Early Neglect and Child Development

Early Neglect and Child Development: Randomized trail compares children in institutions with those in foster care Summarized by Arthur Becker-Weidman, PhD Severe neglect and institutional care cause significant difficulties in attachment, biology, cognitive functioning including executive and neuropsychological functions, and behavioral and emotional regulation. Studies of children in Romanian orphanages and other settings have demonstrated the pervasive and negative impact of such neglect on various domains of child development. Those of us who work with such children know the complexities of helping families with these children. Their difficulties may include disturbed patterns of attachment, sensory-integration dysfunction, various neuropsychological impairments, mental health issues, and problems with emotional and behavioral regulation. These children are extremely challenging to work with and their families need comprehensive and supportive treatments. The Bucharest study, led by Charles Nelson, III, Nathan Fox, and Charles Zeanah, Jr., is a randomized trial comparing the emotional and physical well being of institutionalized children with those place in foster homes. The study involved 136 children in orphanages in Romania. The average age was 22 month, ranging from 6 to 31 months of age. All children selected were free of neurological, genetic, and other birth defects based on a study-team pediatrician's examination. The children selected then has a series of baseline physical and psychological assessment. Half the children were randomly assigned to foster care while the other half remained in the institution. The children placed in foster care were placed in homes that had been recruited, trained, financed, and maintained by the study team. This would be considered high quality foster care. The study team also recruited a third group of typically developing children who lived with their birth families and who had never been institutionalized. The study went on for ten years. One important finding that has significance not only for institutionalized children, but for all children who experience maltreatment is that there sensitive periods during which environmental influences are particularly powerful. The study found that the average IQ of the institutionalized children, measured at thirty, forty, and fifty-two months was in the low to middle 70's while it was ten points higher for the children in foster care. In other words, after only between eight and thirty months longer in an insitutional setting, there was about a 12.5% drop in IQ. The average IQ for the group of children never institutionalized was 100; or about 20% than the children in foster care. Or, to put it differently, about two years in an institution is associated with a 30% lower IQ. The sensitive period seems to be the first two years. The study found that a child placed in a home before two years of age had a significantly larger gain in IQ than a child placed in foster care after two years of age. The study measured attachment and found that the institutionalized children displayed incompletely formed and aberrant relationships with care-givers. However children place in foster care, at 42 months of age (after an average of 20 months in foster care) displayed major improvements in making emotional attachments. About half the children in foster care demonstrated secure attachments while only eighteen percent of the child in institutions demonstrated secure attachments. Sixty-five percent of the children never placed in institutions displaced secure attachments. This seems to demonstrate the capacity of healing relationships to help remedy these significant early deficits. However, as with IQ, children placed in foster care before two years of age were more likely to form secure attachments when compared with children placed after two years of age. Foster care had a major influence on levels of anxiety and depression; reducing their incidence by half. The more secure the attachment between the child and foster parent, the greater probability that the child's symptoms would be reduced. The study examined brain activity using an EEG. They found that infants in institutions has significant reductions in alpha and heightened theta waves, which they stated reflect delayed brain maturation. When measured eight years later they found that children placed in foster care before two years of age showed no difference in EEG when compared with children never in an institution. Children who remained in the institution and those placed in foster care after two years of age showed EEG patterns reflecting delayed brain maturation. Institutionalized children had smaller brain volumes. Finally they examined telomeres, regions at the ends of chromosomes that provide protection from the stresses of cell division and which are shorter in people who have experienced extreme psychological distress than in those who have not experienced such stresses. Children who spent any time in an institution had shorter telomeres than those who had not. REFERENCES Almas, A., et. al., (2012). Effects of Early Intervention and the Moderating Effects of Brain Activity on Institutionalized Children's Social Skills at Age 8. Proceeding of the National Academy of Sciences, 109 (2), 17,228-17,231. Nelson, C., (2007). Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project. Science 318, 1937-1940. Scientific American (2013). How Adversity Affects Young Children www.ScientificAmerican.com/apr2013/orphans, accessed May 11, 2013.

Healing Trauma & Attachment Disorders Workshop

Dr. Becker-Weidman will be presenting two day-long workshops in California:


Arthur Becker -Weidman, Ph.D.
Friday, October 14, 2011
9:00 AM—4:00 PM
Chi co Masonic Fami ly Cente r
1110 W. East Avenue , Chi co CA
Please RSVP to (530) 879-3861 or ldamschroder@sierraff.org
This FREE training is made available through the collaborative efforts of
Sierra Forever Families & California Department of Social Services
Childcare Reimbursement Available call Leslie 879-3861 for more information
Arthur Becker-Weidman, Ph.D. is a Diplomat in Child Psychology and Forensic Psychology, the American Board of Psychological Specialties. He is a Registered Clinician with the Association for the Treatment and Training in the Attachment of Children and is a Certified Therapist, Consultant, and Trainer of Dyadic Developmental treatment®. Dr.
Becker-Weidman has edited and authored four books: Creating Capacity for Attachment (2005/2008), Attachment Parenting (2010), Dyadic Developmental Psychotherapy: Essential Practices & Methods (2010), and The Dyadic Developmental Psychotherapy Casebook (2011). He has four DVD's. Dr. Becker-Weidman is on the Board of Directors of the Association for the Treatment and Training in the Attachment of Children where he serves on several committees. Dr. Becker-Weidman provides training and workshops to parents, professionals, and governments across the U.S. and internationally.
These learning objectives will be addressed:
Participants will be able to describe how parent-child attachment normally develops
Participants will identify the seven domains of impairment caused by Complex Trauma
Participants will be able to identify three general principles of parenting & treatment grounded in attachment-theory & Dyadic Developmental Psychotherapy
Participants will be able to use two new interventions to help parents with children with trauma and attachment disorders
Participants will be able to describe one key element of Dyadic Developmental Psychotherapy and be able to use it in their practice
Parents will be be able to describe the fundamental principles of attachment-facilitating parenting.
Parents will be able to implement at least two attachment facilitating interventions
Course meets qualifications for 6 hours continuing
education credit for MFT’s & LCSW’s as required by the Board of Behavioral Sciences

Mental Health issues of Adopted Children

The National Institutes of Health released a report this week stating “adopted children have higher rates of mental health problems than all other children.”

