Today`s children – Tomorrow`s parents no 37-38

CONTENTS
EDITORIAL
Barbara ONGARI........................................................................................................................2
THE RESILIENCE OF ADOPTED CHILDREN IN ROMANIA
Ana MUNTEAN, Roxana UNGUREANU....................................................................................8
DISORGANIZATION AND RESILIENCE: INTERVENTION WITH CHILDREN IN
THERAPEUTIC INSTITUTION
Estelle GRAVRAND...................................................................................................................15
EARLY DEPRIVATION AND BEHAVIOURAL ADAPTATION IN A SAMPLE OF
ITALIAN ADOPTED ADOLESCENTS
Paola MOLINA, Marta CASONATO, Barbara ONGARI, Alessandro DECARLI.....................24
ASSESSING ATTACHMENT IN FOSTER PARENTS AND ADOPTIVE PARENTS
TO BE
Karin LUNDÉN.........................................................................................................................33
ATTACHMENT, MOURNING AND RESILIENCE IN KAFALA AND ADOPTION
Badra MOUTASSEM-MIMOUNI..............................................................................................39
UP FRONT AND PERSONAL: ADOPTIVE PARENTS’ PERCEPTIONS OF THEIR
EASTERN EUROPEAN CHILDREN’S ADOPTION OUTCOMES IN CONTEXT
Josephine A. RUGGIERO..........................................................................................................49
PILOT STUDY OF THE EFFECTS OF RESPONSIVE TEACHING ON YOUNG
ADOPTED CHILDREN AND THEIR PARENTS: A COMPARISON OF TWO
LEVELS OF TREATMENT INTENSITY
Gerald MAHONEY, Sunghee NAM, Frida PERALES...............................................................67
RESILIENT LIVES AND AUTOBIOGRAPHICAL SUGGESTIONS ITALIEN
NATIONAL TRAINING PROCESS IN THE FIELD OF INTERCOUNTRY
ADOPTION
Giorgio MACARIO....................................................................................................................85
Instructions for authors ............................................................................................................93
Advertising ................................................................................................................................96
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EDITORIAL:
ADOPTION, ATTACHMENT
AND RESILIENCE
Barbara ONGARI1
This monographic number of the TCTP Journal is in honor of the chairperson of its scientific
committee, Blaise Pierrrehumbert, developmental psychologist, director of the Research Unit
of the Child and Adolescent Psychiatry at the Lausanne University (SUPEA). He is one of the
most important Authors who strongly contributed to the development of the attachment theory,
in particularly to the realization of reliable measure tools for attachment for middle childhood
and adulthood. His research topics are attachment, emotional regulation, stress responses, neuro-endocrinian reactivity, traumatism, and prematurity. As leader of several studies granted by
the Swiss National Science Foundation, Pierrehumbert and colleagues showed that the premature birth (threat for the child’s survival, child exposed to invasive care procedures) could
represent a traumatic experience for the parents and could affect later child outcomes. Also the
relationships between attachment, as an expression of emotional regulation, and psychopathology in children have been explored. With other grants, Pierrehumbert and colleagues explored
specific pathologies such as hyperactivity in children and adolescents. His studies on adults
who experienced a trauma in childhood or adolescence (i.e. sexual abuse) showed the prevalence of disorganized attachment representations in these individuals, which can interfere with
the endocrine responses to mildly stressful circumstances, causing a disconnection between
the acute subjective perception of stress and natural defensive body reactions (suppression of
HPAA response).
One of his most significant scientific initiative, during last years, has been the creation of
“The Attachment and Adoption Research Network “ (AARN), an unique cross-cultural group
of scientific researchers in psychology, coming from many different parts of the world on the
basis of a common interest in understanding the development of attachment bonds in children deprived of their blood family. In particular, they shared a common research core project
proposed by Blaise Pierrrehumbert, in order to analyze the attachment bonds towards both
1
Professor, PhD, University of Trento, Italy
E-mail: Barbara.Ongari@unitn.it
2
parental figures and with friends during adolescence, using the same battery of narrative tools,
as well as other behavioral measures. Each national study realized within the AARN network
aimed at explore the nature of the attachment relationships between the internationally adopted
children and their adoptive families, as well with peers and other people of the community, in
an ecological perspective. Moreover, each national team did integrate this common plan with
other research topics, using specific methods.
The AARN network met in correspondence of some international congress: Barcelona 2009,
Leiden 2010, Oslo 2011, Paris 2012, Lausanne 2013 and Timisoara 2014. It appears that these
meetings have been held on an annual base and their main characteristic has been not only the
opportunity for exchanging and discussing the scientific findings: a network of colleagues and
friends has resulted.
Some of the articles proposed in this number of TCTP (Ana Muntean and Roxana Ungureanu, Estelle Gravrand, Karin Lunden, Paola Molina, Marta Casonato, Barbara Ongari and
Alessandro Decarli, Badra Moutassem-Mimouni) are the product of the work of some AARN
fellows.
The issues focus on adoption in the perspective of the attachment theory as well on the possible connections between successful adoption’s outcomes and future resilience, starting from
the evidence of the ill-quality of the previous relational experience of the adopted children. In
this sense, the multiple facets of the concept of resilience itself are addressed. Each contribution proposed here offers interesting considerations coming from the research as well as from
the clinical, training and caring practice, highlighting some specific aspects of the complexity
which characterizes the nature of the interactions inside the adoptive families.
Adoption could be actually considered in the Western Countries an important form of “social
parenthood”, so that many studies already contributed to investigate the nature of the relational
bonds among adopters and adoptees.
The negative role played on the adoptees’ psycho-social development by some crucial factors as their age at adoption, the nature of the previous relationships inside the blood families,
the multiple placements, the length of institutionalization, the quality of the functioning of the
hosting institutions has been empirically demonstrated. The negative early relational experiences increase the risk for short-term and long-term developmental dysfunctional behaviors
(Castle, Groothues, Beckett, Colvert, Hawkins, Kreppner, Kumsta, Schlotz, Sonuga-Barke,
Stevens, Rutter, 2009). The possibility of experimenting high quality care giving environments
inside the adoptive family has been indicated as a main turning point in the children’s development, because this could empower their socio-affective and emotional skills, their emotion
regulation and their behavioral competence, opening better opportunities for their future.
The task for the adoptive parents is a complex one, because they not only must cope with
the children’s current difficulties and needs, planning sensitive and helpful strategies that could
allow them to feel loved and valued within the new family, but also of healing their previous
experience of loss and trauma, in a way that has been defined as “therapeutic” (Schofield, Beek,
3
2006). This could explain the greater amount of requests for psycho-social and clinical support
claimed by the adoptive parents and the fact that adopted children are over-represented in the
mental health services (Juffer, Van IJzendoorn, 2005).
Anyway, this search for help and this openness for receiving advice and support should be
considered in itself a protective factor. The consciousness that parenting these children requires
a great amount of flexibility, mind-mindedness and deep reflective abilities could help the adopters in re-adjusting their personal lives as well as the whole family functioning. This implies
also a deep and difficult inner work for processing the pain related to the limit that stops the
couple’s expectation of having a biological generation: so that they must leave the desire of
having their own child and work hardly for developing the motivation of caring a child who has
had other blood parents.
The protective role of adoption could be implemented by the quality of the psycho-social
interventions aimed at preparing and supporting the adoptive families.
A large body of research based on attachment theory demonstrated that a warm, empathetic,
coherent and reflective care giving allow the adoptees to progressively heal their inner negative representations and their expectations of themselves and of the others, constructing more
regulated and adjusted behaviors. So that the most important factor in order to build a safe
relationship between adopters and adoptees might be the secure adopters’ state of mind toward
the relationships, which in turn influences the quality of their daily care and of their discipline
strategies.
The effects of early deprivation appear of paramount evidence during the adoptees’ adolescence. Adopted teenagers are therefore often considered as an “at risk population”. Some
studies indicated that among the various factors that could affect these outcomes an important
role is played by the fact that, while entering this developmental period, the adoptees begin to
question more intensively their identity, as their awareness of the cultural and ethnic differences
with their parents increase (Bimmel, Juffer, Van IJzendoorn, Bakermans-Kranenburg, 2003;
Van den Dries, Juffer, Van IJzendoorn, Bakermans-Kranenburg, 2009). In effect, to date very
few studies investigated the cross-cultural impact on adopted children played by the different
child-rearing practices.
The article of Ana Muntean and Roxana Ungureanu focuses the connection between
adoption and resilience in a sample of Romanian adopted teenagers, hypothesizing that resilience should be considered a positive outcome of adoption. The fact of having developed a
secure attachment to the new parental figures is supposed as acting as a dynamic process which
can foster resilience. This could be inferred by the result that, despite their aversive previous
relational experience of abandonment, the narratives of these children evidenced their ability
of constructing positive relationships inside and outside the family, their sense of personal worthiness, a well developed self-confidence and sense of humor and their positive expectations
toward their future lives.
4
Estelle Gravrand presents the first results of some case-analysis which are part of a longitudinal in progress study concerning the effects of the therapeutic care offered to deprived
children by a family type facility, inspired to an artistic approach which is supposed as mediator
for building resilience. The assessment of attachment made for three severely deprived boys
at their first entrance inside the care center evidenced some important elements of attachment
disorganization and behavioral disturbances, which could easily considered as consequences of
the deep emotional trauma and neglect they have experimented during their first years of life.
A second evaluation of attachment, two and half years after, provided also ethological observations of their verbal and non-verbal behaviors and other behavioral measures. Obviously each
individual profiles of these three boys is unique and differs from the others for what concerns
the subjective modalities with which everyone is processing his own history of life and is trying
to construct more adequate relational strategies. It’s not at all surprising that the healing and the
recovery psychological dynamics could take a long time, so these three teenagers appear still
working in this direction. Nevertheless the results demonstrate that they have achieved a better
capacity of mentalizing and offer-organizing their relational strategies in a more resilient way.
The two research units in charge of the core project in Italy aimed at analyzing the attachment representations of internationally adopted adolescents (respectively Paola Molina with
Marta Casonato at the University of Turin and Barbara Ongari with Alessandro Decarli at the
University of Trento) focus on the quality of the behavioral adjustment of sample of 28 participants adopted before their sixth year of age. The role of some risk factors that characterized
their pre-adoptive experience, collected from their parents as well from the participants themselves, un-expectedly resulted not associated to these adolescents’ present social adaptation.
Only the high rate of their attachment disturbances at the placement inside the adoptive family, indicated by the parents while fulfilling a standardized questionnaire (a retrospective form
of the Disturbances of Attachment Interview, DAI), seem correlated with their high levels of
internalizing modalities for expressing emotions. The correlation among the early deprivation
they have experienced and their actual adjustment has been investigated, considering the possible moderating role played by the positive attachment representation of their adoptive parents.
In her contribution Karin Lunden discusses an issue of crucial relevance related to the professional practice of approval for becoming foster and adoptive parents: the necessity to include
in the psycho-social protocols a precise evaluation of the attachment security and sensitivity
of the parents to be, considered as the most important predictor for a successful match with
deprived children and for their future safe development and resilience. She presents some preliminary results of a qualitative research aimed at investigating the attachment patterns of foster
parents using a standardized and reliable tool designed to analyze the quality of relationships
to partner and to close others as well as the overall attachment style, the Attachment Style Interview (ASI). Emerged the evidence that only half of the future foster parents show secure, or
even mild insecure, attachment patterns. This result indicates the need that the authorized agen-
5
cies and the professionals re-think the protocols of the assessment procedures for approval, as it
confirms the indications coming from a body of studies which clearly demonstrated that foster
and adopted children are at risk for developmental difficulties for what concerns their socioemotional and their cognitive skills. The main opportunity for them of healing and recovering,
developing healthy, depends on the possibility of having a secure, sensitive and emotionally
available inter-personal environment.
In her study Badra Moutassem-Mimouni proposes some in–depth psychological considerations concerning the relational dynamics, typical of the context of the Algerian culture, involved
in the search of origins acted by adolescents who have been adopted. The feelings and the different modalities of reactionacted by the adopters, when they must cope with the discovery of
the family origins made by their adopted child, are analyzed. Discussing some clinical cases,
Moutassem-Mimouni demonstrates that the mourning process is a two-ways one, as it concerns
the parents as well as the adoptees. The importance of offering a psychological support, based
on the assessment of the attachment patterns respectively of the parents and of their children, in
order to facilitate the inner work of processing the mourning is stressed, as well as the necessity
of implementing more precise and in-depth pre-adoption protocols, that could allow the future
adopters to develop a clearer awareness of their own psychological needs and traumas.
The point of view of some American adoptive parents and their perceptions of the outcomes
of their adopted children coming from Eastern Europe have been deeply explored by Josephine
Ruggiero in an innovative qualitative investigation conducted with 46 adopters, with the aim
of analyzing the parental satisfaction from their personal and up front perspective. The core
issues of the interviews were the strategies they used to deal with the challenges encountered
within the long-term post-adoption period, as well as their pre-adoptive expectations toward
adoption, the perceived role of the agencies that mediated the adoption process and the level of
pre-adoption preparation they got. This study appears especially insightful concerning the cases
where parents indicated the outcomes of their adoptees as problematic and challenging all the
family lives. In the same time they propose interesting considerations on the factors that could
provide successful outcomes when adopting children coming from Eastern Europe.
The issue of the effectiveness of interventions designed for supporting the parents of young
adopted children is questioned in the contribution of Gerald Mahoney. As maternal responsiveness has already been demonstrated by many studies as the main factor that affects the children’s socio-emotional well functioning, this pilot study assesses the feasibility in the adoption
field of a parent-mediated developmental intervention called Responsive Teaching (RT) with
children less than 6 years. RT is a treatment designed for encouraging parents to increase their
responsive interactions and for ameliorating the adoptees’ socio-emotional well-being. It has
been demonstrated as a successful strategy with non–adoptive populations of children affected
by some developmental delays or disabilities, like Down syndrome or autism. Even if the results presented here are only promising and do not completely support the efficacy of RT, nevertheless the evidence of a small decrease in parenting stress as well as of an improvement in
6
mothers’ responsiveness and in children’s social functioning encourages the viability of RT as a
community based intervention for providing support to pre-school adoptees and their families.
Finally, Giorgio Macario discusses the positive role for the adoptees of the autobiographic
approach, along all the life cycle, as a mean for constructing resilient identities. In this sense
the fact of being adopted could be seen, according to Cyrulnik (2009), as an opportunity for developing resilience, on the basis of the new promising meeting with a new caring interpersonal
context. The autobiographic method, in that emphasizes the value of the narrative writing, is
here proposed as a main road for exploring some of the multi-disciplinary and multi-factorial
components of the concept of resilience itself.
To conclude, the collection of articles presented here proposes some empirical evidence as
well as some clinical and training considerations, where adoption is analyzed in the light of
attachment theory and as possibly connected with resilience. During the last recent years the
most part of these issues did represent a central scientific concern of Blaise Pierrehumbert and
his team and a shared field for collaboration and reflection with a number of colleagues all over
the world. The researchers in these domains could find interesting ideas and impulses for their
future investigation.
The students who are approaching psychology, social work or other topics connected with
social sciences can enlarge their knowledge of adoption in its complexity.
We hope also that the professionals who work in the domain of adoption would be inspired
for developing more and more accurate practices.
References
Bimmel, N., Juffer, F., Van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2003).
Problem behavior of internationally adopted adolescents: A review and meta-analysis. Harvard
Review of Psychiatry, 11, 64-77.
Cyrulnik, B. (2009). Resilience: How your inner strength can set you free from the past,
Penguin Books, London, England.
Juffer, F., Van IJzendoorn, M.H. (2005). Behavior problems and mental health referrals of
international adoptees: A meta-analytic approach. JAMA, Journal of the American Medical Association, 293, 2501-2515.
Castle, J., Groothues, C., Beckett, C., Colvert, E., Hawkins, A., Kreppner, J., Kumsta, R.,
Schlotz, W., Sonuga-Barke, E., Stevens, S., Rutter, M. (2009). Parents’ evaluation of adoption
success: A follow-up study of intercountry and domestic adoptions, American Journal of Orthopsychiatry, Vol 79(4), 522-531.
Schofield, G., Beek, M. (2006). Attachment Handbook for Foster Care and Adoption, BAAF,
London, England.
Van den Dries, L., Juffer, F., Van IJzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2009).
Fostering Security? A meta-analysis of attachment in adopted children. Children and Youth
Services Review, 31, 410-421.
7
THE RESILIENCE OF ADOPTED
CHILDREN IN ROMANIA
Ana MUNTEAN1
Roxana UNGUREANU2
Abstract
In his famous ERA (English Romanian Adoptions) study Michael Rutter and his team found
a percent of about 25% of children adopted from Romania, from very bad conditions in institutions, as being resilient. Following this observations the concept of resilience was extended to
include the genetic heritage as well as the cultural framework.
Our study is based on the evaluation of 56 adoptees, aged 11-16 years old, within Romanian
adoptive families. The complex evaluation of adopted children and adoptive families was done
within a national research project on domestic adoption, FISAN (Factors which supports the
success of adoption), funded by the Minister of Education in Romania, during 2008-2011. The
data used here are collected based on Friends and Family Interview (FFI), a semi-structured
interview aimed to identify the quality of child’s attachment.
The resilience is considerate within our study as being proved by the secure attachment of
the adopted child toward his/her adoptive parent or another significant person.
The complex procedure of evaluation as well as the qualitative work on the data will highlight the important emotional and social factors which support the resilience of the adopted
children.
Keywords: resilience, adoption, adolescents, identity
Professor, PhD, Social Work Department, West University of Timisoara, Romania,
E-mail: ana.muntean@e-uvt.ro
2
Researcher, Research Centre for Child Parent Interaction (CICOP), West University of Timisoara, Romania
1
8
Introduction
Within human development, the resilience
is a fascinating topic. When adverse existential conditions expose at risk the development
of the person, the resiliency is pushing a new
bounce back and even is bringing new quality
in development. The concept was developed
in relation with the ‘invulnerable’ and ‘invincible’ children thriving despite the scarce conditions for their life. In a classic longitudinal
study (Werner&Smith, 1982) 505 individuals
were followed, from their birth, until their
40s, in the Island of Kauai, Hawaii. Despite
the poverty and associated adversities faced
during their life, a third of them developed in
a healthy, resilient way.
(Luthar&all. 2000) talks about having personal capacities which can contribute to resilient outcomes following stressful conditions
as well as about resilience which is a ‘dynamic’ process in place only in relation to adverse conditions. Based on the large existing
literature, the authors mentioned “two critical
conditions: (1) exposure to significant threat
or severe adversity; and (2) the achievement
of positive adaptation despite major assaults
on the developmental process.” (Luthar &all,
2000).
Due to this definition to talk about the resilience of adopted children is just normal.
The adoption of an abandoned child brings
to the child traumatized by abandonment as
well as by possible events before and following the abandonment a new chance for
re-bounding. Adoption as a new chance is
tightly connected with the resilience process
of the adopted child. During the last years
more and more professionals and researchers
talked about interventions aimed to stimulate
the resilience (Ionescu, 2011). Even there are
not yet very many voices to claim the resilience of the child as the goal of the adoption,
the resilience of the child should be a pervasive objective of the child protection system
in any country. Michael Rutter (2010) and his
team highlighted the resilience of Romanian
children adopted in UK. His study is probably one of the most known in the literature
focused on child’s adoption. Following the
Romanian children adopted from terrible
traumatizing environment in institutions in
Romania, 25% of those children, placed in
adoptive families in UK, managed very well
and found their way for a healthy development. They were resilient despite all the traumatic past conditions in their life.
The theoretic framework of our research
Our study is based on the evaluation of 56
adoptees within Romanian adoptive families.
The evaluation of adopted children and adoptive families was done within a national research project on domestic adoption, FISAN
(Factors which supports the success of adoption), funded by the Minister of Education in
Romania, between 2008-2011.
We intend to explore here the resilience of
12 Romanian adopted children, aged 11-16.
Despite the traumatizing early life these children could develop a secure attachment toward
their adoptive parents. The secure attachment
is the guarantee for mental health and for pervasive healthy development (Schore, 2001,
a). We do not identify the secure attachment
with the resilience but we consider the secure
attachment as being the sign of the child’s re-
9
silience as well as assurance for further life’s
adversities (Fonagy, 1999). More than that,
taking in account the cascade theory (Masten,
Cicchetti, 2010) we consider the secure attachment as a barrier of the aversive events
cascade in the life of these children who started their life unfortunately with an early traumatic event: the abandonment.
Procedure
Out of the 56 adoptees assessed, 12 adopted teens were assessed and identified as having clearly secure attachment. The evaluation
was done with Friends and Family Interview/
FFI (Steele, & Steele, 2009). FFI is a semi
structured interview assessing attachment
representations in late childhood and adolescence. “The FFI holds significant research
and clinical value in its unique approach to
eliciting and systematically rating autobiographical narratives from an age group that
has been notoriously difficult to assess from
an attachment perspective.” (Kriss &all.
2012). A cross-country comparison on the
invariance of FFI, focusing on the coherence in attachment narratives confirmed the
validity of the coherence assessment with no
difference between Romania and Belgium
(Stievenart &all, 2012). In our qualitative investigation we will try to identify within the
narratives of the 12 adopted teens the aspects
which reveal their resilience. Following the
analysis done by (Earvolino-Ramirez, 2007)
on the concept of resilience we will pick up
for our investigations the common protective
factors which she selected based on the work
of (Anthony, 1974), (Bernard, 1991), (Garmezy, 1991), (Masten, 1994), (Rutter, 1993),
and (Werner&Smith, 1982).
10
These are:
(1) Positive relationship, (2) sense of personal worthiness, (3) believes in her
or his self efficacy, (4) sense of humor
and (5) high expectations.
In order to find the items above within the
attachment narratives of the 12 adopted adolescents we focused on the following questions in FFI:
1. Who are the persons you are close
to?
2. Tell me how you are?
3. What do you like about yourself?
4. How are you at school? Did you have
recent examinations?
5. What are your three best desires for
your future?
Beside these items we take in considerations some common aspects within the narratives of these securely attached adopted
children.
We are working on our data using the qualitative narrative analysis method (Esin, 2011)
focused on the narratives of the respondents
and based on the 5 relevant items mentioned
above.
Results
We analyze here the narrative of the 12
adoptees based on the 5 criteria mentioned
above as being the signs of the resilience.
1. In respect to ‘positive relationship’
all these children in the sample here
are securely attached. This means that
they have at least one exceptional
positive and healthy relationship with
him or her attachment figure. The
secure attachment is proving a positive internal working model (Bowlby,
1973) which in turn works as a pattern
for the relationship with significant
others in the child’s life. We further
investigated their positive relationship through the question: Who are
the persons you are close to? The 12
adolescents mentioned first the mother but half of them mentioned also the
father and the friends. Grandparents
and siblings are also mentioned (3
times, grandparents; 2 times, sibling).
2.The “sense of personal worthiness”
was mostly investigated through the
question: Tell me how you are? or
What do you like about you ? The respondents mentioned very different
aspects considered as personal worthiness: the courage, the talent to learn
new languages, the pleasure to learn
mathematics, the interest for learning,
the way of thinking and even “I like
the way I look”.
There are two answers more elaborated:
a. I like my way of thinking which is a
bit different comparing with my classmates… I am not interested on the
things which are common interest
among peers…
b. My qualities are connected. Being
creative I need social relations. I cannot be creative without others. For instance I like to write and I write about
people. What I like the best on me is
my altruism.
3. All 12 adolescents “believe in her or
his self efficacy”. The questions used
to explore the self efficacy were: How
are you at school? Did you have recent
examinations? or even Tell me about
you? All the respondents mentioned
the good results in the school, insisting on different disciplines according
with their interest. Two answers are
relevant in this respect:
a. Excepting the 5th form I was always the
best in my class…yes, we had some examinations and I had good results and
some of my classmates were jealous on
me…but I ignore them and doesn’t matter what they say I follow my dreams..
and do what I want to do…
b. I can be shay sometimes…But I like to
make acquaintance with new friends
and I like to fight. If I have some problems or something I cannot do it I will
work on that till I become good…
4.The sense of humor is quite common
within the sample of adolescents here.
