptoms are manifested differently and they sometimes go unrecognized.

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A disaster is generally defined as a dreadful event that causes destruction to property, loss of life and sometimes displacement from children from their parents. The effects of these disasters on children are generally never uniform or universal in nature. Depending on the child's age and developmental stages and many other factors determine the psych-medical manifestations of traumatic stress.

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In is widely known that children react differently according to the level of direct exposure to the event. Manifestations and symptoms are more deleterious if the child and family immediately affected (loss of loved one's or destruction of their home), and by the fearful and distressing reactions of their parents. Events that produce few disruptions in the child's social and living situation are less damaging than chronic events that lead to lasting changes in the child's social environment. A good example would be of a child who has lost his home and parents to the floodwaters in New Orleans and because of that has been placed in the foster care system because no other family members can be found. Traumatic stress affects more seriously those children that are most directly involved with the incident, but it can also affect children that are safe in other states indirectly viewing the horrific events on the television or observing the initial and ongoing responses of their teachers at school and their parents at home.

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For children that experience a traumatic event, there is some degree of behavioral and social adjustments problems that should be expected. These are a child's normal response to an abnormal event. After exposure many children experience fears, anxiety and depression. If the problem is recognized in time, they can be helped to cope with their stress, and the symptoms will subside. If these symptoms are ignored, the child will become more susceptible to the prolonged consequences of PTSD.

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After a sever traumatic event such as Hurricane Katrina, parents and caregivers can expect these affected children to go through different stages in the process. In the first stage, which generally is immediately after the disaster, children have reactions of fright, disbelief, denial and grief. Sometimes children are relieved if loved ones have not been harmed.

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In the second stage of a traumatic event, this occurs a few days to weeks after the disaster, children have manifestations of anxiety, sadness depression, hostility and aggressive behavior towards others. Sometimes these children become apathetic, withdrawn, they have sleep disturbances, and they demonstrate play that mimics themes related to the event. This type of behavior is a normal part of the recovery process and generally last a couple of weeks.

For children that have been exposed to this hostile environment for a prolonged period of time, they become at risk for developing PTSD later in life often associated with violent and delinquent behaviors. In such extreme cases it is necessary for these children top receive counseling form a mental health professional.

Children of different ages interpret traumatic events such as disasters, war and abandonment differently. Their developmental ages individually influence their reactions to such events. Medical and Psychological interventions should be aga appropriate.

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The response to younger infants and children is exemplified by mood, anxiety, and behavioral manifestations. These children are unable to understand the intentions and logic of the situations they are placed into. As a result the young child in more concerned with the consequences of the event. Even though little children may have no cognitive understanding of the disastrous event, the destruction, abandonment and loss of loved ones can lead to regression and detachment in order to protect their inner psyche from the surrounding conditions. In the first year of life, such experiences can manifest themselves with increased crying, irritability, exaggerated startle response, and separation anxiety. Toddlers and pre-school aged children can experience sleep terrors and nightmares, and a regression in behavioral skills manifesting themselves as helplessness, clinging behavior and temper tantrums.

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In the older school-aged child, they demonstrate traumatic stress through trauma related play and aggressive behavior. Like the younger children, they too may become withdrawn, apathetic, and exhibit behavioral problems and other forms of somatization, such as abdominal pain, headaches without any medical problems.

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With the worldwide violence, natural disasters and abandonment of thousands of children into orphanages, traumatic stress is a common sometimes ignored entity in the pediatric population. It is incumbent upon the medical profession a whole to identify those children ( ex: victims of the 9/11 disaster, survivors of Hurricane Katrina and any Post-institutionalized child ) no matter how well adapted they appear momentarily appear.

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Immediate identification of these survivors and a timely referral to a mental health care professional provides the only opportunity for these children to improve the outcomes and not suffer from Post Traumatic Stress Disorder or PTSD later in life.

By Mark Lerner, Ph.D. President of the American Academy of Experts in Traumatic Stress, and

Member of Adoptiondoctors.com & Adoptioneducationclasses.com

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What should one look for when contracting with a social worker for a home study?

Sun, 16 Sep 2007 11:41:03 GMT

What should one look for when contracting with a social worker for a home study?

By: Leslie Zindulka LCSW-R of Adoptiondoctors.com

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What should one look for when contracting with a social worker for a home study?

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Selecting a social worker to complete your home study is similar to a birth mother selecting an adoptive parent. You must look at what the social worker has to offer and select one whom you feel most comfortable with.

Your home study should be an interactive and educational experience. You should feel comfortable sharing information and asking questions of your social worker.

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Your social worker must be a New York State Licensed Certified Social Worker. They should be knowledgeable about domestic pre-certification requirements and international immigration requirements as well. The social worker should be familiar with the format of and what specific issues need to be included within the home study report. It should be a well-written documented home study, that is completed within a timely fashion and acceptable to adoption court officials and international officials, if indicated.

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Although, it is not necessary to contract with a social worker that is also an adoptive parent, it is a bonus that can not be overlooked. They know first hand what you're going through. They have experienced the process, the wait and are now parenting in an adoptive family. Currently, adoption professionals are not required to have any formal training or degree to practice in the adoption field. So, to have years of experience and the personal expertise as well, is an asset.

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Independent practitioners complete most New York State domestic adoption home studies. A social worker that is able to "convert" the independent practitioner home study to an "agency" home study should the individual or couple change their path is an added benefit. These are the important issues to consider when contracting with a social worker for a home study.

What should one look for when contracting with a social worker for a home study?

Sun, 16 Sep 2007 11:43:06 GMT

What should one look for when contracting with a social worker for a home study?

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Your home study should be an interactive and educational experience. You should feel comfortable sharing information and asking questions of your social worker.

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What Impacts the Home Study: Who May Adopt

Sun, 16 Sep 2007 11:45:50 GMT

Adoption is considered by many as a "gray" area of the law. This is a big myth perpetuated by ignorance. The fact is that statutes in all states strictly regulate the adoption process. Home studies are completed by Licensed Clinical Social Workers and are done to investigate the adoptive family. Adoptions must be approved and finalized by the court. Home studies are utilized for every adoptive family in the United States whether they are adopting a child domestically or internationally. There are several key elements that are thoroughly evaluated in every home study. Adoptive parents may be married or single, childless or already parenting other children. The three most important factors are a financial disclosure, health statement and background records check.

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You are not required to own your own home or to have a high income in order to give children what they 'need': permanence, stability, a lifetime commitment, and a chance to be part of a family. While there is not necessarily a minimum income that is required to adopt a child, the adoptive family must show they can manage their finances and are able to accept a child into their home without undue financial burden. You will need to provide evidence of employment and salary. Items requested include copies of tax forms, insurance policies, bank statements, mortgage or rent payments, etc. Keep in mind that you don't need to be rich to adopt, but a history of bankruptcy, high debt, and failure to pay child support may be cause for denial.

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The home will be inspected by a social worker to ensure it is a safe environment for a child. There will also be assessments of the marital relationship, lifestyle and medical history. Health examinations are required in order to insure the safety of the child being brought into the home and to establish the physical condition of the adoptive parent(s). If there is an existing medical condition you are not necessarily precluded from adopting a child as long as the condition is not a threat to others and the condition is under a doctor's care and supervision. Having a disability does not automatically disqualify you from adopting a child either. Agencies just want to ensure that you have the capacity to give and receive affection. Divorce or a history of marital or personal counseling also does not automatically eliminate you as a candidate.

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A written report from a physician about the health of each member of the household is required. It must state that you are free from contagious and communicable diseases and have no mental health concerns. If you're in the middle of medical or psychological treatment or have a condition that threatens your life expectancy, you may be prevented from adopting. Most states require that adoptive families undergo some type of criminal and child abuse background records check. When families apply to adopt in New York State, agencies check the Child Abuse and Maltreatment Register to determine whether an applicant, or any person over the age of 18 whom resides in the home, has been the subject of an indicated report of abuse or maltreatment of a child. Then fingerprints will be taken to verify there is no history of criminal activity.

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Having a criminal record does not necessarily prevent an applicant from adopting. Most misdemeanors that occurred in the past should not have an adverse effect on the outcome of the home study, although they will need to be addressed. Background checks are used to insure that a child is placed into a secure and loving family. During this portion of the home study, you will be asked many questions, such as: "Have you ever been arrested and for what?" "Was this the result of 'youth indiscretion'?" "What changes have you made in your life to avoid this from happening again?" "What role do alcohol and drugs currently play in your life?" "Have you ever been treated for a drug dependency?" "Have you ever been seen by a therapist or counselor?" "What was the result and current situation?" The social worker is trying to make sure that every effort is made to ensure that children are placed in a safe environment. Federal and state laws do NOT permit you to adopt if you have been convicted for major felonies against children such as child abuse, neglect, spousal abuse, or a crime involving violence including rape, assault, and homicide. Certain other convictions also make you ineligible if they occurred within the last five years. Misdemeanors stemming from 'youthful indiscretions' usually aren't held against prospective adopters; although, a social worker will want to know if your past behavior is just that.

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If you have a DWI on your record, for instance, she'll ask if you went through a rehabilitation program and what your current drinking habits are. Current abuse of alcohol or other drugs requires the rejection of an applicantIf you have a medical, financial, or prior arrest record that you fear might result in an unfavorable home study, experts advise that you don't wait to mention it. If you plan to adopt internationally, your social worker can steer you to a country that is more likely to be accepting, and can address your situation in the home study in a way that's consistent with the country's cultural values. In a domestic home study an addendum from the court is attached stating the disposition of the prior charges. Be open and honest, the social worker is there to help you create your forever family. After all of these requirements are met, the social worker will finalize the home study, recommending you for the placement of a child. While each situation is different, these are some general guidelines that apply to the things that can impact a home study and the common concerns prospective adoptive parents have.

By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

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Adoption: The Elementary School Years

Sun, 16 Sep 2007 11:51:04 GMT

First grade is when "real school" begins. Six-year-olds now have reached the age when they are required to sit still, pay attention and learn to read and write. During these years, they will gain a new sense of independence as they ride to school on the bus alone and negotiate the cafeteria.

