Wednesday, October 24, 2012
"My Adopted Girl": Many Issues, Many Interventions
An organization I belong to recently received an e-mail from a mother with the subject line, “my adopted girl”. The mother, whom I will call M, tells her story and asks if there is a good book to read to help with the troubles the family is having.
M’s daughter is now 8 and ½ and has been with M’s family since she was 17 months old. She was severely neglected by her 15-year-old parents, according to M. Daughter was angry when first brought into M’s family and M describes her situation by saying “it was hard for us to attach” (although she does not explain exactly what she means by this). The biological mother was not only very young but was said to have had ADD and bipolar disorder and to have used and cooked meth in the home where M’s daughter lived with her.
M says she has always been very firm and consistent with this child, but is now concerned because the daughter steals and lies and does not seem remorseful. M is puzzled about what consequences might curb these behaviors and is worried that as the daughter gets older she will discover even more serious and dangerous behaviors.
There are some other interesting features to the situation. One is that M’s family also adopted three of this daughter’s siblings, one of whom came to them at 9 months after five months of foster care and a brief return to the biological mother. According to M, none of the siblings have any of the same issues that the daughter she is concerned about has.
M also brings up briefly the possibility that she herself has been overwhelmed by the demands of this family, and states that the daughter’s own problems may be only part of the picture. (This is an important insight and makes me feel optimistic about M’s ability to think through and handle whatever is happening.)
Finally, M states that her husband keeps asking if they should get the daughter therapy or not. She doesn’t mention what is meant by this, exactly.
I am going to make some comments and suggestions, but before I do so let me say that I have never met any member of this family and cannot make specific statements about them. In addition, I am not a clinical psychologist and am not presenting myself as such or offering any services.
The first point I’d like to make is that on the basis of M’s description it does not appear that the daughter has Reactive Attachment Disorder, in spite of her troubled early history. Stealing and lying, though very disturbing and problematic behaviors, are not aspects of Reactive Attachment Disorder. I think it would be a mistake to seek therapy that concentrated on attachment issues as a major cause of these behavior problems. If M and her husband seek treatment for this child, it would not be sensible to look for a practitioner who focuses on attachment therapy or on attachment as a primary problem. The fact that the other siblings do not share this daughter’s troubles indicates that this is not simply a problem of separation and adoption.
A second point is that the biological mother’s ADD may have been passed on genetically to this child, and she may be impulsive and lack self-control for that reason. Why do the other siblings not have the same trouble? Genetic transmission does not give the same results every time, and what’s more it isn’t necessarily the case that all these children have the same father. If ADD is a factor in the daughter’s behavior, she may benefit from medication.
Children who have been exposed to drugs either before or after birth have usually been exposed to alcohol too. Effects of fetal alcohol exposure may or may not be apparent in the child’s appearance, but a medical examination might help on this. If alcohol exposure is an issue, the daughter may need special education and may also benefit from medication.
The story of the daughter’s early life also suggests that she may have had little early language experience and may have had language delays with which she has not yet caught up. These would make her easily frustrated, especially in school, and could result in undesirable behavior and poor understanding of other people’s wishes and the consequences of what she does. I would suggest a speech and hearing assessment and speech therapy if recommended.
M’s recognition that she may be overwhelmed is an important one. A mother’s frustration, anxiety, and depression can have devastating effects on children’s development. In this case, it seems that the troubled daughter was adopted first and the other siblings later-- M does not make this completely clear. It is easy to see how even very competent parents could be thrown by dealing with one angry toddler and then having three more young children added to the mix. None of the children may have gotten all the attention they needed at this point, but the troubled daughter may have biological vulnerabilities that gave her real difficulties in giving up the attention she had been getting. M’s e-mail sounds as if she still feels overwhelmed, and this may be one of the keys to the whole set of issues. A good counselor (well-trained and licensed) for M could help support this mother and enable her to help the troubled daughter as well as the other children (who must be affected by their sister’s behavior). This is not to suggest that I think M is emotionally disturbed -- simply that having some professional support can be very beneficial to someone who has taken on the responsibilities M has.
Finally, I’d like to address M’s question about appropriate “consequences”. I doubt that changing ways of punishing the troubled daughter will be of any use. If punishment is to be used, it can only be effective if it occurs very quickly after the undesirable behavior, and this is hard to do with stealing and lying, where the problem is usually not detected until later. In any case, the first question should be whether any of the points I mentioned before can be of help in correcting these disturbing behaviors. More attention, more guidance, and the use of cues to remind a child about what to do are more likely to be effective than any specific “consequences”. Although this child is a little older than most for whom this treatment works, some of the ideas of Parent-Child Interaction Therapy can be very helpful.
I hope M and her family will be able to find a good outcome for this very challenging situation.