As an answer to the question: Tell me
how you are…, out of 12 respondents,
8 are explicitly mentioning:”I like to
laugh…” Mostly this assertion is followed by the mentions of different
significant persons within child’s social environment: mom, the father or
friends.
5.The high expectations item is explored through the question: What are
yours three best desires for your future?
The answers have a large variety but all of
them have the power of a drive which can orientate and lead the future development of the
respondents. The 12 adolescents mentioned
within their narratives the wish to continue
attending the school despite the fact that to
this precise question only 8 respondents were
explicitly mentioning the school. The dreams
11
of the children in our sample are always positives even they are more or less realistic. We
give here two answers: one where the answer
is formulated at general level.
a. To be always beloved, to have what
I need...I do not talk here about
money…never to feel alone.
The other one is more realistic in its expectations:
1. To study and to become doctor. To
have my job and to manage by myself
and not to overload my mom…to have
a dog.
Discussions
Being a qualitative research the size of our
sample is very convenient. The 5 items found
globally within the literature on resilience
gave us a simple tool to work on the data.
This is a superficial and easy way to demonstrate an idea which is common: the secure
attached children are resilient. But the question raised through our analysis is connected
with the stability of attachment quality
and the dynamic of resilience. According
with our results we can expect that these adolescents will show always as being resilient
persons; they proved once their resilience
when being abandoned and placed in institutions after words, before being adopted, and
being successful within their new family in
setting-up a secure attachment. The literature
on resilience stresses the variety of manifestations and the dynamic of resilience (Luthar
&all. 2000). The person can be resilient in
one situation but the same person will behave
differently exposed to a new stressful situation; on the other hand, being resilient in one
domain does not mean an overall resilience in
12
any other existential field. This common idea
within the literature of resiliency is somehow
in opposition to the theory of developmental
cascades: “…effectiveness in one domain of
competence in one period of life becomes the
scaffold on which later competence in newly
emerging domains develop: in other words,
competence begets competence.” (Masten,
Cicchetti, 2010). This theory is supported by
the characteristic of stability of attachment.
We consider the respondents who are securely attached as being resilient. This is hazardous as the resilience can be proved only
within the analyses of the past and stressful
events. Taking in account the cascade theory and the secure attachment they already
proved, it would be better to say just that they
are better equipped for behaving resiliently
when confronting life’s adversities.
Conclusions
Within the little sample here of securely
attached children we found all the most common items mentioned as being the protective
factors in case of resilience.
This conclusion stress one of the aspects
always mentioned within the literature on resilience: the importance to benefit of the support of a trustful significant person. From the
attachment perspective, having secure attachment means having attachment figure available and ready to protect, to calm down the
anxieties and to support. An adolescent in our
sample, stated the relationship between secure
attachment and resilience in the best way. She
answered the question regarding the temporary separation from her parents by saying:
“when I was separated it was like walking on
a stream and I can fall down any time…but
when they are there I know there is a support
under me and I cannot fall down.”
Especially due to their age, when the developmental task is to build-up the self-identity, the dreams on the future are like a powerful drives for these adolescents.
On other aspect which is not investigated within our study, through the instrument
which we used, but just came up during the
narratives of the children is the way in which
they are equipped to ask for support when they
need. All of them mentioned resource persons
in such situations. Mostly of them mentioned
mom but also friends or other relatives. The
healing process post trauma and the secure attachment include the capacity to ask for support and not to deal alone with adversities and
not feeling abandoned by others. The theories
of attachment stress the capacity of secureautonomous adults to ask for support when
they face difficulties. The narratives of adolescents here prove again their resilience and
secure attachment.
Examining the data we notice another particular aspect: all these securely attached and
resilient children have some talents and practice arts or sports. We consider that this way
to express them self is for highest importance
for the resilience of the adolescents. Arts and
sports bring rules and limits which contribute to self-development and self-education.
As we found in other researches in which our
team was involved, the individual capacity to
push him or her to overpass the comfortable
limits in doing some tasks is a common item
for the resilience. It is like resilience is asking
for self-organization and capacity to rise and
keep personal standards.
The last aspect which we found and we
have to mention here is the importance of
pets in the life of these securely attached and
resilient children found in our research.
The particular aspects mentioned above
which can be involved in the process of building up the secure attachment as well as the resilience needs and deserve further explorations.
References
Anthony, E.J. (1974). Introduction: The
syndrome of the psychologically vulnerable
child. In: E.J. Anthony,C. Koupernik, (eds).
The child in his family: Children at Psychiatric Risk. Vol. 3. Wiley; New York, pp. 3–10.
Bernard, B. (1991). Fostering Resiliency in Kids: Protective Factors in the Family, School, and Community. Portland, Ore.:
Northwest Regional Educational Laboratory.
Bowlby, J. (1973). Attachment and loss:
Vol.2. Separation: Anxiety and anger,
London: Hogarth Press.
Earvolino-Ramirez, M.(2007), Resilience:
A concept Analysis, Nursing Forum, vol.42
(2):73-82
Esin, C. (2011). Narrative Analysis
Approaches. In N. Frost, Qualitative Research
Methods in Psychology, Combining core
Approaches. McGrawHill, Open University
Press, pp. 92-119.
Fonagy, P. (1999), Transgenerational Consistencies of Attachment: A new Theory. Paper to the Developmental and Psychoanalytic
Discussion Group; available online at DSPP.
13
Garmezy, N. (1991). Resilience in
children’s adaptation to negative life events
and stressed environments. Pediatrics.
20:459–466.
the era study, inferences, and research implications. Monographs of the Society for Research in Child Development, 75: 212–229.
doi: 10.1111/j.1540-5834.2010.00557.x.
Ionescu, S. (coord.) (2011). Traité de résilience assisté, Ed. PUF/Quadrige, Paris.
Rutter, M. (1993). Resilience: Some conceptual considerations. Journal of Adolescent
Health. Vol. 14, pp. 626–631.
Kriss, A., Steele, H., Steele, M. (2012).
Measuring Attachment &Reflective Functioning in Early Adolescence: An Introduction to
the Friends and Family Interview. Research
in Psychotherapy: Psychopathology, Process
and Outcome, vol15, no.2, pp.87-95.
Luthar, S. S., Cicchetti, D., Becker, B.
(2000). The Construct of resilience: A Critical
Evaluation and Guidlines for Future Work,
Child Development, 71 (3):543-562.
Steele, H. & Steele, M. (2009), Friends
and Family Interview, Center for Attachment
Research, New School for Social Research.
Masten, A.S. (1994). Resilience in individual development: Successful adaptation despite risk and adversity. In:M.C. Wang, E.W.
Gordon, (eds). Educational resilience in inner-city America: Challenges and prospects.
Erlbaum; Hillsdale, NJ, pp. 3–25.
Stievenart, M., Casonato, M., Muntean,
A., Van de Schoot, R. (2012). The Friends
and Family Interview: Measurement invarince across Belgium and Romania, European
Journal of Developmental Psychology, DOI:
10.1080/17405629.2012.689822.
Masten, A., Cicchetti, D. (2010). Editorial: Developmental cascades. Development
and Psychopathology, 22: 491-495.
Werner, E., Smith, R. (1982).Vulnerable
but invincible: A study of resilient children.
McGraw-Hill; New York.
Rutter, M. and Sonuga-Barke, E. J. (2010).
X. Conclusions: overview of findings from
14
Schore, A.N. (2001, a). Clinical implications of a psychoneurobiological model of
projective identification. In S. Alhanati (Ed.),
Primitive mental states, Vol. lll: Pre- and
peri-natal influences on personality development. New York: Karnac.
DISORGANIZATION AND RESILIENCE:
INTERVENTION WITH CHILDREN IN
THERAPEUTIC INSTITUTION
Estelle GRAVRAND1
Abstract:
This presentation concerns family deprived children due to proven carelessness and ill-treatment. Their serious behaviour disorder making their placement in a standard institution ineffective, the social services and judges direct those children towards the PREMA Association
whose global care is built on a family type facility with the means of artistic expression as a
resilience vector with the progressive return to school learning.
Realized within the AARN network, the hereby related study has for aim to develop an assessment grid of the children’s progress during their care. The tools are the following: Attachment story completion task (ASCT), Friends and Family interview (FFI), Child Attachment Interview (CAI), Disturbance of attachment interview (DAI retrospective), and the longitudinal
and unconditional ethological observation of verbal and non-verbal behavior.
The aim is to assess the 10 children from the association; this communication concerns for
now a sib ship of three children 8 and 9 years old (twins).
If the ASCT and the DAI show important elements of disorganization and reactive disorders
concerning attachment at the beginning of their care, two and a half years later the FFI/CAI
joins the ethological observation of verbal and nonverbal behavior to point out the fact that in
spite of the remaining emotional deprivation, the children are able to revisit their story and it
seems as if they had begun a resilience process.
Keywords: family; deprived children; behavioral disorder; institutions; intervention by artistic expression; child’s resiliency; school.
1
Association PREMA, Faculty of Toulon Sud, France.
15
Introduction:
It is within the draft of a memoir on ethology of which the axis is the clinical and family systems attachment in the University of
Toulon Sud (France) directed by Professor
Boris Cyrulnik and Professor Michel Delage
and the encounter with Professor Pierrehumbert that this presentation takes place.
To our knowledge there are few communications concerning reactive disorders symptom intensity of children having developed
an insecure type of selective attachment.
Thanks to the DAI we are going to investigate the presence of a number of symptoms
by the means of « stories to be completed
« , explore their attachment representation ,
then by using the FFI/CAI with the CAME
coding, the organization or disorganization of
their thought processes.
The verbal and nonverbal ethological
observation evaluation scale will complete
those results.
We start from a basic premise: Judges,
Social Services in charge of the children
in cure at PREMA and the institution pros
admit the fact that the children are in a better condition. The main idea of this work is
to try to make the subjective assessments «
objective less » by the means of the attachment specialist’s proper evaluation tools and
through a longitudinal ethological observation method. Hereby, we present the ongoing
work; the gathering and the interpretation of
the data as well as the hypothesis we develop
will evolve as the months go by.
If those children make progress, re socialize, tame their suffering and redevelop after
their trauma, yet is it within the scope of a
resilience process?
16
Among the three evaluated brothers are
they equal in their ability to bounce back and
« heal/give sense « to their wounds?
What is the impact of their initial attachment tie on their development?
Is there a possibility of a positive transfer of
the attachment tie towards other care-givers?
Are the children able to rebuild those ties?
A child that hasn’t developed a selective
attachment in his early childhood, will he be
able, later, to embed organized and secure
working internal models?
Méthodology
Tools:
• ASCT: Stories to be completed with the
children in order to measure their attachment
representation developed by Bretherton,
Ridgeway and Cassidy in1990.
• DAI (Disturbance of Attachment Interview) in order to measure in a retrospective
way the changes of the child’s attachment
disturbance.
The items of this partly structured interview investigate the presence of attachment
trouble signs (reactive attachment disorder)
developed by the AAARN network.
This transmission is retrospective, the indications for rating are excerpted from:
Smyke AT. Dimitrescu A. Zeanah CH. Attachment disturbances in young children. I:
The continuum of caretaking casualty. Journal of the American Academy of Child and
Adolescent Psychiatry. 41(8):972-82, 2002
Aug.
• FFI (Friends and Family Interview)
and CAI (Child Attachment Interview) that
measure organization and disorganization
of thought, FFI developed by Howard and
Nancy Steele, New-York (2003) and CAI by
Target, Fonagy and Shmueli-Goetz, (2003).
Code: CAME (Maps, Attachment, Mentalization, child) developed by Ayala Borghini and al. (On-going).
• Ethological evaluation scale (ad hoc) of
verbal’s and non-verbal’s child behaviors by
Estelle Gravrand (2014).
II.1. Protocol:
It is by the means of a weekly 45 minute
filmed interview for each child that the ethological observation methods have been applied over a period of some 18 months.
The results of the verbal and non-verbal
behavior scale are related to the following
video dates:
John:Keith: Bob:
A: 03/05/12 A: 30/04/12
A: 30/04/12
B: 03/10/12 B: 03/09/12
B: 24/09/12
C: 08/10/12
C: 26/09/12
C: 14/11/12
D: 19/11/12 D: 31/10/12
D: 30/01/13
E: 03/12/12 E: 05/12/12
E: 07/11/13
F: 11/02/13 F: 11/02/13
It is also during these interviews that the
different tests FFI/CAI and ASCT have been
practiced until this date.
The DAI has been submitted to the educators already present in the facility since the
arrival of the children.
There are three video clips showing the
evolution of the three children ( Bob and John
- 9 year old twins , and Keith – 8 years old),
whom we’re speaking of today , and the ethological observation has been based on the
first 20 minutes of the selected interviews (
January 2014 evaluation.
John – 9 years old:
John had a score of 8/10 for inhibited
subtype trouble, two years later his score
was 3/10. The disinhibited subtype troubles
moved from 4/8 to 3/8 and a few hyper-dependant selective attachment sign troubles
have been observed and diminished from 5/8
to 2/8. (Fig1)
some six interviews over a period of around
two years ) .
III. Results:
III.1: DAI:
When arriving in the institution (august
2011) the children had big reactive attachment troubles as shown in the drafts below.
Those signs have for a major part diminished:
17
Bob - 9 years old:
Bob showed attachment reactiv troubles
of inhibited subtype evolving from 10/10 to
2/10 after 24 months cure. Troubles of deinhibited subtype stayed level: 4/8. However
signs indicating a few marks of hyper dependant attachment raised by one point: from
2/8 to 3/8. (Fig 2)
III.2. Ethological observation scale of
verbal and non-verbal behavior:
These are nominal scales designed for this
purpose.
Rating:
Even if the questions are different, we use
the same QCM type (5 questions) to measure the verbal and non-verbal behavior. The
scores are noted on 10. The nearer the score
to zero, the more the child will have synchronized and adapted behavior.
The videos are shown in a chronological
order.
/8to 3/8. (Fig 2)
• Verbal behavior results:
The graph has been calculated after the
mean value of the three children’s scores.
Keith - 8 years old:
The results of Keith show that he had attachment reactional troubles of the inhibited
subtype of 8/10 when arriving in the institution and that 24 months later they are 3/10.
He also showed troubles of de-inhibite subtype when arriving of 6/8, and they are now
2/8. We have noticed an important presence
of hyper-dependant attachment signs (7/8
when arriving, they dismissed to 3/8. (Fig 3)
John 9 years old:
In the A video the words are not coherent with
the expressed emotions. As from the B video
words and emotions are misaligned but coherent, then from the C video they are matching.
At first the language is maladjusted,
blurred with a lot of invented words, then it
will become clear, fluent and concise.
The use of verb, subject, and complement
will happen from the E video and John is going to build elaborated sentences with a careful vocabulary.
18
• Nonverbal behavior results:
All along this year the child will mix in his
speech real and imaginary facts but he is conscious of this agreement he creates with reality. The neutral tone and the unassured voice
at the beginning of the records will settle and
equalize in the course of the interviews.
Bob 9 years old:
As from the A video there is no coherence between his emotions and the words
used. He is, given his age, in a low mean
value concerning verbal expression until the
C video, then he evolves positively. Bob has
got a stutter and has great speaking difficulties that improve as from the C video. Today,
his speaking is fluent, the flow easy, his voice
calm. The child’s speech is adapted to reality,
events and elements pertaining to his history
are named and sense given.
Keith 8 years old:
At the beginning words and emotions
aren’t in ad equation, in the C video they are
misaligned but coherent, then in ad equation
from the D video.
The language at first is cut up, hesitating
but still coherent. In the C video it is unadapt
then from the D video it becomes clear, fluent, and concise.
From the B video the child uses subject,
verb, and complement. Altogether his speech
is adapted to reality and from the C video,
events and elements pertaining to his history
are named and given sense.
At the beginning of the recordings the
prosody and vocality of words lack in harmony: discordant voice, use of an unfitting tone.
From the D video the voice is calm and the
tone fits.
Bob:
Regularly decreasing curve.
John: Curve connected to emotions and
feelings, still decreasing. Keith: Curve connected to emotions and feelings
Mouvements du corps
600
500
400
300
200
100
0
AB CDE F
Bob
Keith
John
Bob: Curve slightly decreasing, the child
remains restless but with less anxiety.
John: Irregular curve, the child is always
moving but without being aggressive. One
notices that the more his body moves the less
his gesture is self-centered. Keith: Clearly
decreasing curve.
Signes faciaux d’inquiétude
100
90
80
70
60
50
40
30
20
10
0
Bob
Keith John
AB CDEF
Bob: Decreasing curve.
John: Fairly linear decreasing curve. Very
expressive child.
19
Keith: Decreasing curve.
John 9 years old:
Q scores en format T
Fréquence regard à l’interlocuteur
300
100,00
90,00
80,00
70,00
60,00
50,00
40,00
30,00
20,00
10,00
0,00
250
200
150
100
50
0
A
B
Bob
C
Keith
D
John
E
F
1
2
3
4
1234
The stories to be completed say for John that
Bob: Very evasive eye contact, the slightly
rising curve is a sign of progress. He makes
contact through the eyes, at first evasive, then
direct.
John: Seeking the eye of his interviewer as
a reassuring sign, first checking whether what
So he is avoiding insecure with a high disorganized propensity.
The scales show a high reaction to separa-
he says is received without judgment; then
tion, an adapted collaboration, and a low level
John builds confidence and converses without
being obliged to stay watchful.
of appropriate affect expression.
Keith: Very disorganized, the child’s moods
condition his state. Mainly, he is communicating when he looks at his interviewer and more
introverted when he casts his eyes away.
The frequency of eye contact with the interviewer may have different functions, such as
reassurance or control, thus we do not expect
that those curves would be decreasing as for
the other index. (Confirmed by the graphs)
III.3 ASCT: CCH code:
These coding methods give four scores based
on attachment representation, built on a Q-sort
method:
Secure, desactivation-avoidance, hyper activation-preoccupation, disorganization, and 7
scales:
Collaboration, parents’ support representation, positive narrative, appropriate affects
expression, separation reaction, symbolic distance, poor narrative ability.
20
he is disorganized: 50.45 points, hyper-activated: 38.95 points, deactivated: 56.99 points
and secure: 43.91 points.
Bob 9 years old:
Q scores en format T
100,00
90,00
80,00
70,00
60,00
50,00
40,00
30,00
20,00
10,00
0,00
1
2
3
4
1234
The stories to be completed say he is disorganized at 67, 80 points, hyper-activated at 59,
01, deactivated at 63, 83, and secure at 34, 97.
(It is noticeable that he is John’s twin brother
and that their scores are quite different).
Bob is disorganized insecure with a high
desactivation level (avoiding).
The scales show a high reaction to separation, a correct narrative skill, a very low symbolic distance and a very low appropriate affects expression.
Keith 8 years old:
talization ».
There are 8 scales : Coherence , Self-reflective , Access to souvenirs , Mentalization ,
Q scores en format T
100,00
90,00
80,00
70,00
60,00
50,00
40,00
30,00
20,00
10,00
0,00
Anger/worry , traumatism , Need of comfort ,
Life struggle .
1
2
After two and a half years in Prema:
4
John:
3
12 34
The stories to be completed show he is disorganized: 75.17 points, hyper-activated: 64.38
points, deactivated: 67.23 points and secure:
29.13 points.
Keith has a low score of attachment secu-
Raw Q score of the subject: secure 51.98,
desactivated 41.87, hyper activated 69.19, disorganized 55.84, Mentallization 58.86.
John has a high hyperactivation score for
his attachment process, and a good Mentallization score.
rity, a very high score of disorganization. His
scores for deactivation and hyper-activation
are also substantial.
The scales show a low level of appropriate
affects expression, a correct level of collaboration, and a high reaction to separation.
III.4: FFI/CAI, code CAME:
We have submitted the FFI/CAI test to the
elder children – 9 and a half years old – and used
the CAME code (charts, attachment, Mentalization, children) built by Ayala Borghini, in
charge of the SUPEA from Lausanne and Professor Blaise Pierrehumbert. Fully detailed in
the score analysis, it allows us to refine and
enlarge our fields of reflexion.
Keith however was overwhelmed by his
The scales show a high level of access to
souvenirs – 65.84 – and of his ability for Mentallization – 61.12 - , the worries/anger score
is high – 60.46 - , the trauma endures under
the surface -51.23- and is confirmed through
the life troubles score – 56.95 - , coherence is
good – 49.05 – and the need for comfort lower
– 47.08 – the self-reflective score is – 60.15 - .
Bob:
emotions, questions on his family and his story brought back his suffering. So we put an
end to the protocol with him.
The CAME Code system allows to measure quantatively the four dimensions of attachment:
«Security, Desactivation, Hyperactivation,
Disorganization « and the dimension of «Men-
Raw Q score of the subject: secure – 56.16
21
- , deactivated – 44.90 - , hyper activated –
49.55 - , disorganized – 47.77 - , Mentallization – 56.78.
Bob has a high attachment security score,
rather hyper activated, and a good Mentallization score.
The scales show a high coherence – 68.31
- , a high level of access to souvenirs – 64.93
- , a fair ability for Mentallization – 62.68 , a high score for anxiety/anger – 61.61 - ,
traumatism – 57.38 - and life troubles – 55.97
– over the average , need for comfort – 52.01
and self-reflective – 50.90 .
IV. Conclusion:
The first results confirm the hypothesis
upon which the children develop positively.
• Among the three children studied, are
the three equal in their ability to bounce back
and « heal/give sense to » their wounds?
• What is the impact of their initial attachment on their development?
It is interesting to notice the attachment
representation differences between the twins
John and Bob, yet they have never been separated. However one has noticed while working with the family that John had not been
supported by his parents unlike Bob « close
» to his father and mother, while Keith was
over-supported by his mother and very much
impacted by his father’s violence.
The mother has being accused of incest by
the three brothers.
But only Keith, separated from the twins,
and alone with her most of the time had undergone recurring incest (according to his
statements).
The attachment reactive problems being high both on inhibited, de-inhibited and
22
hyper-dependant levels, one may wonder
whether he may have suffered from hyperdependant attachment that could evolve into
a disorganized insecure attachment during his
cure.
Still too sensitive and disorganized, even
if Keith progresses, we didn’t wish to evaluate him further with the use of the FFI and
CAI quiz.
Sometimes he is able to elaborate and
mentalize his emotions but it occurs through
brief glimpses.
John , being “put aside” from the family , could have “escaped” and developed an
elusive insecure attachment allowing him to
have more fitting behavior, but still marked
by physical escape pulsions (runaway) or
psychological pulsions (proven suicidal tendencies at his arrival).
Compared to his ASCT attachment representation, the CAME shows that he hyper-activates his attachment process (+ 30 points), he
is more secure (+ 8 points), and paradoxically
more disorganized (+ 5 points) which is normal considering that during a reorganization,
a disorganization may precede new organization.
• Are the children able to reorganize these
ties?
John is able after two and half years of cure
to acknowledge his anger , his trauma due to
his story and he shows the will to understand
and give sense to his past in order to advance
: « to limit my suffering , I tell myself that
each day of my life is a new adventure « .
Bob made a lot of progress in two and half
years, from denying his story he switched to
recognizing it and is beginning to accept it.
It can be seen especially through his verbal
behavior and when comparing the ASCT and
CAME results we notice that his scores have
diminished for Disorganization (- 20 points),
Hyperactivation (- 10 points), Deactivation (20 points), and have risen for Securization (+
11 points).
• A child who has not developed a selective
attachment in his early childhood will he be
able to build internal models, efficient, organized and secure?