For those of us in the adoption world, the report — the 15th in a series issued since 1997 by the Federal Interagency Forum on Child and Family Statistics – may state the obvious. But it is also throws a gauntlet at the feet of social service agencies and policy makers.

During the past twenty years, the adoption landscape has been radically transformed. From the secretive adoption of babies born to unwed and predominantly white mothers, the norm today is arranged, open adoption of newborns, children from foster care or children from institutions and orphanages in far flung parts of the world.

Recent statistics help put this shift into perspective. Out of the approximately 135,000 children adopted in the U.S. last year, 11,000 (most between the ages of one and two) were internationally adopted. Here in the U.S. just over 52,000 children were adopted into non-family member homes from foster care.

Adam Pertman, Executive Director of the Evan B. Donaldson Adoption Institute, and author of Adoption Nation (Basic Books, Perseus Book Group, 2000) said in an interview that, “many adopted kids today enter their new families with pre-adoption lives. For them, this means they’ve experienced abuse, neglect, or [if from an inter-country placement] institutionalization.”

Older parents who can’t have their own children are a key factor driving the demand for more international and foster care adoptions. Not only are these new adoptive families not genetically linked, many parents, like myself, don’t even know the genetic history of the children we end up calling our own.

The upside to this expanded adoption domain has been a tremendous surge in diversity. Parents don’t try and adopt children that look like them nor do they demand infants. The linear homogenous family model is out and the crazy quilt is in. The downside, though, is inadequate support to help parents understand the history of their child or to help prepare these families for potential difficulties, both behavioral and cognitive. In their giddy rush to form a family, naïve parents can be blindsided when confronted by the reality of their adopted child’s extreme needs. To help theses parents cope, an industry of medical, cultural and emotional support services have emerged.

Nothing could underscore the point more clearly than the return in April 2010 of adoptee Artyom Savalyev to his native Russia. His single mother, Torry Hansen, allegedly overwhelmed by seven-year old Atryom’s unpredictable and unstable behavior, determined she could no longer parent him. Instead, Hansen sent her son back on a plane to Russia, by himself, with a note pinned inside his jacket. Artyom remains in Russia at an undisclosed location while the case against Hansen languishes in limbo.

Dr. Lisa Albers Prock, a Developmental Behavioral Pediatrician at Children’s Hospital Boston, and a leading advocate of ‘adoption medicine,’ says she tries to prepare parents for what to expect, but it’s hard, she says, for anxious new parents to grasp the complexities of “kids that have been fully programmed and have to be reprogrammed” in a new setting.

The new NIH report highlights some of the realities on the ground. Of the families surveyed, almost 30 percent of adopted children had moderate to severe health problems and foster care children were the most susceptible. In addition to health problems, many of these children also had an assortment of cognitive deficits such as learning disabilities, ADD and ADHD, or behavior and conduct disorders. Exposure to alcohol or drugs during pregnancy is often thought to be the culprit behind these deficits, as is infant trauma, which can have serious and long-lasting implications later in life.

While this data is distressing, Pertman says reports like this are “helpful and a good wake-up call.” To Pertman, these findings demand that policy makers take notice. The once mandatory emphasis on placement should now shift, he says, “to looking at how to help these kids and families succeed.” The NIH findings also coincide with his Institute’s most recent policy and practice report on the need for post-adoption services.

The NIH report demonstrates families feel challenged. But instead of retreating or giving up, these parents are demanding help. Despite the old Beatles refrain, “Love is all you need,” sometimes you also need a safety net.

Theory of Mind and Attachment

Theory of Mind (ToM) can be defined as the ability to work out what other people are thinking and how this might affect their behavior. In most children ToM shows a significant advance between the ages of three and five. However, the development of ToM is severely delayed in children with autism. In addition, children who have experienced significant trauma and have disorders of attachment also show limited ToM. Several studies have shown that having brothers and sisters can improve children's ToM and researchers from the University of Queensland in Australia studied sixty children with autism to see if this was the case for them too. The researchers measured the children's ToM, executive functioning, verbal mental age and autism symptoms and compared this to the number of siblings the children had and where they fitted into the sequence. The researchers found that the children with older siblings actually had a weaker ToM, perhaps because their older brothers and sisters helped them to interpret other people's actions and stopped them from developing their own skills. Having younger siblings led to a weak improvement in ToM but this was not significant once mental age and autism symptoms were taken into account.

O'Brien, Karen, Slaughter, Virginia and Peterson, Candida C. - Sibling influences on theory of mind

development for children with ASD Journal of Child Psychology and Psychiatry
doi:10.1111/j.1469-7610.2011.02389.x

Caseworker Manual for Adoption Services

The New York State Office for Families and Children has a good Adoption Services Manual for Caseworkers at
New York State Office for Children

Facebook page

The Center for Family Development now has a Facebook page.

Come and see it.

Effects of Institution care on adoptees

What happens when children from severely-deprived institutional backgrounds are adopted into caring families?

Many children adopted internationally have spend months or years in institutional settings. Orphanage care can, at best, be described as neglectful. There is often multiple caregivers and little consistency in care. The opportunity for a caregiver to develop a sensitive, attuned, and responsive relationship with the infant/child is limited or non-existent.

