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1) What are some of the typical behaviors in post-institutionalized children?
2) My child's medical report said he has developmental delays. Should I be concerned or will they catch-up on their own?
3) Should I have my child evaluated for Disorder of Sensory Integration?
4) What can I expect with my child's language acquisition?
5) What are the symptoms of Alcohol Related Neurological Disabilities or what used to be called Fetal Alcohol Syndrome?
6) How long will it take before we start feeling like a real family?
7) What are the symptoms of Alcohol Related Neurological Disabilities or what used to be called Fetal Alcohol Syndrome?

1)

What are some of the typical behaviors in post-institutionalized children?Top Of Page

When children leave orphanages, they enter a world about which they know nothing and have absolutely no experience. Their departure into this unknown world is tantamount to opening the door of the space shuttle and stepping off into the vastness of space. It's understandable, then that the overwhelming emotion most of these children feel is fear. Fear causes some very strange behaviors in people, and some of the behaviors seen in post-institutionalized children seem very odd, indeed. We need to remind ourselves how difficult this transition is for our newly arrived children, especially when some of the more common behaviors start to drive us crazy.

The most common behaviors break down into three broad categories: self-soothing behaviors; defensive and hypervigilant behaviors; bad habits learned as survival techniques in a previous environment.

The oddest behaviors may be the self-soothing behaviors. These can include finger sucking, clothes sucking, hair twisting, full-body rocking, body spinning, obsessive touching of self and objects, staring at hands, head banging, etc. These are repetitive behaviors which were learned during the period of time that the child was understimulated and needed to create his or her own way of whiling away the endless hours of being alone. For the most part, these behaviors will moderate over the first several months within a child's new family. Understanding of the motivation for these behaviors will help you be patient with your child during the transition.

The second broad classification of behaviors are the defensive and hypervigilant behaviors. These include various phobias, hyper-activity, sleep disturbances, oppositional behaviors, sensory defensiveness (reluctance to being touched), separation anxiety, clinginess, overactive startle response, frequent tantrums, obsessive behaviors, food issues (pickiness or gorging). Some of these behaviors stem from deprivation and a lack of interactive experience in the child's past. Some of them stem from the child's very primitive attempt to have some control over his rapidly changing life. A great many stem from a lack of understanding of what's going on around him. These particular behaviors will take longer to disappear than the self-stimulating behaviors because they can only be overcome by example. New foods will not make him sick, there is always plenty of food in his new home, touch will not hurt, water in a bathtub is not dangerous, Mom does come back every time she leaves, no one is going to hit him, he will be safe in his new home, it is not necessary to be in constant motion to avoid being afraid. Language acquisition is a key element in temper tantrums. Without adequate expressive language, newly arrived children, like babies, must resort to crying in order to call attention to their needs.

The third category of behaviors is the hardest to change. These are self-preservative behaviors learned in the institution. Some of the behaviors are learned by watching, some are learned by doing. These include: over-confident sense of entitlement or independence, fighting, pushing, biting, hitting, stealing, lying, hording, bullying, indiscriminate friendliness, lack of integrative social skills. These behaviors will take active behavior modification, constant reminders, and patterning to overcome. Great patience is required to change these behaviors. In some cases, the best you can hope to achieve will be trying to make positives out of negatives. For example, you can stand up for yourself without resorting to physical violence, you can be independent within the limits of living within a family, the consequences of doing something wrong are always worse if you add a lie.

Although there are three broad categories of post-institutionalized behaviors, they all stem from the child's fear of the unknown world into which he has been placed. Great patience and kindness is required to help children let go of these behaviors. Time will take care of most of them, but the time required may be longer than you'd hoped. Consistency and good patterning are the keys to helping your child overcome his often overwhelming fears.