While coding another child from the Association victim of hospitalism, we noticed that
they had the same ASCT scores, which didn’t
fit with the reality of their day to day behavior. It could put in perspective the hypothesis
according to which they would not have developed a selective attachment but have made
a copy/paste of the representations that they
found in the institution in which they developed.
It brings us to the next question: is it possible that a child without a selective attachment
embeds internal models, efficient, organized
and secure, thanks to mimetism and could be
permeated over a period of time by the environment in which they live?
Here we do not talk of “as-if” but of a
sound evolution.
The CAME scores tends to confirm this
hypothesis.
When looking at these results and observations, these children seem to be able to
mentalize and organize their emotions on different levels. Their age and traumatism taken
into account, this progress is encouraging for
the continuation of their life story.
References:
Bretherton, I., Ridgeway, D., & Cassidy,
J. (1990). Assessing internal working models
of the attachment relationship. An attachment
story completion task for 3-year-olds. In M. T.
Greenberg, D. Cicchetti, & E. M. Cummings
(Eds.), Attachment in the preschool years:
Theory, research and intervention. Chicago:
University of Chicago Press.
Miljkovitch, R., Pierrehumbert, B., Bretherton, I., & Halfon, O. (2004). Associations
between parental and child attachment representations. Attachment & Human Development, 6, 305-325.
Smyke, AT., Dumitrescu, A., Zeanah, CH.
(2002). Attachment disturbances in young
children. I: The continuum of caretaking casualty. Journal of the American Academy of
Child & Adolescent Psychiatry. 41(8), 97282.
Steele, H., & Steele, M., &Kriss, A. (2009).
Center for Attachment research, New School
for Social Research. Steele, H., & Steele, N.,
New York 1990.
CAI: Child Attachment Interview. Target,
Fonagy and Shmueli-Goetz (2003)
CAME: Carts Attachment Mentalization
Enfant, Borghini et al. (On going.)
23
EARLY DEPRIVATION
AND BEHAVIOURAL ADAPTATION
IN A SAMPLE
OF ITALIAN ADOPTED ADOLESCENTS
Paola MOLINA1
Marta CASONATO1
Barbara ONGARI2
Alessandro DECARLI2
Abstract
Introduction: Adoption is one of the major protective factors for the adjustment of children
who experienced abandonment and institutionalization (Zeanah et al., 2009). Studying the effects
of early deprivation in adolescence is particularly useful, because adolescence is a critical period
of development and because this period allows to consider the effect of an enduring positive
experience in the adoptive family. Moreover, parents’ secure attachment representations can
help to repair early negative experiences, particularly considering their reflective function.
In this paper we will analyse the effect of adoption in relation to early deprivation in a
sample of 27 Italian adolescents, adopted before the age of 6 and observed in adolescence (1116 years). These results are part of an international research project (Pierrehumbert, 2009),
aiming at collecting information on internationally adopted children.
Method: Early deprivation was rated from biographical informations provided by parents
University of Torino (ITALY)
University of Trento (ITALY)
E-mail: paola.molina@unito.it, marta.casonato@unito.it, barbara.ongari@soc.unitn.it, aledecarli@hotmail.com
1
2
24
(age at adoption, changes in pre-adoptive care, period in institution, etc.) and from a retrospective
form of the Disturbance of Attachment Interview (DAI)(Smyke. A. & Zeanah, 1999).
Adolescents’ adaptation was rated by CBCL/YSR(Achenbach & Rescorla, 2001), filled by both
parents and by adolescents. Measures of different aspect of parental caregiving representations,
were derived from the Parent Development Interview (PDI)(Aber, Slade, Berger, Bresgi,
& Kaplan, 1985), a semi-structured interview, which explores the parental representations
of the ongoing relationship with their children, addressed to adoptive mothers and fathers
separately. Each interview has been video-recorded, transcribed, and rated on a 4 point scale.
Through correlation, we analyzed the relationship between early deprivation and adaptation
in adolescence, considering the effect of parental attachment measures. We hypothesized that
risk factors in pre-adoptive experience negatively correlate with adolescents’ adaptation rated
by CBCL/YSR, and that parental positive caregiving representations, particularly parental
competence, could moderate this relationship.
Results and conclusions: Contrarily to our preliminary hypotheses, the level of pre-adoption
risk was not associated with the behavioral adjustment in adolescence. This could be due to the
protective effect of having lived for a number of years in a supporting adoptive family. With
respect to the caregiving characteristics, our results are apparently less encouraging: maternal
competence does not influences adolescents’ adjustment, and only the relationships between
actual difficult experiences are evident. Further research could help to disentangle the influence
of different variables affecting adopted adolescents’ behavior adaptation.
Keywords: adoption; adolescence; behavioural problems; Parent Development Interview;
Disturbances of Attachment Interview; CBCL; YSR
1 Introduction
Adoption is one of the major protective
factors for the recovery and adjustment outcomes of children who previously experienced abandonment and institutionalization
(Zeanah, 2009).
Age at adoption and the experience of institutionalization have been largely considered
as risk factors for the adoptees’ later adjustment (Gunnar, &all. 2007; Judge, 2003; Verhulst, &all. 1990). Since the interest towards
adoptive sample comes from the experience
of attachment disruptions lived by these children, it is also important to test whether multiple changes in caregiving could affect the
adolescents’ adjustment (Erich, &all., 2009).
David Brodzinsky, one of the most important American experts in the psychology
of adoption, considers family relationships
as the most important background factors in
the adopted child’s adjustment (Schechter,
& Brodzinsky, 1990). Through continuous
reiteration over time, the offering of a new
and positive relational model can play a significant role on the change of the child’s attachment representations (Schofield & Beek,
2006). It is within the context of sensitive,
thoughtful and reflective relationships with
their caregivers that adopted children learn to
25
feel safe, to explore, to make sense, and to
grow (Howe, 2006).
Studying the effects of early deprivation
in adolescence is particularly useful, because
adolescence is a critical period of development and because this period allows considering the effect of an enduring positive experience inside the adoptive family. Indeed,
adolescence represents a critical period for
adopted children. In addition to the typical
issues faced by each individual in this period of life, the variety of physical and cognitive changes of adolescence implies, among
adoptees, the development of concerns about
identity issues such as who they are, where
they come from and what they will become
(Bimmel & all., 2003). Literature has also
shown that adoptees, in the urgency of developing a stable identity, tend to face the typical
adolescence issues before their non-adoptive
peers (Juffer, & van Ijzendoorn, 2005). Thus,
among adoptees the possible difficulties
linked to this period of life may occur even
before entering the teen-ages.
In this perspective, our research will analyse the effect of adoption in relation to early
deprivation in a sample of 27 Italian adolescents (11-16 years), adopted before the age
of 6. These results are part of an international
research project (Pierrehumbert, 2009), collecting information on internationally adopted children.
We hypothesized that risk factors in preadoptive experience negatively correlate, and
that time spent in the adoptive family positive correlate, with CBCL/YSR adolescents’
adaptation. Moreover, we explored the relationship between parental characteristics and
adolescents’ adaptation.
26
2 Method
2.1 Procedure
The sample recruitment was carried out
through social services and agencies for
international adoption. Eligibility criteria
were to be 10 to 16 years old at assessment
and to have been adopted internationally
(between birth and 9 years of age). Informed
consents were given by both parents and each
adolescent before collecting the data.
2.2 Sample
Participants include a total of 27
adolescents (51.9% boys) and their adoptive
parents. The adolescents’ average age at
assessment was 13 years old (SD=2 years).
They had been internationally adopted from
various geographical areas (52% from Asia,
22% from South America, 19% from Eastern
Europe and 7% from Africa). For most of the
parents, the choice of adoption was due to
infertility (82%). At placement, adolescents
were 13 years old (SD=2 years). With respect
to siblings, 14.8% are only children, whereas
the remaining adolescents have one or more
siblings (biological siblings, biological
children of the adoptive parents -18.5%-, and
adopted as well) (see Table 1).
Table 1
Sample (N=27)
M
Girls
Age
Age at adoption (months)
Adopted for infertility
Siblings
Years spent within the adoptive family
2.3 Measures
Early deprivation was rated through
biographical informations provided by parents
(age at adoption, changes in pre-adoptive
care, institutionalization, etc.) and through
a retrospective form of the Disturbance of
Attachment Interview (DAI) (Smyke &
Zeanah, 1999). Adolescents’ adaptation was
rated by both parents and their adolescents
through CBCL/YSR (Achenbach & Rescorla,
2001). The scores for each parent attitude
were derived from the Parent Development
Interview (PDI) (Aber, & all., 1985), a semistructured interview exploring the parental
DS
Range
13
44
2
31
10-16
1-111
10
3
3-16
%
48%
81,5%
85,2%
representations of the ongoing relationship
with their children, addressed to adoptive
mothers and fathers separately. Each interview
has been video-recorded, transcribed, and
rated on a 4 point scale. On the basis of
PDI, 5 scales have been created in order to
synthetize the numerous informations present
in the interviews. To this purpose, items
were chosen on a theoretical basis as well as
looking at their inner correlations. Thus, their
internal consistency was controlled through
Cronbach’s alphas (>.70, see Table 2).
Table 2. PDI Scales
Scale composition
6 items (Coherence; Richness of perceptions;
Reflective functioning; Parental competence;
Parental capacity
Level of child focus; Attachment awareness and
promotion)
Positive parental experience 2 items (Joy/pleasure; Warmth)
3 item (Anger degree; Disappointment/despair;
Negative parental experience
Hostility)
Child’s positive description 2 items (Child happiness; Child affectionate)
2 items (Child aggression/anger; Child
Child’s negative description
controlling/manipulating)
2.4 Data Analyses
First, descriptive analysis of risk factors
and different informant adolescents’
adaptation were performed. Using correlation
analysis the relationships between early
deprivation and adaptation in adolescence
N
13
Cronbach’s
alpha
.922
.867
.883
.735
.760
were examined, considering the effects of
the length of the adoptive experience, of the
parental experience and of their perceives
competence. Due to the ordinal level of some
variables, in order to compare dichotomous
27
risk groups, we used non-parametric exact
tests (Mann-Whitney Exact Test, Montecarlo
Method).
3
Results
3.1 Descriptive analyses
3.1.1 Pre-adoption risk factors
Age at placement is very heterogeneous in
our sample (M=4 years old; SD=3). 85% of the
adoptees had experienced institutionalization,
at least for few months. It is hard to control
for the number of changes in caregiving, but
we can state that they range between one and
three.
With respect to the level of attachment
disturbance during the first year of placement,
21 families answered the retrospective form
of DAI (10% of respondents were fathers,
90% were mothers). At placement, the
average score of attachment disturbances
were 7.4 (SD=3.2) whereas one year later the
same scores decreases to 2.3 (SD=2.3) (see
Table 3).
Table 3. Pre-adoptive experience
M
DS
Range
N
%
Pre-adoptive care
- Biological family
25,9%
-Foster-care
22,2%
-Institution
85,2%
-Placements
1-3
DAI inhibited disturbs:
- At placement
- After 1 years
2.4
.6
2.0
1.0
0-8
0-3
DAI disinhibited disturbs:
- At placement
- After 1 years
2.4
.7
2.0
1.2
0-7
0-4
DAI selective attachment:
- At placement
- After 1 years
.3
.1
.7
.5
0-2
0-2
3.1.2. Behavioural adjustment
Data for adolescents’ adjustment, rated by
self-report (YSR) and parent-report (CBCL,
filled by mothers) are reported in Table 4,
both for the total sample and for boys and
girls separately. Internalizing scores are
significantly higher for girls, as underlined
28
also on normative samples. On average,
behavioral problems in our sample are
similar to those observed in a cross-country
comparison on adopted adolescents (Roskam,
I., & Al., in preparation).
Table 4. Behavioural problems scores: self- and parental-reported
Our sample
YSR
(N = 25)
M
SD
Problem scale Max score
Internalizing
62
Roskam et al., in preparation
CBCL
(N = 24)
M
SD
YSR
(N = 309)
M
SD
CBCL
(N = 309)
M
SD
13,88 10,94 11,38 8,45
Boys
7,77*
6,21 10.18 8.07
10.44
10.32
9.69
9.60
Girls
20,50* 11,27 12.38 0,96
11.78
9.30
8.54
8.24
Externalizing
64
11,48
9,43
7,50
8,08
Boys
12,08 11,98 8,73 10,84
13.46
8.86
12.21
11.31
Girls
10,83
12.56
8.94
8.76
8.68
Total
210
6,07
6,43
4,98
45,52 24,56 30,92 22,58
Boys
37,15 24,16 31,64 24,83
Girls
54,58 22,52 30,31 21,88
(*) Mann-Whitney Exact Test, Monte Carlo Method, p < .005 (Two tails)
3.1.3 Parental representations
In Table 5 the average scores for the
five major scales derived from mothers’
interviews are reported.
Table 5. Mothers’ PDI principal scores (N = 27)
Range
Mean
SD
Parental capacity
6-24
16.26
4.39
Positive parental experience
2-8
5.74
2.30
Negative parental experience
3-12
5.33
1.98
Child’s positive description
2-8
5.19
1.73
Child’s negative description
2-8
3.81
1.52
Parental capacity highlights aspects linked
to parental attachment, investment in the
parenthood, coping strategies and sensitivity
towards the child. Parental experience and
the description of the child, both divided into
positive and negative, respectively refers to
the perception of the pleasure linked to the
experience of being a parent, and to whether
the parent describes the adoptee in a positive
or negative way.
3.2 Risk factors and adjustment during
adolescence
In order to highlight the effect of possible
risk factors, correlations between variables
concerning pre-adoptive experience and
behavioral problems have done. Contrarily to
our hypotheses, no significant results emerged
(p> .05). Since possible differences could be
found within adoptees who have experienced
a higher amount of pre-adoptive distress, risk
29
variables (institution, number of changes,
age and level of attachment disturbances at
placement) were recoded into dichotomous
variables, considering their distribution
within the sample (half subjects in the higher
range and the other half in the lower range).
By comparing them through the MannWhitney Exact test, a unique significant result
emerged: adoptees who differed with respect
to the DAI scores (high versus low presence
of disturbances at placement), showed
significantly different internalizing problems
(see Table 6). Adoptees who scored higher on
attachment disturbances, during adolescence
showed a higher level of internalizing
problems, even when controlling for gender.
Table 6. Maternal-reported behavioral problems with respect to high/low DAI scores
DAI at adoption
Internalizing *
Externalizing
Total
N.
M (DS)
M (DS)
M (DS)
Lower score
9
6,67 (5.39)
5,44 (4,82)
20,11 (17,21)
Higher scores
10
14,60 (8,67)
10,20 (11.35)
39,60 (25,90)
Total
19
10,84 (8,19)
11,35 (8,94)
30,37 (23,81)
(*) Mann-Whitney Exact Test, Monte Carlo Method, p < .05 (Two tails)
On the contrary, having lived in an
institution, having experienced multiple
changes in caregiving, and having been
adopted later does not influence, in our
sample, the rate of behavioral problems in
adolescence.
3.3 Parental competence and experience
Concerning the relationships between
parental competence and experience, and
adolescents’ adjustment (see Table 7), we
found a systematic correlation among the
externalizing problems (both self- and
maternal-reported), the parents’ negative
perception of child, and their negative
experience as parents.
Table 7. Parental caregiving representation and adolescents’ adjustment
YSR (N=25)
Mother PDI Scales
Intern.
Extern.
-,14
-,19
Positive parental experience
,01
Negative parental
experience
Intern.
Extern.
-,25
-.11
-.07
-.11
-,36
-,26
- .22
- .42 *
- .35
-,17
,50*
,24
. 02
. 23
. 19
Child’s positive description
-,20
-,25
-,34
- .10
- .31
- .19
Child’s negative description
-,30
,56**
,19
-.07
.47*
.23
Parental capacity
30
Mother’s CBCL (N=24)
Total
Total
Contrarily to our hypothesis, higher scores
on parental capacity do not correspond to
lower behavioral problems among adoptees.
Parental experience is negatively associated
with externalizing problems, and positively
associated with child’s negative description,
meaning that adoptees who show higher
externalizing problems have mothers who
describe their parenthood experience as more
negative and their child as more difficult and
aggressive.
4 Discussion and conclusions
Our results are preliminary and
descriptive, as our sample size is limited.
Nevertheless, we can highlight the absence
of relationships between early risk factors
and adjustment in adolescence. Indeed,
contrarily to our preliminary hypotheses,
the level of pre-adoption risk was not
associated with the behavioral adjustment
in adolescence in our sample. Only the high
rate of attachment disturbances at placements
seems to be correlated with a higher level of
internalizing problems during adolescence.
Since just a few studies analyzed the effect
of pre-adoptive risks among adolescents,
this unexpected result could be linked to
the reparatory value of having lived several
years (on average 10) within the adoptive
family. The daily and continuous experience
in a good familiar environment could limit
or even help canceling the effects of the
negative experiences, underlined by the
adoption literature (Schofield & Beek, 2006).
Nevertheless, this effect could be enhanced by
a selection bias: although we cannot control
for the number of request sent by adoption
agencies and services, we know that only few
of contacted families accepted to take part
in our study, and these families could be the
better adjusted.
Concerning the caregiving characteristics,
our results are less encouraging, as it seems
that parental competence does not influence
the adolescents’ adjustment. In our sample
only the correlations among actual the
experiences are evident. Deeper analyses
are need in order to better differentiate the
maternal and paternal role, the individual
profiles, and the possible relations among
different risk and protective factors. For
instance, analyzing in a longitudinal
perspective each individual path will allow a
deeper understanding of the time spent in the
adoptive family.
References
Aber, J., Slade, A., Berger, B., Bresgi, I., &
Kaplan, M. (1985). The Parent Development
Interview.
Achenbach, T., & Rescorla, L. (2001).
Manual for the ASEBA School-Age Forms
& Profiles. Burlington, VT: University of
Vermont , Research Center for Children,
Youth, & Families.
Bimmel, N., Juffer, F., van, Ij. M. H.,
& Bakermans-Kranenburg, M. J. (2003).
Problem behavior of internationally adopted
adolescents: a review and meta-analysis.
Harvard Review of Psychiatry, 11(2), 64–77.
Erich, S., Kanenberg, H., Case, K., Allen,
T., & Bogdanos, T. (2009). An empirical
analysis of factors affecting adolescent
attachment in adoptive families with
31
homosexual and straight parents. Children
and Youth Services Review, 31(3), 398–404.
externalizing behavior in adolescent-parent
pairs Does being adopted make a difference?
Gunnar, M., van Dulmen, M., & the
International Adotion Project Team. (2007).
Behavior problems in postinstitutionalized
internationally adopted children. Development
and Psychopathology, 19(1), 129–148.
Schechter, M. D., & Brodzinsky, D. M.
(1990). The psychology of adoption. New
York: Oxford University Press, 167 – 186 .
New York: Oxford University Press.
Howe, D. (2006). Introduction. In G.
Schofield & M. Beek (Eds.), Attachment
Handbook for Foster Care and Adoption.
London: BAAF.
Judge, S. (2003). Developmental recovery
and deficit in children adopted from Eastern
European orphanages. Child Psychiatry &
Human Development, 34(1), 49–62.
Juffer, F., & van Ijzendoorn, M. H.
(2005). Behavior problems and mental health
referrals of international adoptees: a metaanalysis. JAMA, 293(20), 2501–2515.
Pierrehumbert, B. Attachment & Adoption
Research Network (2009). Retrieved from
http://aarnetwork.wordpress.com/ .
Roskam, I., & Al., E. (in preparation).
Cross-informant ratings of internalizing and
32
Schofield, G., & Beek, M. (2006).
Attachment Handbook for Foster Care and
Adoption. London: BAAF.
Smyke. A., & Zeanah, C. (1999).
Disturbances of Attachment Interview.
Section of Child andAdolescent Psychiatry Tulane Univeristy School of Medicine.
Verhulst, F. C., Althaus, M., & Versluis-den
Bieman, H. J. (1990). Problem behavior in
international adoptees: I. An epidemiological
study. Journal of the American Academy of
Child & Adolescent Psychiatry, 29(1), 94–
103.
Zeanah, C., Egger, H., Smyke, A.,
Nelson, C., Fox, N., & Marshall, P. (2009).
Institutional Rearing and Psychiatric
Disorders in Romanian Preschool Children.
American Journal of Psychiatry, 166(7),
777–785.
ASSESSING ATTACHMENT
IN FOSTER PARENTS
AND ADOPTIVE PARENTS TO BE
Karin LUNDÉN1
Abstract
Secure attachment is considered a very important factor in resilience. Literature has shown
that both foster parent´s and adoptive parent´s own attachment significantly affects the development of a more secure attachment in children placed in their care. To measure attachment
will therefore be essential in professional´s assessments. In Sweden there is limited knowledge
of attachment in both foster parents and adoptive parents. A descriptive study was therefore
conducted in order to investigate attachment in both groups of parents. To measure attachment
the Attachment Style Interview (Bifulco, 2002) was used. The group under study consisted of
50 foster parents under assessment for approval. Following questions were investigated: how
many of the foster parents had a secure attachment; how many foster parents where children
already were placed had a secure attachment; how many foster parents with secure attachment
lived together with a more insecure partner. Tentative results showed that just over half of the
foster parents had a secure attachment. Almost half of them had an insecure attachment. Just
over half of the foster parents had same level of attachment as their partners. Almost half of
foster parents with secure attachment lived together with a more insecure partner. As we can see
conclusively there are a substantial amount of foster parents with insecure attachment. Professionals have investigated all of them for approval before they were selected as foster parents.
As secure attachment in foster parents have been proven to be such an important factor for the
development of their placed children the tentative results highlight the need for the possibility
to measure attachment as part of the assessment process.
Keywords: assessment, attachment, foster parents, adoptive parents to be
PhD. , Dept. of Social work, University of Gothenburg, SWEDEN.
E-mail: Karin.Lunden@socwork.gu.se, karinlunden@comhem.se
1
33
Introduction
Children develop in relation to their caregiving environment. For most children their
environment consists of their biological parents but for some children it consists of foster
parents and for again some it is adoptive parents. Today there is considerable knowledge
of the importance of parent’s ability to take
part in their children’s development. There
are some issues that parents have to perform
good enough in order to facilitate the development of their children. Issues that have to
do with protection and comfort but also contribute to children’s cognitive development.
Today we know the correlation between brain
development in small children and parental
sensitivity and how well parents perform their
tasks. There are some parental issues that are
found to be more important than others. Parents have to be sensitive enough, they have to
be emotional available enough and they have
to have a good enough reflective function i.e.
ability to mentalize. They also have capacity
to provide a secure base.
Attachment and care giving
The development of children is a complicated process, which is affected by the interaction between inborn or acquired biological
conditions and different factors in the environment (Sameroff, Fiese, 2000). Attachment
between children and parents play an important role in children’s on going development.
Especially through it’s effect on the development of the brain. Neurological studies have
given us evidence of how mental processes
are formed and the role small children’s experiences play hereby (Siegel, 2001). Children
34
who are adopted of placed in foster homes
may have experienced trauma and/or maltreatment early in life. There is, however, a
possibility to heal and to continue development in a more favourable direction.
To make sure children do develop well in
Sweden like in many other countries, society
has a special responsibility to ensure children
a development as optimal as possible. This is
especially relevant for adoptive children and
children placed in foster care. Earlier Swedish research has shown, however, that a considerable amount of pre school children are
at risk for maltreatment. Despite a mandatory
reporting obligation few of them were reported to Child Protection Services and CPS
assessed even fewer. The possibility for the
children and their families to get professional
help thereby diminished significantly (Lundén, 2011). Several Swedish cohort studies
have shown that both adopted children and
foster children were at risk for different kinds
of psychological and psychiatric difficulties
later on in life (Lindbland & all., 2003; van
IJzendoorn, & all., 2005).