We are finding some answers to these questions bit by bit, as the English and Romanian Adoptees (ERA) Study continues to follow a group of over 300 children adopted from Romanian orphanages in the early 1990s. The ERA researchers are in the process of comparing the Romanian adoptees to non-adopted children as well as to adopted children who never had institutional care. This work is enormously time-consuming and complex, and involves repeated measurements and interviews at different ages, plus delays associated with analyzing, writing, and publishing the results of each phase of the investigation.

A recent presentation of the children’s characteristics up to age fifteen has been published by Michael Rutter and co-authors as "Deprivation-specific psycholcogical patterns: Effects of institutional deprivation" (Monographs of the Society for Research in Child Development, Serial No. 295, Vol.75, No. 1, 2010). The 252 pages of this monograph are absolutely packed with information.

An aspect of the monograph that will be of interest to many is the question raised in the title: whether there are psychological patterns that follow severe social and other deprivation in early life. The ERA investigated a group of characteristics that seemed more likely to occur in post-institutional children than in other adoptees. The following items were included:

1. Quasi-autism: A behavior pattern not identical with autism, but including rocking, self-injurious behavior like hair-pulling, unusual and exaggerated sensory responses, and tantrums in response to changes in routine, as reported in parent interviews (Gindis, B. [2008]. Institutional autism in children adopted internationally: Myth or reality? International Journal of Special Education, 23, 118-123).

2. Disinhibited attachment, as shown in unusual friendliness toward strangers and failure to show strong preferences for familiar people in threatening circumstance. The monograph describes disinhibited attachment as including “inappropriate approach to unfamiliar adults, a failure to check back with a caregiver in unfamiliar settings, and willingness to accompany a stranger and wander away from a familiar caregiver. It is often associated with a lack of appropriate physical boundaries, so that children may interact with strangers intrusively and even seek out physical contact… there is sometimes inappropriate affectionate behavior with strangers and undue physical closeness” ( Monograph, p. 58) .

3. Cognitive impairment, including problems with “mentalization” or the ability to understand what other people might believe or feel about a situation.

4. Inattention and overactivity similar to attention-hyperactivity disorders.

While by no means all children who had come from institutions displayed these problems, even those who had spent more than 6 months in a Romanian orphanage, the ERA group reported that over 90% of those who still showed the behaviors at age 15 had spent more than 6 months in severe deprivation. Those who persisted to age 15 with these problems had often improved (for example, become more likely to be helpful or comforting to others), but odd behaviors still occurred. Some children “annoyed other people but did not know why, and difficulties making or keeping friends were common… In a few cases, … inappropriate remarks included excessively outspoken sexualized use of language” ( Monograph, p. 86). Some children were reported as fascinated with collections, including those of “useless rubbish” like chocolate wrappers.

Childhood trauma memories: New Research

Psychologists have researched how people's memories of a traumatic event can effect how likely they are to develop post-traumatic stress disorder (PTSD) as a result of it. They've found that among adults with PTSD and acute stress disorder (ASD) trauma memories are fragmented and disorganised; are expressed more through the senses than words, and show increased emotional content. However, there has been much less research into how this process works in children. Researchers from the Institute of Psychiatry, King's College London studied 50 children being treated in hospital after an assault or a road-traffic accident. Some of the children developed ASD while others didn't and the children were asked to write the story (or narrative), both of the traumatic event itself and of another event which was unpleasant, but not traumatic. The children with ASD had significantly higher levels of disorganization in their trauma narrative compared to children without ASD and with their own non-trauma narrative. For all the children trauma narratives had significantly higher sensory content and lower positive emotion content than the comparison story. The severity of the children's ASD symptoms was significantly predicted by the level of disorganisation in the trauma narrative and the child's negative appraisals (e.g. 'this event has ruined my life,' 'I'm going mad to feel like this.') of the event.

Salmond, C. H. ... [et al] - The nature of trauma memories in acute stress disorder in children and adolescents Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02340.x

Instutional life has negative effects on Executive Function

Previous research has shown that children who have spent at least some part of their life in an institution tend to have problems with executive functions. Executive functions are higher brain functions such as working memory, the ability to inhibit one's behavior, forward planning, the ability to move from one task to another, impulse control, the ability to start or initiate, and attention. Instruments such a the Behavior Rating Inventory of Executive Function can be used to measure executive functions.

Past research has concentrated on children aged between six and eleven so researchers at the University of Pittsburgh studied 418 children who had been adopted from institutions in Russia where they had been psychologically, but not physically, deprived. 130 of the children were pre-school age while the rest were older. The study found that the older the age the children had been adopted at the worse their executive function was and that those who were adopted after they were 18 months old had worse executive function than those who had been adopted when they were younger. The onset of adolescence was associated with a greater increase in executive function deficits for children adopted after 18 months than for those adopted when they were younger.

Merz, E. C. and McCall, R. B. Parent ratings of executive functioning in children adopted from psychosocially depriving institutions Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02335.x

A study using the Vineland Adaptive Behavior Scales found similar delays, lags, and problems among a group of adopted children.
Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” Child Welfare, 88 (2)137-161.
Also see The Center For Family Development for very useful information.

Update on Artym

(July 2) -- Torry-Ann Hansen, the Tennessee nurse who adopted 7-year-old Artyom Savelyev and then returned him because she said he wanted to kill her, apparently never bonded with the Russian boy. But she did give him a new name (Justin), a new language (English) and comfort food (burgers and fries, with ketchup).

For now, Artyom, once again under the care of the Russian state, is not being fed hamburgers, said Pavel Astakhov, the point man on all things Artyom -- though there is talk of ordering out for the boy's second-favorite dish, pizza. The Russians have also junked the American name ("He's Artyom in Russian Federation," one official said), but they're making sure he doesn't lose his English. "It's very important for his future," Astakhov explained.
In an image taken from Rossia 1 television channel, 7-year-old adopted Russian boy Artyom Savelyev gets into a minivan outside a police department office in Moscow, April 8.
Rossia 1 Television Channel / AP
In an image taken from Russian television, 7-year-old Artyom Savelyev gets into a minivan outside a police department in Moscow on April 8. Torry-Ann Hansen, the Tennessee woman who adopted Artyom, created a firestorm when she sent him back to his home country of Russia.

