ADHD in Internationally Adopted Children

My daughter is diagnosed with ADHD (attention deficit/hyper-activity disorder).  When I explain her diagnosis to professionals and close friends, I always emphasize the H.  Youngest Son is diagnosed with ADD.  He is not hyper, but he has a very difficult time paying attention and is easily distracted.

ADHD/ADD is similar, but different in internationally adopted kids vs. typical kids.  My kids definitely have it, but maybe your internationally-adopted child is dealing with post-institutionalization issues rather than ADHD?  I tried to write an intelligent-sounding article to explain this, but cannot come up with anything as nearly well-written as the following article by Dr. Boris Gindis.  For more great reads by him and others with much more knowledge than I, visit http://www.adoptionarticlesdirectory.com/

Please note:  Dr. Gindis is located in New York, but will do phone consultations with parents.  He is very caring and was very helpful to our family during our first year or so home.
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www.bgcenter.com

Notes on ADHD in internationally adopted children by Boris Gindis, Ph.D.

 ADHD in post-orphanage children is a matter of great practical significance and is an emotionally charged issue for adoptive parents. I have to point out that the core of ADHD - impulsivity, restlessness, and inattentiveness - may be symptoms of many other disorders, or just one of the characteristics of post-orphanage behavior, or social adjustment. Thus, it is a mistake to think in terms of "What is the singular cause of this behavior?" and not "What are the multiple causes?" There is no doubt that many international adoptees have genuine ADHD and may respond well to a traditional treatment that, in most cases, is just medication. Nevertheless, there are other explanations and other treatments of what looks like an ADHD behavior in international adoptees.

One thing that most orphanage survivors have in common is poor emotional and behavioral self-regulation. Hyperactive, disorganized, and disregulated behaviors that are typical for children with ADHD, may in internationally adopted children reflect the impact of abnormal environmental factors of orphanage life on development. I personally believe in a significant social/cultural influence on the origin of this deficit: it is due, at least partially, to the lack of modeling, mediating, and assistance usually provided to children by a caregiver in the family-based upbringing.

Language also plays a critical role in the development of self-regulation, because it allows children to gain some control over manifestations of their feelings, helps them inhibit impulsive responding and behave in a more organized way. Therefore, the issue of specificity of ADHD in post-institutionalized internationally adopted children is a complex one and more research and more careful thinking is needed. It is likely that we are dealing with what could be defined as an atypical attention deficit disorder in children who have a very atypical psychological profile stemming from an atypical background and development.

Look at what Michael Rutter and his associates have found. He studied a sample of Romanian adoptees for approximately ten years. They found a high rate of what they called "inattentive-hyperactive" behavior. They pointedly avoided calling this ADHD, since they found significant differences between this condition and ADHD as it is manifested in "typical" Canadian and American kids. For example, in "typical" ADHD, there is a high correlation between the inattentive/impulsive behavior and aggression (70% co-morbidity), while in the adoption sample, the kids were not aggressive. Similarly, in "typical" ADHD, the overwhelming majority (again, over 70%) of affected kids are boys, while in the adoption sample boys and girls were equally affected. These researchers were very careful in their conclusions about this, but expressed concern that IA kids were being lumped with, and treated like typical ADHD kids when the etiology and symptoms are probably different in significant ways. All children in that study showed improvement over time, with some - catching up completely and others remaining - below their peers despite considerable gains.

It has been well-established through hundreds of studies that the most effective treatment for children over the age of 4 with ADHD is a combination of medication and behavioral therapy. There are some children who don't have symptoms severe enough to warrant medication and can get by on behavior modification alone, but for children with a more serious condition, medical management is needed. I do not see here a place for moral or social value judgment: as one parent stated: "If your son had diabetes, you would give him daily medication without giving it a second thought. ADHD is a medical issue, period." On the other hand, medication doesn't cure ADHD, and as many people have said, "pills don't teach skills." Stimulant medications shouldn't be used as an alternative to teaching a child how to behave and learn in the classroom, particular with ID children were an issue of self-regulation is so urgent.

I believe that social skills training along with language therapy are the most promising counterpart to medical treatment for an IA child who has symptoms of ADHD.