Attachment and non-biological parent’s
care giving
There is a well-documented connection
between both biological and non-biological
parent’s caregiving capacity and type of attachment in children. Studies on adopted
children, for example, have shown that many
children, who have been in orphanage before
adoption, had developed a disorganized attachment, which is known to be connected
with several kinds of psychological and psychiatric difficulties later in life (Smyke &all.,
2010; Rutter &all., 2004). Studies conducted
by the English and Romanian Adoptee Study
Team (ERA), have illuminated the risk for
children concerning attachment. They found
a correlation between the length of children’s
stay at orphanage and severe attachment disturbances. They also found these disturbances
declined in many children when they settled
down in their adoptive family. Kanuik, Steele
and Hodges (2004) have compared children
adopted at the age of 4 years to 8 years with
experiences of child maltreatment with children adopted before the age of 1 year. The
children were followed up at 2 years of age
and results showed that they were doing very
well in general. Especially those children who
were placed with securely attached mothers.
Parental sensitivity has shown to be important in other studies as well. Children and
their adoptive mothers were followed until
the children were 7 years of age (Stams &all.,
2002). Result showed that adoptive mother’s
sensitivity together with the attachment in the
mother-child relation predicted developmental difficulties. The more secure attachment
and sensitivity in child-mother relation the
better social and cognitive development in
the child. Emotional availability can thereby
be considered an important factor for care
giving abilities in parents. Similar findings
have been found concerning children placed
in foster care (Dozier &all., 2001). The concordance between foster mother’s attachment
state of mind and the attachment quality of
their foster placed babies were examined. The
babies had been placed into the care of their
foster mothers between birth and 20 months
of age. Attachment quality was assessed when
the babies were between one and two years of
age. The correlation between foster mother’s
attachment state of mind and babies’ attachment qualities were similar to the level seen
among biologically intact dyads. It turned out
that age of placement was not related to attachment quality. It seems there is a capacity
for small children after disruption to organize
their behaviour around a new caregiver. The
results highlight the existence of a transmission of attachment between generations that
is not genetic.
For obvious reasons the attachment process in adoptive – and foster placed children
are a bit different from children in general.
Many adoptive or foster children have experienced difficult life circumstances earlier
in life such as for instance different forms
of child maltreatment. Many of them have
developed a disorganized attachment and/or
several kinds of psychological difficulties.
Hopefully enough studies also shown that
children can heal (Lundén, 2010).
Experiences from studies in both adoption
and foster care highlight the need for adopted and foster placed children to develop an
attachment as secure as possible. Research
shows a correlation between a more secure
attachment development in these children and
the quality of attachment in their adoptive- or
foster parents. In Sweden all adoptive parents
and foster parents to be are extensively assessed in many areas but not attachment.
Aim and research questions
There are some earlier Scandinavian studies, where different aspects in adoption and
35
foster care have been investigated. So far no
Swedish study has been conducted, where attachment in adoptive- or foster parents to be
have been investigated. In order to learn more
about first foster parent’s attachment a descriptive study was conducted where attachment was assessed using Attachment Style
Interview (Bifulco &all., 2008). Research
questions were
• How many foster parents were
securely attached
• How many foster parents
where foster children already were
placed, were securely attached
•
How many foster parents lived
together with someone more insecurely attached.
Methodology
Participants and procedure
The present group under study consisted
of 50 foster parents involved in an assessment
process for approval. All of them were married or cohabitants. Just around half of them
were between 40 and 49 years old. The remaining participants were mostly older than
49 years of age. Few of them were younger
than 40 years of age. Their attachment style
was assessed in connection with their wish to
be approved as foster parents in a particular
community.
Measurement
To assess attachment Attachment Style Interview (Bifulco &all., 2008) was used. The
Attachment Style Interview is a standardised,
semi structured, investigator-based interview
designed to investigate quality of close rela-
36
tionships to partner and to very close others,
ability to make and maintain relationships,
the degree of secure/insecure attachment and
the overall attachment style.
Tentative results
The present foster parent group of 50 participants is part of a larger group consisting
of additional 50 adoptive parents to be and 50
parents in child protection cases. In comparison adoptive parents to be had a more secure
attachment style than did foster parents to be.
On the other hand foster parents to be were
more securely attached than were parents
in child protection cases. Tentative results
showed that even if participants were assessed
for approval to be foster parents three fifth of
them already had children placed within their
family. As can be seen in table 1 just over half
of the foster parents to be showed a secure
or mildly insecure attachment style while almost half of them showed a highly insecurely
attachment style. A similar amount of foster
parents, who already had placements, were
assessed to have secure/mildly insecure attachment as those with a highly insecure attachment style.
All foster parents to be lived together with
a partner. Just over half of them had the same
degree of attachment style as their partners.
Almost as many of them lived together with
someone with a highly insecure attachment
style.
Table 1. Amount of foster parents to be and degree of secure attachment style
Foster parents
Secure/mildly
insecure
Highly insecure
No - foster children
8(4%)
12(6%)
20(40%)
Yes - foster children
19 (63%)
21(70%)
30(60%)
27 (54%)
23 (46%)
50
In average foster parents to be already had
3.6 children placed in their families. As many
as nineteen of them had more than five children all together including biological children, adoptive children, foster children etc.
Conclusions
Earlier Swedish cohort studies have
shown that both adoptive children and foster
placed children are at risk for developmental
difficulties later in life. There are reasons to
believe that attachment is one contributing
factor. Both adoptive children and foster children most often have experiences of trauma
and/or maltreatment earlier in life, which are
considerable threats towards a healthy development. Several studies have shown the
impact of both adoptive- and foster parent’s
attachment on children’s ability to solve developmental issues and for the healing process (Smyke &all., 2010; Rutter &all., 2004;
Dozier &all., 2001).
Preliminary results showed that over half
of the foster parents to be had a secure/mildly
insecure attachment style assessed by the ASI.
Almost as many foster parents, however, had
a highly insecure attachment style. Data revealed that a considerable amount of the foster parents to be already had foster children
placed within their families. A large amount
of these foster parents had a highly insecure
attachment style. Probably all of them have
been assessed for approval by authorities using current assessment tools. Even if just preliminary the results from this study stresses
the need to assess attachment in both adoptive parents and foster parents to be using a
reliable measurement. Until now there have
not been common to measure attachment in
assessments of any kind. Today, however, we
have access to a standardized research based
attachment interview. There is now a Swedish
version of Attachment Style Interview - ASI.
More and more social workers are trained
in the use of the ASI. The result is that the
Swedish ASI is used in some communities to
assess attachment style as part in assessments
for approval for adoptive and for foster parents to be.
References
Bifulco, A. (2002). Attachment style measurement - a clinical and epidemiological perspective. Attachment & Human Development,
4(2), pp. 180-188. ISSN (print) 1461-6734.
Bifulco, A., Jacobs, C., Bunn, A., Thomas, D. & Irving, K. (2008). The Attachment
Style Interview (ASI). A support-based adult
assessment tool for adoption and fostering
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3, 33-45.
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Dozier, M., Stovall, C., Albus, K., E. &
Bates, B. (2001). Attachment for Infants in
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Infant Mental Health. 2nd edition. NY: The
Guilford Press.
Kanuik, J., Steele, M. & Hodges, J. (2004).
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adopters over the first two years of placement.
Adoption 6 Fostering. Vol. 28, no 2. 61-67.
Siegel, J. D. (2001). Towards un Interpersonal Neurobiology of the Developing Mind:
Attachment Relationships, “Mindsight” and
Neural Integration. Journal of Infant Mental
Health. Vol. 22(1-2), 67 – 94.
Lindbland, F., Hjern, A. & Vinnerljung,
Smyke, A. T., Zeanah, Ch., H., Fox, N. A.,
Nelson, Ch. A. & Guthrie, D. (2010). Place-
B. (2003). Intercountry Adopted Children as
Young, Adults – A Swedish Cohort Study.
American Journal of Orthopsychiatry. Vol.
73, 190-202.
ment in Foster Care Enhances Quality of
Attachment among Young Institutionalized
Children. Child Development, January/February. Vol. 81, no 1, 212-223.
Lundén, K. (2010) Att identifiera omsorgssvikt hos förskolebarn. Vad kan vi lära
av forskningen. [To identify children at risk
for maltreatment. What can we learn from research] Allmänna Barnhuset.
Stams, G-J., J., M., Juffer, F. & van IJzendoorn, M. H. (2002). Maternal Sensitivity,
Infant Attachment, and Temperament in Early Childhood Predict Adjustment in Middle
Childhood: The Case of Adopted Children
and their Biologically Unrelated Parents. Developmental Psychology. Vol. 38, no 5, 806821.
Lundén, K. (2011). To identify pre-schoolers at risk for maltreatment. “Todays children
are tomorrows’ parents. Vol. 30-31, 30-41.
Rutter, M., O’Connor, T. and the English
and Romanian Adoptees (ERA) Study Team
(2004). Are There Biological Programming
Effects for Psychological Development? Findigs From a Study of Romanian Adoptees.
Developmental Psychology. Vol. 48, no 1,
81-94.
38
van IJzendoorn, M., Juffer, F. & Poelhuis,
C., W. (2005). Adoption and Cognitive Development: A Meta-Analytic Comparison of
Adopted and Nonadopted Children’s IQ and
School Performance. Psychological Bulletin.
Vol. 131, 301-316.
ATTACHMENT, MOURNING AND
RESILIENCE IN KAFALA AND
ADOPTION
Badra Moutassem-MIMOUNI1
Abstract
The search for the origins, the need to know of the adopted / kafil child: is it a need to leave
the foster home, or is it a need to strengthen its links with her? For the adopting, try to know
his origins means to lose their foster child really or symbolically. Our work of several decades
with deserted children at birth, with adopted children or in kafala or within the framework of
the circulation of the children, of the donation of child or the taking in of a child without family in Algeria, brought me to qualify my understanding of the desire to know his(her) family
of origin. The reasons are complex and require a deeper analysis in order to encircle better the
deep mechanisms of this need to know: What are the effects of the discovery of the secret on
the adopting and the adopted or mekfoul? What role plays the type of attachment in the resolution of the mourning of the adopted child and in his resilience? This text treats these questions
through studies of cases met in my practice and my researches over more than thirty years.
Keywords: adoption, kafala, desire to know, secret of the origins, the attachment, the mourning, Algeria.
Teatcher in Department of psychology, University of Oran Es-Senia Algeria ; Research Director, Center of research of Anthropology (CRASC) Oran. Algeria ; Coordinator graduate school
in anthropology ; Member of the Editorial Board of the journal Insaniyat (CRASC) since 2005;
Email : HYPERLINK «mailto:mimbadri2013@gmail.com» mimbadri2013@gmail.com
1
39
1.Introduction
Algeria, country of the shores of the
Mediterranean, is a part of North Africa
which is in the crossroads of diverse influences. Arab-berber and muslim country, african country, bordering country of Europe,
Algeria presents a culture of a big diversity.
As in all the cultures, the child occupies a
special place and gives sense to the couple.
The prohibition to procreate out of legal wedlock makes the child precious, strongly invested and sought. For more than thirty years
I accompanied the evolution of the kafala in
Algeria. If the adopted undergo pressures and
live sufferings, the adopting is not exempted
from it. If the kafala allowed helping thousands of rejected children born out of wedlock by offering them a substitution family,
it is not made without difficulties. According
to their conception of the kafala, adopting
and adopted are confronted with more or less
painful situations and have bereavements to
be made.
2. Of the donation in the kafala
A few decades ago, in case of infertility or
of definitive celibacy, we adopted a child of
the family so that everything stays in the family (inheritance, not to introduce a foreigner,
not to take risk that this child introduces the
discord into the family, etc.). So, as in all Africa (Lallemand, 1996), the donation of child
always existed in Algeria, but since a few decades it is less and less practiced. Three factors worked against this mode of collection:
- The first factor is connected to the social
changes: the reduction in the fertility, the distension of the family links by the dispersal of
the members of the family and the weakening
40
of the social links, made that the children are
more and more adopted in the services of the
State (Moutassem-Mimouni, 2001) within
the framework of the kafala (which is a legal and simple adoption without filiations and
without inheritance) or taken in the greatest
secrecy to be declared legitimate (Moutassem-Mimouni, 2012).
- The second factor is of legal order: indeed, Algeria forbade the complete adoption
from its independence en 1962. The kafala
was promulgated by the code of the family
with 1984 and according to the sharia the
child does not take the filiations of the kafil
(adopting), and will not inherit except on provision of the will of the kafil which can bequeath him(her) the fifth of its properties and
more if the heirs agree. Under the pressure
of associations and researchers, decree that
concern change of name in 1992 (N 92-24 of
January 13th, 1992) authorize the kafil to give
his name, but not his filiations and can put
him on the family book to protect the child
and reassure kafils. This last measure was
disputed and questioned and brings adopting
to by-pass the law by dealing directly with
the unmarried mother and to declare the child
as biological child (Moutassem-Mimouni,
2001).
- The third factor is of psychological order: the adopting prefer more and more to take
child of unknown origin (Moutassem-Mimouni, 2012) hoping, by there, not to have to
face the risks of conflicts with the biological
family. For others, they hope to be the unique
referent “he will have nobody but me “what
fills their narcissism and compensates their
infertility. The adopting sometimes goes as
far as feigning a pregnancy in a way that very
few people know that she is going to adopt.
Since the seventies, the births out of wedlock
increased a lot (Freud, 2001) these children
are often abandoned in the birth and taken in
the institutions of the State (Moutassem-Mimouni, 2001). The couples suffering from infertility are the main applicants of kafala, but
more and more single women who did not get
married resort to it (Moutassem-Mimouni,
2012) this practice extends to the three countries of the Maghreb (Algeria, Tunisia and
Morocco) (Boucebci, 1982). The born children out of wedlock present two characteristics which are going to complicate the situation and to strengthen the determination of
the secret of the origins: be illegitimate child
(Moutassem-Mimouni, 2012) child of the sin
thus of the haram (illicit, forbidden from the
religious point of view) what is going to urge
families to keep silent about the origins of the
child either by giving him (her) illegally their
name and filiation, while keeping silent fiercely about the adoption in spite of the obvious
proofs that the child can discover, or to lie by
inventing him(her) a filiation as for example
« it is the son of my cousin from whom the
husband died and left her without resources
«. The fact that the child has no known family is thus going to increase the desire and the
temptation to keep the secret.
3. The research for the origins
The research is a powerful desire which is
felt as a vital need. An enormous energy is
invested in this quest of the origins. This mobilized energy or rather immobilized prevents
from investing in other spaces of action and
knowledge. Often the adopted which antici-
pated prematurely the secret have school and
relational difficulties, are often unstable, etc.
… At the same time this energy carries them
and establishes a constant pressure which
supports them and exhausts them at the same
time. When the adopting refutes this need, it
can constitute a destructive brake.
3.1.The discovery of the secret
The discovery of the secret by the child is
made often late either in the preadolescence
or in the adolescence. Whether it is for the
child or for the adopting, it is an event which
is completely going to upset relationships between both and to cause sometimes very important relational and psychological disorders
at the child and the parents.
3.1.1 Effect of the discovery of the secret
on the child
The adopted is going to pass by several
states: i) the refusal, ‘ I did not believe my
ears, I said to myself they are jealous because
my parents love me “; ii) the doubt “ I looked
for details which would support this thesis “,
this fifteen-year-old girl tells the psychologist
how she wakes up at night, while her foster
mother sleeps to look for indications “ everywhere, including in the refrigerator, the
cooker, the toilet! “. The mother denies all
her strengths the adoption and shows proofs:
photos of sbou ‘ it is the seventh day when
the child is named ‘ tesmiya ‘ the party organized this day can be grand (Moutassem-Mimouni, 2012); iii) the confirmation « one day
my mother told me ‘ I did not carry (wear)
you in my stomach ‘ and this day the world
seemed strange. I went out and I walked for
hours. I did not know what to do nor to whom
to speak «. Disorientation, confusion, is often
41
evoked by the adopted during the late discovery of the adoption.
After this confirmation the reactions are
much contrasted:
- The secret is going to be perceived as
treason and there, the reaction can be very
violent. It is the case of Nadia that is going
to learn by her cousin that she was adopted.
She is brutally going to change, she runs
away of the house, and rejects quite altogether (we shall see this case more in detail).
- Very early Lamia anticipated that there was
a secret, but said nothing. Her reaction is totally contrary to the previous one. I met Lamia
in the direction of the social action (DAS).
It was an eighteen-year-old girl. Her mother
takes me in private conversation and tells me
“I adopted her, but you should not tell her «,
the girl takes me in private conversation and
tells me « I am adopted, but you should not
tell to my mother that I know «. It was very
moving this secret which guaranteed their
mutual attachment (Moutassem-Mimouni,
2001).
- Other cases are going to adapt to this situation sometimes while keeping a rancor and
a hostility more or less marked to their adopting, without damaging too much the relation :
Karim 16 years will say I have no other mother than her, ‘ the other one ‘ threw me and I do
not want to return to the institution «.
3.1.2. The adopting and their suffering
in front of the discovery of the secret by the
child
Few studies dealt with the adopting and
their sufferings to lose really or symbolically the child whom they so much invested,
so liked and for whom they built projects in
42
the shorter or longer term. The adopting are
never completely reassured, it is about a restless parenthood which brings them a lot of
enjoyment but this one is often corrupted by
the doubts which they can have and the fears
of losing this child. For those who informed
the child, they are always afraid of seeing
the one of the biological parents trying to get
back this child, fruit of their efforts and their
education …
As for those who bet everything on the
absolute secrecy, we have two categories:
for the first one, their terror is that the child
learns that it is not theirs, that the secret is
aired “ I would not bear it, it would kill me,
it is unthinkable “ the discovery of the secret
makes them lose their fantasized child, even
if he tries to reassure them that he does not
try to leave, that he wants just to know. A day
a mom who hung on desperately to the secret tells me “if he learns, I shall not bear it,
I cannot keep him”, another one answers the
psychologist” when he will know I shall certainly have died “(she is sixty years old and
he is twelve years old)! Another mom come
“ return her daughter “ in the DAS, while we
tried to convince her (by explaining her that
it is just a crisis, that it is the adolescence,
and that it is going to pass) to give up the
project to undo the kafala, answers “ I cannot bear more that she knows that I am not
her mother, I could not continue to make just
like that “. For these cases, something is definitively broken. It’s as if their attachment to
the child depended on this secret and could
not survive it. This child was only a fantasy
and to lift the veil on the adoption show that
the real child was only a representation. As
long as he did not know he could make illu-
sion and play without him/her knowing the
extra. The adopting make their mourning by
rejecting definitively any link, any attachment. It’s as if the child had never existed.
For the second category, it is the fear of being denied, rejected, of returning to the state
of ‘infertility’ in its sense of ‘ space, absence,
and drought ‘. Thirdly, even when their child
does not want to leave them (and often he
cannot, because when he manages to find his
mother, this one is far from wishing for this
meeting), the adopting feel relegated, they
lose their place as parent “ the first one and the
last one “ as they say when they want to take
child without family. They have the feeling to
be relegated, of becoming a second-class parent, “it is not anymore the same thing, I feel
as swindled. It is me who made everything
and now I am only the other one, ‘the adopting’ “. On the other hand, after all these years
of secrets how to explain to the neighbors, to
the friends, to the knowledge, that everything
was ‘lie’. It is particularly testing for the single women who did not get married and who
hid their celibacy by inventing a marriage, a
divorce or the death of the husband “what am
I going to tell to people?” A mom wonders
with despair. This single woman who adopted
a newborn girl, who was sick, that she looked
and raised in the greatest secrecy. When the
girl was 5 years old, she even moved towards
a district where she was not known and told
that her husband died in an accident. When
her daughter discovered the secret at the age
of fourteen, her big concern was “what am I
going to tell to people?” “What are going to
think the neighbors?” Her daughter asked her
to explain her, to tell her story. “Am I going to
tell her that she is an illegitimate child thrown
by her mother the day of her birth, that I am a
spinster?” This situation put the girl in all her
states; she didn’t understand why her mother
hangs on to her lies. She is fast going to discover that the mother was afraid of what will
be said about her, so she starts to threaten her
to tell everything to the neighbors, to make a
scandal… An arm-wrestling started between
both. Mediation allowed bringing a reassurance to the mother and to the child.
On the psychological plan, during these
crises, we attend a real narcissistic bleeding.
The narcissism of the adopting which was
enhanced by the adoption is badly shaken.
The self-respect is devalued and the frustrations re-appear, the feeling of injustice “ why
me? “, resurgences of the sufferings bound to
the infertility or to the absence of marriage:
my stomach betrayed me said the sterile; my
Saad (fate, luck, part of the life…) betrayed
me, if I had the opportunity to marry someone
I would have my own children and I would
not be in this humiliating and testing situation. It is the adopted child who makes the
adopting parent and the risks of losing this
child return them to the square one.
3.2.Contrasted resolutions of mourning:
case studies
We see by those examples that the mourning has to be made by both sides. Whether it is
for the adopting or for the adopted, the work
of mourning must be accompanied by the
nursing (Schofield, Beek, 2006). As soon as
symptoms appear, it is necessary to act quickly to prevent the situation from becoming inflamed between adopting and adopted. Still
the adopting have to speak about it, ask for
help. Of course the ideal is to make the accom-
43
paniment from the beginning of the adoption.
The role of the adopting is undeniable in the
resolution of the mourning. The type of attachment must be considered as much in the
child’s as in the parents. Often we are in front
of pre teenagers or of adolescent or young
overexcited adults, hurt by the silence of the
adopting and their lack of confidence. The
quoted cases higher also show that the adopting are in insecurity, they are afraid of losing
their child really or symbolically, of losing
their status, their place within their social and
family environment. The following three cases show how the type of attachment and the
reactions of the adopting to the discovery of
the secret can help or aggravate the situation:
1st case: Farida was adopted in the birth
after the death of her father, her mother Fatna
having six children was pregnant of the last
one (Farida in this particular case) and was
completely deprived. She meets a woman
Fouzia in the bath, the latter had miscarriages
and both was too discouraged for opposite
reasons: the one had an additional child while
she had difficulty in making live those whom
she already has, the other one because she did
not manage to have viable children. They develop a plan: when Fatna is going to feel the
first contractions she has to go to Fouzia to
give birth. Farida is going to be registered on
the family book of Fouzia and her husband.
The birth will be celebrated with all the rites
relative to this event through the tesmiya.
Farida will be cherished and raised in the secret. She is going to learn indirectly that she
was adopted but she built an identity enough
solid which allowed her to appreciate the
benefactions of her adoption, she made as if
44
she knew nothing. While was thirty-year-old,
the biological family makes surface. Having
aged, seized with remorse or with greed, the
mother informs her children that their sister had not died in the birth as she had told
them but that she was very alive and lived in
such place. They are going to come to ask to
see their sister at first to know her, and then
gradually they want to incite her to leave her
foster home and make her glitter that she is
going to be able to travel, go in France to her
sister who was settled there, etc.... The temptation is big and in spite of its ambivalence
Farida wants to know ‘ this family ‘. Her foster father, who loved her profoundly and who
had understood the dilemma in which his
child struggled, recommends her not to leave
her work and suggests her leaving at first and
then ‘ you will see ‘ he tells her. She leaves
for France, at the beginning everything was
magnificent, she was treated in distinguished
guest, then gradually, the life takes its course,
each resumes his role and she finds herself
in an ordinary family with her stinginess, her
conflicts, her obvious or latent hatreds. She
caused jealousies … Of the blow she is going to compare both families and realizes
that her real family it is the one who adopted
her, with the other family she shared nothing ; neither values, nor habits, nor attachment which would have been able to make
the faults bearable. From the fifteenth day she
is going to begin calling her foster parents,
crying and asking to return home. When she
is going to return she will categorically refuse to see again her biological family and is
definitively going to close the subject, when
she remembers herself the event she smiles
there “I was crazy and stupid, it is incompa-
rable. We imagine things but finally it is only
of the imagination, I buried them in my head!
