Searching to be Found

Understanding and Helping Adopted and Looked After Children with Attention Difficulties

Randy Lee Comfort

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429918797
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

A practical, supportive book for adoptive parents, carers, teachers and other professionals who live and work with families and children whose happiness and behaviours are affected by attention difficulties and hyperactivity. The examples of real children and adults in everyday situations translate research findings into meaningful strategies for helping families, teachers and children to find more successful means of managing difficult behaviours and emotions.

Chapter One
The adopted/looked after child with attention difficulties

Daniel squirms in the chair, his small legs already running, while his large, sparkling eyes watch the tears dripping into Shirley’s lap. He sees the wet stain growing wider on his new mother’s summer skirt, and waits impatiently for her to talk, but she doesn’t say a word. Before he can stop himself, Daniel moves impulsively toward the playroom door, knocking over the paint jar and splattering the brushes to the floor.

“Are all adopted children like this?” Shirley asks the therapist.

Meanwhile, Daniel’s older sister, Christie, who is in long-term foster care, is a quiet, distant, inattentive child. Her carers question her suitability for adoption because she is so withdrawn and aloof.

“How can we brighten up this little girl?” they ask their therapist.

According to informal reporting, it would seem that a disproportionate number of foster carers and adopters live with children who manifest attention difficulties, usually, but not always, with hyperactivity. While it is clear that adoption or being in care does not cause a child to have Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder (ADHD/ADD), and while having ADHD/ADD does not determine whether or not a child will be taken into care, the association between children who are or have been in the care system and those with attention difficulties is frequently discussed. This relationship, whether clinically proven or just anecdote-based is an important one to understand as parents, carers, teachers, and professionals struggle to meet the needs of a group of children who are at high risk for academic and social failure. Both ADHD/ADD and adopted/looked after children who do not receive the creative intervention they require contribute to the tragic statistics currently describing these groups of children—young people who are vulnerable to loneliness, homelessness, academic underachievement, difficulty getting along with peers, problems dealing with authority, use and abuse of substances, high rates of teen pregnancy, under-employment, and repetitive prison sentences.

Sensitive and multi-modal frameworks for thinking about each child individually are especially useful when living and working with the adopted/looked after child who brings a disruptive early childhood experience into the family and the school. Often, these disturbing and dysfunctional backgrounds help to explain the child’s inattentive and impulsive behaviour. It is equally important to provide a holistic framework for the child whose neurobiological make-up leads him to be aggressive, hostile, disorganized, and unregulated—factors that may or may not have contributed to his/her coming into the care system.

Broadly speaking, ADHD/ADD is usually viewed as a developmental disorder of self-control that consists of problems with attention span, impulse control, and activity level that lead to impairment of the child’s ability to function successfully at home and at school. Some children display these characteristics without being hyperactive as well, and are referred to as children with ADD rather than ADHD. Both of these conditions are characterized by symptoms of inattention, impulsivity, distractibility, and erratic levels of performance. Since this disorder is defined behaviourally (there is no definitive diagnosis for ADHD/ADD), it is inevitable that some children with other neurological, psychosocial or learning disorders may appear to meet some or all of the criteria established for a diagnosis of ADHD/ADD (Nigg, 2006). Children who have been traumatized by violence, abuse, exposure to drugs, neglect, and separation from the birth parent could meet many or most of the ADHD/ADD criteria. (See Appendix I)

Adopted children are those who live with a permanent family other than their birth parents. Virtually all adopted children have been living outside their birth family prior to being adopted. The length of time they live in foster care varies enormously. Looked after children are those who are in some form of temporary care, usually in a foster home, although possibly in a group home. Whether deemed “short-term” or “long-term” care, many of these placements are not enduring, resulting in frequent moves for the looked after child. An increasing number of looked after children are living with relatives in what is now referred to as “kinship care”.

It is not the intention of this book to determine whether or not a child has a clinical attention deficit, but to accept the fact that there are many adopted/looked after children whose lives, which are already complicated and often traumatized, are made even more difficult by their attention dysfunctions. As such, a better understanding of how both neurobiological and psycho-emotional experiences have equipped the ADHD/ADD adopted/looked after child to think and behave will form the basis for considering how to formulate creative and child-specific strategies for improving the child’s overall well-being.

Many adopters and foster carers speak frequently and frantically about the inexplicable behaviours of children who come into their homes. Often their concerns focus on the behavioural difficulties, aggression, hyperactivity, and inattention of the children in their care. Shirley is far from alone when she asks her therapist if “all adopted children are like this?” As social workers often do not have full information on a child’s background, and since most foster carers and adoptive parents receive little or no specific training and education about how to live with and manage children who have been abused and traumatized, they can be overwhelmed by behaviours that are so wide of the mark from anything they have experienced before with other children. Moreover, the particular needs of a child with an attention disorder can be extremely perplexing and exhausting to parents or carers who are trying to put into place all of the love and affection and positive discipline that have worked for them before.