It is not exactly true that Artyom Savelyev has been transformed into the Russian Elian Gonzalez. While many Russians pity Artyom, no one is throwing any parades for him. Still, the analogy is not totally off base.

Less than a year ago, Artyom was living in an orphanage in the town of Partizansk, nine time zones east of Moscow and a few stops from the end of the Trans-Siberian Railway. He had been consigned to a remote corner of a vast country that doesn't think much of orphans -- had he never left the Russian Far East, odds are that Artyom would have faced prison, homelessness, venereal disease and/or premature death. And then, he was magically airlifted to America.

But for Hansen, it turned out that parenting a boy who may have been a victim of fetal alcohol syndrome and definitely had been subjected to violence and hunger was, well, trying. So on April 7, seven months after he arrived in his new hometown of Shelbyville, Tenn., Artyom's new grandmother took him to Dulles International Airport outside Washington. There, Nancy Hansen turned him over to the custody of United Airlines, and he was put on Flight 964 to Moscow's Domodedovo Airport. The flight would be just shy of 10 hours.

Landing in Moscow, he was met by Artur Lukyanov, who had been paid $200 by Nancy Hansen to take him to the Ministry of Education and Science, which has jurisdiction over adoptions. At the ministry, in Moscow's center, Lukyanov gave officials a letter from Torry-Ann Hansen claiming that Artyom had "severe psychopathic issues" and wanted to burn her house down.

Artyom's story soon became a Russian story -- about suffering, fortitude and a child's innocence. Because Artyom was no longer just Artyom but a metaphor for something much bigger, his story had to end triumphantly. America, in the guise of Torry-Ann Hansen, had rejected Russia, and then Russia, in the guise of Artyom, was saved by the Russian state.

And so it was that on April 8, when the twice-abandoned Elian Gonzalez of Siberia -- having zigzagged from post-Soviet backwater to Dixieland nightmare to the loving embrace of the Kremlin -- stepped off an airplane outside Moscow, his journey, Russia's journey, finally began to look up. That was the day everything turned around.

Into the Arms of the State

Artyom's story, naturally, requires an expert storyteller. That Pavel Astakhov has been assigned to that role suggests the Kremlin knows as much.

Astakhov, the 43-year-old, permanently tanned, coiffed and manicured superlawyer whom President Dmitry Medvedev late last year named children's rights commissioner, is the Judge Judy of Russia. Besides running a bustling practice -- according to his website, former clients include Moscow Mayor Yury Luzhkov and accused American spy Edmond Pope -- Astakhov hosts the television program "Chas Suda," or "Hour of the Court."
Russian Presidential Commissioner for Children's Rights, Pavel Astakhov, shows a copy of Artyom Savelyev's US passport to journalists near a children's hospital in Moscow on April 16.
EPA / ZUMA Press
Pavel Astakhov, the Russian presidential commissioner for children's rights, shows a copy of Artyom Savelyev's U.S. passport to journalists near a children's hospital in Moscow on April 16.

The program, which airs daily on state-run Ren TV, amounts to a propaganda organ meant to convince Russians that the Russian Federation is ruled by laws, not men (which is not true). In Judge Astakhov's courtroom, justice is all that counts, not bribes or boyars or even Vladimir Putin. As Astakhov's site notes, "Chas Suda" "creates respect for the law" and "contributes to a positive image of the court in the minds of the people."

Like celebrities everywhere, but especially in Russia, it is important to Astakhov that other people know he is always busy. The first time I called him, on his cell, he didn't answer; nor did he pick up the second, third or fourth time. Eventually, I sent him a text message, and a minute later Astakhov wrote back, saying I should call his assistant. After several scheduled phone interviews that never materialized, I caught the judge in his car going somewhere that, he said, was very important.

On the phone, he was guarded -- not the way lawyers can be guarded, choosing their words carefully to avoid being accused of something they didn't mean; rather, the way celebrities are guarded, shielding from public view the gilded utopia they inhabit.

Artyom, Astakhov said, had been removed to an "undisclosed location" -- an orphanage -- in central Moscow. "It's a special house for orphans," he said. "There are many specialists around him -- pedagogues, psychologists, teachers -- and only five children in this house right now. He is living in one room with a boy of his age." He said Artyom had been put on a special diet for children in his age group (he wouldn't specify what this consisted of) and that doctors had run a battery of tests on him.

Implying not so subtly that Torry-Ann Hansen must be crazy or blind, he added, "He is absolutely normal. I spoke with Artyom many, many times. I saw all the medical exams about his conditions, I mean, mentally and physically, and Artyom is very well."

Lukyanov, the driver, agreed with Astakhov. He said Artyom seemed like a regular little boy when he stepped off the plane. He was wearing a yellow jacket and had a Spider-Man backpack with a Spider-Man doll, a miniature car and pencils inside. But he was confused about where -- and who -- he was. While they were in Lukyanov's Ford heading into Moscow, Artyom began to cry and ask for his "Grandma Nancy." "The boy could not calm down for a few minutes," Lukyanov wrote on his website.

(Lukyanov posted a lengthy dispatch on the site after being accused, in Russia, of abandoning Artyom at the ministry. He insists he stayed with Artyom all day, until he deposited him at Hospital 21, a state children's hospital on the northeastern fringe of the city.)

"When I met him, I didn't know that he is Russian," Lukyanov told me. "After, in the office of the ministry, we recognized that within six months [in the United States] he had forgot his native language ... or pretended that he forgot. At the end of the day, he remembered Russian words and began to understand us better and better."