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Special consideration will be needed when it comes to certain class assignments, because children at this age are still concrete thinkers. Your experience with preschool teachers may help you and your child decide whether to share adoption information with appropriate elementary school personnel. Even though, children in elementary school often feel they are old enough to decide for themselves whether to tell their classmates about their adoption. However, there are two schools of thought on whether 'to tell or not to tell'. Some professionals and adoptive parents think it is unwise to share adoption information with school staff for fear that teachers will blame all problems on the adoption, or cause their child to be made fun of. Others say that parents cannot expect teachers to become more sensitive to adoption issues or use positive adoption language if parents are not willing to share openly their own positive feelings about adoption. With that said, children must be taught that once they do tell, they will not be able to "take it back."

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The parent of a newly adopted school age child, either from the foster care system or internationally, almost has to share the child's adoption with school personnel. This way, the teacher will have a better understanding of the child and will be able to plan useful interventions together with the parent. The teacher needs to know just enough relevant background history so that he or she can understand some of the reasons for the child's current functioning in the classroom. For example, the child may be experiencing attachment, separation or socialization issues, in addition to educational delays.

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At this age, adopted children begin to be able to grasp the meaning of adoption. This may include loss and abandonment issues, fantasizing about birthparents, in addition to recognizing that people will have different reactions to adoption. Children may find it difficult to pay attention in class because there is a preoccupation with this or there may possibly be a learning issue. An older internationally adopted child will most likely need ESL/ LEP (limited English proficiency) services. Once it is established that language is not the issue, you and school personnel must work together to determine if there is a learning disability or emotional issues that are preventing the child from learning. If you think your child will need services not normally provided in the regular classroom, you will need to advocate for them.

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By fifth grade, in many elementary schools, there may be school assignments that need your special attention. Students are often asked to complete the 'family tree' assignment or to 'adopt- a'-whale/ rainforest. This is a natural opportunity to talk about adoption with your child. You can help ease any possible uncomfortable feelings that your child may have about these assignments by talking with the teacher about the child's adoption ahead of time. You may choose to include birth family members as the roots of the family tree or not include them at all. The choice is yours. What a teacher may think is an innocent sounding project to 'adopt-a .', may have negative effects on adopted children of this age, who are still concrete thinkers. An elementary school age child may conclude that all you have to do to adopt is pay money and that it is renewable every year to keep them.

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This of course is not the case. The phrase 'adopt-a' is problematic and maybe can be changed to 'sponsor- a .' to help alleviate any confusion.

There are many varieties of families. Children nowadays can live with adoptive parents, divorced, single, grandparents, or two parents of the same gender. Most teachers in this day and age are aware of these differences. You might suggest to the teacher to emphasize to the class that while families may look different on the outside, on the inside they are all the same. Each has people who care for them and all love one another. Hopefully, if handled in this way, these assignments should be a self-esteem building activity for your child and all the other students as well.

Remember that adoption is forever.

By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

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How Adoption Impacts Children at School: The Preschool Years

Sun, 16 Sep 2007 20:25:23 GMT

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Like all children, adopted children spend a good portion of their waking hours in school. Because school is such an important aspect of children's lives, adoptive parents, like all parents, want their child's school experience to be a positive one. When your child has a problem at school, you might find yourself wondering, " Is this a problem related to adoption, or is it a typical problem common to all children?"

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Your child's nursery school experience is often the first time they will interact socially with other children, without the protection of their immediate family. Educational goals for preschool children are normally simple. Supporting the development of the child's self-esteem, improving social skills, such as taking turns, sharing, and following directions and creative expression are encouraged. Activities may center on learning colors, shapes, number concepts, and letters.

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Whether to tell the preschool staff that your child was adopted is a question with no absolute correct answer. If your adoption is visible, as is the case with transcultural adoptions, the topic will come up automatically. Since preschools are often private and separate from the public school system, the preschool years are a good time for adoptive parents to practice interacting with school personnel and other parents about adoption related issues. This reduces any fears that a label will follow their child throughout his/her school career. Parents can start to get comfortable with the idea of sharing information about their child's adoption if they feel it is appropriate or that it can help their child's adjustment to school. You should do what will make your child feel loved and accepted. It is not; however, necessary to share all the details of the adoptive situation with the teacher.

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Children, who are 3 or 4 years old and were adopted domestically or internationally as infants or toddlers, rarely show any adoption-related school adjustment problems. Since they do not fully understand reproduction yet, they cannot really understand what adoption means. They may happily tell the story of their adoption to anyone who will listen. Preschool children are usually accepting of all children who behave in a friendly way. They do not have prejudices about sexual orientation, race or skin color, unless they are actively taught to have it. Transracially and transculturally adopted children; therefore, probably won't experience prejudice during this stage. Children this age are aware of differences in physical features though, and may need some help to understand them. If the children and teachers in your son or daughter's class at preschool seem curious about adoption, you might want to share positive adoption language and books that either you or the teacher can read to the class about how adoption is just another way to form a family.

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By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

Disclaimer

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What is the purpose of post- placement visits and what do they cover?

Sun, 16 Sep 2007 20:32:39 GMT

Post-placement visits are sometimes referred to as post- placement supervision. The two main purposes are to gather information and to provide support. Once a child has successfully been placed in your home, all states, private agencies and international countries will require one or more post-placement visits. The timing of these visits may need to conform to state, agency or country mandates. The social worker may only need to visit your home once or several times. This generally will take place somewhere between 3 and 6 months or at a 12- month interval, depending on the legal requirements of the county in which you reside and the country from which you adopted. A domestic adoption can not be finalized until a licensed social worker prepares a post-placement home study report. This report is then submitted to the court for a judge to approve the adoption.

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New York

The first purpose of the post- placement visit is to help make this a smooth transition. Adoption of a child can often involve significant adjustments for family members and to your home. Prior to adopting, your home may have been very orderly and now it has been transformed to accommodate toys, baby equipment and general chaos. The social worker is there to provide support, assistance and education to the adoptive parent(s). They are there to answer any questions you may have about general baby care, sibling adjustment reactions and to make referrals to other professionals if indicated. This is an opportunity to explore concerns about attachment, parenting, behavioral and/or health issues with your social worker.

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The second purpose is to gather the necessary information required in order to prepare a written report to the court and or country of your child's origin.

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Many adoptive parents, to some extent are nervous about post-placement visits. They may feel that the social worker is 'spying' on them. Just as with the pre-placement home study, the post-placement report will cover a great deal of information. This report will address the issue of how the child and parent(s) are bonding and adjusting as a new family. The social worker will want to see you interact with your new child. They are not looking for the 'perfect parent', but one who is loving and sincere. Additionally, you will need a letter from your child's pediatrician, stating the current health and developmental status, any health concerns, and that your child is up to date on all immunizations. A positive written statement from your child's teacher also will be needed if they are of school age.

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The post -placement visit needs to result in a favorable finding. In the case of domestic placements, the social worker genuinely wants the adoption to be finalized. They will be eager to help in any way to assure a successful placement. The social worker's post-placement report to the court must state that they think the Petition to Adopt is in the 'best interests of the child' and; therefore, be granted. In almost all cases, the court will follow the recommendation of the social worker that the adoption be allowed to take place.

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By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

Disclaimer

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Does adoption as an option help perpetuate sexual irresponsibility among teens?

Sun, 16 Sep 2007 20:37:47 GMT

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Simply put: No, a teenager will not be more sexually irresponsible just because they are aware that adoption is an option, if they find themselves with an unwanted pregnancy.

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Sexual irresponsibility happens amongst teenagers, who feel omnipotent, have poor communication with adults and a lack of education. Adolescence is a period in your life when you've got tons of energy, everything seems possible and there are no limits to your desires. This trying time presents a challenge for most parents, the teenagers themselves and ultimately our society. Teenagers are often characterized as rebellious, moody, and defiant. Adolescents tend to have a limited capacity for self-monitoring or the ability to accurately judge their own behavior. This can lead to situations of unprotected sex and unwanted pregnancy. This is why effective communication should be on every parent's to do list as an important tool in keeping your teenager safe and aware of the consequences of their risky choices.

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New York

Fact: According to a report on births from the Centers for Disease Control and Prevention, the number of U.S. births to unmarried teens, actually declined to a record low in 2000. Family planning and abstinence education has led to a decrease in unintended pregnancies amongst teenagers.

By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

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Other Children and the Homestudy

Sun, 16 Sep 2007 20:39:43 GMT

If you already have children, either biological, adopted or both, they will be included in the home study process. Their involvement will vary based on their age, but all children will need to meet the social worker. Children's input is usually quite important in the overall assessment of the prospective adoptive individual and or couple.

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New York

For children who are young and non-verbal, the social worker will want to meet them and see how you interact. They will ask you questions about your child's developmental milestones, immunization records and overall health. An older child might be asked to share, draw pictures or even write a statement describing their feelings about having a new sibling. For school age children, the social worker will ask you and your child how they are doing in school, what they like to do in school, favorite subjects, hobbies, in addition to how they get along with friends. The social worker will be very interested in learning how your child is rewarded, disciplined, and more so how your child feels about sharing their parents, toys and t.v. remote control.

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Teenagers and adult children are also an important part of the home study process. A new sibling means sharing time and attention. This age group's feelings are very much considered. A social worker is looking for the teen to have a positive reaction towards adoption. Any adult living in your household will need to be present for the home study interview. Adult children who no longer reside at home may submit a "reference letter". This way an adult child can express their feelings, provide an overall opinion about their parent's ability to parent and give a picture of family life.

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Even though the process may seem lengthy or invasive, it is necessary to ensure that a child is placed in a loving secure home. The purpose is to make sure a child enter a safe environment. The social worker is looking for a family that can comfortably accommodate a new family member, without financial burden. For parents and a home that can provide many years of happiness and fulfillment raising a child into adulthood. The social worker wants to make sure that the newly adopted child will be wanted and accepted by everyone in the family right from the start.

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By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

Disclaimer

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International Adoptees Starting School

Sun, 16 Sep 2007 20:43:38 GMT

First 2-4 Weeks: Things to do when arriving home

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* Get a health examination from an International Adoption Pediatrician.

