Post Adoption Depression

Post Adoption Depression - The Unacknowledged Hazard

By: Harriet White McCarthy Date Posted: 2005-11-25

Post Delivery Depression, long recognized as an expected part of normal pregnancy and delivery is an issue that is openly discussed and well understood by the medical community and the public. Estimates vary, but between fifty to eighty percent of mothers who have given birth will experience the mildest form of PDD called "The Baby Blues" according to Depression After Delivery, Inc. Of those, approximately ten percent will suffer a more serious form of Postpartum Depression which is of longer duration and has more symptoms. The cause of both these manifestations is attributed to hormone changes and imbalances. Families, physicians, and caretakers are alert for symptoms and offer unconditional support to new mothers during this usually brief crisis.

The public and medical attitudes toward PDD are a far cry from the silence and secrecy that surround a much more pervasive problem - Post Adoption Depression Syndrome (PADS) which is a term coined by June Bond in her Spring 1995 article for Roots and Wings Magazine. For those of us who are part of the International Adoption Community, in particular parents of orphanage children, we have the added complication of adopting children who are almost always older than newborns and have been in an institutional setting. In many cases, our new children are toddlers to school-aged, and their histories and language issues add an extra dimension to the possibility of their new adoptive mothers developing PADS.

Over the past seven years, I have been intimately connected to the international adoption community as adoptive mother to three older Russian boys, as a member of the Eastern European Adoption Coalition (EEAC), as Co-Owner and moderator for the Parent Education and Preparedness List at www.eeadopt.org, and as founder and Co-Chair of Piedmont Families Through International Adoption. Post Adoption Depression has been a recurrent and persistent issue in all my support experience. In the Fall of 1999, with the help of the EEAC which made our questionnaire available on-line, I launched a survey to see just how prevalent an issue PADS really is. The results were troubling. Our survey was accessible by members of the AParentRuss-List and the PEP-List whose combined membership now tops 3,100. Non-sufferers of Post Adoption Depression were especially encouraged to answer the survey. Of the 145 parents who responded, over 65% said they experienced Post Adoption Depression, yet only 8 people reported they had been advised by their social workers or agencies that this syndrome even existed. Preparation by those agencies would have been helpful, according to 61% of all respondents, sufferers and non-sufferers.

Why does PADS exist among the adoption community in such high numbers? There are a host of very concrete and understandable reasons. Most newly adoptive parents have spent literally years struggling to get to the point of having a child to parent. Their protracted and unfulfilled hopes, dreams, and longing may cause unrealistic expectations about exactly what it will be like to be a parent, and they are unprepared for the grief they feel when reality confronts the child of their imaginations. New parents may feel guilty about their feelings of ambivalence, resentment, or anger toward their new child. The belief in instant bonding or "love at first sight" is often an unrealistic one. Falling in love with a child is much like falling in love with a future mate -initial infatuation and euphoria give way to the lengthy and often difficult process of adjusting to the day to day presence of another human being. It often takes from two to six months for a real sense of attachment to blossom according to many of the posts of families who belong to EEAC. Being unprepared and unsupported, new adoptive mothers who become depressed often try to "tough it out" without asking for any help whatsoever. Many mothers worry that if they advise their agency or social worker (the ones they have spent months or years convincing of their superior parenting skills) that they are experiencing difficulty, those same agencies and social workers will think of them as unfit parents and, in the worst case scenario, remove the new child from their care. Consequently, a bad situation becomes worse because of lack of understanding and support. First line extended family support available to new birth mothers (and fathers) is often totally missing for adoptive parents. In many cases, after enduring years of disappointment with infertility, family members don't understand why the new mother isn't completely happy and content now that she finally has what she's wanted for so long. Rather than disappoint and confound her family, many new adoptive moms simply suffer in silence, filled with shame and guilt, feeling themselves imperfect or selfish.

