Adoptions Not Always The Stuff Of FairyTales

It was the middle of a blazing Houston summer in 1970 when my parents decided to adopt a 3-year-old boy. They were both 37 years old and already had three children, two girls and a boy. I was the oldest, an adolescent with long blonde hair, skirts I rolled up short on the way to school and a pile of Glamour magazines in my room.

Dad told us we would meet our new brother on a get-to-know-you outing at the Houston zoo. Fine, I remember thinking, but will it take all afternoon? We stared as Tony scraped every crumb of his McDonald's hamburger off the table into his mouth. Later, my parents explained how Tony had been abandoned by his alcohol- and drug-addicted birth mother, along with his three younger brothers, one of whom died of malnutrition.

This, in 1970, was no reason to assume that Tony had been affected. At least not by anything that a good family couldn't heal in a jiffy. My parents could create a better present so that the past no longer mattered.

Mom told me recently that the minute Tony came into our house, she felt the tension. When Tony stole and lied, as most kids do, Dad wouldn't leave him alone. Dad was enraged that Tony wouldn't admit it or even cry. I was astonished that he wouldn't cry. I was crying all the time, when I wasn't arguing his defense. My brother David coped silently, but neither of us could seem to connect to Tony or and enjoy him, either.

My sister Leslie, who is much closer to Tony in age than David and I, clearly did connect. Leslie and Tony were comrades. She truly loved him. I say loved, because he is dead. Tony had just turned 19 and was in the Navy when on April 4, 1986, he hanged himself on his ship. For months afterward, I'd wake up in the night gasping for air, grieving for Tony, for myself, for my failure.

Working at the Northwest Adoption Exchange for six years, I learned that many of the families who adopt special-needs children (this means anyone but healthy infants) and do it well, especially in the black community, are associated with a church. It is an act of faith, no doubt about that. My dad was a very religious man. But for us, religion, like good intentions and even love, wasn't a match for the challenges of raising a very hurt child.

Without the support of a community and specialists, our family crumbled under the weight of it. At work, I thought about Tony as I wrote little biographies of the kids that went into our royal blue binders and onto our Web page. If Tony were in the system today, I'd no doubt be obliged to include in his profile the usual litany of diagnoses: Attention Deficit Hyperactivity Disorder, Reactive Attachment Disorder, Fetal Alcohol Effect and Post Traumatic Stress Disorder. There would be medications and therapy, or at least, awareness.

I thought about my parents when I learned that kids who have experienced extreme neglect and abuse often can't attach normally. Adoptive parents of these children get frustrated and angry at the pervasive detachment; in fact, the adoptive mothers, who take the brunt of the child's unconscious fear and anger, describe the sensation as being attacked.

In addition, kids with the kinds of neurological disorders that Tony must have had don't learn cause and effect. Logic and natural consequences are so many vapors in the room. Tony wasn't capable of blending in or of following the rules. His early brain formation and lack of nurture sabotaged his life. But that isn't the only information I've needed to understand what happened.

What I also learned is that my mother and dad could never have parented him. They had no support, and they had misplaced reasons for adopting Tony in the first place. A sense of benevolence, of needing to share, is not enough. You have to understand the individual child's terms, adjust expectations for attachment and achievement, reach out to every one and any one who can help and then pray. That way, when you realize that you're in over your head, chances are much better that the story won't end in tragedy for you or for your adopted child.

Christi Killien, a mother of three, lives in Suquamish and has published seven books and numerous essays.

Thanks for taking the time to post. Maybe it will get the glitter out of someone's eyes. Or maybe it will help a friend understand what "some" adoptive parents go through.

Attachment Disorder and Holding Therapy
M.Riben

This paper is a result of growing interest on the part of the adoption community in Attachment Disorder and Holding Therapy and recent professional training sessions being held in regard to same at national conferences. Research is presented in the hope of fostering a better understanding of these issues.

The term Attachment Disorder is used in adoption circles to mean a child who, usually because of early parental abuse and/or multiple foster care placements, fails to be able to "attach" or bond with his/her adoptive parents.

Reactive Attachment Disorder (RAD) has been defined as an inability to form normal relationships with others and an impairment in development, usually caused by pathological parental care, though a cause is hard to prove. Reactive Attachment Disorder is believed to be quite common, with an estimated million children with RAD in New York City alone (Karen, 1990).

The National Adoption Center reports that fifty-two percent of adoptable children have attachment disorder symptoms. Twenty percent of the children under five who visit Kaiser-Permanente in Southern California show RAD symptoms(Brill- Downey, 1994).

The DSM-IV (1994) defines Reactive Attachment Disorder (RAD) as markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age five, as evidenced by either:

1. Inhibited Type: persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g. responds to caregivers with approach, avoidance, and resistance to comforting, or frozen watchfulness); or

2. Disinhibited type: diffuse attachments as manifest by indiscriminate sopcialbility with marked inability to exhibit appropriate selective attachments (e.g. excessive familiarity with relative strangers or lack of selectability of attachment figures).