* Get an accurate psychosocial-educational evaluation done in their native language.

* (In New York) New Entrant Chapter 53 Screening arranged by public school staff.

Determining School Readiness: Are They Ready To Start School?

* Cognitive Readiness - ability to learn skills and be available for learning.

* Social Readiness - capacity to function socially and participate cooperatively with peers.

The Right Academic Placement: What Grade Should They Be In?

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Food For Thought:

* Kindergarten is not a mandatory grade in New York.

* There are no legal rules, but here usually 6 years old = first grade.

* Even if their records say they are on grade level, doesn't = the same grade level here.

* Their birth date may not be accurate!

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Options:

* Delay entry into kindergarten or place in a grade level back by one year.

* Place in an inclusion/ transitional class if available.

* Place in age appropriate grade.

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Rule Of Thumb:

* For most school-age students, placing back one year is the more common solution.

* Match your child's actual age and cognitive and social functioning, with requirements for a particular grade = the right placement.

* One year won't ruin their life, but rather provide less academic and social stress now!

* It's more important to have a positive school experience now, which is a pre-requisite for long-term school success!

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What To Expect

Keys to School Success:

* Provide structure and predictable routines at home and school.

* ESL/LEP is a necessary academic K-12 program essential for newly arrived children.

* Share adoption information carefully, sometimes 'less is more', it's their story to tell.

* Basic facts about orphanage life are sufficient.

* Model for teachers and encourage appropriate, positive adoption language.

* Give teachers ideas on how to broaden school assignments/projects.

School Problems 3-5 years Old and Beyond?

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What To Do:

* Evaluate performance and concerns based on functioning since arriving home.

* Consider acculturation, language acquisition, health and neurological problems, and length of time home before you question if your child has ADHD, anxiety, poor attachment or special education issues.

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Red Flag:

* If functioning is more than 2-3 years below chronological age or child has specific identifiable disabilities since arriving or red flags from their records, don't wait, your child may need special education, psychological intervention and/or medical services.

* If services seem needed, a thorough specialized evaluation should be completed.

* Contact your local School District's Special Education Coordinator to request testing.

* Therapeutic interventions beyond the scope of the school for problems such as ADHD, anxiety and attachment contact an International Adoption Pediatrician for guidance.

* Early intervention increases the likelihood of a positive outcome!

By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

Disclaimer

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Contact Between Adoptive & Birth Parents

Sun, 16 Sep 2007 20:45:42 GMT

One may question, is it fair or right for an adult adoptee to expect his/her adoptive parents to now associate in family gatherings with his/her biological family?

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There is not enough research on the outcomes of openness for those involved in adoption. That said, I guess this is a matter of choice with no right or wrong answer for how to feel. There are different degrees of openness ranging from mediated sharing via an attorney or adoption agency to fully disclosed adoptions, involving direct contact between adoptive family and birthparent. We cannot assume that all adopted people want open contact. Remember no one type of adoption fits every person's wants and needs.

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New York

Historically, adoptions have been confidential, but that has changed, as our society has become more open minded, where strict confidentiality is not necessarily the norm. Regardless of the contact arrangement initially established when your child was adopted, when your son/daughter becomes an adult, the pathways of the adoption triad may change, based on current and divergent perspectives on open adoption. In other words, all bets are off. Adolescents moving into adulthood face normal transitions, along with the ones that are unique to adoption. They will have to make the choice to search for their biological family, which is normal or to choose not to, which is a positive decision too. Of course there are pros and cons with everything and we as one third of the adoption triad need to try to be supportive of our adult child's curiosity about their personal history.

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Based on one's own comfort level at any given time, some parents may feel that it is okay with them to associate with their child's birth family if he/she chooses to. They are secure in their relationship and know they raised their child the way they promised to do. They have a strong bond with their son or daughter and know they love each other unconditionally. They feel that being respectful of this relationship shows their child that they are available to them emotionally and are supportive of their choices. It is understandable for your adult child to be interested in learning first-hand about their medical history, discovering similarities in mannerisms and physical resemblance's, as well as, developing a relationship with siblings. These parents feel supporting contacts and even attending biological family gatherings will put to rest any fantasy their adult child may have had.

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Others may feel that under no circumstance do they want to meet or get to know their child's biological family, despite their adult child's desire to. They may feel insecure in their relationship with their child and still experience the pain of not being the birth parent. They may worry that this new relationship will jeopardize their standing as the primary parent. More importantly, they may also be concerned about the emotional impact having a relationship with the biological family will have on their child. The birth parent may have made subsequent improvements to their life or kept other siblings, which can cause emotional turmoil, even if your son/daughter is now an adult.

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Adoption should be viewed as an ongoing process rather than a one-time event. Try to be flexible, open-minded and know that all feelings are normal and common for adoptive parents to experience.

By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

Disclaimer

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What is an adoptive parent profile?

Sun, 16 Sep 2007 20:53:57 GMT

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An adoptive parent profile has many names. It is often referred to as a parent profile, an adoption profile, adoption dossier, adoption portfolio or a family resume.

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Profiles generally include statistical history about yourself, such as age, educational and employment background, your interests and hobbies and your family. They usually have one or more photographs and sometimes a separate letter to a prospective birth parent. Simply put, it is a document that gives background and current information about a person who would like to adopt a child. If adopting via an agency, they will often have a specific format for you to follow. When adopting independently, you may be as creative and original as you like.

New York

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First impressions are extremely important. Your profile is your introduction to a woman or couple planning on making an adoption plan. If adopting through an agency, this will be your first contact. The agency will send your profile along with a few others to the expectant parent for their consideration. You will need to transform your thoughts into heartfelt words. If a prospective birth parent is presented with two or more profiles with the same family criteria, she is more likely to choose the one that is well thought out, organized and creative. Remember that the goal is to connect with the birthmother who is right for you.

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When adopting independently, you already would have spoken to the birth parent one or more times. The adoptive parent profile in this situation is used as a way to showcase things about you that are unique and special. Your profile is an invitation to a birth parent to 'come into your home and meet your family.' Many profiles will sound alike, so you want yours to stand out from the rest. You will describe each other and your marriage, explain reasons for adopting, share your parenting philosophy, hopes and dreams and perhaps even a discussion about religious beliefs if you choose.

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Whether adopting independently or with the assistance of an agency, you will want to include photographs of yourselves, pets and your families. Outdoor, informal photos are considered better and ones, which demonstrate your love of children, are important, as well. You may want to include a picture of yourself with nieces and nephews at the beach, at a sporting event or holiday gathering. A potential birth mother is looking for loving, relaxed people who can relate well to children. Your profile needs to convey that you are a stable individual and/or that you have a strong marriage.

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Some 'don'ts' to consider:

* Make sure you don't sound too professional, too perfect or too much like everyone else.

* Write your resume on an 8th to 9th grade level, one that is easy reading, but remember, not to be too condescending.

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Try to put yourself in the place of an insecure and frightened birth mother that is looking for a place for her child to grow up. She is hoping to find a home, in which her child will be safe, protected, wanted and loved. The woman or couples who read your adoptive parent profile might be instrumental in making your dreams come true. Adoption is not your last resort, but another way to give a child a home and form your forever family.

By Leslie Zindulka LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

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Adoption or Abortion?

Sun, 16 Sep 2007 21:32:15 GMT

By: Leslie Zindulka LCSW-R of Adoptiondoctors.com

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Parenthood, adoption, and abortion are all options for an unplanned pregnancy. When you first learn that you are pregnant, you will need to consider your options and make an informed choice. You may feel that one option is clearly best for you, or the decision may be a difficult or confusing one. The bottom line is that only you have the right to choose the option that is best for you.

New York

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Parenthood is a lifelong journey that doesn't end when your child enters kindergarten or graduates high school, and it is not for everyone. You have the right to make your own decisions about your body and the right to feel supported in whatever decision you make. Some women may not feel that they are prepared to take on the responsibility of being pregnant and raising a child. There are lots of emotional, economic and social responsibilities to being a parent, and some women feel that they do not want to or cannot take on these responsibilities (either now, or ever).

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Abortion is an option you may choose if you feel that you cannot parent a child or experience a pregnancy at this time in your life. Abortion has been practiced in almost all-human communities from the earliest times. The patterns of abortion use, in hundreds of societies around the world since before recorded history, have been strikingly similar. Women faced with unwanted pregnancies have turned to abortion, regardless of religious or legal sanction and often at considerable risk.

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Adoption is another option if you feel abortion is not for you and you are not prepared to parent during this time in your life. If you decide to continue your pregnancy but feel that you cannot raise a child at this time, you may be thinking about making an adoption plan. Adoption isn't necessarily an easy decision either. It is one of the most complex emotional arrangements in which an individual can be involved. Yet, of the other options - aborting the pregnancy or raising the child - adoption may be the most child-centered. It can be a healthy, realistic, and sensible choice for all the parties involved in the adoption triad (birth parent, adoptive parent and adopted child). Adoption is a selfless, loving gesture from a brave woman who has dreams for a child to have a forever family.

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The choice is yours and yours alone to make and live with. Well-meaning friends, family members and professionals can and should only offer support and guidance. The bottom line is that only you have the right to choose the option that is best for *you*. The final decision is yours.

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By Leslie Zindulka� LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

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What are some of the adoption issues teenagers face

Sun, 16 Sep 2007 21:35:36 GMT

By: Leslie Zindulka LCSW-R of Adoptiondoctors.com

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What are some of the adoption issues teenagers face?

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While it is difficult to make a general statement about such a diverse group as adopted teenagers, it can be said that adopted persons generally lead normal healthy lives that are no different from the lives of non- adopted persons. They may; however have experiences that are unique to being adopted, and these issues may have an impact on their lives at varying times. The teen years can be stressful for anyone, but they may be particularly stressful for an adopted teen because of the issues that must be faced during this period of development. The two most common are loss and unresolved grief and identity and self-esteem. Dealing with the loss of the birth family, coupled with a search for self, are two processes that can contribute to shaping the psychological development of adopted persons.

