Jun 20, 2009

Bringing Your Child Home from the Orphanage: ideas

Generally, infants adopted before the age of six months fare no differently than infants raised from birth. However, after six months, the effects of institutional care begin to emerge. It is important to realize that even the best orphanages are not good places to raise a child. In NY state the infant-care giver ratio required by regulation for infant day care is no more than two infants per care provider...so 5:1 is better than 10:1, but still it won't help the child develop a normal, healthy, and secure attachment to a specific figure, which is what the attachment system is supposed to do. Several visits during a year won't make much of any difference on your child's development or on this most important process.

That being said, it is also important to remember that children are rather "plastic" and that attachment develops during the first two to three years of life. So, you will need to do some work when you bring your child home to make up for the early deprivations that your child has experienced.
1. It is best to make the room as similar to the orphanage as possible to make for an easier transition.
2. Serve the same foods at first.
3. Keep ALL others at a distance for the first several weeks to months so your child develops a specific and unique bond with you.
4. It would be best for you to spend the first two to three months at home constantly with the child; carrying the child and physically being present to meet the child's needs and to develop a affectively attuned relationship that will allow you to anticipate your child's needs and meet those, as well.

1) YOU, AND ONLY YOU, WEAR YOUR BABY!! Carry them with you wherever you go, and whatever you do. (Unless dangerous) Attach them to your bodies. A great baby carrier is one that the baby can have skin to skin contact with you – Baby Trekker (1-800-665-3957) is a good one. Carry the baby on your hip; tie to your body under a sweatshirt, front carrier, or in your arms. The more contact the better. These babies were not held enough. Hold Them!!!! A LOT!!! ALL THE TIME!!!! For the rare times the baby is not in your arms, have them in the same room as you are in.

2) YOU ARE THE ONLY CAREGIVER!! You always bottle, feed, bath, dress, change and most of the play. If friends and family want to help let them walk the dog or clean your house, wash bottles or do laundry, bring food or make you tea. No baby-sitters and no sending the baby away for respite. Until your baby is firmly emotionally attached to you, NO ONE the baby doesn't see daily should hold or even touch him or her, and even those that the baby sees daily should hold him or her at a very minimum.

3) KEEP THE BOTTLE AS LONG AS POSSIBLE –EVEN LONGER! You, not the baby, hold the bottle. You can hold the bottle with your chin so you have two hands to snuggle your baby close to you. One handed it also fine. Hold the child the way a nursing mother does – chest to chest, close to you with as much skin-to-skin contact as possible. Look your baby in the eyes and when they do, instantly put the bottle in their mouth and tell them good job!! Keep looking at their eyes so when they are ready for eye contact, you don't miss it. Note: some babies with sensory-integration difficulties may find eye contact too stimulating and it may actually be disruptive to the child.

4) BATHE WITH YOUR BABY; this encourages skin-to-skin contact in a nice relaxing warm fun way.

5) A LOT OF FACE-TO-FACE baby games and funny faces and TONS of smiles and kisses!! Paint bright circles around your eyes. Close one eye, then the other, rapidly blink, and then change speeds, all the time with funny noises. Cover both eyes then one, and so on. Have the baby sit on your lap, and if this is too hard for them at first, lay them on a bed to do it. Then slowly trick them into letting you touch and hold them!! Keep it fun for them.

6) WHEN THERE IS A GREAT DEAL OF ANGER OR AVOIDANCE, the baby NEEDS you to hold them, even if they don't WANT to be held. They feel so far away from you, and have to be brought closer to heal. Cradle the baby in your arms. Have their arm closest to you held close. Talk soothingly to them, and tell them to look in mommy's eyes. They most likely won't at first, and will become very angry, (actually they were already very angry, the anger is just allowed to come out in a safe loved way) other times in their life they were not able to get their needs met; anger and avoidance came out of that. They were often ignored, hit, or yelled at. That is why it is SO IMPORTANT this ALL be done in an extremely loving way. Never squeeze the baby too close, speak harshly, lose your cool or forget why you are doing this. If you get to feel their anger, immediately put them down and call support. You have to remain supportive, yet expect their best. They may try to hit you, scratch, bite, scream and get to you any way they can. Their intense rage is there. Yes, even little babies. Eye contact, feeling safe, and being accepted no matter what in a loving way is the goal here. For whatever reason, they have shut off people. Now they need YOU to heal. Rub them, soothe them in singing, and soft speech, rock them and tell them you love them. Keep it up until they will calm down and look in your eyes and FEEL connected to you. At times they will fall asleep screaming. If so, and if possible, continue to hold them until they wake up, and then continue above. If you need to lay them down, have a monitor on so you can pick them up as soon as they wake up. For the very avoidant baby one unsolicited eye contact a week could be considered good! Keep it up; you have several good eye contacts a minute to look forward to! Remember, you did not create this anger in your baby.