The paucity of literature addressing ADHD/ADD adopted/looked after children and their families and teachers may reflect the difficulty one encounters in trying to understand (1) the complexity of environmental and psycho-social factors that any given child brings into a new family; and (2) the fact that it is so hard for the medical and psychological professions to agree upon a definition of ADHD. Nevertheless, those who live and work with these children recognize the need for help and intervention—both for the child and for the adults responsible for the child’s care and learning.

The persistent questions asked by carers, adoptive parents and professionals include:

• Why is ADHD/ADD so prevalent in the care system?
• Is ADHD/ADD a cause or effect of adoption/being looked after?
• Is being in care/adopted a cause or effect of attention difficulties?
• Are adopted/looked after children really more likely to suffer from ADHD/ADD than are children who are not or have not been in the care system, or is that a myth?

Clearly, there are no simple or straightforward answers to these questions, although it is important to address the issues arising from these concerns, which is what this book proposes to do.

The issue of ADHD/ADD itself is complex, and there is considerable professional controversy about what ADHD/ADD is and is not. Among the questions these professionals debate are the issues of what it actually is and how it can be defined (medically and socially):

• does ADHD/ADD even exist as a proper diagnosis or condition?
• is it a neurological deficit?
• is it the result of poor behaviour management or negligent upbringing?

Since the professionals are still struggling with how to define, diagnose, and treat attention deficits, it is no wonder that parents, carers, and teachers are confused about how to handle the ADHD/ADD child. The situation becomes that much more duplicitous and worrisome if the ADHD/ADD child is also adopted or in care. Teachers, usually more so than parents and carers, can vary widely in their approach to such children.

Mrs Belgrade is not familiar with ADHD. It is her view that teachers teach children and all children are different anyway. Her premise is that she has a certain amount of material to teach in Year 3, and that is what she will teach. Mrs Belgrade makes an effort to engage the children and to teach in a variety of modalities, but that is as far as she will go.

Mr Tuner thinks that he probably has an attention deficit himself, and he quickly gets bored teaching the National Curriculum; therefore, he presents material in the most intriguing ways he can think of, and hopes it comes through to at least several children on any given day. Mr Tuner worries a lot about the children in the care system, as he had considerable experience teaching them previously, so he goes out of his way to make accommodations for these children and their families.

Ms Frances is in her first year of teaching and is totally overwhelmed by her class of thirty students, two of whom she knows are adopted and one of whom she expects has ADHD. She has been taught to think about early childhood development and she knows that many children come to school with various learning disorders, but nothing has prepared her for the activity and emotional level that the adopted/ADHD child has presented from day one. She wants to help and to individualize her curriculum for this student, but has no idea how and what to do.

When it is thought that a child might fall into the spectrum of an attention disorder, it is extremely important that a multi-diagnostic team contribute to the child’s evaluation because there is no biological, neurological or physiological test that can confirm such a diagnosis in and of itself. A multi-diagnostic team will want to include:

• documentation of specific attention deficit traits from parents, teachers, and others directly associated with the child;
• a comprehensive physical examination to rule out other medical conditions that may be contributing to or interfering with normal developmental functioning;
• evaluation of other neurodevelopmental dysfunctions that might be associated with attention deficits, such as processing problems, motor or speech and language delays, social and cognitive incongruities;
• a psychological or psychiatric evaluation of the child’s mental health that might reveal associated or secondary problem areas: learning disorders, anxiety, depression, trauma, attachment difficulties, etc.;
• a psycho-educational assessment that includes intellectual ability and an evaluation of specific learning disorders and learning styles. An overview of the child’s social and behavioural functioning at school as well as the academic standing of the child should be considered;
• a social worker’s assessment of the familial situation and home environment.

Although a comprehensive evaluation can be extremely helpful in many ways, nothing is definitive in the area of ADHD/ADD, and, as shall be seen, children who come into the care system often bring with them similar traits to those children who are categorized as ADHD/ADD. Sometimes, the adopted/looked after child may mirror characteristics that are so closely associated with ADHD/ADD that one can hardly tease apart which is which. This also broaches the question of whether an infant’s very difficult temperament and behaviour (possible ADHD/ADD), may have contributed to poor parental handling and upbringing, and/or whether this infant’s propensity to become an individual with attention problems was exacerbated by the environment in which the child lived prior to entering care. There are babies who are hard to cuddle, to soothe, to engage. If a fragile mother or father is already dealing with compelling personal disruptions, parenting a child of this disposition will not be an easy task.

The recommended treatment for children with ADHD/ADD also varies enormously. Behavioural therapy, involving a system of rewards and consequences, has been the most common approach; however, cognitive behavioural therapy, in which the child is taught to think specifically about his behaviours, is another frequently used form of therapeutic intervention. Some therapists concentrate on helping parents to develop skills for managing and redirecting behaviour that has become out of control. An alternative approach to behaviour management is through diet (cutting out additives and sugars and making various food group adjustments); while yet another, more psychodynamic therapeutic strategy would be that of focusing on a child’s past history, helping him to come to terms with his early experiences. Some therapists might be inclined to concentrate on the neurological components and brain development, paying particular attention to early child development. At times, medication is advised, and has proved to be extremely helpful in well managed cases. Currently, more professionals are looking at non-invasive therapeutic procedures that can help to reorganize neural pathways. Physical and occupational therapists have been using these techniques for many years in their work with children suffering from a variety of sensory integration disorders. Most therapists would utilize some of each and all of these approaches, but any given therapist might have a particular inclination to pursue one line of thinking more strongly than another.