«. The mourning is made: “nobody will love
me as much as dad «. These words echo the
conclusion.
These words echo the conclusion of
SOULE (Verdier, Soule, et coll. 1986) “the
confrontation with the idealized but often
dirty parents, without qualities, or simply real
and ordinary, is most of the time unbearable
and harmful «. For Farida, and for a lot of case
whom we met, this episode is far from being
harmful, quite the opposite it was beneficial,
builder and even helped in the resolution of
the mourning. For her foster parents, this episode ached, but they were rather confident in
their daughter and in their mutual attachment
and they were finally released from their
fears, at the same time it strengthened their
narcissism, they had to say themselves « finally we are better parents than the ‘truths’ «...
For more worried, ambivalent adopting or refusing to make the mourning of their infertility, to see their child discovering this adoption
can destroy definitively the link based on a
conditional attachment, based on the possessive appropriation of the child.
2nd case the impossible mourning: when
sixteen-year-old Nadia is going to learn by
a cousin that she was adopted, she was very
far from suspecting her situation. The worst it
is because the adoptive mom did not tolerate
that her daughter discovers the secret, of the
blow she put her at a distance and rejected
her. The father on the other hand made every
effort to keep her. But not tolerating to be not
only the ‘illegitimate child’, but also the adopted and the rejected by her 2nd mom, she
is going to begin at first to make all which
is forbidden in the ambient culture: go out
with the boys, smoke, be on drugs, to wear
indecent clothes and to oppose everything.
What has even more revolted the mother who
saw her fears strengthened on the fact that
“nothing good can come from such a child
«, this bad object in charge of all the defects.
Nadia eventually leaves the family place of
residence and roam in the street with young
people in escheat, be on drugs, to fight … Her
father made every effort to bring her out from
there but did not succeed. He supported her as
he was able financially. It has been more than
twenty years since she roams. In this case Nadia was not able to say goodbye and the only
person (the foster mother) who would have
been able to help her did not assist her; the
wound was not able to heal to allow her to
take back her life.
3rd case: a restoration. Faiza was placed
in kafala in France there while she was already seven-year-old. Faiza raised by the
sisters spoke French and thus had no particular difficulties to become integrated into the
school. The question of the origins did not
arise because she knew that she was adopted.
But in the adolescence, Faiza begins to oppose, to smoke, to go out with the boys and
gets pregnant. Kafils, not having been able to
bear the shame in front of this behavior, is
going to return Faiza in Algeria on the pretext of holidays, to deposit her in the center
and to undo the kafala. Her reaction was extremely violent, she is bewildered, she does
not understand that we can deposit her as a
cumbersome parcel. She is going to live this
2nd abandonment as treason and is going
there to blame her adopting but also herself.
She is going to show for years of the anxiety,
45
disorders of sleep and of behavior (violence,
aggressiveness, strong consumption of cigarettes). She had even hallucinations without
loss of contact with the reality. Accompanied
by a psychologist, she managed to stabilize
her behavior, but more than thirty years after this second abandonment, she remains
marked and continues to speak about it with a
lot of ambivalence.
S. Freud clearly defined the mourning in
its text “Mourning and melancholy” (Freud,
(2001) as a painful reaction to a loss. The
feelings of revolt, sadness and even despair
gradually have to give way to the reassurance to allow the saddened to take back his
life by investing new external objects. It was
necessary to release a part of energy of the
traumatic event to be able to prelaunch the
temporal process allowing to register new
memories, new projects. Whether it is for the
foster parents or for the adopted child there
are bereavements there to be made. If Nadia
had so much suffering and destroyed her life
it is because she could not bear this second
abandonment by her foster mother who could
not accept that her daughter knows that she
is only the adopting. Maybe that Nadia unconsciously perceived this refusal for a long
time. Such a denial could be the base of more
or less unconscious conducts which corrupt
the relation to the child and weaken his attachment. So when he discovers his origin,
the shady feelings that he perceived at his
adopting created a crack, a wound which is
going to open during the discovery and to
prevent the necessary healing and the mourning in pursuit of his life and of his link with
his foster home?
46
While numerous cases, having made research and which managed to find the mother, become aware that the fantasized mother
is far from the real mother and whom she is
finally only an ordinary, sometimes pathetic
woman, lasts, rejecting; after a desperate collision, they finish by « yabardou « (Moutassem-Mimouni, 2001) literally « they cool «,
what expresses a relaxation of the tension
which supported them during all these years
of hope, and they eventually make generally the mourning of this mother so dreamed.
Most that I met during these last thirty years,
on second thought told me “sometimes I regret having looked for her, but in fact I do
not regret because that allowed me to know.
Now I am going to take care of my life
«For the parents this incapacity and this phobia to tell his origins to the child finds and
reveals in our sense the incapacity to make
their mourning of the «biological» child,
make the mourning also of their infertility or
their forced celibacy. Families about which
the child knew without their knowledge that
he was adopted, brutally cut investment in
the child, because he knows, he does not belong any more to «them». Of object of all the
care, the child becomes a bad object which
is necessary to expel, to reject, and to return
in the DAS. What increases the pain of the
child which does not include, which is going to relive the second abandonment? Often
they express their fear: “if she sends me back,
where I am going to go? I am afraid that she
abandons me as the other one «.
The analysis of the cases of failure of kafala questions in first position the secret on
the origins. But behind this refusal we detect
the insufficiency of the preparation of the
adopting for their role. As any birth requires a
gestation allowing the parents to get ready for
this radical change in their life, the adopting
need to make the mourning of the biological
child to let enough energy invest on this substitution child who risks to remain it and to
be only “the replacement «. As soon as the
real child shows him, the adopted one is rejected and denigrated. That’s why the accompaniment of the adopting is essential in the
maturation of the project of adoption, then in
a good care of the child and finally to help
to solve as one goes along the conflicts, the
misunderstandings, the difficulties inherent
to any parentalisation.
In conclusion, the adoption as the kafala
raises problems in all the countries. The foster
parents just like their children have difficulty
and are confronted with major existential
questions. Some as the others are sometimes
in sufferings and require an accompaniment
and psychosocial care to help them to set
their lives in order and to reduce the returns
of kafala, extremely expensive on the emotional plan for the adopting and the adopted.
There is enough services of help and of support to the adopting and to the adopted. It is
essential to convince the foster homes that to
know his origin is beneficial for their child
but also for them. In a work (Moutassem-Mimouni, 2001) we so ended « The secret on the
origins caused many tragedies, and however
unpleasant it might seem to S.FREUD, the
tragedy of Œdipe is, before being the tragedy
of the incest and the loving desire for the parents, that of the abandonment and the secret
on the origins «.
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UP FRONT AND PERSONAL: ADOPTIVE
PARENTS’ PERCEPTIONS OF THEIR
EASTERN EUROPEAN CHILDREN’S
ADOPTION OUTCOMES IN CONTEXT
Josephine A. RUGGIERO1
Abstract
U. S. parents of 70 Eastern European children participated in telephone interviews with the
author in which they shared their perceptions of their children’s adoption outcomes along with
information about a variety of demographic and contextual variables. The study objective was
to improve understanding of the variables connected with parents’ perceptions by conducting
an in-depth investigation of adoption outcomes. The author spoke personally with 46 parents
of adoptees who had typically had lived in their families for at least two years at the time of the
interview. Respondents rated their adoption outcomes into one of four categories: very successful, pretty successful, somewhat problematic, or very problematic. Although these respondents
rated the outcomes of three out of four children a very or pretty successful, one in four of the
adoption outcomes were described as somewhat or very problematic. The author provides case
examples to illustrate each adoption outcome. This study 1) challenges highly optimistic reports
of questionnaires which claimed parental satisfaction of U. S. adopters of Eastern European
children to be in the high 90% range, 2) recognizes and supports other research indicating that a
sizeable minority of Eastern European adoptees exhibit behavioral and other serious problems
which may require long-term post-adoption services, and 3) addresses an important gap in the
scholarly literature on adoption outcome by grounding parents’ ratings in important demographic variables including the child’s sex and age at adoption, sibling adoptions, and the number of children adopted into a single family at the time of the interview and contextual variables
1
Professor Emerita of Sociology at Providence College.
E-mail: jruggier@providence.edu
This research was supported in part by a grant from the Providence College Committee
to Aid Faculty Research.
The author wishes to acknowledge Shannon Hoey for her assistance with literature searches and Sabrina Raulerson
for her assistance with data preparation and tables.
49
including respondents’ perceptions of each child’s compatibility with them, their pre-adoption
expectations of each child’s adoption outcome, perceived accuracy and completeness of the
information they got about each child from the agency they used, pre-adoption preparation to
adopt a child from a high-risk institutional setting, access to post-adoption services, support
from family and friends and perceptions of the child’s relationship with them and other family
members. The author discusses the implications of this research for adoptive family functioning and for the adoptees in regard to navigating the world of intimate relationships and future
parenthood.
Keywords: adoption outcome, Eastern Europe adoptees, family functioning, qualitative research
Introduction
Adoptive Parents’ Perceptions of Their
Eastern European Children’s Adoption Outcomes in Context.
U. S. citizens have a long history of adopting orphans born in other countries. This history dates back at least to the post-World War
II period. Between 1990 and 2013, a new
wave of immigrant orphans entered American
families. Some of these new arrivals began to
come from Eastern European countries. To
date, Eastern European adoptees to U. S. families number more than 93 thousand children.
Sixty-four percent of them have come from
Russia. Adoptions of Russian-born orphans
by U. S. citizens began as a trickle in 1991
and 1992, peaked in 2004 and declined between 2005 and 20131. Recently, Russian authorities halted adoptions of Russian orphans
by U. S. citizens. Between 1993 and 2013,
nearly 11 percent of the Eastern European orphans who joined American families during
this time frame came from Ukraine. Between
1990 and 2004 inclusive, 8.9% of the Eastern
European immigrant orphans adopted by U.
S. citizens came from Romania. Adoptions of
Romanian orphans by U. S. citizens stopped
in 2005. The remaining 16% of the adoptees
came from other Eastern European countries.2
50
Since 2005, international adoptions to the U.
S. have declined overall.
Literature Review
A growing cross-disciplinary literature on
Eastern European adoptees to the U. S. has
emerged from the work of scholars and practitioners (Federici, 1998; Gindis, 1998; Goldberg, 1997, 2001; Groze, 1996; Groze & Ileana, 1996; Hawk & McCall, 2011; Johnson,
1997; Kreider & Cohen, 2009; McGuinness
& Pallansch, 2007; Merz & McCall, 2011;
Miller, L., Chan, W., Tirella, L. & Perrin, E.,
2009; Miller & Adamec, 2004; Miller, Kiernan, Mathers, & Klein‑Gitelman,1995; Ruggiero, 2007, 2009). These researchers and
practitioners have investigated Eastern European adoptees’ pre-adoption issues and postadoption needs including those experienced by
their adoptive parents.
For example, Miller et al. (2009) reported
behavioral problems as a common trait in
Eastern European adoptees and explored the
risk factors involved. These authors evaluated
cognitive and behavioral outcomes, as well as
parenting stress, in relation to factors such as
arrival age, growth, and prenatal alcohol exposure. They concluded that, although IQ and
achievement scores were generally average
or higher, behavior and school problems were
common and correlated inversely with IQ.
Thus, parents whose child had such problems
were likely to experience increased stress.
Through a longitudinal study conducted at
two points in time, McGuinness & Pallansch
(2007) analyzed problem behavior in children
adopted from the former Soviet Union. Their
study focused on the impact of risk factors and
protective factors on the behavior of a group
of 105 adoptees. These authors concluded
that the protective factors of adoptive family environment have apparently increased
in importance relative to pre-adoptive factors
(except for birth weight), showing that families can play a significant role in the behavior
of these children.
In an thorough review of the literature on
post-adoption interventions for at-risk internationally adopted children and their families, Welsh, Viana, Petrill & Mathias (2007)
reported that “very little systematic information exists regarding the effectiveness of interventions designed to prevent and remediate these difficulties in IA children” (p. 285).
They pointed out the challenges to parents
and practitioners trying to untangle pre-natal
and genetic influences from post-natal environmental variables like pre-adoption neglect, abuse, and institutional deprivations.
In addition, Welsh et al. (2007) identified
an important limitation in the literature they
reviewed: the general focus on infants and
toddlers rather than on older adoptees. An important implication of the Welsh et al. (2007)
research is that savvy parents as well as practitioners, including health care professionals
and educators, may not be able to identify accurately their children’s specific conditions.
When children’s diagnoses are inaccurate,
obtaining essential and effective services may
be delayed or never be obtained.
In response to media reports claiming that
parents of Eastern European adoptees faced
widespread post-adoption challenges, Cradle
of Hope Executive Director, Linda Perilstein,
commissioned a questionnaire survey of
adoptive parents of Eastern European children who had worked with 18 adoption agencies as well as with Cradle of Hope, the study
sponsor. More than 1200 parents completed
the survey, 57% of the targeted parents. Essley and Perilstein (1998) reported that most
of the children were doing well in regard to
health, attachment, adjustment, and development. The Cradle of Hope Adoption Center
survey reported a parental satisfaction rate of
97.5% in response to the statement: We are/I
am pleased that this child has become a member of the family. Other questionnaire surveys have reported positive findings (Claus
& Baxter, 1997; Price, 2000). Unfortunately,
some reports of adoption outcomes of Eastern
European children have lacked systematic investigation into the variables which provide
a context for adoptive parents’ views about
their children’s adoption outcomes. The study
reported in this article includes demographic
and other relevant social variables such as
parents’ perceptions of their children’s connection to them and to other family members.
Sample and Method
Forty-six U. S.-citizen adoptive parents of
70 Eastern European children comprised the
snowball sample of participants who agreed
to speak in depth about their adopted children
51
and their adoption experiences through a
telephone interview with the author. The
author put out a call for participation that
aimed to attract parents of Eastern European
adoptees who had lived in their adoptive
families for at least two years, were typically
older than infancy when they were adopted,
and/or were part of a biological sibling group
adopted into the same family. The author tried
to obtain as diverse a sample as possible.3
The large majority of interviews were
completed by the primary caretaker-- the
adoptive mother. Two couples requested to
complete the interview together. The data
reported here are based on 44 interviews with
46 adoptive parents.
The interview was designed by the author
and consisted of both open- and close-ended
questions. Interviews averaged 90 minutes
in length and covered areas in addition to the
principal variable investigated here: parents’
perception of adoption outcome. Respondents
also answered questions about their adoption
experience(s), how each adoptee was doing at
the time of the interview, the adoption agency
(or facilitator) the respondents used, a typical
weekend day for each adoptee, how the
adoptee related to the respondent and to other
members of the adoptive family, adjectives
that came to mind to describe each child, their
hopes and expectations for their child’s future
and background questions about themselves,
the adoptive family and the adoptees. Because
of space limitations, the focus here is on
parents’ perceptions of adoption outcome(s)
and the important variables that help explain
the reasons behind their perceptions.
Demographic information about the adoptees is displayed in Table 1. Table 1 presents
six single-variable distributions showing
52
percentages and numbers for each category.
These variables include the children’s birth
country, number of children adopted into each
family, the child’s age at adoption, biological
siblings adopted at the same time, length of
time adoptee lived in their family, and sex of
each child. As Table 1 shows, the majority
of adoptees were born in Russia. Romanian
adoptees comprised the next largest grouping. Children adopted from other Eastern
European countries comprised the remainder.
The number of children adopted into a single family ranged from one to five. Although
having one adoptee in the home was typical
of the majority of parents, four in 10 respondents had adopted two children. Two respondents had adopted three children and one had
adopted two sibling groups at different points
in time. At the time of their adoption, six in
10 of the adoptees were between 18 and 59
months old. Almost one in five was between
60 and 119 months old; and four percent were
120 months (10 years) old or older. Only a
small minority of the children was between
seven and 17 months old. Unique to this
research is that siblings adopted at the same
time comprised about 45% of the adoptees.
Female adoptees outnumbered male adoptees.
Because time spent in the adoptive family is
an important variable related to the validity
of parents’ perceptions of adoption outcome,
the author tried to ensure that the children in
this study lived in their adoptive homes long
enough for their parents to become familiar
with any major medical, behavioral, or emotional issues and needs they had. More than
half of adoptees had lived with their adoptive
families for between 24- 59 months. Because
nearly 9 in 10 of the adoptees had lived with
their adoptive parent(s) for at least two years,
the author is confident that participants had
sufficient experience with their children to
accurately place them in one of the four adoption outcome categories.
Table 1. Demographic Information about Adoptees at Time of Interview
Variable
Percentage Total Percentage
Number
Birth Country of Adoptees
Russia 59 (41)
Romania 23(16)
Other Eastern Europe 18
(13)
100% (70)
Number of Children Adopted into Respondent’s Family
One52
Two41
Three or more 7100%(70)
Age of Child at Adoption
7-17 month s17(12)
18-59 months60(42)
60-119 months19 (13)
120 months or older
4(3)
100% (70)
Biological Siblings Adopted at Same Time
Yes45
No55100%
Length of Time Adoptee Lived in Adoptive Home
Under 24 months
13 (9)
24- 59 months54(39)
60 months or longer
33(22)
100%(70)
Sex of Adoptee
Female58.5(41)
Male41.5(29)
100% (70)
At the time they were interviewed, 95%
of the respondents lived in the United States.
Those living in the U. S. were spread out geographically across five regions of the country.
Nearly half lived in either the southwest or
northeast. Seventy five percent of them were
married. The large majority of the remaining
25% of participants identified themselves as
single/never married. Only two respondents
were separated or divorced. Regarding work
status, families comprised of couples were
slightly more likely to have one spouse working full time than both working full time. In
fewer than 10% of these families, neither parent worked full-time at the time of the interview. In contrast, all single respondents re-
53
ported working full time. The large majority
of respondents who worked full-time were
typically employed in fields that required
wither a four-year college degree or a postcollege professional degree. Examples of job
titles included an attorney, a college professor,
a college administrator, a CEO of a company,
a nurse, and a nutritionist. Working spouses
of married respondents were employed in a
wider diversity of fields, both professional
and other. Their professional fields included
an engineer, a business manager, an educator, a salesperson, and a communications specialist. Other fields included employment as
a carpenter, a contractor, a retail clerk, and a
member of the armed forces. By extrapolation from information on jobs held, most of
these adoptive families would be considered
as either middle or upper-middle class at
the time they respondents were interviewed.
Four out of five respondents had no biological children living with them then. Of the respondents who did have biological children
in the home, two-thirds said they had a single
biological child.
In response to the question: Overall, how
successful would you say your adoption
is? respondents chose from four options:
very successful, pretty successful, somewhat
problematic (good and bad days), and very
problematic (more bad than good days). The
author asked participants to provide an adoption outcome for each internationally-adopted child.
After respondents answered this question,
the author then read them the following: I am
going to read a list of possible reasons which
explain successful or problematic adoptions,
especially of older children. Please choose
the answer which best fits your situation. The
54
author then read each interviewee seven statements. These statements asked about participants’ perception of the match/compatibility
of their adopted child with them; pre-adoption
expectations regarding their child’s adoption
outcome; amount of pre-adoption preparation
they received regarding the effects of institutional living on a child’s development and behavior; amount of the pre-adoption preparation they received to parent a child with the
issues or needs their child has; accuracy and
completeness of the information their agency/
facilitator gave them about their child prior to
adopting her/him; perception of the availability of various types of post-adoption services;
and post-adoption support from family and/or
friends. Respondents then ranked each statement from most important to least important
in explaining their perception of their child’s
adoption outcome.
Results and Analysis4
Parents categorized three out of four of
the adoptees as having a positive outcome-either very successful or pretty successful.
They categorized one in four of their children’s adoption outcomes as either somewhat
problematic or very problematic. A hierarchy
of positive reasons emerged for respondents’
perceptions of the adoption outcomes as either very or pretty successful. Perception of
the adopted child as a good match for them
ranked as the most important (85%). The
top reasons respondents gave for choosing
this answer were that the child was similar to
them in likes and dislikes; they could meet the
child’s needs; and they believed the adoption
was meant to be. The next reason parents tended to give was having access to appropriate
or very good post-adoption services (63%).
About one-third of respondents said that they
found the services their child/children needed
themselves. For school-aged adoptees, getting necessary school services was identified
as important. Parents’ responses to access to
school services and the appropriateness of the
services they obtained for their child/children
were not always positive. State of residence
and school district as well as whether the
school was public versus private school made
a notable difference. Respondents’ getting a
lot of post-adoption support from family and/
or friends was next in importance. Almost
six in 10 (59%) respondents reported a high
level of post-adoption support from either (or
both) family and friends. Fourth, a majority
of these parent(s) said that they had realistic expectations (57%) for how the adoption
would turn out. Participants who fell into this
category said that they knew of possible problems and/or had prepared themselves by doing their own research whereas parents who
described themselves as having unrealistic
expectations said they were either unaware of
possible problems with the child/children or
thought that the length of the child’s adjustment period in the family would be shorter.
The health of a child is a very important
factor in parents’ perceptions of adoption outcome. Behavioral and emotional issues are
much more challenging for parents to manage than are physical health issues which can
be corrected through surgery or managed
with medication. Therefore, questions about
each child’s health were included in this survey. Analysis of these data shows that almost
two thirds of the children whose adoption
outcomes were described as very successful
had no diagnosed emotional, psychological,
or behavioral problems. Close to one in four
of the adoptees had some problems which
respondents perceived as short term or manageable with medication. The remaining minority was reported as having some serious
problems. Of the six children whose parents
perceived their adoption outcomes as pretty
successful, half had no diagnosed problems
and half reportedly had serious problems.
Two of the children in latter were adopted by
the same respondent.
The large majority of children who fell
into the “somewhat problematic” adoption
category had serious diagnosed conditions,
according to their adoptive parents. Listed
in alphabetical order—not in order of importance to respondents, these conditions included, Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD),
ADHD with Oppositional Defiant Disorder
(ODD), Bi-Polar Disorder (BPD), Central
Auditory Processing Disorder (CAPD), Obsessive-Compulsive Disorder (OCD), Post
Traumatic Stress Disorder (PTSD), Reactive
Attachment Disorder (RAD), Sensory Integration Disorder (SID), Pervasive Developmental Disorder (PDD), communication processing problems, minor skin problems, and
vision problems. Only two (17%) of the children in the “somewhat problematic” adoption
category had no diagnosed problems upon
their adoptions. In contrast, all six the other
children in the very problematic adoption
outcome were reported to have serious, longterm problems including bi-polar disorder,
Asperger’s syndrome, RAD, Fetal Alcohol
Effects (FAE), institutional autism, PTSD,
ADD, ODD, moderate to severe hearing impairment, and language processing problems.
55
Case examples of respondents who described
their adoption outcome as “somewhat” or
“very problematic” help to illustrate what
these families experienced after the child or
children were in their new families.
When these respondents adopted, adoption
agencies varied considerably in the amount
of pre-adoption preparation they provided to
prospective adopters. About six in 10 respondents reported that the agency/agencies they
used required no pre-adoption preparation of
them. It is not surprising, therefore, that they
were more likely to answer the two agencyrelated questions negatively than positively. A
majority of respondents said that the agency/
facilitator they used did a poor job (62%) of
preparing them on the effects of institutional
living on a child’s development and behavior
or did not prepare them at all (12%). The responses regarding preparing them for their
child’s specific issues were similar: 64% said
they were poorly prepared and seven percent
said they were not prepared at all. A number
of parents said that they did their own research
and taught themselves because the agency they
used was inexperienced in international adoptions and/or gave them no guidance. Responses regarding the accuracy and completeness of
the information their agency/facilitator provided about their children prior to the adoption were mixed. Respondents were allowed to
choose more than one applicable response to
this question. Only about one in three (29%)
of these parents thought they had received all
the information available from the agency/
facilitator about their child/ren. Twenty–four
percent said the information they received was
accurate but fewer than 10% thought that it
was complete. The principal reason respondents gave for the answers of incomplete and
56
inaccurate was that they believed the agency
withheld information from them.