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The 'loss' of the birth parents as a result of adoption sets the stage for the feelings of loss and abandonment that many adopted persons may experience at some point in their lives. Adolescence is a turbulent period for many children, whether they came to their families through adoption or not. Many conflicts can arise during this time of physical and emotional change. Feeling the losses that are associated with divorce or death are considered normal and those people find comfort and support for their grief through socially accepted rituals. With adoption, the person experiences a loss of an unknown person, with no social context in which the loss is recognized. Therefore, if needed adoption loss rituals for your family are encouraged. Even adolescents who are adopted as newborns at times experience a sense of loss, as well as, feelings of rejection and abandonment by the birth parents. Adopted teens may wonder why they were placed for adoption or what was 'wrong' with them that caused their birth parents to give them up. Grief is a common reaction to loss. The adopted teen may have a difficult time finding an outlet for this grief, since grieving for birth parents is not a socially acceptable reaction, especially if the adoptive family placement has been a generally happy one, the adopted teen may even feel guilty for grieving.

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Questions about identity often occur first during adolescence. Not only do they have cliques to figure out, but there are messages, music from the popular culture and media that bombard them too. With all of this, there are hormones raging and causing all kinds of bodily and emotional changes. Although adopted adolescents do have the same trouble searching for a comfortable identity as non- adoptees, problems involving sexual activities and pregnancy, delinquency and substance abuse, and depression are the most common ones adoptive teenagers face. Therefore, the task of identity development during this time is often more difficult for the adopted teenager. The question of the influence of nature versus nurture may become very real to the adopted adolescent, who is trying to determine the impact of all of these influences on his or her own identity. This stage of development includes questions about the biological family, why they were placed for adoption, whether the adolescent resembles the birth parents in looks or in other characteristics. Accompanying these issues of identity are issues of self-esteem. At this age, the teen understands the concept of relinquishment, and may feel rejected or view themselves as damaged goods, even though they cognitively know how a girl gets pregnant, and can understand why someone might not be able to care for a baby after it is born. Although they are older, adopted teens still may not have worked through all their feelings about their adoption.

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Adolescents often express their reactions to loss by rebelling against parental standards. Knowing that they have a different biological origin may contribute to their need to define themselves as individuals. As adolescents move toward greater autonomy, a parent's most difficult task is creating the delicate balance of loving and letting go. Although there were many times in years past when you encouraged your child to become self- sufficient by giving them controlled opportunities to experiment, an adolescent needs to assert their autonomy by taking their own chance to grow as an individual apart from you as their parent. Have discussions about adoption starting from when your child comes home and continue them into the teenage years. The repercussions of adoption can last a long time, and as conscientious parents, you still need to stay involved. Encourage meeting with other adopted teenagers, either through an organized group or informally, to provide your child with support for some of the sticky issues. It is more than appropriate for teenagers to look to their peer group for solutions a they work through this major development task of learning to separate and live independently. Remember, most adopted teenagers survive and grow up to be happy, mature adults!

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By Leslie Zindulka� LCSW-R of Adoptiondoctors.com and Adoptioneducationclasses.com

Visit Leslie on the web at Adoptionsocialworkny.com

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Perinatal (prenatal) encephalopathy

Sun, 16 Sep 2007 21:52:32 GMT

We were just referred a 7 month old boy that was born at 35-36 weeks. The medical report we received says that the neurologist diagnosed him as having "perinatal lesion of central nervous system." In June and August, the notation "early recovery period" was on the report. In October, the notation was "late recovery period."

Is "perinatal lesion of CNS" something that you frequently see? How concerned should we be?

This is an excellent question because it is found all too commonly on many of the medical reports. I have also personally found that many adoptive parents access the internet for most of their adoptive information. It is well know that this is a common diagnosis and that most of the children do very well and do not have a neurological problem. It is because of this internet buzz that many parents and agencies just dismiss this diagnosis without a medical evaluation. Obviously, if a child has this diagnosis and is walking, running and normal developmental milestones on the video, chances are really good that this child will have a good neurological outcome.

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While at first glance one would worry about this diagnosis because it sounds as if the child may have suffered insult to the brain. Most intelligent people obviously are concerned about future neurological damage. According to Russian medical teaching, this diagnosis is given to an infant who had anything out of the ordinary that may have a future impact on the infant's brain development. It does not necessarily mean that the infant has brain damage. The diagnosis can be made on the behalf of the mother with something as common as no prenatal care, or on behalf of the infants status such as prematurity, abnormal laboratory testing or jaundice.

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All that it really means is that this infant is a high risk infant and it needs to be closely observed for problems during the first year of life. It does not necessarily mean that every infant will have a poor neurological outcome. This is obvious since most of the children that have this diagnosis are actually very normal.

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Below I am attaching a accurate translation of this diagnosis in a Russian text book. As you will see, that many of the things listed especially on the behalf of the mother will trigger this diagnosis, especially if the child is left in an orphanage. Such common issues are No prenatal care, lack of medical history, chronic health conditions of the mother. Most children that are abandoned in an orphanage, there is a lack of medical information on the mother, hence making this a higher risk infant. I think that this is why this diagnosis is so very common.

Perinatal (prenatal) encephalopathy: (Variably translated "perinatal lesion or affectation of the central nervous system," "encephalopathia," and many others.) One or more risk factors present in me history of the mother or the baby which may allow for a poor neurological outcome. (see the table that follows.)

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There may be mild neurological impairment in the infant.

Perintal (prenatal) encephalopathy:

Maternal factors :

Lack of known medical history, alcohol or cigarette use, No prenatal care, Anemia Past miscarriages, abortions or premature delivery, Young or old maternal age, High number pregnancy, Chronic health problems, Infections, Poor social situation, Difficult or complicated delivery, Abnormal placenta

Infant factors:

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Low Apgar scores, Abnormal muscle tone or reflexes, Jaundice, Seizures, Irritability or depression, Tremor, Poor suck, feeding problems, Abnormal head circumference, Congenital abnormalities Genetic conditions, Abnormal ultrasound of brain or other parts of body, Intrauterine or perinatal infections, Prematurity, Abnormal prenatal growth, Abnormal laboratory tests,

Perinatal trauma (affectation) of the central nervous system: Synonym for perinatal encephalopathy. Also called perinatal lesion, cranio-cerebal trauma of the newborn and other variations

Stage of condition: The progression of a disease

1) Recuperation or rehabilitation: Improving but still requiring treatment.

2) Residual: Almost recovered but signs or symptoms not completely resolved, expected to be healthy. Also used for late or permanent results such as scar or stroke.

3) Recovery period: Condition or illness completely resolved.

4) Compensated: Abnormal but stable.

5) Subcompensated: Abnormal, clinically unstable, may deteriorate.

Logistically interpreting the limited information given about this child, the diagnosis was given because of the slight prematurity. A couple of months later, he was categorized as being in the Early Recovery period, they thought that the child was doing good and then in the late recovery period: Condition or illness completely resolved.

I am really fortunate to see many children that have this diagnosis listed on their medical, yet after I see them in the U.S.A most of these children do very very well.

Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

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Reader's Question on Leukemia in Chinese girls

Sun, 16 Sep 2007 22:07:37 GMT

In dealing with the medical aspects of international adoption, the usual outcome is almost always a happy ending. Yes, there are those cases where there is an underlying medical condition, developmental delay or emotional trauma. Fortunately, most of these cases can be treated with medications, therapy or surgery. When I treat an internationally adopted child, I obtain the greatest professional satisfaction because I know that I made a difference is a child's life. I know that if this child was not adopted by their family , their medical problems would have gone undetected, because no one cared to look for them and more than likely their illness would have gone untreated.

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Every day in my clinical practice I deal with all types of children with variable types of medical conditions. On my website www.adoptiondoctors.com , I answer many questions placed by worried adoptive families. This question that I am answering today I write about with a heavy heart. As physicians we are trained to deal with all aspects of tragedy, but rarely would a physician encounter a case such as the one I will be describing. The topic today is about a Chinese girl that was fortunate enough to be adopted, and was in excellent medical health for years post adoption. She had very rarely been to the doctor's office other than for routine well care visits. It was not until over two after coming home did this child become acutely ill and succumb to her death secondary to acute leukemia.

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Many people are now wondering if Leukemia is a problem specific to children adopted from China? Is there a test that could be performed for leukemia prior to adopting, and most importantly, does hereditary a play a key factor in the diagnosis?

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The short answer to this question is No! I feel that this was just an unfortunate case.

Leukemia is the most common form of childhood cancer and it generally can affect almost any child anywhere. There are some suspected risk factors which I will mention but all in all no one can predict which child will and which child will not get leukemia.

In this article, I will do a brief over view of leukemia in order to help educate those worried families out there.

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Usually, the leukemia is a cancer of the white blood cells, but leukemia can involve other blood cell types as well. Leukemia starts in the bone marrow and then spreads to the blood. From there it can go to the lymph nodes, spleen, liver, the brain and spinal cord, testicles or other organs. Leukemia is described as rapidly growing (acute) or slow growing (chronic). Almost all childhood leukemia is acute.

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The fast growing leukemia is divided into 2 types:

- acute lymphocytic leukemia (ALL, also called acute lymphoblastic leukemia)

- acute myelogenous leukemia (AML, also called acute myeloid leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia (ANLL))

Leukemia is the most common cancer in children and adolescents. It accounts for almost one third of all cancers in children under age 15. ALL is most common in early childhood, peaking between 2 and 3 years of age. AML is most common during the first 2 years of life and is less common among older children. ALL is slightly more common among white children than among African-American and Asian-American children, and is more common in boys than in girls.

AML occurs equally among boys and girls of all races.

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What Are the Risk Factors for Leukemia? A risk factor is defined as anything that can increases a person's chance of getting a disease such as cancer.

Genetic Risk Factors

Certain genetic or inherited diseases cause children to be born with an abnormal or deficient immune system. In addition to developing serious infections due to their reduced immune defenses, these children also have an increased risk of developing leukemia.

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Although these immune deficiency diseases can be passed on to children, adult leukemia survivors who do not have these inherited diseases do not pass an increased risk of leukemia on to their children.