7) NOW IS THE BEST AND EASIEST TIME TO WORK WITH YOUR BABY.

8) DO A LOT OF BABY MASSAGES. For the real avoidant baby, a half-hour. Each day you delay, the harder it is for them and you. Attachment issues do NOT just go away on their own. They only get worse. Twice a day would be minimum. All the time talk, sing and let that baby know how special they are!! Most of the babies seem to really enjoy this, and my daughter would even get out the lotion as soon as she could reach for it!!

9) ROCK THAT BABY!! They often can't stand you sitting in a rocking chair, but can often tolerate and enjoy you walking and dancing with them in your arms. (Remember face-to-face contact during this) Gentle motion, bouncing and rocking are a must!!

10) SLEEP WITH THE BABY. If you can, the best is to have the baby in your bed close to you. Second choice is to have the baby in their crib right next to your side of the bed with the side rail down. Have the crib touching snug to your bed, so if they climb out, they climb safely onto you!! They need t hear your breathing and know you are close. Yet for someone over one, you get special permission (in writing) to have him or her sleep in your room for mental health reasons. Should not be a big problem. Have the baby always fall asleep in your arms. Nap or night. They need to get used to feeling loved!!

11) SING, SING, SING!!! It lightens the load, and helps the baby feel the happy friendliness they missed out on. Joyful voices are so important!

12) ENCOURAGE EYE CONTACT WHEN FEEDING, BOTTLING, TALKING, CHANGING, AND ALL THE TIME!!

13) EXPECT A DIRTY HOUSE, soup out of the can and sandwiches for supper and piles of laundry. Know that you are not super mom, and that baby can't wait until all is in order to get on with their lives. Here is where all those well-meaning friends that want to hold that precious baby come in!! Let them work!!!

14) EXPECT TO BE CRITICIZED AND ACCUSED as over possessive, spoiling the baby, and making more than you should out of the baby's problems. You will be told all babies do that. This is by well meaning friends, neighbors, relatives, doctors, and social workers. Stick to what YOU KNOW the baby needs, and fight to get that for them. Remember YOU know that baby more than anyone else.

15) HAVE A GREAT SUPPORT SYSTEM. Have a trusted friend (hopefully someone who has had experience in attachment disorder) that you can call without being told you are making too much of it. Read books on attachment disorder. Know what dangers await that baby if they are not helped. Working with an infant or toddler has such a HUGE chance for success!! Not one act of kindness is wasted.

16) GET AN OFFICIAL EVALUATION BY AN ATTACHMENT EXPERT.
That way in court and with workers you do have leg to stand on in getting these babies what they need!!! It is a lot easier when you have a well-respected expert stick up for you.

17) KNOW YOU NEITHER CREATED YOUR BABY'S PROBLEMS, NOR CAN YOU CURE THEM. Your job is to give the baby the tools they need. The rest is up to them.

18) FOR THE BABY THAT HAS NOT YET ENTERED YOUR HOME – when you get that baby, get a piece of clothing or blanket unwashed and used recently by the primary caregiver. The smell will help the move. And don't you wash it!! Keep it close to the baby to help the baby adjust. No matter the baby's age or living conditions, the move to you is not easy. Never push this object, but make it available.

19) HELP YOUR BABY WITH A TRANSITIONAL OBJECT. This is a blanket or soft toy they can sleep with, use it in the car seat, and for the RARE time you cannot be with them. Helps in security.

21) IF YOU DO ALL OF THESE WITH LOVE AND KINDNESS AND THINGS GET WORSE OR REMAIN THE SAME, GET HELP.

11 comments:

Brenda said...

This is such a great post! I am going to link to this on Monday.

Mike and Gail said...

And if they are teens when they come home. What is the list for that?

Arthur Becker-Weidman, PhD said...