The case scenarios provided below illustrate what parents shared about successful and
problematic adoption outcomes and the reasons behind their categorization of the adoption outcome. The scenarios offer readers a
personal glimpse into these parents’ perspectives on what they knew and what they expected in relation to each adoption outcome and on
the child-family dynamic.
Case Scenario #1: The Ideal Type of a
“Very Successful” Adoption Outcome
A married couple adopted two biological
sibling girls from Russia when the girls were
11 months and two years, eight months old.
The parents perceive their daughters’ adoption
outcomes to have worked out perfectly. At the
time of the interview, the children had lived
with their adoptive parents for two years. The
primary caretaker (adoptive mother) rated the
adoption outcome for both girls as very successful. The most important reason she gave
for this outcome was they the couple worked
with an excellent, well-connected adoption
agency which made the adoption process fast
(seven months from start to finish). She also
stated that they were well prepared by their
home study agency. The home study agency
they used required them to attend seminars,
listen to guest speakers from a variety of fields
and read a large manual. Their social worker,
who had seven internationally adopted children herself, was very knowledgeable about
the effects of institutional living on children.
They got accurate and complete information
about their daughters, had realistic expectations about how the adoption would turn out,
obtained appropriate post-adoption services
for the girls’ hearing and language needs and
received a lot of post-adoption support-- especially from friends. This respondent described
her children as “healthy and normal, a good
match for them.”
Case Scenario #2: A “Pretty Successful”
Adoption Outcome of Romanian-Born
Daughter
A married couple adopted a girl from Romania when the child was almost two years
old. The girl had lived with her adoptive family, including a stepbrother, for about four
years. The respondent, a college professor,
ranked the poor preparation by their adoption
agency as the most important factor explaining some of the challenges they faced with
their daughter. She mentioned not being told
anything about sensory problems, attachment
issues, ADHD, how to discipline the child
without spanking her, how to handle language
acquisition, or how to build a bond with the
child. This respondent described the couple’s
pre-adoption expectations as unrealistic in
that they thought love and good food would
be all that their daughter needed to thrive.
Having a lot of support from the respondent’s
father and siblings and thinking that the child
was a good match for them-- because of her
intelligence, good nature, and sunny disposition, made a big difference both in dealing
with her issues and in the respondent’s perception of the adoption as pretty successful.
Accessing appropriate pre-school services
for her daughter from people knowledgeable
about institutionalized children and as well
as recommendations of specialists and free
counseling also helped.
Case Scenario #3: A “Somewhat Problematic” Adoption Outcome of Hungarian-Born Son
A married couple who had adopted two
unrelated children, a boy and a girl, from
Hungary at the same time completed the interview together. These respondents used the
rating of somewhat problematic for their son,
the older of the two children. They rated their
daughter’s adoption as very successful. Their
son was five years old when they adopted
him. He had lived with his U. S. family for
two years when the interview took place. According to his parents, their son had a number of extremely serious emotional, psychological, and behavioral disorders, including
RAD, PTSD, ADHD with ODD, SID, and
CAPD. He also had some physical problems.
These parents described their son as unprepared to live in a family and identified the
lack of information about relevant post-adoption services as the most important reason for
considering this child’s adoption outcome as
somewhat problematic. They also said the
school services they obtained for him were
“piecemeal” and “inadequate.” They found
many of the post-adoption services their son
needed themselves. Regarding post-adoption
support, this couple stated that it “dwindled”
over time. Although their extended family was
supportive, they did not live close enough to
provide significant help. They also stated that
their contemporaries had much older kids
and that their son’s behavior alienated them
from making friends with other families who
had children the same age as him. About the
adoption agency they used, this couple said
that nobody mentioned any of their son’s issues before his adoption. They described the
information the agency provided about their
son as inaccurate and incomplete, saying that
the agency had a lot of information which
57
they could have translated into English and
given to the couple but did not.
After the adoption, this couple was left to
figure out what was going on with their son
and to find resources on their own. They said
their pre-adoption expectations for how things
would turn out with their son’s adoption were
unrealistic, stating that “they thought they
could/would be loving parents and easily
so.” These respondents described their son as
a good match for them in terms of his love
of learning but a poor match because of his
many problems which affected his ability to
live in a family.
Case Scenario #4: A “Very Problematic”
Adoption Outcome of Russian-Born Son
This respondent was separated from her
husband at the time she participated in the
interview. They had adopted their son from
Russia at seven years old. The boy lived with
his mother and saw his father on weekends.
He was their only child and was then 14 years
old. She described her son as having many
“severe” conditions including BPD, RAD,
Asperger’s Syndrome, OCD, ODD, ADHD
and a mild case of Tourette’s Syndrome. She
stated that the medications on which he was
placed at the time helped him only “a little.”
After he entered puberty, this boy’s behavior
became more extreme. He became more destructive (e.g., trashing toys, banging walls),
began cussing, and started shoving and slapping his mother and children he encountered.
His mother said he badgered her a lot to get
what he wanted but was less aggressive with
his father. The respondent stated that tensions surrounding their son’s behavior were
instrumental in causing the couple’s separation. The top ranked variable she chose to
58
help explain her rating of this child’s adoption outcome was poor preparation by the
adoption agency regarding the effects of institutional living on a child’s development
and behavior. She said that the agency did
not seem to understand these issues even
though the social worker they used had herself adopted two children with whom she was
having problems at the time. Second, the respondent thought the information the agency
gave them about their son, although probably
complete, was inaccurate. Third, although
the couple had two agencies in their adoption
of this child, neither agency prepared them to
deal with the seriousness of his issues. She
stated that their expectations were unrealistic
because they didn’t know about the kinds of
serious problems their son might have. She
felt that this child was a poor match for them
because “they are not (trained as) therapeutic
parents or psychiatrists.” She also said they
got no post-placement services from the medical community because health care providers
had no experience with older post-institutionalized children, especially with children who
has emotional problems. The lack of support
from family and friends made it even more
difficult to deal with their son’s many serious
needs.
Respondents’ perceptions of how well
their adopted child fit into their family was
an important contextual variable which was
very likely associated with their choice of
the child’s adoption outcome as successful
or problematic. Respondents described 90%
of the children as having a positive relationship with them. For three quarters of the
adoptees, parents described this relationship
as very good to excellent. For an additional
14%, respondents described the child’s relationship as good.
Of those parents who had adopted two or
more children, often biological siblings, they
perceived their relationship with their second
(or younger) child as more positive than their
relationship with their first child. Parents
who rated their child’s relationship with them
in positive terms described the child as being
“close or very affectionate.” These descriptors included enjoying each other’s company
and spending one-on-one time together. For
the remaining one in 10 of the children-those categorized as having a “so so” or “not
very good” relationship, these parents made
comments like: “We are just caretakers.” “I
am resented as an authority figure.” “There
are underlying tensions.” “The child is very
difficult, jealous of spouse, or still has some
institutional effects.”
Married respondents perceived their child/
children as generally having equally good relationships with their spouse. They described
this relationship as very good to excellent for
about six in 10 of the children, and as good
for about one in 10. Parents with spouses either present in the home or who maintained
contact with the child, gave the same explanations that they mentioned for themselves,
some adding that their spouse was more lenient or played more often with the child.
When relationships were problematic, respondents typically described their spouse as
less tolerant or understanding of the child’s
issues than the respondent was.
Respondents stated that the children’s relationships with their adoptive grandparents
varied depending on the grandparents’ health,
proximity (geographical location) of the
grandparents’ residence to the child’s home,
grandparents’ age and activity level, his/her
interest in interacting with the adopted grandchild, and his/her ability to handle a child who
is challenging. Nine out of 10 of the children
who had interaction with their grandparent(s)
related very well or well with them. When
grandparents lived close, the children tended
to see them regularly and to develop a loving
relationship with them.
For adoptees with one or more other children in the home, either biological or nonbiological siblings, three out of four of the respondents reported that the adoptee had either
a very good or a good relationship with her/
his sibling(s). Although a number of parents
referred to the existence of “typical sibling
rivalry” or of behaviors of the child or sibling that were barriers to positive interaction,
some also talked about their children spending lots of time together and the younger child
idolizing his/her older sibling(s).
In sum, the most successful adoption outcomes reflect a connection between the child/
ren and their adoptive family. In contrast, the
problematic adoption outcomes reflect either
ambivalent or no connection between the
child/children and their adoptive family.
Other Variables Examined in Relation
to Perceived Adoption Outcome
Tables 2-4 present cross-tabulated data.
Table 2 shows perceived adoption outcome
and the child’s age at adoption. Table 3 shows
perceived adoption outcome and the child’s
sex. Table 4 presents the distribution of adoptees by sex and age.
The data in Table 2 suggest an association
between a child’s age at adoption and parents’ perceptions of the adoption outcome.
59
As Table 2 shows, respondents described all
the children whom they adopted at 17 months
old or younger as having either a “very successful” or a “pretty successful” adoption
outcome. Parents also reported a “very successful” adoption outcome for all three of the
children who were adopted at ages 10 years
(120 months) or older. The two age categories in the middle showed the most variation
in parents’ perception of adoption outcome.
All the children with “somewhat problematic” and “very problematic” adoption outcomes fell in the two middle age-range categories with children adopted at ages 18-59
months most likely to be identified by their parents as having problematic adoption outcomes.
Still, the adoption outcomes of the majority of children even in these two middle-age range
categories were categorized by their parents as positive.
Table 2. Perceived Adoption Outcome by Child’s Age at Adoption
Adoption Outcome
Very Successful
Pretty Successful
Somewhat Problematic
Very Problematic
TOTAL
7-17
months
n
11
1
0
0
12
%
92
8
0
0
100
18 -59
months
60- 119
months
120 months
and older
n
25
4
10
3
42
n
7
1
2
3
13
n
3
0
0
0
3
The data in Table 3 suggest an association
between sex of the adoptee and parent’s perception of adoption outcome. Specifically,
More than eight in 10 of the female adoptees
were described by their parent(s) as having
either very or pretty successful adoption out-
%
59.5
9.5
24
7
100
%
54
8
15
23
100
%
100
0
0
0
100
TOTAL
n
46
6
12
6
70
%
66
8.5
17
8.5
100
comes. In contrast, two-thirds of the male
adoptees were described as having either a
very or pretty successful adoption outcome.
Thus, male adoptees were 21% more likely
than female adoptees to have parent-perceived problematic adoption outcomes.
Table 3. Perceived Adoption Outcome by Child’s Sex
Adoption Outcome
Male
n
%
n
%
Very Successful
30
73
16
55
Pretty Successful
4
10
2
7
Somewhat Problematic
6
15
6
21
Very Problematic
1
2
5
17
TOTAL
41
100
29
100
The data in Table 4 suggest an association between the child’s sex and his/her age
at adoption. Females in this study tended to
60
Female
be adopted at younger ages than males. Specifically, one in four of the female adoptees as
compared to seven percent of the males were
adopted between seven and 17 months old.
Close to two thirds of the females as compared to about six in 10 of the males were
adopted at ages which varied between 18
Table 4. Child’s Sex and Age at Adoption
Age at Adoption
7-17 months
18-59 months
60-119 months
120 months and older
TOTAL
When viewed together, the data in Tables 2-4 appear to support a joint interaction
among the variables of age, sex, and adoption
outcome for the children in this study.
Discussion and Future Study
By the end of fiscal year 2013, more than
93,000 Eastern European children were part
of U. S. families. That number of adoptees
from Eastern European sending countries to
a single receiving country, the United States,
is huge. It is of paramount importance that
well-conducted research on these adoptees
and their families study them at different
phases of the children’s lives through adulthood.
Participants in this study stated that virtually all of the adoptees entered their families
directly from orphanage settings. Adopting
directly from institutional settings in Eastern Europe is the typical route for adoptive
families of these children. Depending on their
age at adoption and the events in their early
history, children may live in orphanages from
several months to many years. Some of the
children in the present study had lived their
months and 59 months old. Males were 20%
more likely than females to be adopted at five
years old or older.
Female
n
%
10
24
25
61
4
10
2
5
41
100
Male
n
%
2
7
17
59
9
31
1
3
29 100
whole lives in an orphanage before they were
adopted. Just over one-third of the adoptees
in this study were diagnosed with emotional,
psychological, or behavioral problems after
they arrived in the United States and were
examined by U. S. doctors or other professionals. From comments respondents shared,
the author concluded that more than a few of
these adoptees should have been classified
as having special needs before they were offered for adoption but were not presented as
such. The designation of a child as likely to
have special needs prior to his/her adoption
is important for several reasons. First, preadoptive parents could make a more informed
decision about whether or not to adopt the referral of a child or children IF they know in
advance about special needs, especially about
pre-natal exposure to alcohol, issues with attachment and behavioral problems observed
before adoption. Second, unless their needs
are physical and correctable through surgery
and/or medication, special needs children require more and longer-lasting post-adoption
services and a greater investment of parents’
time, energy, and financial resources. Third,
61
the risks of parental burnout and possible disruption of the adoption are higher.
The study reported here offers social and
behavioral scientists and professionals in
medical and related fields a unique, in-depth
glimpse into how 70 adoptees from populations at-risk for special needs are doing in
their American families, how their adoptive parents perceived each child’s adoption
outcome, and how some have dealt with the
long-term post-adoption, challenges they encountered. Although parents rated three out
of four of their child/ren’s adoptions as successful, it is apparent to the author that rating
some of these children’s adoption outcomes as
successful was due more to the respondents’
extraordinary creativity and pro-activity in
doing their own research about their child’s
issues and in searching for needed post-adoption services and less to the children having
an optimal start and an easy post-adoption
period for them and their families.
Most people desire, and expect, to adopt
a healthy child. Many seek infants or young
toddlers. All expect to adopt a child who will
fit into their family after a reasonably-brief
period of adjustment. In three quarters of the
adoptions in this study participants got what
they expected. Participants who adopted children under 18 months old-- all of whom reported very successful adoption outcomes for
these children-- appear to have gotten what
they expected. Other research on adoptees
from Russia has reported age to be a relevant
factor in behavior problems, especially during adolescence (Hawk & McCall, 2011) and
in parents’ ratings of deficits in their schoolage children’s executive functioning, including working memory and control of inhibi-
62
tions when compared to children adopted at
younger than 18 months old ( Merz & McCall,
2011). Children adopted before they were 18
months old reportedly showed fewer behavioral problems in adolescence than children
adopted at 18 months or older (Hawk & McCall, 2011). Interestingly, Merz et al. (2011)
found that differences in executive functioning did not appear in pre-school age children
and were not related to prematurity. Overall,
these studies support the findings reported in
this article.
Age can mask dysfunctional pre-adoption
experiences. What traumas did adoptees experience in his her birth home and/or in orphanages prior to being adopted? Older children
come to their adoptive families with an already-formed personality and a pre-adoption
history. Adoptees of all ages also come with
genetic predispositions and risk factors. The
high rate of alcoholism and domestic violence
in Russia are examples of major risk factors
which affect a child’s pre- and post-natal development and early experiences in a family.
To lead to intimate inter-personal relationships later in life, a secure attachment with a
parent or other consistently-attentive caregiver must occur within the first seven months of
a child’s life (Stout, 2005: 131). How likely
is a secure, early attachment to have occurred
for older children with troubled pre-adoption
histories and even for infants who have spent
their whole lives in orphanages? The reasonable answer is not very likely. Because such
secure attachments are not likely in the preadoption phase, it is not surprising that attachment and behavioral issues were most likely
to reported in the adoptions perceived as in
this study. Another variable to consider is the
child’s desire to be adopted. Children who
want to be adopted will have an easier time
of attaching to their adoptive parents. This
statement rises the question of how young is
young enough to ask a child if s/he wishes
to be adopted by non-biological relatives and
move to a country far away from his/her birth
country. This author suggest that children as
young as three years old ought to be asked,
counseled, and given an informed say in the
decision to be adopted either outside or inside
their birth country.
The positive adoption outcome reported in
this study for adoptees 10 years or older is
both hopeful and should be explored further
through subsequent research. One reason for
this outcome may be that older children in
this study somehow had a better understanding of, and appreciation for, how families actually function. They might have established
positive attachments in their birth families or
possibly with other caretakers during their
formative months and these attachments may
have enabled them to establish future attachments with their adoptive parent(s). The older children may have been waiting for their
chance to be adopted into
a loving family and were open to the opportunity when it came along. Exploring other variables which may be associated with respondents’ perceptions of adoption outcomes
can also provide insights into factors related
to a child’s adoption outcome.
Based on previously-cited questionnaire
surveys (See Essley and Perilstein, 1998;
Claus & Baxter, 1997; Price, 2000), one
would expect most parents’ perceptions of the
adoption outcome for the child/ren they adopted to be concentrated at the positive end of
the continuum. The data reported here support that conclusion overall. However, one in
four adoptees was categorized as having either somewhat or very problematic adoption
outcomes. For the families of these children,
completing the adoption was the beginning
rather than the end of their struggle to be parents. Even if one in four is a rough estimate,
when extrapolated to the more than 93 thousand Eastern European children adopted by
U. S. families, the numbers of adoptees and
adoptive families that may fall into this category is staggering.
Since most previous research had focused
on adoption outcome success, the study reported here is especially insightful in the
situations where respondents perceived the
adoption outcome of their child/children as
problematic and as significantly challenging
family well-being. In such situations, the preadoptive information adoptive parents were
given was minimal and/or inaccurate beyond
any obvious physical problems the child had
at the time. When one considers a child’s
“health,” however, physical health is only
one dimension of “global health.” Moreover,
many physical health conditions are treatable
through surgery and/or medication. Mental,
emotional and behavioral health issues, however, are often more challenging to diagnose
and to treat effectively. Such conditions may
also not manifest themselves right away.
Although there is not a lot of variation in
adoption outcome reported by respondents,
relatively speaking, there is more variation
than what is typically reported in surveys
conducted by adoption agencies. Although
adoption outcome is not exactly the same as
satisfaction with the adoption, the two vari-
63
ables are correlated. Trained professionals,
including Ronald Federici (1998), an adoptive parent of five Romanian-born adoptees
and a neuropsychologist who diagnoses and
works with special needs adoptees from Eastern Europe, have expressed skepticism of the
highly-positive results reported in surveys
conducted by adoption agencies-- viewing
them as over-estimated and self-serving for
the agencies.
Many children adopted from Eastern European countries have now reached adolescence and young adulthood. Therefore, it is
important to ask how they and their families
are doing. One way we can get glimpses into
various stages of their children’s lives is by
asking them as well as their adoptive parents.
Important milestones on which to focus include completion of educational goals, ability
to find and sustain work obligations, successful development of long-term relationships
and genuine intimacy and trust with a potential or actual spouse/partner, and where they
are in terms of their thinking and behavior
regarding parenthood.
With this goal in mind, the author encourages social scientists and others to develop
cross-disciplinary investigations and dialogues about adoption as a vibrant sub-field of
family studies. This sub-field should involve
doing more high-quality, cross-disciplinary
longitudinal research on adoptees and their
adoptive families at various stages in the life
cycle of the children and their families. Such
research could provide a more solid foundation for addressing policy issues and appropriate advocacy on behalf of the diversity of
adoptees and adoptive families we have in
contemporary societies currently. 64
References
Claus, D. & Baxter, S. (1997). Post-adoption survey of Russian and Eastern European
children: conducted by Rainbow House International. Retrieved June 24, 2011 from http://
www.rhi.org/Anews/SurveyResults1997.
html.
Essley, M. & Perilstein, L. Adoptions from
Eastern European orphanages overwhelmingly successful. (March, 1998). Retrieved
June 24, 2011 from http://www.cradlehope.
org/surv/html/Survey Findings
Federici, R. (1998). Help for Hopeless
Child. A Guide for Families. Alexandria, VA:
Federici & Associates.
Gindis, B. (1998). Navigating uncharted
waters: School psychologists working with
internationally adopted post-institutionalized
children. COMMUNIQUÉ [Part 1], 27(1) 6-9
and [Part 2], 27(2), 20-23G.
Goldberg, R. (1997). Adopting Romanian
children: Making choices, taking risks. Marriage and Family Review. Vol. 25, Nr 1/2, pp.
79-98.
Goldberg, R. (2001). The social construction of adoptive families: A follow-up study
of adopting Romanian children.” International
Review of Sociology. Vol. 11, Nr 1, pp. 89-101.
Groze, V. (1996). Successful Adoptive
Families: A Longitudinal Study of Special
Needs Adoption. Westport, CT: Praeger.
Groze, V. & Ileana, D. (1996). A followup study of adopted children from Romania.”
Child and Adolescent Social Work Journal.
Vol. 13, Nr 6, pp. 541-565.
Hawk, B. N. & McCall, R. B. (2011). Specific extreme behaviors of post-institutionalized Russian adoptees.” Developmental Psychology. Vol. 47, Nr 3, pp. 732-738.
Johnson, MD., D. (1997). Adopting an institutionalized child: What are the risks?” The
Post, Issue #9 (January‑February), pp. 1‑3.
Kreider, R. & Cohen, P. N. (2009). Disability among internationally adopted children in the United States. Pediatric, Vol. 124,
pp. 1311-1318.
McGuinness, T. M., & Pallansch, L. (2007).
Problem behaviors of children adopted from
the former Soviet Union. Journal of Pediatric
Health Care. (May/June), pp. 171-79.
Merz, E. & McCall, R. (2011). Parent ratings of executive functioning in children adopted from psychosocially depriving institutions. Journal of Child Psychology and Psychiatry. Vol. 52, Nr 5, pp. 537-546.
Miller, MD., L. C., Chan, W., Tirella, L.
& Perrin, E. (2009). Outcomes of children
adopted from Eastern Europe. International
Journal of Behavorial Development. SAGE
Journals Online. Retrieved 17 Nov. 2010.
<http://jbd.sagepub.com/content/33/4/289.
refs.html>.
Miller, MD., L. C. & Adamec, C. (2004).
Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and
Providers. Cary, NC: Oxford University
Press.
Miller, MD., L. C., Kiernan, M. T.,
Mathers, M. I. & Klein‑Gitelman, M. (1995).
Developmental and nutritional status of internationally adopted children, Archives of
Pediatric and Adolescent Medicine. Vol. 149,
Nr 1, pp. 40‑44.
Ruggiero, J. A. (2007). Eastern European
Adoption: Policies, Practice and Strategies
for Change. New Brunswick, NJ: Transaction Publishers.
Ruggiero, J. A. & Johnson, K. (2009). Implications of recent research on Eastern European adoption for social work practice, The
Child & Adolescent Social Work Journal.
Vol. 26, Nr 5, pp. 485-504.
Stout, M. (2005). The Sociopath Next
Door. New York: Broadway Books.
U. S. C. I. S. Immigrants admitted as orphans by sex, age, and region and selected
country of birth. Table 15 for Fiscal Year
1993-2002; Table 10 for Fiscal Year 20032004; Table 12 for Fiscal Year 2005-2013.
Website address for fiscal year 2013 statistics
is http://www.dhs.gov/yearbook-immigration-statistics-2013-lawful-permanent-residents.
65
NOTES
The statistics on Russian adoptees to the
U. S. were prepared by the author from statistics provided by the U. S. C. I. S. Source: Immigrants Admitted as Orphans by Sex, Age,
and Region and Selected Country of Birth.
Table 15 for Fiscal Year 1993-2002; Table 10
for Fiscal Year 2003-2004; and Table 12 for
Fiscal Year 2005-2013.
1
The other Eastern European countries
from which U. S. citizens have adopted include Albania,
Armenia, Belarus, Bulgaria, Estonia, Hungary, Kazahkstan, Latvia, Lithuania, Moldo
va, Poland, and the Republic of Georgia.