“Memory was trauma, and memory was all they had, primal memories of a type it is impossible to forget” (Grant, 2006, p. 185).

Both Daniel and Christie are complicated children who reflect the difficulties presented by many children in the care system and who manifest a variety of dysfunctional behaviours. Even the professionals trying to assess and help these children and their families struggle to come to definitive diagnoses and evaluations of children who present with symptoms that can be mistaken for one condition or another. Indeed, it is not unanticipated that many adoptive parents and carers will wonder how much being adopted/looked after enters into the equation of a child’s disruptive behaviours and emotions. Most families who take in a child with unruly and unpredictable behaviour, a child who does not sit still and cannot follow through on tasks, a child who acts impulsively and appears to be terribly scattered in all aspects of life, inevitably will question the possibility of an attention disorder.

Since Christie does not display the rambunctious, frenetic behaviour of her brother, she is less likely to be thought of as a child with attention problems. She might be thought to have a low IQ or attachment difficulties. She may be seen as being excessively shy and withdrawn. Children with attention difficulties who do not also have hyperactivity (more frequently girls than boys) are often overlooked or improperly labelled as they do not command the immediate attention of teachers, parents, and care-takers.

In fact, Christie’s foster carer was not considering ADD when she talked to the therapist about Christie. This was a woman who knew very little about Christie’s background—in this case, no fault of the social worker’s, who also had little or no idea of what Christie had been through—but was trying to help a little girl to become more involved with the world around her. At the same time, Christie was afraid of that world, and was making every effort to withdraw from it; but, this was not known to her carers or social worker, and Christie was unable to express these feelings herself.

Concomitantly, however, Christie’s inherited attention deficit disorder made thinking coherently and sequentially about what was going on in her life an even more difficult task.

In an ideal world, both Christie and Daniel would benefit from a comprehensive assessment of their cognitive, educational, medical, emotional, and psycho-social functioning; yet, both are children whose attention disorders are not easily explained, even with very expert evaluation, because their early childhood years were so fraught with traumatic disturbances.

Being adopted or looked after is more concrete than being ADHD/ADD. A child either is or is not adopted/looked after, although children living in “kinship” care situations and those in very short-term care can be somewhat harder to define and describe. Usually, because adoption and fostering are more specific than is ADHD/ADD, less controversy exists among professionals who write about children looked after or adopted than among professionals investigating ADHD/ADD.

In the field of adoption, even nature vs. nurture is not much of an issue any more. The question is not if the environment can make a difference, but when and how it can make a difference. Although there is general agreement that genetics play a role, the exact interplay of genes and environment is not clear-cut either.

All researchers working in the adoption/fostering field agree that for most children in the care system in contemporary society, there will have been substantial experience of neglect, possibly malnutrition, feasibly domestic violence, and usually inadequate cognitive and emotional stimulation. Moreover, in many instances, there also will have been physical, sexual, and/or emotional abuse. Frequently, exposure to adults who substance-abuse is also a part of the child’s environment. Experts agree that there may be neurological, intellectual, physical, emotional, and social consequences resulting from these injurious situations. At the very least, each and all of these children will have suffered to some degree from separation anxieties.

One can theorize about ADHD/ADD adopted/looked after children for a long time, or one can assume a more practical approach. Searching to Be Found has taken a practice-based orientation, which tries to formulate a plan of intervention that is based on research and theoretical knowledge of complex children, but which provides parents, carers, teachers, and health professionals with the insight, understanding, strategies, and techniques they need when living with and teaching this unique group of children. There probably are some “right” and “wrong” answers in this field, but ultimately what is right and wrong might only pertain to any given child and family. I do not personally believe that smacking is ever right, and I would propose that consistency is almost never wrong. I know that “love” is not enough, and that doing exactly what one is supposed to do day after day is too much to ask of anyone— parent/carer or child alike. On the other hand, child rearing is not about perfection; it is about doing the best that each of us can do. The chapters in this book do not talk about th...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Dedication
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• PREFACE
• CHAPTER ONE The adopted/looked after child with attention difficulties
• CHAPTER TWO Understanding the effects of maltreatment on early brain development and the consequences for ADHD/ADD and adopted/looked after children
• CHAPTER THREE The ADHD/ADD adopted/looked after child at home and in the community
• CHAPTER FOUR The ADHD/ADD adopted/looked after child at school
• CHAPTER FIVE Social development in the ADHD/ADD adopted/looked after child
• CHAPTER SIX Conclusions
• APPENDIX I: Characteristics of Attention Deficit (Hyperactivity) Disorder
• APPENDIX II: ADHD/ADD adults who are adopted or who grew up in care
• APPENDIX III: Helpful suggestions for teachers and parents/carers
• APPENDIX IV: Resources
• REFERENCES
• INDEX