Astakhov said Artyom was not ready to meet journalists. Nor would he reveal any details about the orphanage where he's staying except to say it has had remarkable success placing orphans with foster and adoptive families. (In the past year, Astakhov said, the orphanage has placed 150 children. He did not say if these children had been placed with foreigners or Russians, who are generally resistant to taking in parentless children.)

That said, photographs of a smiling Artyom at the orphanage have popped up on the website of the state news agency RIA Novosti. In one picture, Artyom, in a short-sleeve, blue-and-white striped shirt, plays with the iconic wooden toy known as a matryoshka doll. Behind the little boy, with his tousled blond hair and toothy grin, is a bright orange stuffed bear and a freshly made twin-sized bed.

"The most traumatic months were in Torry's family, when she pulled his hair and she punished him for everything," Astakhov said. " 'Don't cry, don't yell, don't play, don't go out from this house.' Everything was prohibited for Artyom. I think it's over, and now we are doing all the best for Artyom's future, for Artyom's present."

America and the Scandale d'Artyom

One reason English could be important for Artyom's future is that he may opt to go back to America. That would be easy enough since he is now a dual citizen of Russia and the United States, which granted him citizenship when Hansen adopted him. As one former diplomat put it, "Your mother may give you back, but your motherland never will."

Astakhov said Julie Stufft, a U.S. Embassy official, had visited with Artyom at the orphanage. Stufft referred questions about the boy to embassy spokesman Kevin Kabumoto, who refused to discuss the case, citing the Privacy Act. Tom Armbruster, the U.S. consul general in Vladivostok, cited a May 13 statement issued by the State Department on U.S.-Russian talks on adoption and, presumably, how to make sure that people like Torry-Ann Hansen (or, worse yet, Peggy Sue Hilt, who in 2006 pleaded guilty to killing the Russian girl she'd adopted) don't wind up with future Artyoms.
Artyom Savelyev plays in a children's hospital in Moscow, Russia on April 9.
EPA / ZUMA Press
Artyom Savelyev is all smiles as he plays in a children's hospital in Moscow on April 9.

"Both teams are committed to reach an agreement to increase safeguards for intercountry adoption," Mary Ellen Hickey, head of the U.S. delegation, said in the statement. Furthermore, whatever agreements are hammered out will be "legally binding" and "each country will define its competent bodies responsible for coordinating bilateral cooperation in adoption."

That is exactly what the United States has resisted and Russia has sought for years. What brought an end to the impasse was the scandale d'Artyom. The Americans were embarrassed. The Russians were livid. Finally, the political alignment had shifted, and the Americans -- who have sought to make nice with the Russians ever since Barack Obama reset relations with the Kremlin -- signed off on a slew of new regulations and identity checks.

The final agreement, details of which have yet to be made public, is expected to be signed in a few months. This makes Russia happy (victory over America!) and comes at a low cost to the Obama administration: Many, if not most, of the people who adopt Russian children are churchgoing -- many got the idea to adopt a Russian child while doing missionary work in the former Soviet Union -- and white. (Adoption officials say Russia is a popular destination for adoptive U.S. parents because it has a huge cache of parentless kids with the "correct" skin color, unlike, say, China.) This is a constituency that did not vote for Obama in 2008 and is unlikely to do so in 2012.

Too Many Children, Not Enough Homes

Since the 1991 Soviet collapse, American families have adopted more than 50,000 Russian children. The pace of adoptions held steady in the 1990s but began to drop in 2003. Although no one at the Kremlin ever articulated a change in policy -- the Kremlin rarely, if ever, articulates changes in policy -- that decline parallels a shift in attitudes at the very top toward foreigners and especially Americans.

Now, a mere 1,700 to 1,800 Russian children are adopted by Americans yearly, despite ongoing demand. "It's all about saving the children," said Michelle Helton Jayroe, who traveled in December 2008 from her Alabama home to Samara, about 550 miles southeast of Moscow, with a friend who was adopting a little boy. "She would adopt 25 if her husband would allow. ... She's hoping for two more, at least."

That is likely to get tougher. Russia has permitted foreigners to adopt its children because there are not enough Russians to take them in. That's because most Russians are poor: In 2008, Russia ranked No. 75 in per capita income, with the average Russian grossing the equivalent of $9,660, between No. 74 Mexico and No. 76 Chile, according to a World Bank report this year.

And it's because, since Soviet times, there has been a stigma attached to orphans. "For many years, if a Russian family decided to adopt a child, they would fake a pregnancy," said Ekaterina Bridge, head of the Russian branch of the World Association for Children and Parents, the Renton, Wash., agency that facilitated Artyom's adoption. "They didn't want that someone would later tell their child. They'd prefer not to tell the child that he had been adopted."

Moscow has never been happy about the need for foreigners to pick up the slack. Like capitalism and world peace, the Russian leadership tends to view adoption as an instrument that may or may not serve its interests; the fact that these interests often diverge from those of Russia's roughly 700,000 orphans, most of whom remain in orphanages, is irrelevant.

This is especially troubling to parentless teenagers on the verge of "graduation." Every year about 20,000 kids, having recently turned 17, leave Russian orphanages, according to Anna Sergeeva, director of the New York office of the Russian Children's Welfare Society. "A majority of them fall into a high-risk category (crime, homelessness, prostitution)," she wrote in an e-mail. "Ten percent commit suicide, and only 4 percent are admitted to colleges or universities."

These figures would seem to suggest that Russia should push for more, not fewer, adoptions. Not so: Sergeeva predicted the number of adoptions would drop again this year.

