Read an Excerpt
PARENTING THE HURT CHILDHELPING ADOPTIVE FAMILIES HEAL AND GROW
By GREGORY C. KECK REGINA M. KUPECKY
PIÑON PRESSCopyright © 2002 Gregory C. Keck and Regina M. Kupecky
All right reserved.
Chapter OneWho Is the Hurt Child? Understanding the Attachment Cycle
For those who have read Adopting the Hurt Child or have a good understanding of attachment issues, this chapter-condensed, with permission, from our first book -will serve as a review. For those new to the topic, this will provide an introduction to the hurt child.
There is a common children's verse that says, "Sticks and stones may break my bones, but words will never hurt me." For the abused child, nothing could be further from the truth. While the effects of physical abuse usually heal over time, the psychological insults experienced by the child bring deep, long-lasting pain. These wounds fester within, creating ongoing difficulties for both the child and the adoptive family.
Many adoptive children did not experience early childhood trauma, neglect, or abuse. In these cases, the issues they face are common to all children and are supplemented by issues related directly to adoption. But for adoptive youngsters who lived through a difficult start, there is a range of developmental complications tied to the abuse, trauma, or neglect.
The problems that adoptive parents often see in their children are most likely the result of breaks in attachment that occur within the first three years of life. This condition is often diagnosed as Reactive Attachment Disorder, which impairs-and even cripples-a child's ability to trust and attach to other human beings.
Often mothers understand attachment issues before fathers do. This is because healthy children first attach to their mothers -beginning in the womb. Most adopted children blame the birth mothers for their abandonment, abuse, and/or neglect, and target adoptive mothers with their most negative behaviors.
At the beginning of Lara's assessment, her father said he thought his daughter was fine, and the problems were all in her mom's head. When Lara was in session, both parents watched on a video monitor from another room as the child manipulated, swore, lied, and tried to prove to the therapist that she was the boss. "Daddy's little girl" was showing her true colors, and her father admitted, "If I hadn't seen it, I wouldn't have believed it." Lara's mother was vindicated, her father was forgiven, and the family could begin to heal.
ATTACHING DURING THE CRITICAL YEARS
Most professionals who work with and study the process of bonding and attachment agree that a child's first eighteen to thirty-six months are of vital importance. In a healthy situation, this is the period within which the infant is exposed to love, nurturing, and life-sustaining care. It is the time when the bonding cycle is repeated over and over again:
* The child has a need.
* He expresses that need by crying, fussing, or other-wise raging.
* The need is gratified by a caregiver, who provides movement, eye contact, speech, warmth, and/or feeding.
* This gratification leads to the development of the child's trust in others.
When abuse and neglect occur, they can interrupt the attachment cycle-leading to serious problems in the formation of the personality and most likely affecting him throughout adulthood. When the cycle is not completed and repeated, difficulties may arise in critical areas, such as
* Social/behavioral development
* Cognitive development
* Emotional development
* Cause-and-effect thinking
* Conscience development
* Reciprocal relationships
* Accepting responsibility
SYMPTOMS OF REACTIVE ATTACHMENT DISORDER
A child born into a dysfunctional environment that features abuse and neglect as overriding themes will not experience the attachment cycle with any predictability. As a result of this attachment interruption, he may exhibit many-or perhaps all-of the following symptoms:
* Superficially engaging and "charming" behavior
* Indiscriminate affection toward strangers
* Lack of affection with parents on their terms (not cuddly)
* Little eye contact with parents (on parental terms)
* Persistent nonsense questions and incessant chatter
* Inappropriate demanding and clingy behavior
* Lying about the obvious
* Destructive behavior to self, to others, and to material things (accident-prone)
* Abnormal eating patterns
* No impulse controls (frequently acts hyperactive)
* Lags in learning
* Abnormal speech patterns
* Poor peer relationships
* Lack of cause-and-effect thinking
* Lack of conscience
* Cruelty to animals
* Preoccupation with fire
When faced with these behaviors, the pain and heartache experienced by the adoptive parents cannot be underestimated, nor can the hope that comes with identifying this disorder. From identification comes treatment that can fill in the child's develop-mental gaps and allow him to grow to maturity.
