Stepping Back Into the Light

Yes, it was therapy day for The Princess and I this morning.  If you’ve read this blog for a while, you know therapy has not been a very productive or fun time these last couple of months.  Today was different.  The Princess was engaged, made appropriate eye contact, paid attention as much as her ADHD would allow her to do, and she PARTICIPATED!  She was even pleasant.  I believe our happy, sweet girl is on her way back.

We have eased out of using Seroquel XR 50 mg/day over the last month, and have slowly added Abilify.  The Princess has another med check on Friday, but I believe this is working for us.  She is also on Focalin XR before school and a generic (not slow release) Focalin after school.  Abilify is usually added to an anti-depressant.  She is not on one of those now, but the Abilify seems to be helping anyway.  (Maybe tomorrow, I should do a post on medications?  I could list those I know and what they’re used for and let you know how effective they’ve been when we’ve used them.  The thing is, there are on-going adjustments that are made as the kids’ systems get used to the medications and they become less effective over time.)

I’m proud of my girl.  She’s working.  It’s hard.  She’s not always conscious of what she’s doing or how she’s behaving, but she wants to be.  She responds well when she’s approached in a manner that displays teaching rather than irritation or condemnation.  She just wants the freedom to be who she is, but she needs to learn the tools to help her mature and navigate the world.  Today, she was willing to start working on that again.

I feel like we’re stepping back into the light.

Trauma Triggers

The ministry team at our church asked me to share a list of things I observe as trauma triggers in The Princess and Youngest Son, and to also list things I’ve observed as trauma triggers in other adopted children.  Below is the list I gave them.  (I didn’t want to overwhelm them with too many things all at once.)

I'm posting the list here so others can refer to it.  You may want to share this with a teacher friend, or youth ministry team leader you know.  Perhaps, you’ll add some things of your own to this list in the comment section for this post.  I will add some myself with an (*) after the list I gave our ministry team.

Universal Trauma Triggers (things I’ve seen most internationally adopted kids, and many foster/adopt kids react to on some level)

Blood, gore, dead babies, dead animals, dying people, people starving in Africa (pretty much any topic you THINK they SHOULD know about should really be discussed with the parents of traumatized kids first).

Orphan care ministry (triggers survivor’s guilt).

Talk about the “blessing” of adoption (triggers guilt for caring about bio family).

Movies about adoption, movies where adoptive parents are portrayed as evil or mean, movies about orphanages, child trafficking, sex trafficking, child abandonment.  (Parent permission before showing movies might be a good standard practice in children’s and youth ministry.)

Talk about a child being adopted – even if everyone already knows it.  Adopted kids don’t want to be the topic of discussion; they just want to fit in

Loud noises, alarms, sudden changes, changes in routine, new teachers/leadership can also be triggers for many adopted kids.

Do not assume adopted kids, especially older, internationally adopted kids that lived in orphanages, know what you’re talking about.  Their world knowledge is VERY limited and it will take significant time to “catch up” on things most people would think “everyone” knows.

*Holidays, especially Halloween and Christmas.  Birthdays, pretty much any celebration, especially if it isn’t all about them.

*Too much “stuff.”  Our kids are overwhelmed with too many choices – everything from a full menu at a restaurant, to too many clothing choices, and too many toys.

*Affection from people other than family members.

*Gifts – even little gifts like a piece of candy.

*Rewards – especially if they’re for doing something any well-behaved kid SHOULD be doing anyway.

Triggers more specific to Youngest Son and The Princess (but can also be triggers for other adopted kids, too):

Talk about suicide, especially suicide by hanging.

Talk about alcoholism, prostitution, divorce.

Talk about their birth country.

When people ask them what their “actual name” is – yes, this has happened in youth group.  Their “actual” names are the names they have now.

Questions about their orphanage or their life in Eastern Europe, including questions about their birth family.  (Youth group members need to learn this is inappropriate conversation.)

Certain smells can be triggers, including fish, fried potatoes, and anything burned.

Questions about therapy or medications.

People assuming they know what is being talked about – for example, The Princess became very upset about hearing one of the youth leaders had a miscarriage – not because she understood what that was, but because she felt stupid, and like “everyone was talking in jibberish.” 

*When one of our older boys comes home to visit.  (It messes with routine, territory, and attention issues.)

*Any new recipes Mama T tries for supper.

*Painting the house, or moving the furniture.

*Other kids not having coats on when it’s cold outside.

*People leaving their animals outdoors.

*When a child is being publicly disrespectful – like in a store.

Other ideas?  Please do share below.  I love on-topic comments!

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