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There are also several other inherited disorders that increase a child's risk of developing leukemia:

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Children with Down's syndrome (trisomy 21) have an increased risk of developing leukemia. Children with Down's syndrome are 15 times more likely to develop either ALL or AML than are other children.

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Klinefelter's syndrome is a genetic condition in which males have an extra "x" chromosome. This causes infertility, prevents normal development of male features (such as body hair, deep voice, etc.), and is also associated with an increased risk of developing leukemia. Several other genetic disorders (neurofibromatosis, ataxia telangectasia, Wiscott-Aldrich Syndrome, and Fanconi's anemia) also carry an increased risk of developing leukemia,

Environmental Risk Factors

Environmental risk factors, such as radiation and certain chemicals, in our surroundings may increase the likelihood of developing leukemia.

Radiation exposure: Radiation injury is a major environmental risk factor in developing childhood leukemia. Japanese survivors of the atomic bomb had an increased risk of developing AML, usually within 6-8 years after exposure. Similar risks occurred after exposure to nuclear reactor accidents. Exposure of the fetus to significant radiation within the first months of development may also carry an increased risk of developing ALL.

Certain chemicals: Exposure to chemicals such as benzene may cause AML in adults and, rarely, in children. ALL has not been linked to any cancer-causing chemicals.

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Other factors that have been studied for a possible association with ALL include exposure to insecticides; mother's age at birth; mother's use of alcohol, cigarettes, diethylstilbestrol (DES), or contraceptives; father's occupational exposure to chemicals and solvents; and chemical contamination of ground water. Now one could say that some of these things may be found in an orphan child's environment, but it would not be specific to just China, it could be from anywhere in the world. Regardless, none of these factors has been linked conclusively to leukemia.

Can Leukemia be prevented?

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Children with a known increased risk of developing leukemia (because of Down's syndrome, for example) should receive careful, periodic medical checkups and at that time routine complete blood counts or CBC. The frequency of leukemia in children with these syndromes, although greater than in the general population, is still very rare.

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Signs and Symptoms of Childhood Leukemia

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Most of the signs and symptoms that children with leukemia develop result from a lack of normal blood cells caused by crowding out of normal blood cell-producing bone marrow by the leukemia cells. It has been my experience that children do not just come to the office with a Diagnosis of leukemia. They tend to have multiple visits with strange complaints. Their illness or symptoms never completely resolve or they just get worse. The diagnosis is usually suspected after a physician does a complete blood count and it is discovered that the blood lines are abnormal.

Sometimes children present with repeated infections that do not respond to antibiotics. They can have a high fever, and become very sick. Also, some children present with vague symptoms of leg pain that is initially diagnosed as growing pain. Leukemia is a cancer of white blood cells, children with leukemia may have extraordinarily high white blood cell counts, but these affected leukemic cells do not protect against infection the way normal white blood cells do. Thus the classic case is a child with prolonged fevers that do not respond to conventional therapy even after many days to weeks.

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A child with leukemia may bruise easily or have increased bleeding from small cuts and nosebleeds. There may be pinhead-sized red spots on the skin that represent bleeding from tiny blood vessels. This results from poor production of blood platelets, which are important for plugging holes in damaged blood vessels.

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Some children present with recurrent bone pain. Many times they may be diagnosed initially with growing pain. The diagnosis again is suspected after an abnormal CBC is performed. The pain is caused by an accumulation of the leukemia cells underneath the covering of the surface of the bone. Some children will also have a lack of appetite.

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Unfortunately, a poor appetite is run of the mill in Pediatrics. Leukemia often causes enlargement of the liver and spleen. Enlargement of these organs would be noticed as a fullness, or even swelling, of the belly. The lower ribs usually cover these organs but when they are enlarged, the doctor can feel them.

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Leukemia can also spread to lymph nodes. The child, a parent, or a health care professional may notice swollen nodes that are close to the surface of the body (lymph nodes on the sides of the neck, in the groin, underarm areas, above the collarbone, etc.). Swelling of lymph nodes inside the chest or abdomen may also occur. These are sometimes detected only by imaging tests, such as CT or MRI scans.

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Headache, seizures, vomiting: Leukemia cells can spread outside the bone marrow. This is called "extramedullary spread." It may involve the brain and spinal cord, the testicles, ovaries, kidneys, lungs, heart, intestines, or other organs. Headache, poor school performance, weakness, seizures, vomiting, difficulty in maintaining balance, and blurred vision can be symptoms of CNS leukemia.

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Rashes, fatigue, and weakness: AML can cause some unique symptoms. Leukemia cells may spread to the gums, causing swelling, pain, and bleeding. Spread to the skin can cause small darkly colored spots that can resemble common rashes. One unusual but very mysterious consequence of AML is extreme tiredness, weakness, and slurring of speech, which occurs when very high numbers of leukemic cells make the blood too "thick" and interfere with circulation through small blood vessels of the brain.

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As you can see, leukemia is a very difficult diagnosis to predict. Suspicion for this illness should be made when a child presents with what appears to be vague or mysterious signs and symptoms that do not resolve after the routine time frame. The suspicion is generally made after a good history and physical examination is performed followed by a complete blood cell count. The definitive diagnosis is made by a bone marrow aspiration.

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Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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Intestinal Parasites in the orphan child

Sun, 16 Sep 2007 22:12:35 GMT

Are Intestinal parasites common in orphan children? What do I as an adoptive parent need to know?

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Unfortunately, intestinal parasites, particularly parasitic infection is the most common medical condition that I diagnose in many of the Internationally Adopted children that I examine shortly after they arrive to the United States. The principal reason why these children are so prone to this condition is because of crowded living conditions of the orphanage, and because of the poor hygiene by both the children and the staff that cares for them. Intestinal parasites are widespread in orphanages across the world. Clinical finding encountered in infested child can range from anemia, chronic diarrhea, and failure to gain weight. In Eastern European orphanages, Giardia Lamblia infestation is the most common organism, but in other parts of the developing world, multiple infestations can coexist. Reinfection rate in developing countries can be so great that medical professionals do not even bother to treat them.

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Clinical signs that should suggest a parasitic infection in an Internationally adopted child:

1) Bloating

2) Diarrhea

3) Vomiting

4) Trouble digesting foods

5) Rectal itching

6) Recurrent abdominal pain

7) Large volume in stools

8) Blood or mucous in stool

9) Abdominal distention

Unfortunately, these vague abdominal signs and symptoms can also be associated with many other problems encountered in adopted children, such as, introduction in new foods to the diet, food allergies, and lactose intolerance.

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In order to determine which child is infected with parasites, universal screening should be performed at the post-arrival visit regardless if there are signs or symptoms. It is imperative to diagnose and threat the infected child before it becomes a public health hazard for the home and school system. Three screening stool samples for intestinal parasites need to be carefully investigated 2-3 days apart. Multiple specimens are required to increase the detection rate. A special collection kit that will be supplied by the reference lab needs to be used in order to collect the stool specimen. Stools that have been collected in the early morning left to sit for a couple hours are not adequate for evaluation. My personal approach to the collection of stools is as follows. At the post-adoption examination, I provide the collection medium to the parents and multiple tongue depressor sticks. They can catch to stool in the diaper and immediately transfer the specimen to the appropriate collection medium. In the toilet trained child, I suggest that they apply saran wrap around the toilet bowel and allow the child to stool right into the wrap. The parent can the use the tongue depressor sticks and transfer the specimen into the transport medium. In both cases, the parents are instructed to immediately deliver the specimen to the laboratory for processing. Along with the routine screening for Ova and Parasites, I concomitantly check for Giardia Antigen, and Cryptosporidium antigen.

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Just because the initial evaluation of the stool testing was determined to be negative, sometimes a late onset presentation of intestinal parasite can occur moths later. Children that have persistent signs or symptoms of intestinal pathology should be retested, regardless of prior studies. Therapy may need to be implemented if stool evaluations are determined to be positive.

Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Additional information and references:

1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC

2)William W. Hay M.D. Current Pediatric Diagnosis and Treatment. McGraw-Hill Medical Publishing.

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Malnourished orphan children and Iron Defciency Anemia

Sun, 16 Sep 2007 22:16:46 GMT

Do malnourished internationally adopted children suffer from Iron deficiency anemia? Could this be a probable cause of the child's developmental delay? What do I as an adoptive parent need to be aware of?

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It is a well-known fact that all children need a well balanced diet in order to assure a healthy physical and cognitive development. Children that live in orphanages unfortunately suffer from malnutrition and environmental deprivation of varying degrees, depending on the country of origin. These combined deficiencies can lead to serious vitamin deficiencies can lead to serious, but easily reversible medical complications if they are recognized in a timely fashion.

Iron deficiency Anemia: is by far the most common deficiency found in the many of the internationally adopted children that I evaluate. Iron is essential for the normal brain growth, production of hormones, and energy metabolism. Children with this deficiency are at risk for suffering from severe anemia and developmental delays.

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There are various reason why an institutionalized child is at risk for this deficiency.

a) Lack of maternal prenatal care

b) Poor maternal health, most of these mothers are anemic themselves

c) No prenatal vitamin's

d) Low birth weight of infant

e) Prolonged bottle-feeding with formula that is not fortified with iron.

f) Use of tea in diet, which has an ingredient that inhibits iron absorption by the body.

g) Intestinal parasitic infections causing microscopic blood loss.

h) Concurrent lead poisoning.

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Normal term infants are born with enough iron stores to prevent deficiencies for the first 4 months of their lives. After four months, enough iron needs to to be absorbed through their diet, of therapeutic supplementation in order to keep up with their rapid growth and development. The most common age for iron deficiency is between 6 months and 24 months. Earlier deficiency generally occurs if there was a decrease in the iron stores secondary to prematurity, small birth weight, neonatal anemia. Older children need to be evaluated for blood loss.

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There is significant evidence clinically that clearly indicates, that Iron deficiency in addition to causing anemia, additionally has some influences on behavior and cognitive development, that if left untreated can persist into later childhood.

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Clinical signs of Iron deficiency Anemia: The signs and symptoms can vary with the severity of the deficiency.

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1) Mild anemia: is generally asymptomatic which means without any signs of symptoms.