2)

My child's medical report said he has developmental delays. Should I be concerned or will they catch-up on their own?Top Of Page

Unfortunately, the term developmental delay has been identified as just another frequently seen but pretty meaningless and overused description on adoption referrals. It's a great misfortune to assume that, because ignoring the presence of true developmental delays can have profound consequences by the time a child enters school. The fact is that most of the children coming into new families from Eastern Europe DO have true developmental delays. They are not just a little behind in development....they are lacking pieces of development. Human beings build upon previously learned and mastered skills. If some of those skills go unlearned or unmastered, all that follows will stand on shaky ground.

The rule of thumb within the community of physicians who specialize in international adoption is that a child loses a month of physical and cognitive growth for every three months spent in an institution. It would follow that the less time spent within an orphanage, the quicker the catch-up from developmental delays will be. As a general rule, that assumption is correct, although there may be other issues to take into account on a case by case basis (pre-maturity, low birth-weight, previous abuse and trauma). Because most of the children coming from Eastern Europe have been in institutions for some length of time, and because many of them have suffered from poor prenatal care, low birth-weight, and/or environmental insults, most of them have some degree of developmental delay. They are at great risk if these delays aren't identified quickly or if the appropriate interventions are ignored.

"Developmental delay" is not a term that means a child is just developing a little slower than his or her peers. It means that a child has foundational "holes" in development. Those "holes" may not be evident until a comprehensive foundation is required for higher learning. Just as one needs a strong physical foundation upon which to build a home, so one also needs a strong cognitive foundation upon which to build higher education. Too often the developmental delays so easy to overlook in a very young child become magnified when the child enters the school environment. At that point, the child is already at a tremendous disadvantage compared to his home-grown and well-nurtured peers. On the other hand, if these silent developmental delays can be identified very early after the child comes to join his or her new family and if the proper interventions and therapies are immediately undertaken, the risk of serious repercussion later on when the child enters school can be minimized.

Along with the requisite medical evaluations and re-inoculations, it would be well-advised for all parents to have their newly arrived children seen by a developmental pediatrician. That person is an expert in pinpointing exactly where the child falls on the cognitive side of the developmental scale. Don't assume that if a child is "on the charts" for height, weight, and head circumference that they have no developmental delays. Sometimes the delays will be global, sometimes not. Often the developmental pediatrician will see things that we aren't trained to see. The developmental pediatrician can offer suggestions about ways to help your child make up for these cognitive deficits and can offer referrals and suggestions for other professionals you may need to see.

It has often been said that in adoption one should plan for the worst and hope for the best. In the case of developmental delays where the risk is so high for all post-institutionalized children, early identification and intervention is the key. The longer a parent waits for a thorough understanding of a child's development, the heavier the load becomes above that potential developmental "hole". Identifying and fixing that "hole" will avoid a major collapse later in a child's life. Yes, this is yet one more evaluation you need to have done when your child comes home. Yes it takes time and effort to go back and fill in the blanks, but in the long run, the frustration and unhappiness you will save yourself and your child makes it well worth the attention you pat to this issue.


3)

Should I have my child evaluated for Disorder of Sensory Integration?Top Of Page

Should You Request a Sensory Integration Evaluation for Your Child Adopted from an Institution?
By Harriet McCarthy

There are some who feel that every child coming from an institutionalized background would benefit from a Sensory Integration evaluation by a certified Occupational Therapist. I agree with them. My understanding of this need comes from my on-the-job training with my two sensory disordered Russian boys, from books, medical periodicals, and on-line classes which explore the effects of childhood trauma. It also comes from a wealth of anecdotal information shared on the PEP-List (Parent Education and Preparedness) at our EEAC website.

An evaluation for sensory issues is as important as an evaluation for developmental issues in newly arrived children, and I have always recommended a scheduled appointment with a Developmental Pediatrician be made as soon as possible. An additional evaluation by an occupational therapist trained in sensory issues is well worth the modest price and a little more of your time.

