Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, February 21, 2013

Russian Adoption: Trying to Talk About Maxim Shatto



I got up at 4 o’clock this morning to go to a TV studio and be linked to a Russian Channel 1 program (“Life with Mikhail Zelensky”) focused on the deaths of Russian children adopted by parents in the United States. As it turned out, the birth parents of Maxim Shatto, the three-year-old recently killed in Texas, were interviewed on the program, and told a rather sad and somewhat sordid story of having left two young children with a grandmother who may have been a poor choice of caregiver, with the subsequent taking of the children into care and placement for adoption. (I only know this because of the services of Alexander the simultaneous translator, who was speaking into my ear while shouting and periodic applause filled the Russian studio.) You can see this at http://www.youtube.com/watch?v=BcBXI2oTN6g&feature=share.

There is so little information available about Maxim’s death that I cannot possibly say what lay behind this event. I was asked to describe attachment therapy for the program, and did so, but I was not asked whether I thought Maxim had been subjected to any aspect of that unconventional treatment. Again, I cannot think either way about this until I know much more. I am curious as to whether the little boy had failed to gain weight in his adoptive home, because this suggests the use of parenting techniques advised by AT proponents. I was also asked about restrictions on prescription of Risperdal, the adult psychotropic medication that Maxim is said to have been taking, and I was able to say that there is little control over these off-label prescriptions.

But of course these are not all the things I would have liked the chance to say. Although I am very concerned about misinformation given to adoptive parents about attachment  and about appropriate mental health treatment for adopted children, and although such misinformation may be most directly responsible for mistreatment of children, the picture is obviously much bigger than this. The absence of other information may drive adoptive parents to over-reliance on questionable mental health advice.

Aren’t all adoptive parents supposed to have some hours of pre-adoption education according to the Hague convention? Yes, they are, but there is no clear statement about what those hours cover. I understand that some programs concentrate on “scrap-booking” about the children’s lives--  a fine thing to do together, but not a matter that takes long to explain. The change.org petition I mentioned recently wanted pre-adoptive parents to be told that children with Reactive Attachment Disorder were likely to be violent and dangerous, and this request suggests to me that perhaps some pre-adoption programs already hand out this inaccurate claim.

What would be some good things to include in pre-adoption education? One topic I’d like to see covered would be the problems that children adopted from institution abroad are actually likely to have. These include difficulties with attention and distractibility, as well as with the “executive function” that allows a person to make decisions about what to do, including stopping a course of action that was undertaken by mistake or judged to be wrong after it is begun. In addition, post-institutional children are likely to have language delays and to need speech therapy. (Language delays are the source of many behavior problems, because a child who cannot understand what he’s told, and who can’t explain his problems, is quite likely to be frustrated to the point of tantrums or other displays of distressed emotions.)

What is the purpose of telling pre-adoptive parents these things? One is to clarify for them that emotional or behavior problems displayed by an adopted child may have to do with more than his or her emotional development. They may occur in connection with cognitive or language delays that are not necessarily obvious to the casual observer.

A second point of giving this information--  and this, I think, is essential--  is to allow pre-adoptive parents to look for and arrange appropriate services in the area where they live, or to discover (better now than later) that getting such services may require extensive travel. For example, in how many parts of the U.S. can people find a bilingual, Russian/English, speech therapist to work with a child whose English is very limited and whose Russian may be delayed? In how many areas can people find a therapist who can do Parent-Child Interaction Therapy, an evidence-based treatment that helps parents and children communicate and decreases oppositional behavior? If the parents cannot get access to these post-adoption services, will they find themselves limited to practitioners who use heavy-duty medication to stop “difficult” behavior? Information given to the pre-adoptive parents early--  and given consideration by the adoption caseworker—can make the difference between desperation and good functioning in the months to come.

Let’s back up a bit, though. I’ve just mentioned that the caseworker should have some idea what resources are needed and will be available to the adoptive family. This brings up the likelihood that abusive adoptive parents (like abusive non-adoptive parents) are not just “bad people” who should have been screened out to begin with. Like many events in life, abusive behavior toward children is probably determined by the interaction of multiple risk factors, like an absence of resources. If there are few such factors, abuse is unlikely; with addition of factors, it becomes more and more probable. Adoption caseworkers need to look at a whole list of such risk factors, not simply a checklist that shows whether the parent candidates are acceptable.

If a child will have many needs for professional services, and the family lives at some distance from services, that is a risk factor.