A Country's Outrage -- and Ambivalence

Artyom's story, like that of the Iraq War and the Bush administration's handling of Hurricane Katrina, has provided the Russian state with a prophylactic that safeguards it against external criticism -- We're all rotten, aren't we? But more important, it reaffirms Russia's idea of Russia, that of a battered and impoverished people that fights and perseveres and defies the many forces arrayed against it: fascists, imperialists, CIA agents and, of course, soulless would-be mothers from Tennessee.

Alexandra Ochirova, an adoption specialist who sits on the 126-member Public Chamber, a government panel that is meant to serve as the nation's public conscience, was reflecting on the nature of motherhood. We were at the Winter Garden Cafe, at the National Hotel, across the street from Red Square, and Ochirova was sipping an espresso. She said she was deeply troubled -- pained -- by the case of Artyom Savelyev. "The only motivation to adopt a child is love," Ochirova declared. "This is all that must be there."

(Pavel Astakhov agreed when we spoke. "You really need only love and attention and, of course, patience. For example, Torry Hansen didn't have patience, love or attention.")

What about medical records? I asked Ochirova. Hansen had claimed that orphanage officials in Partizansk withheld information about Artyom that would have alerted her to his behavioral problems. "What information?" Ochirova said. "Was he a terrorist? A killer? Perhaps she was unaware that he didn't enjoy a king's upbringing."

When she was at Moscow State University, Ochirova studied philosophy (Immanuel Kant, Georg Hegel and, of course, Karl Marx) and the greatest of all Russian prophets, Fyodor Dostoevsky. The world would be a better place, she said, if its leaders, beginning with Barack Obama, read more Russian literature and especially more Dostoevsky, whose most famous novel, "The Brothers Karamazov," ends with a little boy's funeral.

She asked if Obama had been following the story of Artyom. I said that I had no idea but that he probably had other things to worry about: the oil spill, the economy, the war in Afghanistan. Ochirova became livid. "What can possibly be more serious than this problem? This is the first problem. What we really need is a new moral order."

No doubt. There's something strange about a country that is teeming with unwanted children and has no one to take them in and can't decide if it should let other people, in other countries, fill that niche. That ambivalence inhibits action, which spawns backlog and, ultimately, a permanent subset of parentless children.

Exhibit A: Artyom Savelyev, Russia's most famous parentless child. Adoption officials, Astakhov said, are reviewing the applications of three families hoping to adopt Artyom. Astakhov stressed that all of the families are Russian, but then he said that that is not important. "A little boy, a little girl, are very flexible. It does not matter to them."

In two to three months, Artyom will be placed in a new home, and then his life will begin. Astakhov wouldn't say much about the candidate families -- for instance, where they were before Torry-Ann Hansen showed up -- except that they live in Moscow and that they are all "promising."

"One of these families," Astakhov said, "is the family of former diplomats who have good experience with adopted children because they raised a boy who was adopted many years before. This family will be the best family for Artyom. Both mother and father speak English very well."

Peter Savodnik is a writer based in New York. His book about Lee Harvey Oswald's time in the Soviet Union, provisionally titled "The Interloper," will be published by Basic Books next year.

Suicide and Child Abuse: a link

Suicide is one of the leading causes of death worldwide but what causes it is still not well understood. Mental-health problems are an important risk factor but most people with a mental-health problem do not think about killing themselves. There is strong evidence that people's experiences contribute more towards their mental-health problems than their genes and that bad experiences in people's childhood are linked to more thoughts about, or attempts at, killing oneself in later life. However, there has been less research into this than into genetic factors or mental-health problems. A team of researchers led by Ronny Bruffaerts from Gasthuisberg University Hospital in Belgium studied an international sample of 55,299 people asking them about their experiences in childhood and whether they had thought about, or tried to kill themselves. They found that bad experiences in childhood were associated with an increased risk of suicide attempts and thoughts of suicide. Sexual and physical abuse, especially during adolescence, were consistently the strongest risk factors.

Reference:
Bruffaerts, Ronny ... [et al] - Childhood adversities as risk factors for onset and persistence of suicidal behaviour. British Journal of Psychiatry, July 2010, 197(1), 20-27

Seel

Adoption: What disclosures are requuired?

The lawsuit described in a recent New York Times article by Pam Belluck raised important questions regarding the disclosures that should be made by adoption agencies to their adoptive families.

At the Center for Family Development we frequently find that families have not been fully or adequately informed regarding the mental health, health, and psychological status of the child they are wanting to adopt. In many instances the agency has not informed the family of the potential risks and issues that may be presented. We find that this lack is more common in international adoptions, and particularly in those programs that bring a child to the US for a few weeks for "camp," with a family, and more often with adoptions from Russian and Eastern Europe. We do find that agencies doing domestic adoptions of children in the child welfare system seem to do a more comprehensive job of fully informing parents of actual and potential issues.

By Pam Belluck
New York Times
Apr 28, 2010

Scores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.

Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.

The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.

They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.

After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.

Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.

Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.

The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.

After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.

The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)

Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.

“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”

No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.

But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.

Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”

Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”

Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.

“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”

As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.

Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.

Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.

While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)

“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”

In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.

In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.

The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.

Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.

“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.

But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”

The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.

“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”

Anticonvulsant medications and potential risks

Certain anticonvulsant drugs could be associated with an increased risk of suicide, attempted suicide or violent death. Anticonvulsants are used to help people with epilepsy but can also be prescribed for bipolar disorder, mania, neuralgia, migraine and neuropathic pain. Researchers from Harvard Medical School analyzed data from 14 states about patients fifteen-years old and over who started taking anticonvulsants between July 2001 and December 2006. They found that the risk of suicidal acts was increased for gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazapine (Trileptal), tiagabine (Gabitril) and valproate (Depakote).

You can find out more about this research at

http://psychcentral.com/news/2010/04/15/broadly-used-seizure-meds-may-increase-suicide-risk/12858.html

Artyom Savelyev

In today's New York Times there is an excellent editorial about the story of Artyom Savelyev (Sunday April 18, 2010, pg9) titled "A Safe, Loving Home."