The more I learn about trauma, abandonment, institutionalism, neglect, abuse, helplessness, hopelessness, rejection, malnutrition, and prematurity - and what their effects are on a child's brain - the more I understand why so many of our PI (post institutionalized) children have mild to grave, often pervasive sensory issues. These abnormalities present themselves as hearing problems such as central auditory processing disorder, vision problems like amblyopia and partial blindness, or oral sensory issues which cause feeding and swallowing problems or lack of proper sucking and chewing skills. A child may have an over sensitivity or under sensitivity to smells which can cause reactions ranging from an overactive gag reflex to the refusal to eat. It is sensory problems that cause the difficulties with tactile sensations -some children crave too much and crash, twirl, press, or spin into everyone and everything - some children avoid it and refuse to be touched at all, acting-out inappropriately or recoiling in panic when someone or something gets too close.

Misdirected sensory cues cause a number of problems. They can keep a child from sitting or standing still, prevent a child from understanding what you are saying to them, cause speech abnormalities, gross and fine motor problems, dyslexia and learning disabilities, and passive, regressive, or aggressive behavior. They may cause eating problems, which keep a child from ingesting enough nourishment, or cause them to gorge on anything and everything. They cause sleep and toileting disturbances. Quite frequently, processing problems aren't simply one-dimensional but multi-layered, affecting several dynamics of a child's perception.

All this sensory disorganization has to do with the brain's chemicals, the hormones they produce, and the effects of those hormones on the child's ability or inability to accurately process the sensory input of touch, movement, taste, sound, smell, and sight. In an institutional setting, many, if not most of these sensory components, are missing or diminished. Orphanages are quiet places. Often the light is very dim and auditory and visual stimulation is at a minimum. Children don't get the opportunities for enough movement or touch. There is very little variety in diet, much of it is soft, and often there is barely enough food to keep a child adequately nourished. Extra-large holes in bottle nipples speed up the feeding process, but never allow the development of good sucking skills. Interaction between children and/or between children and caretakers is minimal. Beyond the orphanage window is a very small, circumscribed, unchanging picture of a world waiting to be explored by children who have no opportunity to do so. Normal cycles of need aren't rewarded with comfort. Lack of stimulation in all these sensory areas interrupts production of the beneficial hormones needed for a state of calm - hormones which are released when children feel a mother's gentle touch, see the warmth and approbation of her smile, or sense the safety of her fierce protectiveness. Instead, high levels of stress hormones flood the brains of these confined children who have rotating caretakers, causing different neural development than that which is normally seen in healthy, nurtured children. The deficits and atrophy these high stress hormone levels create cause a child's perceptions to be processed in a distorted manner. Under these circumstances, it is easy to understand why a child would be very frightened, confused, or overstimulated after institutional care.

The good news is that the brains of most children from institutional settings are plastic enough throughout childhood to be healed and made whole, even when considerable damage has taken place. It takes work. Most of the time it takes some therapy and early intervention. It always takes time, patience, gentleness, kindness, and understanding. First, we must learn to recognize a sensory disordered and frightened child when we see one. New parents need to learn how to calm that frightened child, and that child must learn to accept a state of being calm within his or her new surroundings. Once a state of fairly normal equilibrium is reached, stress hormones sufficiently reduced, and the fight or flight response moderated to low levels, young brains will begin to perceive the world differently - less threatening and more bearable. With time, the appropriate stimulation and retraining, these children can begin to process sensory input in normal or near normal ways, and the potential for a happy and complete life for that child is possible.

Consequently, if you are wondering at all about an Occupational Therapy evaluation, get one. Because these sensory changes happen deep inside the brain, they are invisible to the outside world except for the effects of their devastation. These abnormal processing issues are often very subtle. It takes a trained expert to see and evaluate them correctly. Although there are many excellent resources on the subject of sensory integration, and parents are certainly encouraged to learn all that they can, this is not a do-it-yourself project for you and your child. What looks absurdly simple in the orchestrated play of the Occupational Therapy setting is actually the end result of an extremely complex discipline which takes many years and a specialized degree to master. The competent occupational therapist can and will give you ideas for a sensory "diet" to work with at home, but the direction and focus of the therapy will be accomplished best within a clinical setting.

