Educational and Mental Health Intervention for Internationally Adopted Children
In June of this year, in a rather obscure professional journal called “Child and Adolescent Social Work Journal” (Volume 24, # 3, 2007, pages 285-311), an article was published titled ‘Intervention for Internationally Adopted Children and Families: a Review of Literature.”
The authors (J. Welsh, A. Viana, S. Petrill, and M. Mathias) are university-based researchers; Dr. Janet Welsh is the leading author. This article marks a new page in the history of contemporary international adoption in this country, which began on a large scale in the late 1980s - early 1990s, when the first groups of children from Romanian orphanages arrived in the US. Since then over a quarter of a million children from overseas institutions have been adopted in the US. Initially, the first question on the minds of adoptive parents and helping professionals (almost exclusively medical doctors at that time) was “What is wrong with these children’s health?” Soon after the second question emerged: “What can be done to rehabilitate and remediate these children?” In order to answer the second question, other professionals are to be engaged along with medical personnel: educators, psychologists, social workers, therapists, etc.
The authors of this article took upon themselves the tremendous task of collecting information about existing research and “best practices” of rehabilitative and remedial work with international adoptees. To the best of my knowledge, this is the first meta-analysis of existing remedial efforts in the field of international adoption. It allows us to assess what has been done, to see our weaknesses and strengths, to identify critical issues and draw the perspective – in short, this is a long-overdue summary for practitioners and researchers working with international adoptees and their families. It was not a big surprise to find that rehabilitative medical efforts are better organized, more diverse, and more adequately researched than remedial (educational and mental health) attempts. Indeed, in the US we have over 200 physicians who have identified their sub-specialty as international adoption, many specialized medical clinics, a significant number of high quality research publications, and good publicity.
As far as the psycho-educational and mental health services involved, this review was limited to less than three pages out of the 21 that comprised the article. Indeed, there is not much to describe, with the exception of a few controversial methodologies related to attachment. Why is this so? Is psychological and educational remediation less important than medical? Obviously not: psycho-educational and emotional/behavioral issues are no less urgent than medical ones. Moreover, proper education in such cases as ARND (FAS) or developmental disabilities (e.g. PDD) is the only means of rehabilitation. With a certain disapointment, the authors of the article wrote that in the field of education and mental care for international adoptees, “Treatment decisions are often made on the basis of clinical experience or judgment alone because no scientific evidence base currently exists to guide them” (page 302). What’s the solution? The article recommends identifying “best practice” models in international adoption agencies’ functioning, in mental health care, and in education and using these models as guidelines for practitioners. This recommendations sounds like an “emergency call” to rectify the current situation, but in lieu of viable research it is the first step in creating effective post-adoption mental health and educational support for children. The article contains a set of recommendations for practitioners (pages 303-306). I would like to highlight the following findings of this publication:
1. The degree of a child's successful rehabilitation may significantly depend on such factors as the quality of orphanage rearing and the initial medical/mental health status of the child. The age of adoption is also cited as a predictive factor (the younger the child the better the outcome), but I would challenge this assumption not only based on my own clinical experience, but also on a growing amount of research showing a lack of correlation between age of adoption and the severity of problems.
2. An elevated rate of emotional and behavioral difficulties in international adoptees in comparison with population at large is an established fact that should point the direction for our remedial efforts. In such a situation it is only reasonable to expect the diversity of remedial techniques to address these issues. However, as the article indicates (four pages are devoted to this), most behavior issues in international adoptees are attributed to attachment issues and most remedial methodologies are grouped around attachment therapy of different kinds. The review of itself is relatively objective and could serve as a good introduction to the topic. The bottom line, however, is that there is a strong tendency to consider many (if not all) behavior issues through the prism of attachment problems. Although there is, indeed, a co-morbidity between distorted attachment and externalized/internalized behavior problems, the jury is still out on which one comes first and how they interplay. It is good that the reviewed article clearly and convincingly calls for proceeding cautiously with the diagnosis and treatment of attachment disorders. (In my opinion, the attachment issue, no matter how important, is blown out of proportion in the field of international adoption (see my article Attachment disorder: are we trying to fit square pegs into the round holes? at http://www.adoptionarticlesdirectory.com/Category/Attachment/74).
3. The level of language, cognitive, and developmental delays in international adoptees is also elevated, but the researchers were not able to find any reliable methodology for this kind of remediation with the exception of the SmartStart Curriculum (p. 300), which is intended for younger children (under 8 years old). The large and growing group of older (school age) children (16% of all international adoptees in 2005-2006) needs our help urgently. They lose their native language and in many cases need extensive help to compensate for their detrimental pasts, for the lack of early education, cultural differences, and emotional disturbances they must deal with trying to catch up with the “moving target” - their peers, raised in a nurturing environment from the start. Unfortunately, as the article clearly shows, no remedial material is available which is specific for this group of international adoptees
4. Pre-adoption parental preparedness and post-adoption support are a significant factor in overall problem prevention. As of now, most pre-adoption training is concentrated in adoption agencies that may not have sufficient resources to respond adequately to the needs of their consumers; in the medical offices specializing in international adoption pre-adoption training is mostly limited to medical issues. The necessity of creating multi-disciplinary post-adoption centers for families is obvious – the article clearly states this need.
5. The procedures and methods of initial (on-arrival) screening and, if needed, full assessment by a multidisciplinary team is a paramount issue stressed in the article (pp. 293-294). In the medical field there is a good foundation for such a “universal protocol” developed by the leaders in the field (Drs. Aronson, Miller, Johnson, Jenista and others). In the other domains, such as psychology, education, speech, and language, this work (with a few exceptions, such as BGCenter, page 300) has not been even started.
To conclude, we have the first attempt to summarize our achievements in the domain of post-adoption support and services; we thank the authors for their findings which will help guide our work on behalf of our most vulnerable and valuable asset: our children.
Dr. Boris Gindis is a child psychologist specializing in psycho-educational issues of older internationally adopted children. He is chief psychologist at the Center for Cognitive-Developmental Assessment and Remediation, the lead instructor at Bgcenter Online School, the author of many publications on international adoption issues and frequent presenter at conferences and workshops. firstname.lastname@example.org www.bgcenter.com