As the editorial states, while we don't know all the facts and details, returning a child is "profoundly wrong." The response of the Russian Foreign Ministry, while understandable, is, in my opinion, also wrong. Since 1991 over 50,000 Russian children have been adopted by US families. Currently there are 250 adoptions nearly completed and 3,500 pending. Children do better in families than in orphanages. That being said, many children who come from orphanages, which are frequently over-crowded and understaffed, have a variety of difficulties that sometimes require very specialized care, such as Alcohol Related Neurological Dysfunction, Sensory-Integration Dysfunction, and various psychological and emotional problems caused by chronic early maltreatment.

The inadequacy of post-placement services for families is a problem that we can fix by requiring agencies to provide those services. The problem of inadequate information from the orphanages, under staffing, and over crowding is something the other government can and must fix.

Finding homes for Children in Foster Care

A recent article in the NY Times describes the efforts of one man to track down the relatives of children in foster care and to help children move into permanent adoptive homes. His work is quite inspiring. Mr. Lopez, a former police detective, now does gumshoe work for what he calls a more fulfilling cause: tracking down long-lost relatives of teenagers languishing in foster care, in desperate need of family ties and in danger of becoming rootless adults.

"Finding an adoptive parent for older children with years in foster care is known in child welfare circles as the toughest challenge. Typically, their biological parents abused or neglected them and had parental rights terminated. Relatives may not know where the children are, or even that they exist. And the supply of saints in the general public, willing to adopt teenagers shaken by years of trauma and loss, is limited."

This is an inspiring article.

The article can be found at:
http://www.nytimes.com/2010/01/31/us/31adopt.html?pagewanted=1&em


href="http://www.nytimes.com/2010/01/31/us/31adopt.html?pagewanted=1&em">

ADHD among Internationally Adopted Children: Empirical Study

There is a very interesting and informative study in the most recent issue of the European Child & Adolescent Psychiatry titled, ADHD in international adoptees: a national cohort study The abstract is summarized below:

Several investigators have reported an increased frequency of attention/hyperactivity symptoms in internationally adopted children. In this national cohort study, the authors aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985–2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the "odds ratios".

The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10–15-year olds) and girls (2.1 vs. 0.3% for 10–15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice.

Of course it is still unclear whether the children actually had ADHD since attention difficulties and related "ADHD" symptoms can also be caused by sensory-integration dysfunction, trauma symptoms, Complex Trauma, attachment difficulties and disorders, and Bipolar disorder. The fact that the children from Eastern Europe had the highest rate of use of ADHD medication does suggest some environmental rather than a genetic cause for the attention problems; suggesting that the cause may lie with the effects of chronic early maltreatment on development (Complex Trauma)

John Rosemond got it wrong

In a Baltimore Sun article, Sept 2nd 09, John Rosemond, wrote an article that is inaccurate regarding the factors sometimes associated with adoption. He claims that "Attachment Disorder lacks scientific proof," and goes on to state, "The facts: A consistent body of hard, objectively gathered scientific evidence to the effect that adopted children are more prone to psychological problems than children who live with one or two biological parents is lacking." The article goes on to criticize "adoption specialists," and describes the "case" of a three-year old to bolster his point. I find that the article is simplistic and distorted.

Mr. Rosemond has little or no training on the subject about which he is writing here. Mr. Rosemont is a "Psychological Associate," holding a MS. His background does not qualify him to offer expert advice on this particular topic.

Mr. Rosemond's statement is just wrong. Many children adopted through the child welfare system and internationally have suffered years of maltreatment (abuse and/or neglect). As you know, in the US and most countries, it is very difficult to remove a child from the parents and even more difficult to terminate parental rights. Things have to be pretty gruesome to have a parent's rights terminated and the child placed for adoption. So, the facts are: There is a consistent body of hard, objectively gathered scientific evidence to the effect that adopted children are more prone to psychological problems than children raised from birth. For example, Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990).Children who have experienced chronic maltreatment and resulting complex trauma are at significant risk for a variety of other behavioural, neuropsychological, cognitive, emotional, interpersonal and psychobiological disorders (Cook et al. 2005; van der Kolk 2005). Many children with histories of maltreatment are violent (Robins 1978) and aggressive (Prino & Peyrot 1994) and as adults are at risk of developing
a variety of psychological problems (Schreiber & Lyddon 1998) and personality disorders, including antisocial personality disorder (Finzi et al. 2000), narcissistic personality disorder, borderline personality disorder and psychopathic personality disorder (Dozier et al. 1999). Neglected children are at risk of social withdrawal, social rejection and pervasive feelings
of incompetence (Finzi et al. 2000). Children who have histories of abuse and neglect are at significant risk of developing PostTraumatic Stress Disorder as adults (Andrews et al. 2000; Allan 2001). Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average) and antisocial behaviour (4.3 times average) (MacMillian 2001). The effective treatment of such children is a public health concern (Walker et al. 1992).


Mr. Rosemont goes on to state, " On the other hand, there is significant evidence to the effect that even orphaned children exposed during their early, supposedly "formative" years to severe conditions of emotional deprivation and material neglect recover quite nicely when adopted by loving parents." This statement does have an element of truth to it. One element of helping children who have experienced chronic early maltreatment within a caregiving relationship is loving parents. But there are other elements necessary to address and resolve the underlying traumas that may be continuing to distort the child's relationships and psychological functioning.

Orphan: boycott

The bad press this movie is getting is heating up as more and more adoption groups and outraged parents voice their objections to this movie.

I encourage people to contact Warner Brothers. More to the point, I encourage you to contact your local theater and request that they do not screen the movie. Getting many people to contact the theater and to state that you will not attend that theater as long as that movie is showing may get them to not screen the film.

Editorials in the local paper would also help.