Dr. Boris Gindis is a child psychologist specializing in psycho-educational issues of older internationally adopted children. He is chief psychologist at the Center for Cognitive-Developmental Assessment and Remediation, the lead instructor at Bgcenter Online School, the author of many publications on international adoption issues and frequent presenter at conferences and workshops.

www.bgcenter.com
Article Source: http://www.adoptionarticlesdirectory.com

UPDATED! - Fact Sheets for the Classroom

Educating teachers about PTSD, RAD, ADHD/ADD, FASD/FAE, PDD, anxiety, depression, and even Aspergers is a chore each year for me.  It is a necessary chore, however.  Unfortunately, our teachers are overworked and underpaid and frankly, clueless about what it REALLY means to deal with all these things, or how to best educate a child with complex trauma.  (Let's face it, we were all clueless, too until we had to deal with it face-to-face ourselves.)

I wish I'd found these Fact Sheets back in 2007.  They are posted on the Kansas State Department of Education website and are designed to give teachers an overview of the challenges our kids face every single day.  They are not comprehensive, but they provide the basics.  (Besides, I've learned most teachers don't bother reading much of the information given to them even by their own administrators.  Even if they WANTED to, there just aren't enough hours in the day to read everything they're told is "essential.")  

I've developed a lot of presentations and materials of my own through the years and I promise to share more of those over time on the blog.  But my best piece of advice for communicating your child's needs to his or her teachers is to develop a relationship with them.  Be prepared to advocate (a.k.a. "fight") when you need to, but work with your child's teacher to show them you appreciate their professionalism.  Hopefully, they in turn will respect your expertise as a therapeutic parent, raising a hurt child.  

Do not expect a teacher to work like a therapist.  Their job is to educate your child.  Give them tools that support them in their job, even as you ask them to support your job as a therapeutic parent.  Hopefully, they'll appreciate your efforts to make their job easier, and thus make your job easier by avoiding those triggers which set your kids off on behaviors most teachers never get to see.

     *Attention Deficit/Hyper-activity Disorder - ADHD/ADD

     *Post-Traumatic Stress Disorder - PTSD

     *Reactive Attachment Disorder - RAD

     *Anxiety

     *Depression

     *Pervasive Development Disorders - PDD

     *Fetal Alcohol Spectrum Disorder - FASD/FAE

     *Asperger Syndrome

Additional resources for the classroom here:  Child Mental Health Resources

New Chapter or New Book?

There’s an old saying.  You know the one  -- something about changes -- about closing one chapter and beginning another.  For me, I think it’s more like beginning an entirely new book.  As I write this first blog post in this new, semi-anonymous blog, I’m ready for a truly new book in my life.  I cannot rewrite the past – not for myself, and certainly not for the hurt kids I’m raising.  Their beginning was too hard.  Too raw.  Too painful.  While my past with them as their adoptive mom is painful as well, there are too many changes from what once was – even from just yesterday.  There are too many things that are no longer true for us.  There are too many dreams I’ve had to let go, but there are also too many things I want in what’s yet to be -- too much life to simply begin a new chapter.  There must be an entirely new book.  Granted, it won’t be a stand-alone edition.  It cannot be.  This new book can only be written because it builds upon what is already published in permanent ink, on stained pages, bound by a hard cover.  The past is past.  My kids’ past is not pretty.  The work we do to help them navigate that past and write the book that is their future is also ugly most of the time.  This is true.  Our future as a family living with the aftermath of our children’s past trauma, abuse, neglect, and post-institutionalization is forever tied to that past. 

So, who am I?  What is the synopsis of this book? 

I am a wife and a mom.  I have six children.  Some are young adults, beginning life on their own.  Some are still in college and still dependent upon us.  Some are young teens, living at home, attending public school, and working through a past and toward a future they only dreamed about until four years ago.  My youngest two children are biological siblings, but have only been our children for four years.  They are amazing kids.  They’ve come so far from the frightened orphans who landed at JFK airport in the summer of 2007.  Yet, they will always deal with their past.  Their lives deserve a new book, but that book will forever be written based upon the past.  Their psychological diagnoses look like alphabet soup to those not familiar with the terms.  There is PTSD, RAD tendencies, ADD/ADHD.*  We also deal with anxiety (sometimes quite high for both kids), and major depressive disorder in my son. 

My kids were not born in America.  They were born and lived the first decade of their lives half way around the world.  Not all kids will have suffered the kinds of things my kids have suffered.  Some will have suffered more.  Some less.  I do NOT believe all adopted kids are attachment disordered.  However, I do believe all adopted kids have experienced trauma.  Just going through the process of getting adopted is traumatic.  A child leaves all they know, even if it is hard, and is placed with a family they do not know.  In the case of international adoption, they’re also placed into a culture and a language they do not know.  (Imagine being plopped in a country whose culture you have little to no experience with and with a bunch of people you cannot understand who cannot understand you!)