If you suspect your child may have sensory issues, the earlier you have an expert evaluate your child, the better off he or she will be, and the sooner you and the therapist can start to reverse any damage that may already exist. A multi-sensory evaluation is another issue to consider seriously along with all those medical and dental exams, all those tests, re-tests and re-inoculations. Have your child evaluated by a good Occupational Therapist trained in Sensory Integration theory and therapy techniques. It may ultimately make life much easier for you, your child, and for your entire family.

Copyright © 2001 By Harriet McCarthy. All rights reserved.


4)

What can I expect with my child's language acquisition?Top Of Page

One of the main issues suffered by post-institutionalized children who have been abused, neglected, sensory deprived or developmentally delayed is that it is their speech/language patterns often suffer. It's very possible, especially with older children, that you will be tricked into thinking nothing is wrong. Children who are already of speaking age when they join our families often acquire conversational language very quickly. Don't be lulled into thinking that rapidly learned conversational language will equal proficient comprehension. It is vitally important to have all speaking children evaluated for any speech/language disability as soon as they arrive - preferably in their mother tongue. Please see Sharon Glennen's article: Language and the Older Adopted Child which explains this need in depth.

A speech/language evaluation is not terribly expensive, doesn't take more than a few hours to do, and will give you a wealth of information. The evaluation will not only tell you if there is a problem, it will tell you what the problem is and offer some suggestions about how to handle it.

Language is laid down at a very early age - some feel that a baby listens to and recognizes its parent's voice even before it's born. If the child hears differently, can't hear well, lives in a mostly silent environment (like an orphanage), or doesn't have a chance to hear normal interactive conversation, disruption in the normal development of speech is often the outcome. Sometimes these disruptions are very subtle or may appear to be limited to a few mispronounced sounds. Sometimes they appear to be memory, word retrieval, or sequencing issues. A good speech/language pathologist can be a valuable tool in determining what's going on. If there is a deficit in the process of building language skills, it may very well be carried forward into academic problems - particularly when it comes to learning to read and understanding word problems.

If a speech/language problem is diagnosed (which happens in a very high percentage of post-institutionalized children), then a course of language therapy will be in order. Speech/language problems and/or auditory processing problems carry this caveat: there is no quick fix. Don't buy into any program or gimmick that offers a quick fix - they don't work if there is a real processing problem going on. There's not even a "moderately fast fix. The only fix that really works for these issues will be a sloooooowww fix. It may take years to remediate these problems, and even after years of therapy and what looks like success, you may find that the child still doesn't understand a lot of academic concepts or remember very ordinary words. Oftentimes, a child with auditory processing problems may appear "drifty" or "spacey". This may be because he's only comprehending fragments of conversation or instructions and working terrifically hard to fill in the blanks while trying to keep up with the pace of conversation. Language is a completely abstract function. The more sophisticated and complex the language is, the more difficult it will be to comprehend. Where does this really count? It counts in school. In the first three grades (K, 1, and 2), children are said to be learning to read. When a child graduates to third grade and beyond, he is said to be reading to learn. If there are language processing problems that haven't yet interfered with learning to read, you can be sure they will interfere with reading to learn.

There is also some recent and very enlightening research being done on the additional cultural component of language. There are several articles of interest in Dr. Gindis's "Publications on Adoption" section of the Web site. This particular article is titled "Cognitive, Language, and Educational Issues of Children Adopted from Overseas Orphanages" (this is an Adobe PDF file and requires Adobe Acrobat to view).

It's never too late to start fixing and/or repairing some of the damage from auditory processing disorders, speech/language delays, or articulation and sequencing problems. Yes, the older a child gets the harder it is and the longer it may take, but don't let that deter you. And don't let the school system talk you into adopting a "wait and see" attitude based on their contention that your child's delays are all part of English as a Second Language. A child's complete mastery of language is vital to later academic success. It's also fundamental to development. If there is a diagnosable problem, identifying it and fixing it is one of the greatest gifts you can give your child.