Bowlby (1969, p.194) and others (Verney & Kelly, 1981) believe that attachment begins with connectedness in-utero between mother and child, helping the "child to develop a sense of self...and an identity" (Fahlberg, 1991, p.1). Necessary in the development of the caregiver-child bond are: eye contact, skin-to-skin contact, rocking, feeding, and vocalizations (Ainsworth, 1972; Cohen, 1974; Masters & Wellman, 1974; Yarrow, 1961, 1964, 1972). Without these critical interactions, and/or without needs being met infants can lose interest in the world, not develop trust in others (Erickson, 1950), become "insecure" or "anxiously attached" or even die.

Many believe that attachment begins even before birth on a neurological and emotional level. (Spangler, 1991; Beckswith & Cohen, 1989; de Kloet & de Wied, 1980; Gatspar, et al., 1992; Gunnar, et al., 1989; Isabella, et al., 1989; McKewen & Gould, 1990).

According to these researchers, the expectant mother's attitudes about her child, and whether or not she uses substances during pregnancy, can affect neurochemicals and hormones which in turn effect neurological and emotional development of her child.

Attachments, however, are not balck or white and there is no precise period of time for attachment, they rather run along a continuum between secure and unattached, with the normal child falling somewhere in the middle (Magid & McKelvey, 1987, pp.6-7).

Early abuse and/or neglect are considered the forerunner for attachment disorders. Cook (1991) reports that infants who do not receive a reciprocal smile or acceptance from parents internalize this rejection as shame. Children who have been abused quite naturally develop behaviors to defend against being abused again. These behaviors include avoiding attachment, for attachment would mean giving up control, and trusting that an already insane world would care for him. Children with attachment disorders exhibit three specific problem areas (Fraiberg 1980):

1. Developmental retardation: Conceptual thinking remains low, even after favorable environments are provided. Language skills, grossly retarded in all infant studies, improve in a favorable environment but are never fully regained.

2. Poor impulse control, particularly aggression: Follow-up studies of RAD children show control of aggressive impulses particularly lacking (McKelvey & Stevens, 1994).

3. Impairment in the capacity to attach: Relationships are formed only on the basis of need, with little regard for one caregiver over another.

Another diagnostic and observational tool is the "Children's Garden Attachment Model" (Carson & Goodfield, 1988). It is also important to evaluate each parent's behavior toward the child. Many childhood disorders in the DSM-IV (1994) have similar presenting symptoms to RAD (such as Attention Deficit Hyperactive Disorder, Oppositional Defiant Disorder, Separation Anxiety, Adjustment Disorder, Post Traumatic Stress Disorder).

The single factor which differentiates RAD from other disorders is a history of attachment disruptions. Others include the following symptoms to describe RAD, many or most of which must be present for a true diagnosis:

· Superficially engaging and charming
· Lack of eye contact
· Poor peer relations

· Engages in persistent nonsense questions or incessant chatter
· Fights for control over everything
· Indiscriminately affectionate with strangers

· Not cuddly with parents
· Is inappropriately demanding or clingy
· Destructive of self, others, things

· Cruel to animals, siblings
· Poor impulse control
· Engages in stealing, lying

· Engages in hoarding or gorging on food
· Has a preoccupation with fire, blood or gore
· Experiences developmental lags

· Lacks cause and effect thinking
· Lacks a conscience
· Has abnormal speech patterns

TREATMENT

Traditional psychological techniques are often ineffective for children with RAD because such treatments presume several characteristics, which the RAD individual does not have. These characteristics are: the ability to profit from experience; sufficient conscience-control to delay gratification; concern for others; enough anxiety and/or guilt to want to change; enough respect for authority figures to develop sufficient trust to profit from counseling; and the existence of sufficient conscience structure to provide a foundation for personality growth or change through counseling (Stellern, 1988).

Attachment Therapy uses a combination of therapeutic techniques such as the body therapies of Reich and Rolph, psychodynamic techniques such as psychodrama and age regression, the holding techniques of Welch and Tinbergen (1984), grief and loss work, and Redecision Therapy of the Gouldings (Goulding & Goulding, 1978). Treatment goals are to: contain conduct problems; increase verbalization of the negative feelings and perceptions; foster communication of needs and negotiation of differences; and promote positive encounters.

Confrontational therapies, which include holding therapy, have been successful, but have often been viewed as too intrusive by the general therapeutic population. To treat such a questionable diagnosis with an even more questionable therapy seems risky at best. Additionally, there are only a handful of trained attachment therapists in the US; the east coast in particular is sadly lacking (The Post: Parent Network for the Post- Institutionalized Child, Meadow Lands, PA 15347).

Children that are treated in attachment and bonding centers (such as the Attachment Center at Evergreen Colorado, Human Passages Inst., The Attachment and Bonding Center in Oh.) usually bring along their home-based primary therapist, who is trained in follow-up therapy and identification, at the same time that the child is being treated. Holding Therapy is also practiced with adopted children at such places as Connell Watkins & Assoc., Co. They believe that "it is essential that the resistance and angry bio-rhythms of the child be interrupted through the release of deeply repressed emotions (fear, grief, loneliness, etc.)"