I’ve seen people deny the fact that their kids have a traumatic background.  They can deny it all they want, but then adolescence hits, and they’re not prepared for the trauma that exhibits itself all wrapped in all the "normally" crazy teenager crap, because they pretended their kid was normal and had no traumatic past.  They want their kids to be “normal” so badly that they ignore the fact that being adopted isn't "normal!"  It's not commonplace.  It's not common practice.  If it were, everyone who had biological kids would also have adopted kids.  If it were, adoption would be as commonplace as pregnancy.  For some of those people in denial, dealing with past trauma without much knowledge about its effects on a kid isn’t so bad; for others, it’s pure hell.  Still, even for those for whom it is not so bad, they might handle it better if they’d taken the time to get to know others who’ve been through it – or worse.  It just breaks my heart to see these folks struggle, when they could have been open and learning all along – and maybe even making a friend or two along the way-- someone who would “get it” in way others can’t when they meet these kinds of challenges with their kids.

My kids have seen some really horrible things.  They’ve watched people they love do things many cannot begin to imagine.  They’ve experienced things no one should.  They’ve been told terrifying lies by people they trusted.  They have felt things no child should ever have to feel, and they have the scars to prove it.  Yet, here they are.  They function amazingly well.  My son can fix just about anything mechanical and my daughter is a straight-A student.  They have survived.  They truly fight to be “normal.”  So badly, they just want to “be normal.”  While our family is probably far from “normal,” at least they have a chance – a chance they did not have four years ago.  Still, that chance does not come without a price.

I am also recently retired from a career position I have deeply loved.  I made decisions that helped people.  I developed programs and administered services that changed people’s lives for the better.  I worked to keep families whole and kids healthy.  I engaged volunteers in collaborative efforts and I raised awareness by working with media outlets to bring people the news.  I was recognized in the community as a leader, even if that leadership sometimes ruffled feathers because I didn’t go with the status quo.  My job was an extension for me of who I am – what I am – where my heart rests beyond my family – and how I “make it” in this world.   I got to help people.  I got to make a difference.  I got to be me. 

Oh, when I say “recently retired,” I mean “yesterday.”  --  Literally.

I am also fairly well-educated in a traditional sense, as well as self-educated out of necessity.  I’ve read more essays about child trauma, abuse and neglect, and more journal articles about mental health diagnoses, and even more web sites about adoption and the issues of internationally-adopted kids coming out of orphanages, than I ever imagined I would.  I’ve talked with more moms of kids with issues that are far more severe than those of my kids, and have held more moms in my arms who are tired and just don’t know what else to do, than I can begin to count.  Thankfully, there are those that have done the same for me.  I’ve learned a lot these last several years.  I’m writing this blog because I think I have a lot I can offer – things for which even teachers and therapists have come to me for an opinion.

I can sometimes be awfully lazy, but I cannot be still – not in my spirit – not in my heart.  I cannot “just rest and take some time” in my retirement, not even to regroup as I adjust to not working outside the home.  I’m not old.  Okay, so I’m older, but I’m not old.  I’m not ready to retire.  Sharing myself, trying to help others, seeking help for my own struggles, NEEDING help in the form of support by other trauma mamas who “get it” – all these things are things I value.  They are all part of who I am.  They are as breathing is to me.  So, I’ll write.  So, I’ll begin this new blog.  I may be more anonymous than I’ve been in the past.  I think this may actually be more helpful to those reading the blog, because I can be even more open about our family’s struggles with a shield of anonymity.  So, if you happen to know me, please do not name me here.  For now, just call me “Trauma Mama T,” or “Mama T,” or even just “T.”

My plan is to write about my life as a mom, as I work to help my kids with their past trauma while they develop skills to navigate a world that doesn’t usually understand the fact that some things just do not heal, no matter how much time and love you invest.  Love does not heal all wounds.  Time doe not heal all wounds.  But love – and time – sometimes, LOTS of time – allows us to teach our kids skills that can help them make it through, and maybe even to thrive in ways they, and we, can only learn as we go along. 

This is a different kind of parenting.  This is a different kind of life.  This is my life.  If it is also your life, or even if you’re just curious, perhaps you’ll join me here.  Thanks for reading this far.

And so the blog – and this new book in my life – begin.

*PTSD:       Post-Traumatic Stress Disorder

  RAD:         Reactive Attachment Disorder

  ADD:        Attention Deficit Disorder (without hyper-activity)

  ADHD:     Attention Deficit / Hyper-Activity Disorder