There is a crisis of epidemic proportion within the International Adoption Community. It has the potential to compromise the health and well-being of many adoptive families. Known as Post Adoptive Depression or PAD, it affects over 65 percent of adopting mothers according to a recent survey by the Eastern European Adoption Coalition (EEAC), yet goes unacknowledged or unrecognized by agencies, social workers, and most of the medical community.

Post Delivery Depression, long recognized as an expected part of normal
pregnancy and delivery is an issue that is openly discussed and well
understood by the medical community and the public. Estimates vary, but
between fifty to eighty percent of mothers who have given birth will
experience the mildest form of PDD called "The Baby Blues" according to
Depression After Delivery, Inc. Of those, approximately ten percent will
suffer a more serious form of Postpartum Depression which is of longer
duration and has more symptoms. The cause of both these manifestations is
attributed to hormone changes and imbalances. Families, physicians, and
caretakers are alert for symptoms and offer unconditional support to new
mothers during this usually brief crisis.

The public and medical attitudes toward PDD are a far cry from the silence
and secrecy that surround a much more pervasive problem - Post Adoption
Depression Syndrome (PADS) which is a term coined by June Bond in her Spring
1995 article for Roots and Wings Magazine. For those of us who are part of
the International Adoption Community, in particular parents of orphanage
children, we have the added complication of adopting children who are almost
always older than newborns and have been in an institutional setting. In
many cases, our new children are toddlers to school-aged, and their
histories and language issues add an extra dimension to the possibility of
their new adoptive mothers developing PADS.

Over the past seven years, I have been intimately connected to the
international adoption community as adoptive mother to three older Russian
boys, as a member of the Eastern European Adoption Coalition (EEAC), as
Co-Owner and moderator for the Parent Education and Preparedness List at
www.eeadopt.org, and as founder and Co-Chair of Piedmont Families Through
International Adoption. Post Adoption Depression has been a recurrent and
persistent issue in all my support experience. In the Fall of 1999, with the
help of the EEAC which made our questionnaire available on-line, I launched
a survey to see just how prevalent an issue PADS really is. The results were
troubling. Our survey was accessible by members of the AParentRuss-List and
the PEP-List whose combined membership now tops 3,100. Non-sufferers of Post
Adoption Depression were especially encouraged to answer the survey. Of the
145 parents who responded, over 65% said they experienced Post Adoption
Depression, yet only 8 people reported they had been advised by their social
workers or agencies that this syndrome even existed. Preparation by those
agencies would have been helpful, according to 61% of all respondents,
sufferers and non-sufferers.

Why does PADS exist among the adoption community in such high numbers? There
are a host of very concrete and understandable reasons. Most newly adoptive
parents have spent literally years struggling to get to the point of having
a child to parent. Their protracted and unfulfilled hopes, dreams, and
longing may cause unrealistic expectations about exactly what it will be
like to be a parent, and they are unprepared for the grief they feel when
reality confronts the child of their imaginations. New parents may feel
guilty about their feelings of ambivalence, resentment, or anger toward
their new child. The belief in instant bonding or "love at first sight" is
often an unrealistic one. Falling in love with a child is much like falling
in love with a future mate -initial infatuation and euphoria give way to the
lengthy and often difficult process of adjusting to the day to day presence
of another human being. It often takes from two to six months for a real
sense of attachment to blossom according to many of the posts of families
who belong to EEAC. Being unprepared and unsupported, new adoptive mothers
who become depressed often try to "tough it out" without asking for any help
whatsoever. Many mothers worry that if they advise their agency or social
worker (the ones they have spent months or years convincing of their
superior parenting skills) that they are experiencing difficulty, those same
agencies and social workers will think of them as unfit parents and, in the
worst case scenario, remove the new child from their care. Consequently, a
bad situation becomes worse because of lack of understanding and support.
First line extended family support available to new birth mothers (and
fathers) is often totally missing for adoptive parents. In many cases, after
enduring years of disappointment with infertility, family members don't
understand why the new mother isn't completely happy and content now that
she finally has what she's wanted for so long. Rather than disappoint and
confound her family, many new adoptive moms simply suffer in silence, filled
with shame and guilt, feeling themselves imperfect or selfish.

Our survey didn't ask for gender specifics from our respondents, but we
assume that most of the questionnaires were from women. An unknown but very
important issue is Post Adoptive Depression in new fathers. Stress plays a
major role in what we suppose to be an equally prevalent issue. New adoptive
fathers are usually the ones to return to work sooner, and they have the
added issue of juggling job and new fatherhood simultaneously.

While all of the above issues pertain to all adoptive parenting, our
international community has additional components which load the deck. In
almost no case are we adopting newborns. Among other things, we deal with
grief over the loss of unknown histories and missed bonding opportunities.
We see our children for a very brief time before the adoption is finalized
and we often "discover" disturbing surprises about our children's
backgrounds after the fact. Our older children come equipped with distinct
personalities, some of which meld smoothly into our families, others of
which are a jarring and daily reminder of our differences. We adopt children
who have experienced an almost unimaginable amount of loss. We adopt
children who have suffered the effects of institutionalism, hospitalism, and
global neglect. We often adopt children with hidden academic, emotional,
neurological and medical needs. Frequently, newly adopted children attach
themselves to only one of the two parents, leaving the other parent saddened
and disappointed. Add to all that the stress of out-of-country travel, jet
lag, communication difficulties with our older kids and foreign country
hosts, sleep depravation, and cultural shock. Our decks come loaded with the
potential for frustration, powerlessness, and worry - a perfect prescription
for the onset of depression.