5)

What are the symptoms of Alcohol Related Neurological Disabilities or what used to be called Fetal Alcohol Syndrome?Top Of Page

Many of our adopted Eastern European children may be suffering the effects of alcohol-related neurological disabilities. Unfortunately, many of the parents of those children have no access to maternal history, birth history, or early life history of their children which is necessary for a definitive diagnosis. Children with the obvious facial and physical features of Fetal Alcohol can be evaluated and diagnosed by a physician specialized in this field, but for those children who don't have a lot of physical symptoms, it becomes much harder to pin down the diagnosis. To complicate matters, many other neurological disorders (AD/HD, sensory integration issues, language/auditory processing disorders, learning disabilities, executive functioning problems) share symptoms with alcohol-related neurological disorders. Teasing all these issues apart is a little like untying the Gordian knot. Many times, the closest we can get to determining if maternal alcohol consumption has interfered with the development of our children is a strong suspicion and not much else.

If you are concerned about your alcohol-related neurological disabilities in your child, the FAS Community Resource Center has a good list of symptoms:

One question that gets asked a lot is how far to go in trying to get a diagnosis. That's an individual decision, of course, but in my personal experience (and there are those who will strongly disagree), it's not so much the underlying cause of my children's disabilities that's important, it's the symptoms I need to treat. While you can't reverse fetal alcohol effects, you can target specific symptoms with appropriate therapies.


6)

How long will it take before we start feeling like a real family?Top Of Page

Of course it depends on the individual family, but there are some milestones a lot of us experience along the road to feeling like a "real family" after the adoption of our children. The most important thing is not to panic if it seems to be taking a long time for things to settle down. You family is not unusual. Most families go through a bumpy transition, whether they are going from two adults to a family of three or if they are already a family adding more than one child - any new introduction of a family member can throw things into chaos.

The first six months of being a new family is a time for all its members to get to know each other. Some families experience what is known as a honeymoon period. The honeymoon is the period of time that everyone is on best behavior. Many of us in the international adoption community experience very short honeymoons before the children start acting out. I have adopted three 5-6 year old boys from Moscow and never once had anything that even vaguely resembled a honeymoon. Why are international honeymoons so short? It has to do with the overwhelming transitions these children are making. Consider this: they are losing their home (even though it may have been an orphanage), they are losing the only adult caretakers they have ever known, they are losing their familiar tastes, smells, sounds, and surroundings. They are walking or being carried off into the unknown. Most adoptees are far too young to understand what's happening to them. They are leaving with total strangers with whom they have only rudimentary experience. The strangers are speaking a different language and they don't seem to understand what it is the children want and need. The children may be having experiences which are completely new to them (visits to hospitals and clinics, car rides and sitting for long periods of time in traffic, walking into places where there are a lot of strangers, wearing completely different clothing than ever experienced before, eating different food), and that's all happening before they even leave their country of birth.

Once home with their new families, if these little adoptees have become at all comfortable with all the newness of the adoption experience in Eastern Europe, they are thrown into chaos all over again. Now they have routines to learn, meal times they have to adjust to, rules and expectations of their new parents to understand, along with all the stimulation of unknown experiences (turning lights, television, VCRs, radios, microwaves on and off, having unlimited choices of foods and snacks, opening and closing doors, going outside, shopping, meeting relatives and friends of the new parents, swimming in pools, taking bubble baths, and on and on). At times, these new arrivals have the added challenge of joining an existing family of other children. That kind of adjustment affects all the kids who suddenly have to find their place in the new pecking order. This can result in a lot of sibling rivalry and arguments, a lot of whining and crying and complaining, and a lot of hurt feelings. Many parents don't think to anticipate these sibling problems and it becomes an extra set of problems they aren't prepared for.