2) Moderate Anemia: tiredness and exhaustion, irritability, pale skin delay in motor development.

3) Severe Anemia: with complete depletion of iron stores, nail deformities, glositis, heart failure.

Most children that arrive at the U.S.A. are of the mild to moderate anemia category. During the Post-Arrival medical evaluation, a routine complete blood counts or "CBC: is performed. This test is used as a screening tool to see if a child has a low hemoglobin or hematocrit, which would indicate iron deficiency. While this is an excellent screening tool, unfortunately, these laboratory abnormalities appear commonly after there is already a depletion of the body's iron stores. A more accurate laboratory test would discover the deficiency earlier be "Iron studies: Serum ferritin, iron levels, iron binding capacity and transferring levels" These are diagnostic tests and not screening tools. Children that are internationally adopted should all be considered high risk for being iron deficient. This diagnosis should be confirmed or dismissed with the iron studies. We should not wait for the child to become anemic. A proactive attitude needs to be taken.

Therapy for Iron deficiency is very easy to implement. A nutritious well balanced diet is mandatory. Children will benefit from iron fortified cereals, formula and foods. Some iron rich foods are ( beans, peas, spinach, and meats). While many parents feel that milk is healthy for the growing child, excessive amounts of milk are a major cause of iron deficiency anemia even here in the U.S.A. Milk should be limited to only 19 oz per day during the second year of life. Supplemental multi vitamins fortified with iron or even therapeutic doses of iron may be necessary to treat the internationally adopted child.

By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Additional information and references:

1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC

2)William W. Hay M.D. Current Pediatric Diagnosis and Treatment. McGraw-Hill Medical Publishing.

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Positive PPD in the Internationally Adopted child

Sun, 16 Sep 2007 22:22:53 GMT

The purpose of the tuberculin (PPD) skin test is to identify people who have the tuberculosis germ in their bodies. Many times these people feel perfectly fine without any symptoms. This germ is generally dormant requiring many years and a weakened immune system before causing real medical disease.

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Tuberculosis is an illness that primarily affects the lungs, but it can also affect other organs such as the bone, kidney, brain and the lymph nodes. For decades the incidence of TB has decreased in the USA. It however, has increased steadily during the late 1980's to early 1990's. Adults with active tuberculosis now probably were infected with the germ many years prior and they did not take the preventative treatment as we do today. They also were infected at a time when their body and their immune system were much stronger and better able to protect itself. If a child is diagnosed to have active TB, it means that someone in the household or in the immediate daycare or orphanage setting must have active disease, thus infecting the child.

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What is commonly seen in children who lived in orphanages is a positive PPD test. A positive test by itself only means that the child had been exposed to the tuberculosis germ and that they have it in their body. If this goes untreated, then this person can become ill with active tuberculosis anytime in the future. Since this a dormant germ, it can take anywhere from 20-30 years to become reactivated generally when the body is much older and has a weaker immune system.

If a child had a positive PPD, the standard of care is to obtain a chest x- ray in order to look for active tuberculosis of the lung. If the chest x-rays is positive and the child is diagnosed with active TB, it means that someone in the household or the orphanage must have the active disease and has infected the child. This child is generally symptomatic with a long standing cough, night sweats and weight loss. This condition is highly contagious and the child needs to be admitted to the hospital for further work-up and treatment with a multitude of anti-tuberculosis medication.

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For a child that has only a positive PPD and a negative chest x-ray with absolutely no clinical symptoms, this condition is not contagious and it will not spread to other members of the household. In order to ensure that the tuberculosis germ does not become activated and cause illness as the patient becomes older, it is necessary to take a preventative medication called INH or Isoniazid. This medication needs to be taken daily for nine months in order to prevent future tuberculosis symptoms. While INH is generally quite safe, it can cause temporary changes in the liver functions thus it requires close monitoring by a physician.

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By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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""Medical Issues of the Post Institutionalized Child""

Sun, 16 Sep 2007 22:25:19 GMT

By: George Rogu M.D. of Adoptiondoctors.com

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Generally, children that are placed for international adoption are placed because of a multitude of reasons. They are rarely if ever placed because they come from intact family networks with perfect family medical and past medical history. These children are placed because of abandonment, poverty, illness or death of parents, or severe familial dysfunction (such as drug abuse, alcoholism, child abuse and or neglect). All of these conditions can bring on a multitude of health conditions in a child. Children that have been referred to for international adoption may have also encountered a lack of healthcare and immunizations, poor prenatal care and early childhood neglect.

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Some of the major Health problems encountered in these children may include malnutrition, lice, tuberculosis, intestinal parasites, minor congenital defects, developmental delays scabies, and severe infections such as hepatitis (A, B, C) and HIV infection or AIDS and syphilis.

The overall emotional and psychological health of the child that live in an orphanage for a prolonged period of time can be affected. If the child is placed in the hostile institutional care setting, with little social interaction, and no stable maternal figure, the critical emotional and psychological development is disrupted. It is because of this abnormal normal the living arrangement that future emotional and psychological conditions such as (reactive attachment disorder, sensory integration dysfunction, ADHD, posttraumatic stress disorder) can develop even after the child is adopted and placed into an intact family unit.

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After a family receives a referral, it is very important that they have all of the available medical information (medical records, videotapes, pictures) evaluated by a physician who has an interest and experience in interpreting international medical documents. Growth parameters need to be plotted on standard growth charts, screening laboratory tests need to be interpreted, and medical diagnoses found on the chart needs to be evaluated in order to determine if they are significant or not. After speaking with many families about their referrals, I have found a universal question that is asked of me. Are all of these diagnoses that I found on the Russian medical report are common and can be easily dismissed.? I agree that many times many times the diagnosis is placed without supporting data; they should not be dismissed just because they are on many reports.. Only a trained physician is able to determine if a particular diagnosis a significant or not. I always state, "this diagnosis can mean something or it can mean nothing, we need to investigate it further and figure it out" When I perform a pre-adoption evaluation, I sometimes feel more like a detective rather than a physician.

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The role of the pre-adoption evaluation is not to pick out the child for family. Its role is more of an educational role empowering parents with the knowledge in order to make an informed decision whether to adopt or not adopt that particular child.

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Health problems seem in children place for international adoption.

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1) General infections: such as hepatitis, HIV infection, syphilis and intestinal parasites, skin parasites (scabies, lice) can be encountered in these kids.

Blood screening tests are used to determine if the child has or was exposed to HIV, syphilis and or hepatitis. The vast majority of countries open for international adoption provide these results in your child's medical history. These tests are not diagnostic of any illness and should only be used as a screening tool. It does not mean that the child will not be exposed to the disease after the test was taken. Generally it is reassuring to have a negative screening test. It just means that the likelihood of the child actually having one of these illnesses is low. Upon arrival to the U.S.,a repeated HIV, hepatitis, and syphilis test need to be performed upon arrival and after six months. Intestinal parasites are also commonly found in children with that live in overcrowded quarters. Giardia infection is found in the stool specimen of many children. It is easily treated after the child comes home.

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2) Fetal alcohol syndrome: is a common risk factor in eastern European countries and in Russia. It should is not as common in Asia where alcohol consumption is not a societal norm. fetal alcohol occurs when the fetus is exposed to alcohol during the pregnancy. Fetal alcohol is a cluster of related problems. There is no one specific test to determine exposure. Some of the common characteristics this entity are listed below:

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I. Small head circumference and brain size (microcephaly)

II. Mental retardation and developmental delay

III. Abnormal behavior such as short attention span, hyperactivity, poor impulse control, extreme nervousness and anxiety.

IV. Visual difficulties

V. Slow physical growth before and after birth

VI. Distinctive facial features such as:

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= flat nasal bridge

= within the upper lip

= short upturn nose

= smooth skin surface between the nose and upper lip (missing philtrum)

= small eye openings

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While the actual diagnosis of fetal alcohol syndrome or fetal alcohol effect cannot be definitively made during the pre-adoption evaluation, suspicion or risk may be determined.

3) Reactive attachment disorder: is a condition in which a child has great difficulty forming last thing, loving relationships. It usually results from neglect or abuse or because the child has not formed a bond with a parent or primary caregiver. If his condition occurs as a child its older he or she is unable to sustain healthy relationships with anyone. The risk for RAD can be minimized if the ratio of caregivers to children as low. A good ratio is one caregiver for every three or four children; the bad ratio is one caregiver for every 20 children. When evaluating videotape, one can look for evidence of how the child interacts with other people.

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4) Sensory integration dysfunction: can result when babies are unable to explore their surroundings and are left alone in the cribs for long periods of time and do not receive the loving touch of a caregiver. As a result, the body senses interpret information inappropriately. For example, the nervous system can over react to heat and cold or noise, bringing out hostility, withdraw, and clumsiness in the child. This disorder can be treated to therapy and provided by an occupational therapist. It is very hard to tell from the video if the child has sensory integration dysfunction.

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5) Tuberculosis: generally children have exposure to bacteria and not active disease of the lung. Children found to have been exposed, through a positive PPD screen, all children are placed on prophylactic treatment with Isoniazid for nine months. This regimen helps to prevent the spread of the disease to the lungs.

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6) Immunization status: some children may have some immunizations (hepatitis b, polio, DTP) but many times they have nothing.

7) Malnutrition and neglect

8) Developmental delay and growth delay

9) Rickets secondary to poor nutritional intake and lack of sunlight

10) Physical in central abuse

11) Lead poisoning

As you can see, children available for international adoption may have a wide array of potential health problems. It is reassuring to know that most of these health problems faced by these children can be effectively treated with modern medicine. The only problem is that you may not know the child's health problem until you have returned home.

If the child's medical history and video tape look good to it would be prudent to have these documents evaluated by a physician in order to determine if" can this be something or is it nothing"

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By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

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Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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Child tested positive for syphilis at birth?

Mon, 17 Sep 2007 06:06:54 GMT

A diagnosis of congenital syphilis is very difficult to establish because clinical signs of infection may not be apparent and many times the blood test are unreliable. Syphilis is a sexually transmitted disease that is transmitted form the mother to the infant via the placenta. Fortunately, if this disease is discovered during the prenatal visits it can be easily treated with Penicillin. Untreated maternal infection in the early stages of the pregnancy can lead to significant fetal morbidity whereas infection in the later part of the pregnancy can produce a symptomatic infant.