When I reviewed the data concerning the length of time adoptive parents
suffered from PAD, a very disturbing picture emerged. While most post
delivery "Baby Blues" are of very short duration (less than two weeks), 77%
of survey participants with PAD reported that they suffered their symptoms
from two months to over one year with 45% suffering for six months or more.
85% of sufferers reported that their depression affected their health in
some way (serious weight gain/loss was followed by sleep disturbances and
headaches), 70% felt that PADS had interfered with smooth transitions and
bonding with their new children. Clearly, Post Adoption Depression is a
significant, multi-faceted issue that needs to be acknowledged, better
understood, and unconditionally counseled and supported by the entire
adoption community!

How To Weather The Storm

Knowing that the probability of having PADS is significant will give you a
chance to prepare in the event that you are among the majority who suffer
with this syndrome. Preparation might include discussing the possibility
with your primary care provider as well as your child's future pediatrician.
Make sure your agency is aware of the PADS and that they understand the
dynamics and prevalence of this issue. They should be prepared to support
your need to locate help and/or services should you need them. If you have
previously suffered from depression in your life, you are at greater risk.
Make sure your mental health care provider is standing by in the event that
you need support with medication and counseling. Alert and educate your
family and spouse. Explain that you may all need extra emotional support the
same way new birth families do.

Dr. Bill and Martha Sears, The Baby Book lists several excellent suggestions
for the Postpartum family which are equally relevant to Postadoptive
families. When you finally arrive home from your international trip with
your new child(ren), make sure that you have sufficient "nesting" time.
Without guilt, hold visitors at bay for a few weeks. The exception to this
rule would be the one designated family member or close friend who can
provide domestic help and support in order to give time for the new nuclear
family to learn about each other and start the bonding process. Before you
travel, investigate your company's adoption benefits and maternity leave
policy. Take the maximum allowable time before trying to go back to work. Be
sure to get plenty of sleep and exercise. Fresh air and a brisk walk do
wonders to mitigate mild depression. Taking a child for a walk is one of
life's greatest inexpensive pleasures - fun for you, fun for your child,
good for bonding. If you are single or if your spouse is unavailable to
provide child care while you rest, arrange for a sitter who can come in
while you nap, run errands, or simply take care of personal grooming.

New competence as a parent often means a deterioration of competence in
other areas of your life. Don't allow yourself to feel guilty about less
than perfect housework or a reluctance to cook your usual gourmet fare. Plan
to put most of your life "on hold" while you settle in those first several
weeks. If you know letting things go might drive you mad with anxiety, have
alternate plans in place for others to take over for you with housework or
chores. Have a store of good frozen foods on hand to help with meal
preparation.

If you are married, one of the most profound changes that comes with
parenting is the change in your relationship with your spouse. Prepare for
that change and mitigate the negative impact by setting aside some special
times for the two of you to be together without the new child. This is a
vital part of successful parenting - important to both of you, but also
important in the message it sends to your child. Your strong, dependable
relationship with one another is one of the greatest gifts you provide to
your new child. If you are fortunate enough to have a secure and happy
marriage prior to adoption, spend the effort it takes to nurture and sustain
it.

Preparation for PADS is the key to surviving it and shortening its duration.
Accept the fact that adoption carries some risk. Expect surprises,
frustrations, and setbacks with your new child as part of international
adoption. Celebrate if there are none! Before your child comes home, take as
many parenting classes as you can. Expect to be a therapeutic parent.
Bonding and attachment are slow processes. Learn to be patient and give
yourself and your child the one-on-one time required for attachment and
bonding to grow. Your adoption journey doesn't stop the day you bring your
child home. That day is really only a beginning. Plan for the continuation
of your pre-adoption emotional roller coaster ride for at least the first
year. If you have adopted a severely challenged child, plan on riding for
two years! Reach out for help. Be honest with your social worker and agency.
If you are having difficulties, tell them! You might be pleasantly surprised
at how helpful they can be, but they can't help you if they don't know you're
suffering. Join a support group such as those available at
HTTP://EEADOPT.ORG, or locally. There are literally thousands of people
ready to help and lend support. Provide private time for yourself, your
spouse, and your other children. Keep stimulation, social, and work
pressures to a minimum for as long as you can. Ask your extended family and
friends for understanding and support. Accept your limitations and don't be
afraid to fail. We learn by making mistakes. If your adoption situation
proves particular difficult, remember to tell yourself everyday that
tomorrow will be better, because it probably will be.

Most of all, know that what you are feeling is a normal response to stress,
that you are not alone, and that there is help for this difficult phase of
your adoption experience.

Symptoms of Depression

Diagnostic Criteria From DSM-IV

Five or more symptoms in a two week period.

1. Depressed mood most of the day, everyday (feeling sad, empty, or tearful)
or feeling

exceptionally irritable.

2. Markedly diminished interest or pleasure in all or almost all activities.

3. Significant weight loss or weight gain, increase or decrease in appetite.

4. Insomnia or hypersomnia nearly every day.

5. Psycho motor agitation or retardation nearly every day observable by
others

(restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt nearly
every day.

8. Diminished ability to think or concentrate, or indecisiveness nearly
every day.

9. Suicidal thoughts or ideation.