2
To target as diverse a sample as possible,
the author a) sent a description of the research
project to two large Eastern European adoptive parents groups whose administrators
agreed to advertise a call for participation
among their members, b) recruited respondents through adoptive parents who were
leaders of, or involved in, adoptive parent
support groups in various parts of the United
States, c) developed a web-page describing
the research, and d) asked adopters who had
3
participated in an earlier survey conducted by
the author to refer other adoptive parents they
thought would be interested in participating
in the interview study.
Because of privacy issues and the sensitive
nature of adoption, it was not possible to obtain a true, national-level random sample of
either adoptive parents or international adoptees from a country or groups of countries.
There is no existing nation-wide list of adopt-
66
ers from which to choose a random sample.
To date, there have also been no large-scale,
national samples of U. S. citizens who adopted children from countries with potentially
notable numbers of children with, or at-risk
for, special needs and available for international adoption.
Because this sample of respondents is
non-random, statistical tests and measures
which require random samples are not used
in the analysis of the data. Rather, the author
uses percentages in this largely qualitative
analysis.
4
PILOT STUDY OF THE EFFECTS
OF RESPONSIVE TEACHING
ON YOUNG ADOPTED CHILDREN
AND THEIR PARENTS: A COMPARISON
OF TWO LEVELS OF TREATMENT
INTENSITY
Gerald MAHONEY1 Sunghee NAM2
Frida PERALES3
Abstract
Objective: The purpose of this pilot study was to examine the feasibility of a parent-mediated developmental intervention called Responsive Teaching at enhancing maternal responsiveness and addressing the development and social emotional functioning of young adopted
children. Methods: Twenty eight parent-child dyads in which all children had been adopted and
were under six years of age were randomly assigned to two treatment intensity groups: 3 and 6
months. Each group received weekly individual Responsive Teaching sessions in which parents
were coached to use Responsive Interaction strategies to enhance their interactions with their
children during daily routine activities.
Results: Mothers in both the 3 and 6 month intervention groups made significant increases
in responsiveness, while their children made improvements in their development and social
emotional functioning. Treatment group differences in children’s development and social emotional functioning were not significant; but maternal responsiveness ratings at the 6 month observation were significantly higher for mothers in the 6 versus the 3 month group. Intervention
effects were not associated with children’s age or time living with parents, but international
adoptees made greater improvements than domestic adoptees.
Conclusions. Responsive Teaching appears to be an effective intervention for encouraging
parents to increase their responsive interactions with their young adopted children whether they
receive 3 or 6 months of intervention services.
1
Ph.D, Case Western Reserve University, Cleveland, Ohio
E-mail: gim14@case.edu
2
Ph.D, Case Western Reserve University, Cleveland, Ohio
3
Ph.D, Case Western Reserve University, Cleveland, Ohio
67
Implications for Practice: Responsive Teaching is a relationship focused intervention that
has the potential to help reduce the high incidence of developmental and social emotional problems commonly observed among young adopted children.
Key words: social emotional functioning; young adopted child; Responsive Teaching; responsive interaction strategies; mother responsiveness; international adoptees; domestic adoptees.
The development and social emotional
functioning as well as academic performance
of the majority of adopted children is comparable to their non-adoptive peers (Bimmel,
Juffer, van IJzendoorn, Bakermans-Kranenburg, 2003; Stams, Juffer, van IJzendoorn
& Hoksenbergen, 2005; Keyes, Sharma, Elkins, Iacono &McGue, 2008). Nevertheless,
adopted children are more likely than nonadoptive children to experience a number of
developmental challenges including developmental delays, low IQ, deficits in communication (van IJzendoorn, Juffer & Poelhuis,
2005), as well as disorders in self-regulation
and other social emotional conditions (Bramble, Radel, & Blumberg, 2007; Juffer & van
IJzendoorn, 2005; Keyes, et. al., 2008). In addition, a disproportionately high percentage
of adopted children receive special education
(Welsh, Viana, Petrill, Mathias, 2007) and
mental health services (Sharma, et. al., 2008)
and have low levels of academic achievement
(van IJzendoorn, et.al., 2005). Although it is
difficult to compare the prevalence of these
problems among domestic and international
adoptees, some maintain that the extremely
adverse pre-adoption histories of many international adoptees place them at greater risk
for these problems than domestic adoptees
(e.g., Wiersbicki, 1993; Welsh, et. al., 2007).
Reasons for the developmental and social
emotional problems associated with adoption
68
are complex. However, the most frequently
cited reason is the difficulty that adopted children have in establishing a secure attachment
with their parents (Howe, 2003; Handley-Derry, 1997; Marcovitch, Goldberg, Gold, Washington, Wasson, Krelwich, 1997; Juffer, Bakermans-Kranenburg, van IJzendoorn, 2005).
Attachment problems have been attributed to
a number of factors including the age children are adopted, the number of placements
and disrupted attachment relationships children experience, the quality and consistency
of care during pre-adoptive placements, as
well as unresolved health issues, inadequate
nutrition and prenatal exposure to drugs and
alcohol (O’Connor & Rutter, 2000; Stams, et.
al., 2000) . In addition, the limited experience
many adopted parents have raising children is
thought to increase the stress they experience
managing their adopted children’s unique social-emotional behaviors, thus exacerbating
their children’s attachment challenges (Edelman & Connolly, 1986; Levy-Shiff, Goldschmidt & Har-Even, 1991).
Despite the high rate of attachment problems among adopted children, it is unlikely
that all of their developmental challenges
can be attributed to attachment. Given the
rates of attachment problems reported for
adopted children (e.g., Juffer, et. al., 2005;
Howe, 2003) compared to their incidence of
developmental and social-emotional prob-
lems (Keyes, et. al., 2008), many adopted
children undoubtedly develop appropriate
attachments yet still manifest developmental
delays or social-emotional challenges. Such
problems may be associated with the inherent characteristics of these children both with
respect to their capacity for developmental
growth as well as their temperament style
and other challenging social behaviors (c.f.,
Wierzbicki, 1993). Yet numerous studies of
nonadoptive children suggest that even when
parent-child attachments are not problematic,
children’s development and social emotional functioning are not simply a reflection of
their inherent vulnerabilities, but are also affected by the degree to which their parents
engage in highly responsive interactions with
them (Mahoney & Nam, 2011). For example,
while disabilities such as Down syndrome or
autism severely impact the communication
skills of these children, the level of communication competence these children acquire
is greatly influenced by their parents’ level
of responsiveness (Mahoney, 1988; Siller &
Sigman, 2002; 2008).
Early interventions that have been designed to either address adopted children’s
social emotional challenges or prevent such
problems from occurring have tended to focus on enhancing maternal sensitivity (i.e.,
responsiveness) to promote secure attachment. Results from these interventions have
generally been favorable at enhancing maternal sensitivity and children’s attachment
(Bakermans-Kranenburg, van IJzendoorn,
& Juffer, 2003), and some have reported
improvements in children’s play and social
competence as well (van IJzendoorn, Bakermans-Kranenburg, Juffer, 2005). Most of
these interventions have been brief, presumably because research suggests that shorter
interventions are more effective than longer
ones (van IJzendoorn, et. al, 2005). In addition, most attachment interventions have been
conducted with children who are in their first
year of life, raising the question about their
effectiveness with older children (van den
Dries, Juffer, van IJzendoorn, BakermansKranenburg, 2009).
While attachment-based interventions offer a promising method for addressing some
of the social emotional problems of adopted
children, their focus on attachment as the major target of intervention may not be appealing to parents who are not challenged by relationship or attachment problems even though
they may be concerned about their children’s
development and risks for future problems.
However, these parents may be more enthusiastic about interventions which either focus
on the child development issues that are of
concern to them and/or emphasize preventing
their children from acquiring such problems.
The purpose of this study is to evaluate
the feasibility of a general developmental intervention called Responsive Teaching [RT
(Mahoney & MacDonald, 2007)] as a means
of enhancing the quality of parent-child relationships as well as addressing the developmental and social emotional issues that
adoptive children are experiencing. RT is a
parent mediated intervention designed to enhance children’s cognitive, communication
and social emotional functioning. Similar to
attachment based interventions RT encourages parents to engage in highly responsive
interactions. This occurs by coaching parents
to use Responsive Interaction (RI) strategies
69
during play and other routine activities with
their children. RI strategies are suggestions
that help parents modify their interactive behavior such that it reflects each of five components of responsive interaction: Contingency
– “Respond immediately to little behaviors”;
Reciprocity – “Take one turn and wait”; Affect – “Interact for fun”; Match – “Do what
my child can do’; and Non-Directiveness –
“Follow my child’s lead”.
One of the major features of RT is that RI
strategies are not used to change parents’ interactive style, but rather to help their children increase their use of the pivotal developmental behaviors which are purported to be
the foundations for developmental learning.
Thus, to address parents’ concerns about their
children’s cognitive development, RT may
encourage parents’ use of RI strategies to
promote their children’s “social play”, “exploration”, or “practice”. If parents’ concern
is communication, RI strategies may be recommended to promote children’s “joint attention” or “intentionality”. For social emotional
concerns, parents might be asked to use RI
strategies to promote their children’s “trust”,
“cooperation” or “self-regulation”. By emphasizing that the purpose of intervention is
to change the child as versus the parents, RT
attempts to reduce implications that parents
are to blame for their children’s problems.
Four studies have been reported with children with developmental delays or disabilities which support the effectiveness of RT
(Mahoney & Perales, 2003; 2005; Karaaslan,
Diken & Mahoney, 2013; Karaaslan & Mahoney, 2013). The children who participated
in these studies ranged from six months to almost five years. In each of these studies, RT
70
was conducted during individualized parentchild sessions either once or twice a week for
periods ranging from 4 to 12 months. Results
from all studies indicated that RT resulted in
significant improvements in mothers’ responsiveness; three reported improvements in children’s cognitive and communication development (Mahoney & Perales, 2005; Karaaslan,
et. al., 2013; Karaaslan & Mahoney, 2913);
and two reported social emotional improvements (Mahoney & Perales, 2003; 2005). In
general, the age children began receiving RT
did not affect intervention outcomes. In addition, intervention effectiveness was not associated with children’s diagnoses, although social emotional improvements were observed
primarily for children experiencing problems
in this domain (Mahoney & Perales, 2003;
2005).
In this study, adopted children and their
parents were randomly assigned to one of
two RT treatment intensity groups: three or
six months. Each of these groups was scheduled to receive one RT session each week.
The purpose was to determine whether these
different levels of treatment intensity would
be associated with changes in parents’ style
of interaction and psychosocial functioning,
as well as children’s development and social
emotional functioning. In addition, we were
interested in exploring how intervention effects would be associated with the children’s
age, time with their parents, and status as a
domestic or international adoptee.
Methods
Sample
This study was approved by the Institutional Review Board of Case Reserve Western
University. Subjects were recruited through
program flyers that were distributed to medical clinics and social agencies that provided
services to adopted children and their families. These flyers described the project as a
“preventive intervention” and did not require
that parents had concerns about their children’s current development or social emotional functioning. A total of 35 parent-child
dyads signed an approved subject consent
form to participate, and the final sample consisted of 28 dyads. Subjects excluded from
the final sample either discontinued participation (n=4) or failed to complete follow-up
assessments (N=3). The demographic characteristics of subjects excluded from the study
were not significantly different from those of
the final sample.
As indicated on Table 1, the average age
for mothers was 41.2 years and 45.7 years
for fathers. The majority were married (90%)
and white, non-Hispanic (90%). Sixty eight
percent of the mothers were college graduates and 71.5% were working either full or
part time. Families had an average of 2.6 children and most (78.5%) had annual incomes
greater than $60,000.
Table 1. Demographic characteristics of parents and children
3 Month
6 month
(n= 14)
(n=14)
Variable
%
Characteristics of Parents
Age mother
Age Father
Number of Other Children
Marital Status (% Married)
Race
White (Non-Hispanic)
Black
Education
High School
Post-Secondary
College Graduate
M (SD)
%
41.9 (4.6)
43.0 (4.2)
2.1 (2.6)
93%
79%
21%
0.53a
1.15a
1.38
86%
100%
7%
29%
0%
29%
64%
71%
14%
29%
Part-Time
57%
43%
7%
21%
71%
M (SD)
40.5 (5.2)
48.4 (16.9)
1.1 (1.4)
Mother Employment
Full-Time
Family Income
$20-40,000
$40- 60,000
Over $60,000
Statistics
7%
7%
86%
3.36b
1.08b
3.61b
1.18b
71
Characteristics of Children
Age at Intervention Onset
Age at Adoption
Gender (% Males)
% International Adoption
% Resided in Orphanage
% Foster care
Race
White (Non-Hispanic)
African American
Hispanic
Asian
Other
a
72
21%
64%
57%
33%
32.2 (16.1)
14.4 (13.2)
36%
29%
0
29%
7%
43%
71%
57%
67%
36%
0
29%
21%
14%
37.8 (16.9)
11.6 (12.6)
0.80a
0.32a
1.44a
0.15a
0.00a
1.05b
8.48b
ANOVA; b Chi Square
Children’s mean age was 35 months at the
for either 3 or 6 months. Sessions were con-
start of intervention and 32% were boys. On
average children were adopted at 13 months
and had lived with their parents for 22 months.
The children were racially diverse, including Caucasian (36%), African-American
(14.5%), Hispanic (14.5%) and Asian (25%).
Sixty seven percent were international adoptees and 57% had resided in orphanages.
A trickle process randomization procedure was used to assign subjects to treatment
intensity groups. The only significant group
difference (See Table 1) was children’s race:
the three-month group included more African-American and the six-month group more
Hispanic children. At the onset of intervention treatment groups did not differ in terms
of mothers’ interactive style (Table 2), parenting stress (Table 3), as well as children’s
development (Table 4) and social emotional
functioning (Table 5).
Procedures
Subjects received weekly parentchild intervention sessions based upon the RT
curriculum (Mahoney & MacDonald, 2007)
ducted by RT certified interventionists and
were provided either in family’s homes or at a
center based facility. Each session lasted approximately 60 minutes.
RT is organized around 16 pivotal behaviors that are used to enhance children’s cognitive, communication and social emotional
functioning (see www.Responsiveteaching.
org for a more detailed description). During
each session interventionists discussed the
pivotal behaviors that were the objectives for
the child; introduced one or two RI strategies
to promote these behaviors; demonstrated the
strategies; coached parents in their use the
strategies: and developed a plan for parent
follow through.
Data Collection
Parent-child observations were collected at
baseline, 3 and 6 months. All other child and
family assessments were collected at baseline
and 12 months. Because some children were
older than 42 months at pre- assessment, two
different tests were used to assess developmental ages (DA): the Bayley Scales of Infant
Development and the Battelle Developmental
Inventory. DAs were converted to ratio developmental quotients (e.g. DA/CA x 100).
The Bayley Scales of Infant Development,
2nd Edition (Bayley, 1993) were used to assess children less than 42 months. The Bayley
is considered to be one of the best measures
of early general development. Average interrater reliabilities are .88, and test-retest reliabilities exceed .90. Predictive validity studies indicate that 2-year old Bayley scores are
highly associated with preschool IQ scores.
The Battelle Developmental Inventory
(Newborg, Stock, Wnek, Guidbaldi, & Svinicki, 1984) was used to assess children who
were 42 months or older. The Battelle is an
individually administered assessment for
children up to 8 years of age. It measures
five developmental domains: personal-social,
adaptive, motor, communication, and cognition. It was standardized on a nationally representative sample of children and has high
test-retest and interrater reliability. Battelle
developmental quotients are highly correlated with the Bayley developmental indices (rs
= .81 to .90) (Newborg, et. al., 1984).
The Vineland Adaptive Behavior Scale,
2nd Edition (Sparrow, Cicchetti & Balla,
2005) was also used to assess children’s communication. This parent report instrument
yields estimates of children’s functioning
across four domains: Communication; Daily
Living; Socialization; and Adaptive Behavior.
Correlations between the Vineland and other
adaptive behavior and intelligence tests range
from .40 to.70 (Sparrow, et. al., 2005).
Two scales were used to assess children’s
social emotional functioning: the Child
Behavior Checklist (1½-5) (CBCL) and
the Temperament and Atypical Behavior
Scale (TABS).
The Child Behavior Checklist for ages 1.5
to 5 years [CBCL/1.5–5 (Achenbach &Rescorla, 2000)] is a revision of the 1992 checklist for children age 2–3 years [CBCL/2–3
(Achenbach, 1992)] and was normed on a
national sample of children. It yields three
normative subscales scores: Internalizing,
Externalizing, and Total Problems.
The Temperament and Atypical Behavior
Scale (TABS) assesses problem behaviors of
children between one to six years of age. This
parent respondent instrument assesses four
factors: Detached, Hypersensitivity/activity,
Under-reactive, and Dysregulated. The corrected split-half reliability for the TABS is
.95 for children with disabilities.
Children and mothers were video recorded
playing together for seven-minutes with a
standard set of developmentally appropriate
toys. Mothers’ style of interaction was rated from these videotapes with the Maternal
Behavior Rating Scale (MBRS) (Mahoney,
Powell, & Finger, 1986; Mahoney, 1992).
The MBRS is a twelve item scale that assesses four interactive dimensions: Responsiveness, Affect, Achievement Orientation,
and Defectiveness’. Research indicates that
the MBRS assesses parenting characteristics
associated with children’s development; that
ratings on the scale are stable over time for
parents not involved in parenting interventions (Mahoney & Bella, 1998); and that it
is sensitive to interactive changes promoted
through parent mediated interventions (Mahoney & Powell, 1988; Mahoney, Boyce,
Fewell, Spiker, & Wheeden, 1998).
The Parenting Stress Inventory-Short
Form [PSI (Abidin, 1995 - 3rd Ed.)] was ad-
73
ministered to assess the psychological status
of mothers. The PSI is a 36 item self-report
questionnaire that has three subscales (parental distress, dysfunctional parent-child
interaction and difficult child) and a Total
Stress Index. Internal consistency for the Total Stress Index is .91, and for the subscales
are: (a) .87 for Parental Distress; (b) .80 for
Dysfunctional Parent-Child Interaction; and
(c) .85 for Difficult Child (Abidin, 1995).
Responsive Teaching Intervention Service
Logs were used to document the services that
each family received. After each intervention
session, service providers completed logs indicating: (a) the strategies discussed during
each intervention session; (b) Intervention
Topics; (c) follow-up activities mothers were
asked to implement at home; and (d) mothers’ follow-through with suggestions from
the previous week.
Coding and Reliability of the Maternal
Behavior Rating Scale.
Each mother-child video was coded independently by raters who had received 40 hours
of training and had attained 80% agreement
within one point on a five-point Likert scale.
Pre- and post- intervention observations were
coded at the same time to avoid rating drift.
Observations were randomly sorted so that
pre- and post- observations were counterbalanced and were not coded consecutively for
any dyad. A second rater coded 20% of all
observations to assess reliability. Interrater
reliability as estimated with the Spearman
correlation was .81. Raters attained 72% exact agreement and 99% agreement within one
scale point.
Results: Comparisons of Treatment
Groups
For the following Treatment Group comparisons, a repeated measures multivariate
analysis of variance (MANOVA) was used
to examine the effects of Time (Intervention)
and Time x Groups to compare intervention
changes for the two groups . ANOVAs were
used to explore these effects for individual
scales or subscales.
Intervention Effects on Mothers` Interactive Style. MBRS ratings from baseline, 3
and 6 months are presented in Table 2. At the
beginning of intervention, mothers had average ratings on MBRS subscales that clustered
near the midpoint.
Table 2. Intervention Changes in Mother’s Style of Interaction
3 Month
Group
Variables
Pre
M
6 Month
Group
3
SD M SD
6
Pre
3
M SD M SD M SD
F F (Time X Partial
(Time) Treatment Eta2
6
M
SD
Maternal
Behavior
Rating Scale
0.49
.42
Responsivea
2.9 0.5 3.3 0.7 3.0 0.5 3.1 0.7 3.7 0.6
3.6
0.7 6.21**
0.55
.19
Affecta
2.9 0.3 3.0 0.5 2.9 0.5 2.9 0.4 3.2 0.3
3.1
0.5
1.65
0.34
.06
Achievement/
2.9 0.5 2.7 0.3 2.6 0.4 2.7 0.5 2.5 0.3
Directivea
2.5
0.4
2.44
0.30
.09
a
74
2.51*
MBRS Subscales: *p<0.05, **p<0.01
Results for the MANOVA were significant
for Time (p<. 05) but not for Time x Groups
(p>.05). Univariate analyses indicated that
the effects of Time were significant for responsiveness (p < .01) but not the other two
subscales. Eta square indicated that the effect size for responsiveness was in the large
range. Post hoc comparisons indicated that
for both groups responsiveness was significantly greater at 3 months than at baseline (t
= 4.01, p < .001) while differences between
responsiveness at baseline and 6 months were
not significant (t = 1.95, p > .05).
A between subjects ANOVA was used to
further explore group differences in responsiveness at 3 and 6 months, controlling responsiveness at baseline. Results indicated
that group differences were not significant at
3 months (F = 1.62, p > .05) but were significant at 6 months (F = 6.03, p < .05). As depicted on Figure 1, responsiveness declined
from three to six months for mothers in the
3 month group but remained stable for the 6
month group.
Intervention Effects on Mother’s Psychological Status. Table 3 presents Parenting
Stress Index scores. While mean total stress
scores were within the normal range for both
groups at baseline and 12 months, 22% of
the sample had clinically significant scores at
baseline and only 9% had clinical scores at
the 12 month follow-up. Results from the
MANOVA indicated that the effects for Time
and Time X Group were not significant (ps>
.05). However, univariate analyses indicated
significant Time effects on two subscales, parental distress and dysfunctional parent-child
interaction, as well as for total stress (ps <
.05) indicating decreases in parenting stress.
Table 3. Intervention changes in mothers’ psychosocial functioning
3 Month
Variables
Pre
M
6 Months
Post
SD
M
SD
Pre
M
SD
Post
M
F
F Time X
Time Treatment
SD
Parenting
Stress IndexPSI
Partial
Eta2
Time
2.01
1.32
.24
Distress
24.7
7.0
21.0 4.2
24.8
8.2 23.4 4.8
4.07*
0.86
.16
PC
20.8
8.0
17.2 4.8
22.4
6.9 20.1 6.2
6.41*
0.30
.23
Diff child
24.6
8.8
24.7 7.1
30.9
6.7 27.3 8.3
1.53
1.57
.07
Total Stress
70.1
21.8 62.8 12.8 78.1 16.1 70.8 16.7 5.41*
0.01
.21
CES-D
9.2
8.5
0.12
.13
P<0.05; **P<0.01,
*
***
6.6
2.9
11.5
8.5
8.5
5.0
2.96
P<0.001
75
Intervention Effects on Child Development. Table 4 reports pre- post scores on both
Bayley/Battelle Developmental Quotients
(DQ) and the Vineland Adaptive Behavior
Scales. On both scales children were in the
low average range at baseline and increased
to the average range at the 12 month observation. Twenty one percent of the children had
Bayley/Battelle Developmental Quotients
that were 75 or lower at baseline and only 5%
had scores in this range at the at 12 months.
Similar percentages of children had DQs t
75 or lower at baseline and 12 months on the
Vineland.
Analyses of Bayley/Battelle DQs indicated a significant effect for Time (p < .01)
indicating that 12 month DQs were greater
than baseline DQs. However, the Time X
Treatment effect (p > .05) was not significant. Analyses of the Vineland also indicated
significant effects for Time (p < .01) but not
Time X Treatment (p > .05). Univariate analysis indicated that communication, daily living and adaptive behavior DQs were higher
at 12 months than at baseline (ps < .01). Eta
squares for both instruments indicated large
effect sizes for intervention changes over
time.