The two most commonly used screening tests for syphilis are (1) VDRL: is useful for screening and follow-up of known cases and (2) RPR: used for screening. All screening tested need to be confirmed with a more specific test called the FTA-ABS that can verify current or past infection. If this test is positive then the likelihood of having the infection is pretty good and needs to be treated.

The causes for the false positive results on the initial screening test can be secondary other medical conditions such as: (aging, pregnancy, mononucleosis, hepatitis, IV drug addiction, and some autoimmune disorder like lupus). Another reason for a false positive screening test or (VDRL or RPR) it may represent passively transferred antibody from the mother and not actual congenital infection. In cases where it is believed that the positive test result is from passive maternal transfer in the absence of active infection, it is required to follow-up with serial measurements of VDRL and they should reduce to normal values by a couple of weeks.

Like in adults this infectious disease is easily treatable with inject able penicillin.

Infants with a positive confirmatory serology for syphilis should be evaluated fully.

A complete history of the maternal disease and therapy is mandatory. The infant needs to have a complete blood count done, liver function test; long bone x-rays, spinal fluid examinations.

Treatment needs to be given to infants with:

1) Whose mother's were inadequately treated?

2) Mother's who received treatment less than one month prior to delivery.

3) Mother's who were given other medications other than penicillin.

4) Mother's who had undocumented or a poor blood testing response to treatment.

If the mother had received adequate therapy and there are no clinical or laboratory signs present, this infant may be followed without therapy but needs to have serial monthly blood tests performed. Rising titers or clinical signs usually develop by 4 months in infected infants.

Infants with proved or suspected congenital syphilis require treatment with injectable penicillin every6- 8 hours for 14 days.

Clinical signs:

Newborns: usually symptomatic but when signs do develop after a few weeks they are, Jaundice (yellowing of the skin), anemia (low blood levels), large liver and edema or swelling. Some may even have severe signs of meningitis or infection of the spinal fluid.

Young Infants: normal for first few weeks and then develop skin lesions, and a paralysis of the arms or legs. There is usually an enlarged liver or spleen, and like the newborns there is anemia. "Snuffles" (rhinitis or continuous runny nose) with a thick mucous drainage that excoriates the upper lip is found sometimes. A syphilitic rash usually occurs on the palms and feet but may occur anywhere on the body. They look like bright red spots that gradually fade.

Syphilis in the young infant may lead to stigmatas recognizable in later childhood

1) Rhagades: scars around the mouth and nose

2) Depressed nasal bridge (saddle nose)

3) Permanent upper teeth peg shaped with a central notch ( Hutchinson teeth)

4) High forehead secondary to low grade meningitis

Children: (untreated with spinal fluid meningitis complications)

1) Eye problems and infections

2) Deafness, mental retardation

3) Speech defects

4) Bone manifestations

Prognosis:

1) Severe disease if undiagnosed may be fatal to a newborn.

2) Complete cure can be obtained if young infant is given Penicillin

3) Treatment of primary syphilis with penicillin is curative

4) Blood test reversal occurs within one year

5) Permanent neurological sequelae occur only with severe spinal disease.

Questions that you need to ask?

1) What test were performed and at what ages? Where they repeated or confirmed?

2) Was the mother treated during the pregnancy with penicillin?

3) Was the infant treated with penicillin and for how long? Was it injectable?

4) What if any follow-up testing was performed?

By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and

Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Congenital hip dysplasia in the orphan child

Mon, 17 Sep 2007 06:19:10 GMT

This term is antiquated and the only reference that was found was from literature dating from the 1970's. It does indeed refer to dysplasia of the hip, but that does not necessarily mean that there is true medical disease of the hip. The coxofemoral joint is the hip joint.

Depending on when you do a sonogram of a baby's hip many children can be incorrectly diagnosed with developmental dysplasia of the hip. This is especially common in Russian medicine because normal developmental variants are "diagnosed" as disease, when in reality this is just a normal developmental variant without medical implications.

Hip Displasia - this diagnosis appears reasonably frequently in Russian many of the Russian Medical reports. Unfortunately, it potentially refers to the western diagnosis of "congenital hip dislocation" and there is no supporting radiological studies performed to support this diagnosis.

This particular diagnosis may indicate a suspected problem or just a normal developmental stage. Of it may just mean almost nothing if it is just written.

The true Western definition of Congenital Hip dysplasia describes: an abnormal development of the hip joint with instability and possible dislocation of the thigh bone from the hip socket. This condition is also referred to as developmental hip dysplasia. This medical condition generally is present at birth or shortly afterwards.

During normal gestation of the fetus, the head of the thigh bone (femur) should be sitting centered in a shallow socket called the actetabulum. This actetabulum should cover the head of the femur bone as if it were a ball sitting in a cup. When congenital hip dysplasia occurs, the development of the actetabulum in the infant allows the head of the femur (thigh bone) to ride upward and out of the socket. This condition becomes more noticeable especially during weight bearing stages of a child's development.

Causes of Congenital hip dysplasia:

There is a familial tendency towards hip dysplasia, with females being affected more so than males. This type of disorder is found across many different cultures and around the world. The incidence has been higher in cultures where there is a practice of swaddling and using the cradleboards for restraining infants.

The incidence is also higher in infants born via cesarean section and in those born in a breech presentation.

Diagnosis:

The hip disorder is generally suspected during a physical examination by moving the hips to determine if they the head of the femur moves in and out of the hip socket. During the examination a distinct clicking sound is produced with the motion. This test is performed in the newborn period. In the older babies, there may be a lack of range of motion in one or both hips; while in the older infant hip dislocation is evident if one leg looks shorter than the other.

In the past x-rays were performed to detect abnormal finding of the hip joint. Ultrasound is now performed because it is a safe and diagnostic of hip dysplasia. Ultrasound has advantages over x-rays because it can investigate several positions during the procedure, while x-rays observe only one view. It is very hard to make a diagnosis of hip dysplasia without radiological images to support that diagnosis.

The treatment of hip dysplasia has an objective to replace the head of the femur back into the socket (acetabulum), by applying constant pressure. By doing this, it enlarges and deepens the hip socket.

In the past stabilization was achieved by placing rolled cotton diapers or a pillow between the thighs, thus forcing the knees to remain apart in a frog leg position. With the advances in technology, different harnesses and slings were created to obtain the same effect. These slings are used in infants up to six months of age.

A hard cast can be used to obtain the same effect of spreading the legs apart and forcing the head of the femur into the socket. In older children, surgery may be required to reposition the joint.

Unless this condition is corrected soon after birth, abnormal stresses can cause malformation of the developing femur bone, causing a limp or waddling gait. If cases of congenital hip dysplasia go untreated, this unfortunate child will have difficulty walking, and subsequent pain as the child gets older.

By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Zinc Deficiency and the orphan child

Mon, 17 Sep 2007 06:23:08 GMT

I have heard than many orphanage children that has developmental delay may also suffer from Zinc deficiency? Is this correct and what can we do to manage it ?

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As with many other types of other vitamin deficiencies found in the Internationally adopted child, Zinc deficiency has been linked to many of the problems found in these children. Attention-deficit hyperactivity disorder, learning difficulties, growth and developmental delays as well as immune dysfunction have all been implicated. It is still not clearly understood if Zinc deficiency is the primary cause of these conditions. Or is the Institutional environment. What is known is the fact that after Zinc deficiency is appropriately treated, some of the developmental and behavioral problems improve to a degree.

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Dietary factors and environmental health factors that may cause Zinc deficiency:

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1)Lack of meat, fish, poultry

2)Diets high in fiber (legumes & cereals) will inhibit Zinc absorption

3)Diseases of the intestinal tract that cause poor absorption (enteritis)

4)Chronic diarrhea secondary to infectious origin cause excessive loss of Zinc

Clinical signs of Zinc Deficiency are not specific.

1)Enlarged liver and spleen

2)Irritability

3)Diarrhea

4)Skin rashes around, eyes, nose, and mouth

5)Hair thinning and loss

6)Friable nails

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As you can see, Zinc deficiency is not easy to diagnose .Many American physicians would not even entertain such a medical condition in their daily routine medical analysis. Before it can be diagnosed, it first must be thought about. All Internationally adopted children should be considered of high risk.

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Zinc deficiency can be associated with numerous medical problems. Growth delays are found in many Internationally adopted children as is Zinc deficiency. Zinc is very important in the regulation and synthesis of many types of different hormones, such as Growth, thyroid, and androgens. This is why many of the Zinc deficient children are smaller than their peers.

Zinc deficiency is additionally associated with an increasing susceptibility to infections, with a prolonged recovery rate. Children that reside in an Institutional environments are prone to recurrent infections because of crowded living conditions. Orphan children that also suffer from Zinc deficiency take much longer to recover from a simple ear infection. Zinc deficient children are also prone to develop parasitic infection. It is not definite if the reason is because of poor hygiene in a crowded environment, but it is recognized that intestinal parasites are better able to survive in a zinc deficient host.

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Cognitive developmental delays are also associated with Zinc deficiency. The effects of this deficiency depend on at the age when it occurs. Children seem to be more vulnerable to the cognitive effects of zinc deficiency during periods of rapid growth.

Some of the cognitive developmental problems associated with this conditions are:

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1) Behavioral issues

2 ) Impaired response to stress

3) Short term memory deficits

4) Lack problems solving skills

5) Spatial learning problems

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It is believed in the medical community that Zinc can play an important role as adjunctive therapy to stimulant medication in the treatment of Attention deficit disorder. While ADHD is another medical condition found in Internationally adopted children, it is also found commonly in children from the general population in the U.S.A.. There are several studies state that ADHD children have a decreasing Zinc level. This has also been my personal experience in private practice.

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The relationship between International Adoption, Zinc Deficiency, growth delays, and behavioral problems remains a mystery. I am convinced that there is an association, but a cause and effect scenario still needs to be investigated.