Jason was removed from his neglectful birth mother when he was a year old and was placed in a very nurturing foster home before being adopted at age two and a half. By the time he was six, he was hitting and biting his adoptive mother and other authority figures. His past neglect-coupled with his unexpressed anger and sorrow over leaving his foster home-resulted in his becoming a very troubled child. Even though his history had few moves and much nurturing, he was still a child with unresolved loss issues that impacted his attachment.
EFFECTS OF ABUSE AND NEGLECT
Even before a child is born, the building blocks of development are being laid. During the critical nine months that the child is within his mother's womb, he must receive sufficient nutrition and be free of harmful drugs if he is to develop into a healthy baby.
Many of the children who hurt were born to mothers addicted to drugs and/or alcohol. These children can be viewed as life's earliest abuse victims, because prenatal maltreatment may have prevented some of their physiological systems from developing properly. Oftentimes they are not primed to attach to a caregiver. Impeded by immature neurological systems, they are often hypersensitive to all stimulation. They do not like light and may perceive any touch as pain. In fact, any child in chronic pain, even when nurtured by the most loving caregiver, may develop attachment disorder as the pain short-circuits his ability to attach. Sadly, a baby born with fetal alcohol syndrome or with drug-induced problems is most often tended to by a substance-addicted mother who is incapable of providing even basic care. The infant's heightened sensitivity and irritability may set him up for further abuse or neglect, because the mother faces the added challenge of parenting a baby who is often fussy and upset.
Children placed into an orphanage shortly after birth receive little one-on-one care. No matter where in the world the orphan-age is located, this early placement can affect a child's development and create attachment issues.
Whether the abuse and/or neglect occur in utero or after the child is born, the results may be similar. The attachment cycle breaks, and the likelihood of attachment disorder is great. Without the intervention of proper therapy, this emotional condition can create problems for a lifetime.
Mike was ten months old when he entered foster care as a failure-to-thrive child. By the time he was adopted at the age of three, the physical traits of failure-to-thrive were gone. But his anger remained. He came to us at fifteen after multiple treatments, including counseling, anger management, day treatment, residential treatment, and in-home therapy. When we showed him a photograph of a failure-to-thrive child and explained where his anger came from and where it belonged, he began to change and join the family.
CHOOSING THE RIGHT KIND OF THERAPY
To maximize the effectiveness of therapy for a child with attachment difficulties, treatment must be directly related to the problems that the family and the child are experiencing. Specific problems warrant specific solutions, and boilerplate methods serve no purpose. In most cases, finding the right therapist to point out the right path is the first step toward family harmony.
We continue to hear complaints from adoptive parents stating that mental health professionals blame them for their children's current problems. It is an unfortunate fact that many of those who attempt to provide treatment to adoptive parents with disturbed children know very little about issues related to adoption and are not well versed in the potential damage that early trauma can cause. This is particularly alarming when we realize that besides failing to provide effective therapy, these well-meaning professionals solidify the child's existing pathology and complicate subsequent therapeutic efforts. It is not unusual for us to work with families who have seen four to six mental health professionals with little or no results.
Beth, adopted at age eighteen months, is now twenty-four years old. She was in treatment with a psychologist to discover why she had such a hard time making commitments-to both other people and to a job. She suspected that her early life had impacted her adult life, and she began to educate her therapist about adoption and attachment issues. Finally, she became frustrated with his comments, such as, "I didn't know that," and "Can I borrow your books?" Ultimately, she grew weary of spending her money to educate her therapist and switched to an adoption-friendly professional who soon had her on the right road.
