Post-Traumatic Stress Disorder in Internationally Adopted Children - Parents and professionals need to know that even young infants can and do develop PTSD from abandonment, neglect and the adoption process.

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Post-Traumatic Stress Disorder in Internationally Adopted Children

Parents and professionals need to know that even young infants can and do develop PTSD from abandonment, neglect and the adoption process.

July 31, 2007/ Jessica Gerard

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.

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.

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.

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.

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.

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.

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!

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.

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.

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.

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.

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.

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.

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.

We need to read and learn about the causes and symptoms of PTSD in adopted children before we meet our children.

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.

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.

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.

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.

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.

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.

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.

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.