Dear Mike and Gail,

Good question and thank you for asking. If they are teens, it is much more complicated. Issues that will make a difference in how you approach the situation include:
A. Has the child been in the orphanage from birth or was the child placed at an older age?
B. If placed at an older age, why? Abuse, neglect, loss of caregiver?
C. If placed at an older age, what were the child's experiences before placement?
D. What was the caregiver:child ratio in the orphanage?
E. Might there have been prenatal exposure to alcohol?

So, as you can see, it gets complicated. I would recommend that as a first step, you secure a thorough and comprehensive assessment of the teen. You'll want that assessment to be by one who is trained and experienced in assessing such children (see my website www.Center4FamilyDevelop.com for a listing of therapists and for additional details or see www.attach.org for a listing of registered clinicians. You can also look at my DVD on Assessment:
http://www.amazon.com/Assessing-Children-Complex-Attachment-Disorders/dp/0982288301/ref=sr_1_3?ie=UTF8&s=dvd&qid=1245692669&sr=8-3 on Amazon.com)

Such an assessment should include an evaluation of or screening of issues the following areas that may be impacted by the teens experiences:
Attachment
Biology
Behavioral Regulation
Emotional Regulation
Dissociation
Cognition
Self-Concept

In addition, screening for neuropsychological issues and sensory-integration issues should also be included.

Let me know if I can be of any further assistance. I hope this response was helpful.

Blog restriction said...

The details of this post also apply to toddlers, right?

Arthur Becker-Weidman, PhD said...

It would be more complicated with a toddler because of the lingering effects of chronic early maltreatment. For example, there may be sensory-integration issues to consider. Certainly attachment issues would also need to be considered and addressed. So, while the general principles described in the article would probably apply, there are a number of additional factors to consider.

Melanie said...

Wow,that was a quick reply. Thank you. I adopted my son from Ukraine at 17 mos. I have been to an attachment specialist, however there aren't any in my town who specialize in children adopted internationally. Maybe I'm wrong, but based on what I read, I believe that children adopted from orphanages have more to overcome than other children with attachment challenges. We worked on many activities from your blog post and there was/is progress. We recently experienced setbacks and I'm worried it's because I didn't continue them as frequently.

I'm not sure if I can ask you a question here ..... but, how do you know the difference between post institution behavior and attachment disorders.
Melanie

Arthur Becker-Weidman, PhD said...

Melanie,

Very good question. The distinction between "post-institutionalized" behaviors and "attachment disorders" can best be understood if you think in-terms of a "ven-diagram." Post institutionalized behaviors are the big circle and within that circle would the the smaller circle of attachment disorders.

Related to post institutionalized behavioral issues is the clinical construct of Complex Trauma. Complex Trauma refers to early chronic maltreatment within a care-giving relationship. As you can imagine, what often occurs in an orphanage falls within that, primarily as neglect.

Complex Trauma and the results of significant orphanage experience can lead to impairment in several domains:
Attachment
Behavioral regulation
Emotional regulation
Cognition
Biology
Dissociation
Self-concept

I'd suggest that you may want to get a thorough assessment of your child by someone with the appropriate training, experience, and certifications. My website has several people listed and you can also look at the list of registered clinicians at www.attach.org

regards

Melanie said...

Thank you for your response. I live in Ontario, Canada and I assume your list of people are in the US?

I did find someone located about 4hrs from my town. She appears to be the most experienced in this kind of stuff. http://www.sandrawebbcounselling.com

Thanks again for your input.
Melanie

Arthur Becker-Weidman, PhD said...

Dear Melanie

My list of therapists includes several in Canada, in Ontario and near Toronto. My office is about 1.5 hrs from Toronto.

regards

Melanie said...

Hi Dr. Becker-Weidman,

I'm about 5 hours east of Toronto.

I'm certainly not close to being an expert but I don't see severe behavior like you see out there. For ex. no tantrums, really good sleeping and quick learning. I am interested in learning more about Dyadic Therapy though.

Thank you for this dialogue :-). It's nice to have this exchange.
Melanie

Arthur Becker-Weidman, PhD said...

If you want to learn more about Dyadic Developmental Psychotherapy, then you could look at my website:
www.center4familydevelop.com

also, the article at:
http://www.center4familydevelop.com/research.pdf will be helpful.

If you can get a copy, or e-mail me for the PDF copy, of the article:
Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Family Social Work, 13, pp.329-337. will provide you with a good description of the evidence-base of this effective an empirically validated treatment.

Finally, the book I co-edited, Creating Capacity for Attachment is a sort of treatment manual for this approach.

regards

Art