Our survey didn't ask for gender specifics from our respondents, but we assume that most of the questionnaires were from women. An unknown but very important issue is Post Adoptive Depression in new fathers. Stress plays a major role in what we suppose to be an equally prevalent issue. New adoptive fathers are usually the ones to return to work sooner, and they have the added issue of juggling job and new fatherhood simultaneously.

While all of the above issues pertain to all adoptive parenting, our international community has additional components which load the deck. In almost no case are we adopting newborns. Among other things, we deal with grief over the loss of unknown histories and missed bonding opportunities. We see our children for a very brief time before the adoption is finalized and we often "discover" disturbing surprises about our children's backgrounds after the fact. Our older children come equipped with distinct personalities, some of which meld smoothly into our families, others of which are a jarring and daily reminder of our differences. We adopt children who have experienced an almost unimaginable amount of loss. We adopt children who have suffered the effects of institutionalism, hospitalism, and global neglect. We often adopt children with hidden academic, emotional, neurological and medical needs. Frequently, newly adopted children attach themselves to only one of the two parents, leaving the other parent saddened and disappointed. Add to all that the stress of out-of-country travel, jet lag, communication difficulties with our older kids and foreign country hosts, sleep depravation, and cultural shock. Our decks come loaded with the potential for frustration, powerlessness, and worry - a perfect prescription for the onset of depression.

When I reviewed the data concerning the length of time adoptive parents suffered from PAD, a very disturbing picture emerged. While most post delivery "Baby Blues" are of very short duration (less than two weeks), 77% of survey participants with PAD reported that they suffered their symptoms from two months to over one year with 45% suffering for six months or more. 85% of sufferers reported that their depression affected their health in some way (serious weight gain/loss was followed by sleep disturbances and headaches), 70% felt that PADS had interfered with smooth transitions and bonding with their new children. Clearly, Post Adoption Depression is a significant, multi-faceted issue that needs to be acknowledged, better understood, and unconditionally counseled and supported by the entire adoption community!

How To Weather The Storm
Knowing that the probability of having PADS is significant will give you a chance to prepare in the event that you are among the majority who suffer with this syndrome. Preparation might include discussing the possibility with your primary care provider as well as your child's future pediatrician. Make sure your agency is aware of the PADS and that they understand the dynamics and prevalence of this issue. They should be prepared to support your need to locate help and/or services should you need them. If you have previously suffered from depression in your life, you are at greater risk. Make sure your mental health care provider is standing by in the event that you need support with medication and counseling. Alert and educate your family and spouse. Explain that you may all need extra emotional support the same way new birth families do.

Dr. Bill and Martha Sears, The Baby Book lists several excellent suggestions for the Postpartum family which are equally relevant to Postadoptive families. When you finally arrive home from your international trip with your new child(ren), make sure that you have sufficient "nesting" time. Without guilt, hold visitors at bay for a few weeks. The exception to this rule would be the one designated family member or close friend who can provide domestic help and support in order to give time for the new nuclear family to learn about each other and start the bonding process. Before you travel, investigate your company's adoption benefits and maternity leave policy. Take the maximum allowable time before trying to go back to work. Be sure to get plenty of sleep and exercise. Fresh air and a brisk walk do wonders to mitigate mild depression. Taking a child for a walk is one of life's greatest inexpensive pleasures - fun for you, fun for your child, good for bonding. If you are single or if your spouse is unavailable to provide child care while you rest, arrange for a sitter who can come in while you nap, run errands, or simply take care of personal grooming.

New competence as a parent often means a deterioration of competence in other areas of your life. Don't allow yourself to feel guilty about less than perfect housework or a reluctance to cook your usual gourmet fare. Plan to put most of your life "on hold" while you settle in those first several weeks. If you know letting things go might drive you mad with anxiety, have alternate plans in place for others to take over for you with housework or chores. Have a store of good frozen foods on hand to help with meal preparation.

