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Children process adoption throughout early years: each stage of childhood has its own challenges; look for red flags that may indicate a need for treatment.

WASHINGTON -- During each stage of childhood, adopted children must master a different level in processing their unique life story, Kay Seligsohn, Ph.D., said at the annual meeting of the American Academy of Pediatrics.

"Each stage has its own tasks, its own challenges, and its own red flags," said Dr. Seligsohn of the Children's Hospital and Harvard Medical School Adoption Program, Boston.

The tasks of the toddler years are to develop a sense of autonomy and self-identity. Adoption during these years can hinder the process. "They are taken from the only home they have known and dropped off in a place where they know no one and may not even speak the language," Dr. Seligsohn said. "Imagine what that teaches them--that they have no autonomy at all."

This experience, combined with the limited language and cognitive skills of a toddler, is the root of the attachment delays and behavioral problems these children often experience as they settle into their new family. "Parents should anticipate that they will see extreme 2-year-old behavior."

But behavior issues, "beyond the normal 'terrible twos,'" should be red flags that the attachment process isn't going well or that the child might have an underlying medical or psychological problem.

"We diagnose a lot of fetal alcohol effects and sensory integration problems at this stage," Dr. Seligsohn said.

Toddlerhood also is the best time to begin introducing the child's personal adoption story, she said. "The best way is simply to have it become part of the general family fabric, like knowing what town they live in."

The preschool years are a time of emerging self-awareness for children. They experience an explosion of physical skills and language development. At this stage, children can parrot their adoption story as though it's a bedtime tale, but probably don't really understand much of it, she said.

Adopting a child who is preschool age has both its challenges and its rewards. "They know what a family is and are often looking forward to belonging to one. But they will go through a period of extended grief and loss even if they are going to a better situation."

The behaviors surrounding grief and loss can be upsetting to adoptive parents, who view adoption as a time of happiness and excitement.

It's important to let parents know that the grieving process is both normal and necessary. "Attachment proceeds slowly because of the grieving, but it moves simultaneously with it," said Dr. Seligsohn.

It is also during the preschool years that children start to lose their past memories. It can be very beneficial to record those recollections before they are lost, so the child can later hear a complete record of his or her life. If the child isn't fluent in English, hiring an interpreter can be a good investment.

During this time, attentional issues, hyperactivity, fetal alcohol effects, and language delays can emerge. Preschoolers also can suffer from extreme anxiety that manifests as nightmares or monster fears. Older children can become obsessed with worries about separation.

Children in the latency phase are developing their self-esteem and cognitive skills, as well as their sense of logical reciprocity. For many children, this new thought process allows them to understand for the first time the concept of a birth family and, consequently, its loss. "They think, 'If I was adopted, my real mother gave me up.' "

This realization concerning the birth family is always accompanied by grief and sadness, Dr. Seligsohn said. "It might not be extreme--it could be as brief as a few days of feeling blue. But it can be quite problematic."

Children can begin to idealize their birth family and compare it to their adoptive family--usually to the adoptive family's detriment. These family romance fantasies are "a normal part of the process of understanding that your parents aren't always good, and that you can love them and be angry at them at the same time," she said.

This issue usually abates toward the end of middle childhood, but for some children it can be connected with the development of oppositional or mood disorders, which would include depression, anxiety, bipolar, and posttraumatic stress disorders.

"There is a higher incidence of these disorders in the adopted population, so it's good to check this out when the parent expresses any concern," she advised.

Adopted adolescents are struggling to understand their ego and sexual identity. Adoptive parents often aren't much help during this crucial period, Dr. Seligsohn said.

"The [adoptive parents] are horrible at talking about sexuality, especially if there is a history of infertility that led to the adoption. There's also the myth that all people who place kids for adoption are promiscuous teenage moms."

Unfortunately, she said, adopted teenagers may believe this as well and may engage in high-risk behavior as a subconscious way of identifying with their absent birth parents.

Adolescence is the time when most adopted children begin searching for their birth families. The advent of the Internet has made it much easier to do this and much easier to be secretive about it. It's important to monitor Internet use to forestall secrecy.

Adoptive parents need to understand and support the child's need to discover this very important part of his or her past, Dr Seligsohn said.

BY MICHELE G. SULLIVAN

Mid-Atlantic Bureau
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Title Annotation:Child/Adolescent Psychiatry
Author:Sullivan, Michele G.
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Dec 1, 2005
Words:878
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