Orphan: A movie to boycott

Warner Brothers is releasing a movie that is already evoking serious concern among adoption groups, mental health professionals, and others in the child welfare system. "Orphan" presents the story of an adopted child who is "damaged goods" and is violent and aggressive toward her adoptive family while appearing sweet and innocent to others. She is presented as a calculating, cunning child whose intention is to hurt her new family.

Children with complex trauma or disorders of attachment may be aggressive, violent, and difficult to live with. However their behavior is usually grounded in fear. Their early experiences may have "taught" them that relationships and intimacy are to be feared and avoided because these are inconsistent, painful, and not helpful.

This movie is a grounded in the myth that adopted children are emotionally disturbed because of "bad genes," and so there is not hope. Nothing could be further from the truth. See: "Brown University Child and Adolescent Behavior Letter" (Demick, K.( 2007) "Challenging the common myths about adoption". Vol. 23 (4), p. 8).

Complex trauma often results in impairment in several domains and must be treated with effective, evidence-based, and empirically validated treatments, such a Dyadic Developmental Psychotherapy. How long the child has experienced maltreatment is a major factor in outcome. In addition, the adoptive parent's understanding of the early trauma and how that effects later behavior is also key to a good outcome. For older children "usual" or "automatic" parenting is usually not good enough and some form of therapeutic parenting is necessary (see Creating Capacity for Attachment edited by Arthur Becker-Weidman & Deborah Shell). The research is clear that the factors associated with "placement stability," include the caregiver's commitment, sensitivity, insightfulness, and state of mind with respect to attachment.

This film sends the wrong message. It is also based on incorrect data and information regarding the effects of early trauma on child development and what parents can do.

Boycott this film.

Temperament

Temperament is a largely genetically determined set of characteristics that remain unchanged from birth throughout life. Beginning as early as four months of age, a child’s temperament can be determined. These temperamental traits are largely unchanged throughout life. Understanding temperament is important since these personality traits do not change. A parent needs to understand these dimensions so that the parent can adapt to the child.

Temperament refers to enduring traits of a person’s approach to the world. These dimensions are found in all children across cultures. A child’s temperament is a core element of the child’s personality. Since it is unchangeable, understanding temperament is essential to knowing how to approach your child. What may appear to be a problem may actually be a mismatch between your temperament and that of your child.

1. ACTIVITY LEVEL: Physical motion during sleep, play, work, eating, and other daily activities.
(High or Low; Active or Inactive).

2. REGULARITY: The predicable recurrence of a child’s response to daily events. The rhythm of their body functions such as sleeping, eating, elimination. In school age children, regularity is observed as consistency, organization, or predictability. Is the child orderly with toys and possessions? Is the child’s after-school routine the same each day?
(Predictable or Unpredictable).

3. INITIAL REACTION: The child’s reaction to new people, places, things, foods, and routines. For example, tries new foods, refuses, or looks it over, pokes it, and then tries a bite.
(Bold or Inhibited; Approaching or Cautious).

4. ADAPTABILITY: Like initial reaction, but refers to the child’s long-term adjustment after the initial response. The ease or difficulty with which the child’s first reaction can be changed. How quickly does the child make transitions or adapt to changes in routine? How quickly can the child make a choice? How does the child react to last minute changes?
(Flexible or Rigid; Quick or Gradual).

5. INTENSITY: How much energy the child puts into a response. Is the child loud? How does the child respond to disappointments, praise, failure, surprise, or frustration?
(Intense or mild).

6. MOOD: What is the child’s dominant mood or overall pattern? Is the child generally positive, negative, or in between?
(Positive or Negative).

7. DISTRACTIBILITY: Is the child able to tune out surrounding sights, sounds, or people and continue without interruption or is the child distracted by outside stimuli? This is not the same as persistence. A child can be easily distracted yet return immediately to the task at hand and stick with it until it is completed. How quickly can a baby be soothed?
(Rarely or Often)

8. PERSISTENCY AND ATTENTION SPAN: Persistency is the child’s tendency to stick with an activity despite interruptions or outside distractions. Attention span is demonstrated by how long a child sticks with an activity when there are no interruptions.
(Often or Rarely; Persistent or not; Short or long).

9. SENSITIVITY: Sensory threshold or the amount of stimulation required to get a response. Watch all five senses (sight, hearing, touch, smell, taste).
(Nonreactive or Sensitive).

TEMPERAMENT CHECKLIST

Temperament is composed of nine dimensions. Temperament is easily determined at birth and does not change; it appears to be genetically determined. Temperament can be thought of as one of the basic elements of personality that is not changeable. It is not right or wrong, it just is; although temperaments different than one’s own can seem to be “wrong,” they are not. At the Center we use the Cary Temperament Scales to measure a child’s temperament and provide parents with a report detailing their child’s temperament and the potential strengths and pitfalls that the parent and child may experience. The traits on each continuum are neither good nor bad. However, mismatches between a parent’s and child’s temperament can create discord and problems. The following check list is not meant to replace a professional assessment or to substitute for a reliable and valid test such as the Cary. However, this check list can help you identify areas of match and mismatch between your temperament and that of your child.

The fact that you have temperament traits on the other side of a scale item form your child, or spouse for that matter, does not mean that a problem exists. It merely means that you and your child have different temperaments on that dimension. It does mean that as a parent you do need to be particularly sensitive to that dimension since your proclivities and those of your child are different. However, as a parent it is your responsibility to adapt to these differences and accommodate your child. Knowing that you and your child differ on a dimension of temperament, which is not a changeable dimension of personality, allows the parent to know that he or she must adapt to the child. This also can help a parent realize that when a child is “pushing” your buttons, that it is your issue and not something that your child should be expected to change. When there are significant differences in parent-child temperament, the parent will need to take extra steps to be sure that he or she adapts to the child.