If you are married, one of the most profound changes that comes with parenting is the change in your relationship with your spouse. Prepare for that change and mitigate the negative impact by setting aside some special times for the two of you to be together without the new child. This is a vital part of successful parenting - important to both of you, but also important in the message it sends to your child. Your strong, dependable relationship with one another is one of the greatest gifts you provide to your new child. If you are fortunate enough to have a secure and happy marriage prior to adoption, spend the effort it takes to nurture and sustain it.

Preparation for PADS is the key to surviving it and shortening its duration. Accept the fact that adoption carries some risk. Expect surprises, frustrations, and setbacks with your new child as part of international adoption. Celebrate if there are none! Before your child comes home, take as many parenting classes as you can. Expect to be a therapeutic parent. Bonding and attachment are slow processes. Learn to be patient and give yourself and your child the one-on-one time required for attachment and bonding to grow. Your adoption journey doesn't stop the day you bring your child home. That day is really only a beginning. Plan for the continuation of your pre-adoption emotional roller coaster ride for at least the first year. If you have adopted a severely challenged child, plan on riding for two years! Reach out for help. Be honest with your social worker and agency. If you are having difficulties, tell them! You might be pleasantly surprised at how helpful they can be, but they can't help you if they don't know you're suffering. Join a support group such as those available at HTTP://EEADOPT.ORG, or locally. There are literally thousands of people ready to help and lend support. Provide private time for yourself, your spouse, and your other children. Keep stimulation, social, and work pressures to a minimum for as long as you can. Ask your extended family and friends for understanding and support. Accept your limitations and don't be afraid to fail. We learn by making mistakes. If your adoption situation proves particular difficult, remember to tell yourself everyday that tomorrow will be better, because it probably will be.

Most of all, know that what you are feeling is a normal response to stress, that you are not alone, and that there is help for this difficult phase of your adoption experience.

Symptoms of Depression
Diagnostic Criteria From DSM-IV

Five or more symptoms in a two week period:

Depressed mood most of the day, everyday (feeling sad, empty, or tearful) or feeling exceptionally irritable.
Markedly diminished interest or pleasure in all or almost all activities.
Significant weight loss or weight gain, increase or decrease in appetite.
Insomnia or hypersomnia nearly every day.
Psycho motor agitation or retardation nearly every day observable by others restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness nearly every day.
Suicidal thoughts or ideation. 