If one or both parents have a history of depression and have limited access to treatment, that is a second risk factor. (Just as perinatal mood disorders can be a factor in a birth mother’s abuse or neglect of a child, parents with a history of depression may respond to adoption with depression and inappropriate behavior.)

If the family is socially isolated, this is a risk factor. Planning to homeschool may or may not indicate social isolation, but this should be considered as a possibility interpretation.

If there are already many children in the home, if the parents have fostered many children, or if the parents are adopting more than one child at a time--  counter-intuitively, these are all risk factors that should be considered by caseworkers, because they may indicate problems with individual relationships with children, rather than the “wonderful self-sacrificing nature” so sentimentalized by the mass media.

If the potential adoptive parents believe that their primary job is to make the children obedient, this is a risk factor.

Again, we are talking about identifying risk factors for abuse of adopted children. No single one of these or many other possible factors means that an adopted child will be mistreated. Even if they are all present, abuse or neglect will not necessarily be the outcome. But as risk factors are added, and as family stresses like illness or unemployment unpredictably occur, the results may be abusive treatment, of either the systematic kind advocated by some proponents of attachment therapy, or plain old, unsystematic, common or garden maltreatment.

We can make use of information about risk factors to do a better job of screening potential adoptive parents. We can improve matters by better pre-adoption education of those who are not screened out. But forgive my cynicism if I say that we probably won’t, as long as the adoption industry makes money both inside and outside the United States.

PLEASE NOTE: A longer  Russian TV discussion of the use of attachment therapy can be seen at http://www.1tv.ru/news/world/227626. You will need to type this in, not click on it here. 


4 comments:

  1. Dear Jean, unfortunately your comment was taken out of context on the programme and was used as a general proof that America is a place where children adopted from abroad are systematically mistreated and killed. Maxim was used as "yet another case", with numerous Russian officials announcing he died due to mistreatment before investigation was over. I understand that you are working with some Russian-speaking colleagues. Please, try to get the full story on the treatment of Maxim's tragic death by the Russian media.

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  2. Yes, I know that was a problem-- that's why I rushed home and wrote this blog post. I will work on this, and as I said in a part of the interview that did not get put on the show, we have very little information to go on right now.

    I was shocked when I saw the complete show (I couldn't see it from the studio) and saw all that holding therapy footage. However, I have to say that America IS a place where some foreign-adopted children have indeed been systematically mistreated and have died. Whether this was true of Maxim remains to be seen.

    I must say, I'd be happier if someone other than Mary Landrieu was a major figure in this investigation.

    Let me point out, by the way, that I recommended to Rossiya-1 that they invite Adam Pertman of the Evan B. Donaldson Foundation to be on this program. They said they had left him a message-- I don't know whether he declined or they didn't follow through.

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  3. I very much admire Adam Pertman's work. I met him at an adoption conference last year run by the Rudd Center for adoption research at UMass-Amherst. He gave a talk on the role that social media will increasingly play in the lives of adopted children and the death knell that social media will ring for most "closed" options worldwide soon. This could be a good thing for international adoptions, especially ones that are going badly, at least in the case of children who are old enough to access social media (which is, what?, probably about 7 years old today, and dropping as we speak).

    In addition to your list of topics that should be covered in pre- and post-adoption education, I would add information about the many kinds of disorders (apart from the oft-discussed "attachment disorder") that otherwise healthy newborns can come into our lives with, including, particularly, FASD, ADHD, and autism spectrum disorders. People are so often concerned about drug exposure, but in general, drug-exposed newborns are able to bounce back after withdrawal fairly nicely, on average.

    Exposure to alcohol as a fetus, however, can be devastating, life-long. As can unrecognized ADHD (which is a dominant genetic characteristic) and so, so common---and I would imagine, may be especially common among women who become pregnant unintentionally (thus leading to adoption in some cases) due to the impulsivity that characterizes ADHD.

    Just some thoughts based on some of the tough issues that I see raised in thoughtful parents' blogs about raising their adopted children.

    Thanks for doing all the work that you do on behalf of adopted children, even if it occasionally gets quoted out of context in the Russian-language media. What a reach you have!

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  4. Thanks for the kind words and for the suggested additions. It's an excellent point that drug exposure isn't nearly the problem that people used to think, although cocaine-exposed babies may need work for the motor effects of extensor rigidity.

    I think a real practical problem for the education we're trying to outline here is that there's a limited number of hours available to do it, and that excited potential adopters may have a lot of trouble taking in the information in a format that must seem like just another hoop to jump through.

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