* * *
The reason for this ineffectiveness in treatment is startling in its simplicity. While graduate training enables therapists to deal with the neurotic personality, it does not adequately prepare them to deal with children who have not yet made it to a developmental level that is complex enough to be neurotic.
WHAT MAKES THERAPY FAIL
Young people with developmental delays-whether social, psychological, or cognitive-tend to be extremely skilled at figuring out the traditional therapist's goals and style. They effectively assume the role of victim, and the therapist responds with sympathy. Rarely does a clinician challenge a victim child, which is precisely what needs to be done when the child is faking it. When the therapist buys into the victim positioning, his sympathetic response serves to empower the child-and disempower the parent.
To compound the situation, many children who have experienced neglect, abuse, and abandonment have not yet developed an internalized set of values by which they judge themselves and others. They are not able to receive and experience empathy-nor can they develop insight-so they tend to project blame onto others and onto objects. They blame their adoptive parents for causing their anger, and they blame toys for breaking. They blame things that could not possibly be responsible for anything!
Most often, children or adolescents who engage in projecting blame have not yet developed a conscience. They become adept at engaging others in a superficial manner, amplifying the distorted reality that exists with their therapists. They even manage to draw teachers and others into their web of delusion, making these outsiders to the family feel that these "poor children" are quite easy to be around and are truly misunderstood by those who should know them best-their parents.
Many professionals are quick to endorse the helplessness of these children and their lack of social competence. While the young con artists are initially satisfied with their success at hooking yet another adult, they will ultimately hold him in contempt for "being so stupid."
Scores of therapists have fallen into this category and will be of little help to the child and his family if they continue to blame the parents or the family system for the child's difficulties. Character-disturbed children and adolescents are highly skilled in engaging the therapist when it should be the other way around.
It is an interesting dichotomy that the same therapists who are easily taken in by disturbed children find it difficult to work with the parents. Because their efforts are focused on helping the parents understand and tolerate the child, the implied- and sometimes direct-message is that the problem is one of parenting.
When parents are influenced to feel that their own issues are to blame, they may assume the "I need to change" role. Even when they objectively know that they were perfectly functional prior to becoming adoptive parents, they may be seduced into identifying themselves as the ones who should change. When their thinking no longer matches their experiences, they can feel crazy.
Mary, a single mom, adopted three children. "If one more person says what a saint I am, I may kill them! I feel like I want to kill these children at times, and I'm doing the best I can. When they tell me I'm a saint, I feel like a fraud. No one knows how angry I get at times."
* * *
Many parents with whom we have worked describe years of nonproductive therapy. At the suggestion of therapists whose empathy focused solely on the child, they kept charts of chores, doled out rewards and stickers, and imposed monetary fines. They compromised their values, altered their expectations, and skewed their rules. They were therapeutically robbed of their parenting roles, resulting in an unexpected shift of power from them to their troubled child. Once this occurred, there was little reason for their child to change.
After many failed attempts at therapy, adoptive parents frequently become defensive, guarded, and overly controlling in their relationships with therapists. Once this happens, the parents are likely to look as if they are, indeed, the ones who need help. We often ask parents, "Did you feel and act this crazy before you adopted Bobby?" When we approach them from a humorously empathic point of view, we generally get a response such as, "Finally, we've found someone who understands!"
WHAT MAKES THERAPY WORK?
In order to help the child with attachment difficulties, it is necessary to provide therapeutic support to his adoptive parents, as well. This serves a twofold benefit:
* To counteract years of minimization and disbelief by mental health professionals, teachers, social workers, and extended family members
* To enable parents to receive, process, and utilize the information the therapist gives them, because it is presented in an atmosphere of support
Let's face it -anyone will listen and respond more positively to an ally than to someone who is placing blame.
Excerpted from PARENTING THE HURT CHILD by GREGORY C. KECK REGINA M. KUPECKY Copyright © 2002 by Gregory C. Keck and Regina M. Kupecky. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.