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By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Additional information and references:

1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC

2)William W. Hay M.D. Current Pediatric Diagnosis and Treatment. McGraw-Hill Medical Publishing.

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H. Pylori screen in asymptomatic adopted child

Mon, 17 Sep 2007 06:30:33 GMT

The incidence of H. Pylori is very low in children of industrialized countries. The incidence increases by a small amount every year and it dramatically increases after the age of 20 years.

Transmission is usually by person to person contact, and water supply is also incriminated as a mode of transmission.

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There seems to be an increase incidence of H. Pylori gastritis in children with the following exposure factors:

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1) children where a parent already has H. Pylori 2) Low socioeconomic class 3) Children of third world countries, where the water supply is contaminated 4) Institutionalized children 5) Certain ethnic populations, African-American, Chinese, East Indians, Mexicans.

Clinical manifestations of H. Pylori infection: Many children can be asymptotic, or there may be acute or chronic pain

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Acute symptoms: result from inflammation of the stomach lining, thus causing abdominal pain, nausea, heartburn, and other meal related symptoms. Children with H. Pylori usually do not respond to conventional treatments with ( antacids, and dietary manipulation)

Chronic Abdominal pain: H. Pylori should be considered in all children with recurrent abdominal pain that do not respond to conventional antacid therapy. It should also be considered if the child has any of the following signs or symptoms:

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* a) Recurrent abdominal pain

* b) Night time abdominal pain

* c) GI bleeding

* d) Meal related stomach ache or fullness

* e) Family history of peptic ulcer disease

The older the child is the more likely the diagnosis can be made because of the increase of prevalence of H. Pylori with age.

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Diagnosis of H. Pylori Invasive vs. Non-Invasive

Aggressiveness of the evaluation should be determined by the age group of the child, severity of the symptoms and the presence of the high risk group.

Endoscope

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* 1) Invasive testing: (Endoscopy) direct visualization of the stomach lining. One would identify inflammation and gastritis. A tissue biopsy would also be taken and sent to the pathology lab in order to identify microscopic evidence of gastritis and inflammation.

* 2) Stomach wall tissue obtained at biopsy can also be cultured in a special media. (similar to a throat culture in a pediatric office)

* 3) Rapid ureases test (clo test). A piece of stomach tissue is placed in a media and a chemical reaction occurs. If it changes colors it is considered positive. (similar to the rapid strep test in a pediatric office)

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Noninvasive methods: Serologic blood testing IgG to HP may help detect H. Pylori Infection.

This type of testing is much cheaper to perform but it is also less sensitive than the endoscopy. In the adult population, in view of the fact that colonization with HP is quite high, a positive result may be just colonization with the organism. The clinical relation to disease must be judged clinically. In other words, a positive serologic test in a asymptomatic patient is more than likely to be colonized with the HP and not cause any type of disease process, and a positive serologic test in conjunction with abdominal complaints is active disease and needs to be treated.

In children, most pediatric gastroenterologist do not recommend treating a child based on serologic testing alone, although a positive result in a child may be more specific than in an adult because of the low prevalence rate of the pathogen.

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In regard to internationally adopted children and universal screening for H. Pylori, it is not a routine practice since children in general have a low incidence of H. Pylori infection. When evaluating a Internationally adopted child, it must be remembered that these children have an increased incidence of infection when compared to children from the USA. Each case should be evaluated individually, and if there is even the slightest suspicion of abdominal complaints, these kids should be tested and referred to a Pediatric gastroenterologist.

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By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

edical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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Can immunization records from orphanages be relied upon?

Mon, 17 Sep 2007 06:36:02 GMT

To revaccinate or not is a very heated and emotional decision that all adoptive parents need to face with the help of their general pediatrician. While obviously, the safest and the most accurate way is to just revaccinate every child regardless of immunization records. Unfortunately, this method does not sit well with many parents; I feel that each case needs to be evaluated on an individual basis.

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There are many reasons why physicians in the U.S.A do not want to accept the immunization records for internationally adopted children. In this article I will try to elaborate on these concerns, and explain my personal style to vaccinations.

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A) Inadequate background medical records: Children that are adopted internationally either live in orphanages or are now placed in the foster care system. There may be many prior placements for this child and the medical record may not be forwarded with that child. In some cases, a child may have been placed in an orphanage at an older age, and vaccinations may have occurred prior to placement, and these records are not forwarded.

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B) Immunocompromised children: Children that grow up in foreign orphanages usually have a weakened immune status. This condition occurs because of the poor living conditions, malnutrition of the child, and lack of medications to treat simple illness. Because of their weakened immune system, these children may not be able to mount an adequate immune response to the vaccine. The sequence of vaccination boosters may not have been given appropriately, hence not mounting an immune response to the vaccine.

Other reasons: why these children may not mount an immune response is as follows:

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1) factitious immunization practices

2) use of outdated vaccines

3) Poorly stored and improperly handled vaccinations

4) Biologically impotent vaccinations because of poor manufacturing, transport and storage. Without the proper cold storage for these vaccines, there is no guarantee of their effectiveness.

5) Vaccines could be expired, making them completely ineffective.

6) Improper vaccine schedule for primary and secondary series.

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Much of this information presented comes from experience with children adopted many years ago in the eighties to early nineties. Since then, orphanages have changed for the better. In the times that we live in now, most people care about children and try to advocate for them. Orphanages especially in the Eastern European countries are now better staffed, supplied, and health care is now available. Granted it is not at the level that we have here in the U.S.A, it has greatly improved improved. Shortfalls do exist however. If the child lives in the main city of a particular country, funding is available, but if they live somewhere on the outskirts, you could be sure that healthcare is limited and may even be nonexistent.

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My personal approach to vaccinations is as follows:

1) If the parents are agreeable to just restating all vaccinations I will

2) If parents are afraid of vaccinations, I will draw serologic studies and see if the child mounted an immune response. I will complete the vaccination program as indicated under the AAP catch-up schedule.

3) In a very limited number of cases I may opt to just continue with the vaccine schedule from where they left off if a number of criteria are met;

a) Childs growth and health parameters are perfect

b) Vaccine record appears to be valid, with dates and manufactures, and absolutely no suspicion of foul play.

c) All blood work is normal

d) If the parents agree with this program

e) If I have had multiple children with the same health condition from the same orphanage.

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While the revaccination decision can be pretty emotional for parents because of extra shots, realistically even in children who got some vaccines overseas, they did not get a lot of them. Vaccines generally encountered on the medical record are only the Hepatitis B, DTP and Polio. Many times they do not even have the complete series; I would need to give them booster vaccines anyway. I rarely ever see the HIB, MMR, Chickenpox or the new Prevnar vaccines.

The revaccination controversy does certainly exist; I feel that it is somewhat over publicized. Vaccines are good things to have. They prevent many of the deadly childhood illness that many young doctors today here in the U.S.A, may never have seen.

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There are many people out there that have many personal stories related to the side effects of vaccinations. Some of these people are advocates against mass vaccination in the U.S.A, I respect their decisions and all that I can do as a physician is try to educate them. I never try to forcefully impose a doctor's belief and the standard of care on them. It is really good for their general health that most everyone around them is already vaccinated.

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I know that today, because of mass vaccination in the U.S.A, our children rarely die from these illness that may have affected them if they were to remain in the orphanages, such as Polio, Pertusis, HIB Meningitis just to name a few.

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By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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Reader's Question on HIV Infection

Mon, 17 Sep 2007 06:40:23 GMT

While there is no cure for AIDS yet, doctors are now able to diagnose infants earlier, prevent mother-to-infant transmission and provide life enhancing treatments for those affected.

Dynamics of Perinatal HIV transmission:

1) During pregnancy 2) During labor & Delivery (maternal infant exchange of blood and other maternal secretions the actual delivery) 3) After delivery through breast-feeding.

Several clinical factors increase the risk for perinatal HIV transmission:

* 1) Clinically advanced HIV disease in the mother

* 2) High plasma viral load in the maternal blood

* 3) Maternal IV drug use during the pregnancy

* 4) Preterm delivery

* 5) Breast feeding

The standard screening test for HIV infection is called the ELISA. This test checks for the HIV antibody. A positive result does not necessarily mean that the patient is ill. It needs to be confirmed with a more specific test called a western blot test. This test is extremely important because some persons can have a non-viral (other medical or immunologic conditions) that can give a false positive ELISA test result. Rarely, (in less than 1%) will an infected person fail to make antibody response to the HIV virus but these patients are usually obviously very ill. A similar situation may occur[gr1] in the very early weeks after the maternal primary infection with the HIV virus. Almost always in both these types situations the more sophisticated test like (western blot, viral cultures, PCR) is always positive.

Infants who are born to HIV-infected mothers will have positive test results for the HIV antibody, regardless of infection status. This is due to the maternal transplacental passage of maternal antibodies to the infant.

The average time to lose the maternal HIV antibody is about 10 months of age while all children lose the maternal HIV antibody by 18 months of age.

A diagnosis for HIV can usually be made by 2 - 4 months of age if the test performed are checking for HIV virus in the blood (nucleic acid detection or HIV culture).

In an infant who was exposed to HIV mother, a negative test result during the early period of life does not reliably rule out infection, but if this infant is otherwise well, and has had at least two negative HIV cultures or nucleic acid test performed over the age of one month and another over the age of 3 months, this infant is unlikely to be infected.

These infants should be monitored for signs and symptoms of the disease and should also be retested at 12 mo, 15 mo , 18mo and 24 mo. In order to look for a reversion to a negative status and to confirm the absence of the infection.

For the above referenced child we need to ask a few questions?

* 1) Find out exactly what type of HIV testing was performed, (ELISA, western blot. PCR or viral culture)

* 2) what was the child's health status for the past 15 months? Did they have an overabundance of respiratory infections, ear infections, thrush in the mouth?

* 3) Try to find out what is the biological mothers health condition like now

If the appropriate test was indeed performed and this child did not present with an unusual amount of infections, chances are good that this child has not contracted the HIV disease. Obviously, as per the follow-up protocol, we need to perform more HIV testing at 18 months of age and 24 months of age. If the titers continue to remain negative, the patient is a more than likely clear.

By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

Disclaimer

medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.