Article Source: International Adoption Articles Directory

Inducement: Adoption Language We Must Understand

Inducement: Adoption Language We Must Understand

from Fall 2004 Adoptalk by Maris Blechner This article introduces a philosophy promoted by Family Focus Adoption Services in New York, where Maris is executive director. The concept of inducement, as borrowed from psychologists, has helped adoptive families and family support professionals to view adopted children's acting out behaviors in a more positive way, and was adapted for use in the adoption field by Maris' creative, innovative, always-thinking, and deeply committed senior staff. In a world where telephones and e-mail dominate our interactions, we sometimes forget there are other ways to communicate. In the adoption world, particularly, communication without words takes on special meaning, and psychologists have given us a concept of non-verbal communication that makes an incredible amount of sense in the context of adoption. It is called inducement. Whatever else inducement may be to the world at large, those of us who live or work with adopted children need to understand that inducement is absolutely the language of the abandoned. Family Focus staff are convinced that it is the most important conceptual tool we have to understand why children act the way they do. Inducement and Abandonment Inducement, as it applies to relationships, is simply defined. With no words required, one person sets up a situation to make another person feel what the first person feels. All of us do it to a greater or lesser extent. One classic example is when we come home from work after a terrible day. While we may say nothing, our actions cause everyone else in the house to feel as angry or upset as we are. It's a very common human experience and certainly not unique to abandoned children. However, abandoned children are experts at setting up a situation to make someone special feel exactly how that child feels. There is no question that children in foster care whom we place for adoption are filled with negative feelings—the "baggage" we hear so much about. What is the common experience that all children placed for adoption share? Abandonment, or better stated, perceived abandonment. In truth, there are many birth parents who made plans for their children and perhaps even walked away purposefully to insure that their child would have a better life. Yet, as we have learned directly from adoptees, the sense of having been abandoned is central to adoptees' experience. Abandonment is the most awful experience that any human being can endure. In fact, there are no words in our language to truly describe it. Then too, think when adopted children are abandoned. Abandonment usually happens pre-verbally, at a very young age—timing that adds to the sense that words cannot even adequately describe an abandoned child's painful feelings. Adults, however, can pretty easily list some of the emotions that perceived abandonment engenders. How does an abandoned person feel? Isolated, guilty, lost, filled with profound sorrow, enraged, worthless, hopeless, helpless, and most of all, crazy. This, too, we learned from adoptees. Unfortunately, "crazy" makes a great deal of sense if one defines it as feeling that one's inner self is totally out of sync with the outside world. Think of a child moving to a new home: feeling sorrow when everyone else is happy; feeling anxious when everyone is saying, "Don't worry"; feeling lost when everyone else is saying how lucky she is to be there. Then add intensity. A child who feels abandoned feels intensely alone, intensely angry, intensely sad, intensely mad, and intensely crazy. Intensity is one of the qualities of all inducement. The other quality is that all of the feelings a child shares in this non-verbal way are negative. Anyone working with adoptive parents has surely heard the parents complaining that they are experiencing intensely negative feelings as a result of what their children are doing. In fact, parents who call an agency, a friend, or a therapist, often use the same words that describe an abandoned child's feelings: "I feel so hopeless." "I have never felt such rage before." "I just feel so sad." "This child is making me crazy." That is solid proof of inducement. In short, the difference between general inducement and inducement by adopted children is that the feelings the children induce in their parents are specifically the horrible feelings of abandonment, hidden in the children for long periods of time, until they feel safe enough to communicate them. We have long recognized that foster children keep their most negative feelings buried deep inside. If they were to communicate them to their foster parents in the non-verbal way that children most often communicate, it would create a cataclysmic explosion. The children would be removed from the foster home and probably institutionalized. We know that foster children, understanding that they don't have a permanent family of their own, have developed a thick skin as part of their coping mechanism for surviving in foster care. To maintain that thick skin, all of those negative feelings must be tucked far below the surface. When What Looks Bad Is Really Good What makes a child finally open up and start to communicate those horrible deeply buried feelings? We believe that children open up when they feel safe within a forever family. As a result, a child's communication of deeply buried feelings is absolutely a good thing. Communication is certainly part of healthy family life. It is proof that an adoption is a success and that a child has accepted his adoptive parents as real parents, because it is to his real parents that a child will want to communicate and finally start to get rid of that lifetime of negative feelings. Yet, how does that success often look? Very bad. How does it feel? Very bad. How does the outside world see a child who is acting out her negative feelings? As an out-of-control child; as a child who doesn't want to live there any more; as a member of a family in bad shape. To summarize, if communication is good, and if a child communicates by acting out, then what looks bad, and feels bad, is really good. What looks like a failing adoption is really a strong and