Yet another issue often experienced in new families is a rejection of one or the other parent in a couple. As much as we can explain this kind of rejection within the context of our new children's backgrounds, it's almost impossible NOT to take this personally. There are strategies new families can use to get over this particular hurdle, but during the period of time the parent is being rejected, things can be pretty awful. Rejected parents often feel very sad and lose self-confidence - not a good thing at a time adults need all the self-confidence they can muster to parent their new child.

Around the six-month mark, things start to settle down and become a little more routine. Before that point, expect a lot of ups and downs. A second milestone seems to be at the first anniversary of the adoption. A third occurs at about the 18 month mark. Eventually you'll have a day when you realize that you feel like a family. You might have the same experience I did. When that magical moment came, I looked at my husband and realized he was feeling exactly the same emotion. We had finally arrived! It was a sweet feeling, indeed.


7)

What do all those abbreviations mean?Top Of Page

If you belong to any Internet support lists or chat sites, you'll know that there is a special code you'll need to learn or have handy as a reference in order to understand all the messages. The code has to do with the abbreviations seen on the medical reports for our new children. With the help of several long-time Internet mavens, I've come up with a list of these abbreviations and their meanings. Here they are:
AD/HD Attention Deficit Hyperactivity Disorder - Can be
Predominantly Inattentive Type or
Predominantly Hyperactive Type or
Predominantly Hyperactive-Impulsive Type or
AD/HD NOS Not Otherwise Specified
AD Anxiety Disorder - can be NOS
APD Auditory Processing Disorder
ARND Alcohol Related Neurological Disorders
ASD Acute Stress Disorder
BED Behaviorally, Educationally Disabled
BiPD Bi-polar Disorder
BPD Borderline Personality Disorder
blclp Bilateral Cleft Lip and Palate
CAB Child Antisocial Behavior
CD Conduct Disorder
DBD Disruptive Behavior Disorder NOS
DD Dear Daughter
DH Dear Husband
DS Dear Son
DW Dear Wife
DD Developmental Delays
DD NOS Dissociative Disorder Not Otherwise Specified
DPD Dependent Personality Disorder
DSI Disorder of Sensory Integration
EE Eastern European
EI Early Intervention
FAE Fetal Alcohol Effects
FAS Fetal Alcohol Syndrome
FAS/E Fetal Alcohol Syndrome/Effects
FASD Fetal Alcohol Spectrum Disorder (this is sometimes referred to as ARND
FSU Former Soviet Union
FTT Failure to Thrive
GAD Generalized Anxiety Disorder
HBV Hepatitis B
HCV Hepatitis C
HOH Hard of Hearing
IA International Adoption
IA Doctors International Adoption Doctors
ICD Impulse Control Disorders
IDEA Individuals with Disabilities Act
IED Intermittent Explosive Disorder
IEP Individual Education Plan
ILP Individual Learning Plan
LDs Learning Disorders
LOL Laughing out loud
MR Mentally Retarded
NPD Narcissistic Personality Disorder
NVLD Non-verbal Learning Disabilities
OCD Obsessive-Compulsive Disorder
ODD Oppositional Defiant Disorder
OT Occupational Therapy or Occupational Therapist
OTOH On the other hand
PAD Post-Adoption Depression
PD-NOS Personality Disorder Not Otherwise Specified
PDD-NOS Pervasive Developmental Delays Not Otherwise Specified
PI Post-Institutional or Post-Institutionalized
PT Physical Therapy or Physical Therapist
PTSD Post Traumatic Stress Disorder
RAD Reactive Attachment Disorder
ROFLOL Rolling on the floor, laughing out loud!
SAD Separation Anxiety Disorder
SID Sensory Integration Disorder, now called DSI
S/LP Speech/Language Pathologist
SS Social Skills
TTD Transient Tic Disorder
UMD Unspecified Mental Disorder