Holding therapy, also called holding/attachment therapy, rage reduction, and dynamic therapy has been called one of the most effective, powerful, intrusive, emotionally charged and controversial therapies used in treatment of children with Reactive Attachment Disorder. There are two holding methods.

Zazlow began using attachment therapy in the 1970's, calling it the Z-process to treat infantile autism. Describing autism "as an extreme form of failure to develop normal attachments" (Zazlow & Menta, 1975, p. 63), holding therapy is one technique amongst many, and it is to be combined with baby play, treatment of specific learning difficulties, family therapy and psychotherapy, thorough medical screening and exclusion of food intolerances, appropriate educational measures, family support, etc. It is not recommended for use by itself, and needs to be applied rationally with an understanding of its processes and effects.

Zazlow's rage- reduction method involves physically holding the child to confront and work through rage and motor resistance in order to reinstate a positive relationship with the therapist. Generally, the therapy is used by the therapist to induce rage. Zazlow believes that rage within holdings is the last resistance of negativism and also the beginning of positive behavior (Zazlow & Menta, 1975).

On a 20/20 segment about holding therapy, it was shown that some clinics which offer this type of radical therapy separate the RAD children from their adoptive families for up to a month a time. Indeed Connell Watkins & Assoc. practice a form of holding therapy called "intensive" which involves the entire family (or as many as are available) coming to Colorado. The family stays in a licensed, professional therapeutic foster home so that they will have knowledgeable and strong support as well as help in processing the two-week experience. Staying with a host family also makes it possible for the child to get reinforcement of therapeutic tasks while his/her family can take a much needed break, according to Connell Watkins & Assoc.

All of these therapies have the same goal: to recreate the bonding cycle that an infant experiences with her mother. The purpose of attachment therapy is to "provide a crisis of intimacy" between parents and child from which a closer and more loving relationship can grow (Crawford, 1986, p. 43). Welch and Tinbergen (1984), developed the mother-child hold called Holding Time (described in Welch's book by the same title). This involves the parent herself, rather than a therapist, doing the holding.

Welch advises parents who try this to anticipate, and be prepared for, the following six stages to generally follow:

1. Quiet sufferance, amusement, and embarrassment: The child may think that the parent is not serious and will soon give up. The child may also be determined not to do what is expected of her.

2. Bargaining: The child promises to be good if the parent stops.

3. Anger, volcano stage: The child may spit, scream, swear, attempt to get free, bite and try to cause alarm by saying that he is in pain, cannot breathe, will vomit, is going to die or needs to urinate. The parent must accept this calmly and perhaps even silently.

4. Weeping and wailing: This may be the most difficult stage for the parent. She must stand up to the temptation to feel sorry for the child, to feel guilty about what she is doing, or in any way to save the child from experiencing the full range of emotions in a controlled environment.

5. Acceptance: The child begins to fight less, becomes relaxed and tired. The mother usually recognizes this stage when it comes and decides that the hold and weight can be slowly removed. The child will usually want to respond to the mother's caressing by putting her arms around the mother.

6. Bonding: The end of the cycle is the important healing time when helpers quietly leave the room. The child will usually curl up in the mother's arms like a much younger child. Tissues are needed to mop up tears, spit, and sweat, and this allows the parent to perform a caring task that would normally be out of place with an older child.

Both Zazlow and Welch believe that the rationale for using holding is to reestablish trust by creating a crisis situation in order to regenerate the trust cycle and consequently, a bond. In the most intrusive level of holding therapy, the therapist uses techniques to insure his and the child's safety.

The child is wrapped in a blanket and physically restrained by several adults. This process itself takes away the child's control, creating feelings of helplessness. Taking away the child's control is considered important because ultimately it is believed children who control adults do not feel safe (Gruen & Prekop, 1986). The child who has had control taken from him, it is believed, will feel free to express his feelings.

Children with RAD do not like to be held, some because they have been previously held or touched in inappropriate ways and against their will. They fear closeness because it can mean loss of control to an authority figure who may again hurt them and thus fight very hard to have control, to prevent being hurt again.

Greun and Prekop (1986) contend that being held promotes fear and makes it accessible: "The experience of rage, hate, fear, and shame in the context of being held brings security. However, the lifestyle in our technological society all to often brings with it a deficit in holding" (p. 251).

But critics of holding/attachment therapy see it as abusive (Reber, 1996). James (1989) notes that if used improperly it could traumatize an already traumatized child. Certainly holding/attachment therapy is intrusive and provocative. Those individuals who have unresolved issues of abuse, loss, grief, anger, and pain will be emotionally pricked while in the presence of the holding process (Reber, 1996). Many individuals thus inclined could find this therapy physically and emotionally abusive.

Research on the effectiveness of attachment therapy is sorely needed. Nearly all articles published worldwide on the subject of attachment therapy merely explain the process with results presented anecdotally, relying on authors' case studies of success alone. Before this controversial practice can be condoned and/or supported, in-depth, empirical and longitudinal research need to be done in this area in order to ascertain the effectiveness of attachment therapies, especially in view of the dire consequences (Reber, 1996).

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