Medical Records. Parents may not get an accurate medical history or may have no medical history or family background; the medical records may be sporadic and spotty. When parents bring a child home, it is important to get a thorough medical examination, including age-appropriate screenings and an assessment of the child’s growth and development. In addition, it is important that the child have an assessment of her nutritional status. Contact and meet with a pediatrician familiar with the height and weight charts for the child’s birth country (or supply them yourself), to set norms for your child.
Emotional Development. Many children have slow emotional development because they have never been allowed to express emotions (some call this ‘The Silence of the Kids’). Many have never learned how to modulate emotions. They may have problems with affect dysregulation (emotional reaction) and be diagnosed as hyperactive or attention deficit disordered. They may have problems putting feelings into words and act out with poor impulse control instead. They may not have the words to describe internal physical or emotional states. They have never even been asked how they feel, let alone know what a sad, mad, or glad feeling is.
Attachment Difficulty. Those children may have an attachment problem and have difficulty with affection and emotional intimacy. On the extreme end of the attachment spectrum, children have Reactive Attachment Disorder, which is a complete inability to connect in a reciprocal fashion. Many post-institutional children have difficulties giving and receiving love (because of their own absence of positive touch and loving,) and do not trust others, primarily due to lack of physical and emotional contact with a primary caregiver. Attachment is reciprocal, is based on love, and takes time to develop. New parents sometimes confuse a Trauma Bond (which is instantaneous and based on terror) with an Attachment Bond when they adopt a child who appears to attach immediately.
Loss and Grief. Many children have a true sense of loss at leaving the orphanage and feel grief when they are separated from that world, no matter how awful it was. Even children adopted as babies and toddlers can internalize sad events of their young lives and exhibit ambiguous loss.
Age. A child adopted at over eighteen months of age, in particular, may have noticeable developmental delays. There is always the possibility that the child has a history of abuse, stored as pre-verbal memories and unable to be recounted. They may even be dissociated or repressed memories.
Sensory Issues. Some children may have problems regulating and filtering sensory input. These children may have problems regulating behavior control, temper control, and adapting to changes.
• The hypersensitive child can be fearful, cautious, negative, and/or defiant. The under-reactive child may be withdrawn, hard to engage, or self-absorbed.
• The motor-disorganized, impulsive child may have an extremely high level of activity and a lack of caution. She may appear to be ‘driven’ and unable to settle down or organize behavior. She may over or under-react to loud, high, or low-pitched noises, bright lights, touch, foods with certain textures, coordination, touch, pain, odors, temperature, motor planning, attention, and focusing, among others.
• Some children may be inconsolable when hurt or frightened, unreceptive of attention or touch.
• Some may have little or no conception of personal space and property, constantly tripping over their feet, or falling down easily.
• Some may have no skills for conversation or friendship.
Post Traumatic Stress Disorder (PTSD). Some internationally adopted children may have symptoms of Post-Traumatic Stress Disorder. PTSD is defined in part in the DSM-IV as: Being exposed to a traumatic event where a person experiences, witnesses, or is confronted by event(s) involving actual or threatened death or serious injury, and a response that involves intense fear, helplessness, or horror. Abandonment, institutionalization, loss of a primary caregiver, abuse, neglect and the swift and traumatic life changes in a child’s world through the act of international adoption, can contribute to a child developing PTSD. PTSD must be addressed and treated for the child to realize his full emotional and cognitive potential. Not addressed and treated, a child’s PTSD can impact the parent-child relationship, the child’s self-perception, and other areas of the child’s life. The symptoms of PTSD can interfere with or affect a child’s attachment to her parents by limiting safety and trust development.
A few of the symptoms of PTSD in young children:
• Hyper-vigilance, anxiety and exaggerated startle response–some children will be constantly on guard, looking for any danger that might befall them, and fearful of exploring the environment around them.
• Problems concentrating and focusing, and ADHD type behaviors due to increased levels of cortisol (a hor- mone secreted by the adrenal glands in response to any kind of physical or psychological stress).
• Less ability to give emotionally in a reciprocal fashion.