successful adoption. What then is the purpose of inducement? Is inducement simply a way for children to communicate how they feel to their parents? Not completely. Like all unconsciously motivated behavior, inducement has more than one purpose. Its biggest purpose is to express the child's cry for help to the parents. The children induce terribly painful feelings in the adults—perhaps only some small fraction of what the children feel—and then they sit back (unconsciously) and watch what the parents do with their feelings. If the adult can't handle such terrible feelings without rejecting the child or doing something else negative, then what chance does the child have to handle those same feelings constructively? Separating the Inducement Message from Behavior At those critical moments in a placement, when a child has opened up and begun to heal by communicating some horrible feelings (without even being aware of what is happening) and letting a parent feel them, what is the worst thing a parent can do? The worst thing is to blame the child—even though blaming the child is certainly an understandable and instinctive reaction. Instead, a parent holding a child accountable for his behavior makes the child feel safe. The child is acting out purposefully. The child is deliberately choosing the way in which he acts out, though he is often unconscious of what really motivates him to act out. The parent who understands there is good communication going on will practically deal with the acting out behavior, and respect the message behind the inducement for its tremendous value. If, as sometimes happens, the adoptive parent, worker, therapist, school, or Child Protective Services uses the child's acting out (the child's inducement-motivated behavior) to decide that the adoption is a failure, they are doing exactly the wrong thing at exactly the wrong time. Not only are they feeding the confusion and feelings of craziness already within the child, they are breaking up a solid family and interrupting the child's healing process. We must emphasize two points about inducement. First, for a child to act out sufficiently to communicate negative feelings to adoptive parents, he or she may have to do some pretty terrible things. Children are masters at understanding how to push buttons. One family may react terribly to a child hurting a family pet. Another family may react just as strongly to a child eating leftovers from the refrigerator without saving any for anyone else. Children have a strong unconscious sense of how to engender negative feelings in others. Second, and usually more surprising to the field, inducement is a dynamic that enters an adoptive family even if that family was a child's foster family for a dozen years. It is only when a child believes that he is finally going to be adopted, and will finally have a real family, that the inducement begins. Most children in foster care won't communicate those feelings, and most foster families are not trained, or warned, that becoming your child's adoptive parent changes the entire dynamic in the home. Family Focus has placed hundreds of older children and teens who absolutely believed their adoptive parents were going to be there for them forever. Upon adoption, the natural next step for those children who finally felt safe was to start to open up and communicate those feelings. As expected, many of those families experienced sometimes terrible acting out because of the child's need to induce negative feelings in the adoptive parent. Fortunately, our families are forewarned. They are trained to understand that inducement is a good thing that feels bad, an intensity that is almost shocking in its depth. Those families have lots of negative behavior to cope with, and no easy time. The answer for parents who understand and believe in the concept of inducement, though, is never disruption. They hold on and do what all parents must do. So, what are adoptive parents supposed to do during the inducement stage? There is no magic answer. However, the knowledge that inducement is healthy communication should take a great deal of weight off parents and stop them from worrying that their adoption is failing. Beyond that, parents must keep parenting and dealing with their children's negative behaviors as other parents would. Negative behaviors warrant appropriate consequences, and positive behavior must be rewarded. Parents' overall responsibility is always to model appropriate responses to both a child's negative behavior and their own negative feelings. The same holds true for the negative feelings that are induced by the child, and recognized by the parents as such. Parents show children how to deal with anger, for example, or sorrow or disappointment by talking about their feelings, and talking about what they are doing about them. It is part of the lifelong parenting job. Family Focus presents workshops and talks about inducement to help others comprehend its challenge and value. We strongly believe that the more families and workers understand—and see inducement as a healthy adoption dynamic—the more the adoption field, like the children, will thrive.

North American Council on Adoptable Children (NACAC) 970 Raymond Avenue, Suite 106 St. Paul, MN 55114 phone: 651-644-3036 fax: 651-644-9848 e-mail: info@nacac.org Feedback

Happy March Everyone!

Lots of new things are happening at CHOICES. 

We are excited to have Cheryl Fix back at CHOICES as our Executive Director. 

There are matching meetings coming up in Parksville on March 31st and in Vancouver on May 5th.

This is an opportunity to talk with guardianship workers from the Ministry of Children and Family Development about some of the wonderful children in foster care that are waiting for families.  Call me for more information at the office anytime.1 888 479 9811.

One of our families has offered to speak with families about post adoption depression.
Debbie is more than happy to speak with anyone wanting to know more about post adoption depression. Her personal experience as a parent and waiting parent are invaluable!  cdeb@shaw.ca

This month's movie pic is ADOPTED by Barb Lee.
This is a great movie that looks at transracial adoption and openness in families.

Call the office anytime if you have questions.

Holly