Table 4. Intervention Changes in Child Development
Variables
Developmental
Quotienta
Vineland
Adaptive
Behavior
Scale
3 Month
M
SD
M
6 Months
SD
M
93.4 14.1 101.4 12.8 89.8
SD
M
SD
20.2 96.8 19.9
F
(Time)
F (Time X Partial
Treatment Eta2
7.71**
0.34
.28
3.82*
0.46
.40
Communi84.4 13.5 99.8
cation
14.7 85.6
19.5 92.5 15.8
13.71***
1.81
.35
Daily
Living
80.5 9.6
14.1 77.2
15.0 83.5 10.5
12.32**
0.20
.32
Social
84.2 10.9 88.9
8.7
81.9
14.9 86.4 11.8
2.25
0.72
.08
Adaptive
behavior
79.9 10.9 92.7
13.8 78.4
17.1 85.2 14.0
10.68**
0.98
.29
a
89.3
Ratio Developmental Quotient computed from Bayley or Battelle developmental ages;
P<0.05, **P<0.01, ***P<0.001
*
Intervention Effects on Children’s Social
Emotional Functioning. Table 5 presents prepost measures of children’s social emotional
functioning both for the CBCL and the TABS.
Average scores on both instruments were
within the normal range for both instruments
at baseline and 12 months. However, while
21% of the children had Total TABS scores
76
that were in the clinical range at baseline,
only 8% had clinical scores at 12 months.
The overall MANOVA for the CBCL
yielded significant effects for Time (p <
.001) but not for Time X Treatment (p > .05).
Univariate analyses indicated that 12 month
scores were significantly lower on each of
three subtests (ps < .001). Intervention effect
sizes were in the large range on all measures,
indicating substantial improvement in socialemotional functioning.
Results for the TABS paralleled those for
the CBCL. The overall MANOVA indicated
a significant effect for Time (p < .01) but not
Time X Treatment (p > .05). However, univariate analyses indicated that Time effects
were significant for only two of the four subscales: Hypersensitivity/Activity (p < .001)
and Dysregulation (p < .05). Pre- post differences were also significant for the Total TABS
score (p < .001). Intervention effect sizes on
the TABS were in the moderate range.
Factors Associated with RT Intervention
Effects
Table 5. Intervention Changes in Children’s Social Emotional Functioning
F Time
Partial
3 Months
6 Months
F
X
Eta2
Variables
Pre
Post
Pre
Post
Time Treat
Time
ment
M
SD
M
SD
M
SD M SD
CBCLa
Internalizing
Externalizing
Total Problems
TABS b
Detach
Hypersensitivity
Underreactive
Dysregulation
TABS Total
a
14.40***
1.39
.64
49.9
12.4
43.5 11.6
55.4 10.0 46.4 9.5 46.24***
1.25
.64
52.7
10.6
44.6 11.6
54.9
9.4 48.7 6.7 21.54***
0.39
.45
52.4
11.4
44.1 11.4
56.1
9.7 48.0 7.4 32.92***
0.01
.56
1.03
0.11
.61
.10
39.1
21.9
45.6 16.3
5.63**
41.6 16.3 45.9 16.0 2.56
42.8
16.0
48.0 11.7
37.3 11.9 50.9 7.2 14.66***
2.95
.40
47.6
12.1
50.8 10.6
49.5
7.6 53.1 3.3
2.96
0.01
.12
42.6
16.4
47.3 11.7
41.5 15.4 51.2 5.3
6.97*
0.84
.24
84.3
28.0
95.0 19.9
79.7 22.1 99.2 16.6 13.05***
Child Behavior Checklist;
b
Temperament and Atypical Behavior Scale;
Two sets of hierarchical regression analyses were used to explore factors associated
with intervention outcomes. The first set explored the effects of children’s age at adoption and the amount of time they lived with
their adoptive parents; while the second set
explored how children’s status as a domestic versus international adoptee was associated with intervention outcomes. Both sets
of analyses were conducted for each of the
dependent variables reported in the previous
section. For each regression model the depen-
*
1.09
P<0.05; **P<0.01,
.37
P<0.00
***
dent variable (e.g., Time 2 Outcome) was examined with a hierarchical regression model.
The first step included the Outcome at Time
1. The second set included the variables of interest: age at adoption and time with parents
for the first set of analyses; international vs.
domestic adoptee for the second set of analysis.
Results from the first set of analyses indicated that neither children’s age at adoption
nor time with adoptive parents was associated with any of the dependent variables. The
77
one exception was that Vineland Communication DQs at Time 2 were negatively associated with the amount of time children lived
with their adoptive parents (Beta = -.36; t =
2.04, p < .05).
The second set of analyses indicated that
intervention changes on most variables, including mothers’ interaction style, parenting stress, and children’s social emotional
functioning as assessed both by the TABS
and CBCL were unrelated to children’s status as an international or domestic adoptee.
However as reported on Table 6 international
adoptees made greater developmental improvements on the Bayley/Battelle and Vineland than domestic adoptees. This effect was
significant for every developmental measure
with the exception of the Vineland Daily Living Scale.
Table 6. Relationship of domestic versus international adoption status to child development
outcomes
Dependent
Variable
Model
Beta
T Value
DevelopmenDevelopmental
tal
Quotient T1
Quotient T2a
.730
4.77
.000
.53**
.343
2.52
.021
.61**
.539
3.27
.003
.21**
.408
2.77
. 011
.41**
.487
4.81
.009
.21**
.299
2.91
. 007
.27**
.598
3.80
.001
.33**
.283
1.88
. 072
.39**
.510
3.02
.006
23**
.453
3.04
. .005
.47***
Adoption Status
Vineland
Communica- Vineland Communication
tion T1
T2b
Adoption Status1
Vineland Social
Vineland Social T1
T2 b
Adoption Status1
Vineland DaiVineland Daily
ly Living
ing T1
T2 b
Liv-
Adoption Status1
Vineland
Vineland Adaptive BeAdaptive BehaviorT1
havior T2 b
Adoption Status1
Significance
R2
R2
Change
.08
.20
.06
.06
.24
Bayley/Battelle Ratio Developmental Quotients; b Vineland Developmental Quotients; 1Adoption Status: 1=
Domestic, 2= International *p < .1; ** p < .05; *** p<.01
a
78
Discussion
This pilot investigation was designed to
assess the feasibility of Responsive Teaching as developmental intervention for young
adopted children and their parents. Because
there was no control group, the degree to
which the intervention outcomes were greater than might have occurred with parents and
children who received no intervention services cannot be determined. However, the results generally paralleled those reported from
more rigorous evaluations of RT with other
populations of parents and young children.
Most notable were improvements in mothers’
responsiveness as well as children’s development and social emotional functioning, each
of which resulted in large effect sizes similar to what has been reported in previous RT
evaluations. In addition there was a small decrease in parenting stress which had not been
reported in previous studies.
This study was designed to explore three
issues that have practical implications for providing early interventions services to young
adopted children and families. In particular,
we examined how factors such as treatment
intensity as well as the age of children at the
onset of intervention and/or the amount of
time they had lived with their parents might
affect intervention outcomes.
We had expected that intervention outcomes would be greater for parents and children who participated longer in intervention.
Yet, similar to findings from the attachment
based intervention literature (van IJzendoorn,
et. al., 2005) nearly all intervention effects
appeared to be as robust for low versus high
treatment intensity groups. The one exception was intervention changes in responsive-
ness. Although both groups made comparable
improvements in responsiveness which plateaued at the three-month observation, low
treatment intensity mothers decreased their
responsiveness from three to six months while
high- treatment intensity mothers maintained
their level of responsiveness.
In so far as maternal responsiveness is
causally related to children’s development,
it was surprising that group differences in
responsiveness did not affect children’s developmental outcomes. Perhaps, the drift in
responsiveness for low treatment intensity
mothers is a factor that has long-term as versus short term implications. Although short
term attachment interventions have produced
changes in parenting sensitivity that have
sustained from 12 to 18 months, long-term
follow-up studies have reported that these
early effects do not sustain over time (van
IJzendoorn, et. al., 2005). Thus while low
treatment intensity interventions may produce short-term child outcomes that are comparable to those observed in more intensive
interventions as reported in this study, more
intensive, or longer term, interventions may
reinforce mothers’ responsiveness thus having a greater probability of enhanced child
effects over time.
In addition, while attachment based interventions have been reported to be less effective for children younger than 12 months
versus older children (van den Dries, et. al.,
2009), no age effects were observed in this
study. This failure to find age effects may be
associated with the fact that our sample consisted predominately of children older than 12
months of age as well as the fact that measures
of attachment which may be highly sensitive
79
to age effects were not used as outcome measures. Nonetheless, the child intervention effects observed in this study were quite robust
and clinically significant, mitigating concerns
about age effects that were not identified in
this study.
We had expected that the less time children lived with their parents the less likely
their parents would have developed habitual
patterns of interacting with them. As a result, we reasoned that parents of newly adopted children regardless of their children’s
age would be more amenable to suggestions
to modify their style of interaction than parents who had lived longer with their children.
However, we found no evidence to support
this. RT appeared to be as effective with parents of newly adopted children as with parents whose children who had live with them
for even more than two years.
Finally, we had expected that international
adoptees would benefit more from participation in the intervention than adopted children.
This had been reported in previous attachment based intervention studies (Klein-Velderman, Bakermans-Kranenburg, Juffer, &
van IJzendoorn, 2006) and was thought to be
associated with international adoptees having
more negative emotions (Belsky, 2005). Although international adoptees made greater
developmental improvements than domestic
adoptees in this study, the lack of group differences in children’s social emotional functioning suggests that this had little to do with
international adoptees having more negative
emotions than domestic adoptees. Rather
this effect appeared to be associated with the
fact that although group differences in communication skills were not significant at the
80
onset of intervention, many of the international adoptees in this sample had been recently adopted and had limited English skills
at the onset of intervention. This may have
accounted for their making greater progress
in their communication development than domestic adoptees, and may have also contributed their advantages on other developmental
assessments as well.
In conclusion, results from this study suggest that RT is a feasible intervention both for
promoting maternal responsiveness as well as
enhancing the development and social emotional functioning of young adopted children.
However, because of the quasi-experimental
research design as well as the small sample
used for this evaluation, results from this
study can only be interpreted as “promising”
and clearly do not support the efficacy of RT.
Nonetheless, because results observed in this
study were robust and clinically significant as
well as similar to findings from more rigorous evaluations of RT, there is a strong need
to examine how these results would hold up
with more rigorous research designs that include larger and more diverse samples of parents and adopted children.
Both the high and low intensity treatment
models that were evaluated in this study were
more intense than typically provided in attachment-based interventions. Yet, the finding
that the three month intervention was nearly
as effective as the six month intervention has
major practical implications, especially since
public funding for post-adoption services is
limited. However, on a more cautionary note,
results indicating that parents who received
3 versus 6 months of intervention began to
decline in responsiveness 3 months after their
intervention was completed is a concern that
needs to be addressed. Given the likelihood
that parental responsiveness is the main factor affecting children’s development and social emotional functioning, this finding points
to the need of RT, and perhaps other attachment-based interventions, to develop mechanisms for reinforcing parental responsiveness
after intervention services have ended.
Finally, the widespread use of intervention
models in community based practice is partly
dependent upon the capacity of these models
to address the needs of the populations of parents and children that are typically encountered. Children can be adopted at any age, not
just under 12 months of age; many parents
do not seek developmental services until long
after they have adopted their child; and most
agencies serve a mix of domestic and international adoptees. Results from this analysis
indicated that none of these factors were associated with intervention outcomes for parents or children. In addition, as also occurs in
practice, several of the children in this study
had developmental, social emotional and quite
possibly attachment problems at the onset of
intervention, but none of these conditions appeared to influence the effectiveness of this
intervention. In general, the results from this
pilot investigation underscore the viability of
RT as community based option for providing
developmental service to preschool adoptees
of all ages and ability levels regardless of the
amount of time they have lived with their parents and whether they are international or domestic adoptees.
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454.
RESILIENT LIVES
AND AUTOBIOGRAPHICAL
SUGGESTIONS ITALIAN NATIONAL
TRAINING PROCESS IN THE FIELD
OF INTERCOUNTRY ADOPTION
Giorgio MACARIO1
Abstract
This report will consider the crossroad between two virtuous factors. On one hand, the multi-factorial and interdisciplinary approach that increasingly characterizes the concept of resilience today.
On the other hand the contributions of autobiographical method that enhances the history
of the individual in the family and in different contexts where they belong, contributing to the
spread of the ‘turning narrative’ in society and emphasizing the value of writing.
The area is referring to the training for inter-country adoptions in Italy, continuously active
since 2001, and we will try to find a shared area between resilient lives and autobiographical
suggestions, that tell us about the person but at the same time helps us to understand the society
that surrounds it.
Keywords: autobiography, resilience, writing, international adoptions, narratives.
1
Trainer and psychosociologist, (ITALY). E-mail: macario.g@gmail.com
85
1 Introduction. about adoptions, resilience and autobiography
“A scarecrow tries not to think about. It’s
too painful to build an inner world full of
atrocious performances. You will suffer less
when you have wood in place of the heart and
straw under the hat.
Is enough, however, that a scarecrow encounters a man alive that infuse a soul, because it is, again, tempted by the pain of living. (...) Then, the scarecrow begins to speak
again and sometimes even write his own autobiographical chimera. “ (Cyrulnik, 2009)2
The identification of a plural category defined by Boris Cyrulnik of ‘hidden children’,
which opens in-depth analysis of the world of
adoption as non-traumatic factor, represents the
starting point of a interdisciplinary reflection.
The subject of resilience, or better the resilient lives, is extremely important for the
world of adoptions and, particularly, for inter-country adoptions. Cyrulnik confirms this
approach when he says: “The adoption is not
a trauma: indeed, it is a meeting that allows
evolution resilient.” (Cyrulnik, 2009)
On the other hand, the autobiographical
suggestions, always present in the adoptive
paths, are spreading in a growing number of
contexts, which apply an autobiographical approach3, (Regione Piemonte-ARAI (2009) oriented to the construction of a autobiographical
method. The confirmation of the possibility
that adoptive experience could usefully contribute to implementation of the autobiographThe review of the book of Boris Cyrulnik (2009), by
the author, is available at:
http://www.lua.it/index.php?option=com_content&tas
k=view&id=1423&Itemid=77
3
Among the various significant initiatives on this
subject that have been made throughout
​​
the country:
-the project of Adoption Center of ASL Province Milan 1 on the value of the adoptive tell stories (“C’era
una volta” - Seminar on 22 October 2008);
-the regional project of Regione Piemonte-ARAI
“Racconto di me: il valore della narrazione fra genitori e figli adottivi”
2
86
ical method comes from the most national expert autobiography and a leading expert at the
European level, Duccio Demetrio. Demetrio,
in his speech at the European Conference in
2010,4 identifies the adoption as autobiographical transition and, in this regard specific that:
“...the representation of the adoptive event,
can better be defined thanks to narrative attentions, or better, narrative, since adoption, and
not only that, it is a story generating life stories
to meet, re-examine, re-organize and forget
too.” (Demetrio, 2013)
2 Writing, autobiography, resilience
focused on adoption
Comparison with our own adoptive history begins in the early days, of course, but
it does not end with the attainment of adulthood. Adulthood involves, as also indicates
Marco Chistolini, a re-signification of its own
adoptive history gaining greater self-awareness, particularly with respect to their origins
(Chistolini, 2010).
The search for information on the origins,
has became during last years the center of the
attention in Italy5 Pregliasco, 2013), and the
subject of recent significant legal pronouncements6, makes possible to take action on the
part of the adopted person inquiring about his
past and possibly establish a contact with the
Commission for intercountry adoption, Resilience
and autobiographical approach in intercountry adoptions’, Florence, 8-9 june 2010.
5
In addition to the recent specialized training conducted by the Commission for intercountry adoption
in 2012, entitled “L’accesso alle informazioni sulle
origini nelle adozioni internazionali: Aspetti giuridici,
psicosociali, relazionali.”, deserves to be mentioned
the most recent book of the Istituto degli Innocenti:
Pregliasco, R. (2013) (a cura di), Alla ricerca delle
proprie origini. Carocci Editore).
6
See the recent pronouncement of the Constitutional
Court, judgment of 22 November 18, 2013, n. 278 declaring the unconstitutionality of article 28, paragraph
7, of the Law of 4 May 1983, no. 184, in the part that
does not allow the court to consult again the mother
who has refused to recognize the child, even many
years after.
4
biological parents. In Italy, there are very few
people active in this kind of search but the
possibility of being able to start has to be considering a factor of resilience.
The autobiography, on the other hand, is
considered as an experience of re-identification, and Demetrio tells us “The autobiographical writing is nothing more than the
re-writing of our history; it goes back into the
scene, we again becomes, somehow, protagonists and characters of our life, we are back
into the game as if you go up on a stage.”
(Demetrio, 2010)
The autobiographical writing is considered
a useful tool to be used in the field of adoption, however, not only with adults (Mazzonis, 2010). The autobiographical writing is
also considered a clinical tool in an autobiographical perspective but different from clinical therapeutic perspective (Demetrio, 2008).
Adoption generates multiple autobiographical stories, but they are just the different possibilities of writing that Demetrio enhances when he says: “There is always something more in a script.” (Demetrio, 2013).
Firstly, writing is a valuable opportunity for
the author to find himself considering explicit
and implicit areas influenced by the unconscious. Second, are those who have responsibilities for education, parenting, guidance
or treatment that can identify more signs of
comfort or discomfort of the narrator: the motivation to writing, or running away from this,
allow a better understanding of the levels of
self-consideration expressed by the adopted
person.
If we consider the writing a sort of additional adoptive parent, we can define an experience in itself potentially ‘resilient’, which
helps us to resist the wounds of life.
Recognizing the central importance of the
contribution of Cyrulnik about adoption as
a possibility of a resilient evolution, Demetrio underlines that writing can facilitate the
emergence in the adoptee of an ‘internal biographer’. The internal biographer, in fact,
may be central for the mental health of the
adoptive person because places himself at
the center as a major character of the story,
a ‘clerk’ at the service of its author. This specific factor,-characterized at the same time by
storytelling and writing- is not resilient only
because it makes the person self-sufficient. It
becomes central because it amplifies the role
of the ‘facilitator of storytelling’ (which could
be defined as ‘external biographer’), both for
the parent that attend together with the adoptee at his everyday life, and for the operator
that assists and supports its growth path.
However, the author who has been adopted and who writes about himself trying to observe better, provides the best narrative synthesis that can help to understand the close
interconnection between the stated various
factors. Here is what Daniele Callini tells us
in his book entitled “44 steps” (Callini, 2006):
“The rigor and method I’ve learned from
Dad Franco. (...) The speed and instinct decision-making are a resource of Mamma Cristina (adoptive parents). (...) I have no doubt
saying that I have assimilated the courage of
my mother. Moreover it requires an enormous
courage to give birth to a child that you do
not want or you are not able to keep. The tenacity, strength and endurance, I think I have
received them from my blood father. Even if
I do not know who he is, I feel that these resources are a gift from him.” (Macario, 2010)
A summary ‘masterful’, certainly resilient.
87
3 Resilience and training of operators
for intercountry adoptions
“A good education for resilience requires
the establishment of programs and projects
that facilitate the child, in his family and in the
community, building solidarity networks and
the opening of a space capable of facilitating
a positive development. The prospect of integration between the various professionals underlies the assumption that considers the person as a whole not parceled depending on the
context or on the historical moment in which
it appears.” (Cyrulnik, Malaguti, 2005).
This passage, taken from the introduction
to the cited volume, edited by Cyrulnik and
Malaguti, can significantly represent at least
two of the milestones of the training activities
for inter-country adoptions, made ​​in the last
15 years in Italy by the Commission for Intercountry Adoptions in collaboration with the
Istituto degli Innocenti in Florence.7
The formation activities organized for the
operators involved in international adoptions
in Italy (200 to 300 for each year) has always
sought to combine the best reading of the
changing environment and tools that can be
used for an enhancement of the ‘natural powers’ of adoptive couples, adoptive parents and
adopted children of the same time.
As it says Franca Olivetti Manoukian:
“Everyone who lives and coexists in a social
context is asked to share the guidelines which
this discomfort should be addressed with.
Operators are more competent than others
simply because they have available elements
The author was responsible for scientific and training activities, launched in 2001 and which continues
until now. The documentation of the formative work
carried out is contained in 8 volumes of the series
Studies and Research (numbers 1, 4, 7, 10, 15, 17,
18, 20) for free download at the website of the CAI:
http://www.commissioneadozioni.it/it/bibliografia/
studi-e-ricerche.aspx
7
88
of knowledge and experience for identifying
and for guiding how to treat the discomfort.”
(Olivetti Manoukian, 2011).
The perspective of empowerment not only
connected to the professional aspects but also
to educational parenting, has in a cross concern a lot of topics discussed during many
years. Between this topic: intercultural aspects, specificity of adolescence, scholastic
inclusion in the post-adoption - where ample
space is given to the possible interpretations
of the ‘new resilient development ‘ theorized
by Cyrulnik (Favaro, 2012) - adoptive sib
ships, professional and self-help groups to the
assessment of the couple and special needs.
Regarding the assessment of the couples -to
give just one example, very significant and in
line with other European studies - (Palacios,
2013) it was possible to deepen the evolution
from a predominantly evaluative approach to
an accompanying perspective during the entire adoption process.
On the other hand, the integration between
the different professional knowledge has always been a leitmotif of in-depth training,
characterized as inter-professional training
(psychologists, social workers, judges, the
three most consistent professionalism), but
also interdisciplinary (psychological, social,
anthropological and legal) and inter-organizational (teams adoptions of public services,
the authorized agencies, the juvenile courts
and prosecutor’s offices, the organizations).
The effort for empathizing with the problems of the adoptive couples and of the adopted children, and the subsequent identification of additional factors to promote resilience was then even more significant during
the training experiences made ​​in Eastern Eu-
rope in 2004-2005 (Macario, 2005), and during joint training Brazil-Italy in 2009-2010
(Macario, 2011).
A further authoritative confirmation of the
central inter-professional aspects in the world
of adoptions comes also from two Authors inspired to the systemic approach who state: “...
the more you support the training for all those
people (judges, social workers, counselors)
who approach the families ‘dare to take’, the
more it contributes to social welfare”( Scabini, Cigoli, 2010).
The European Conference of 2010 on
adoptions and resilience, mentioned above,
has led to synthetize many other elements
considered during the subsequent years.
Along with the autobiographical suggestions
more often we would like to understand the
centrality of the resilient lives in order to better support the different contexts of growth of
the adopted children.
The multifactorial and interdisciplinary approach that characterizes resilience is
becoming even more important inside the
considerations of Elena Malaguti, who has
analyzed the process of resilience not only in
reference to the individual but also to groups
(family, community. .), that, in particular difficult moments, must be able to put in place
resources for reorganizing in a positive way
his own path and life plan, according to an
evolutionary approach.
Resilience is spontaneous, but it implies
stress to be activated, becoming an opportunity for personal and social evolution. There
can be several theoretical models: cognitivebehavioral, medical, eco-systemic and clinical. It remains “a complex object that is by its
nature not predictable, chaotic and does not
meet the natural laws” that “does not work
according to linear patterns but in a systemic
and dynamic way,” “as a function of the interactions and transitions occurring stable
between a person in permanent development
and its environment.”8
The Lectio Magistralis of Beràstegui Pedro-Viejo (2013), finally, starting from the
studies and research on inter-country adoption in the European context, has made a significant contribution to deepening the three
fundamental concepts of risk, resilience and
recovery. Some authors have questioned
whether the adoption itself may represent a
‘risk factor’ for the problems of adaptation
for a child already vulnerable by abandonment.9 (Beràstegui Pedro-Viejo, Gomez-Bengoechea, 2006; Schofield, Beek, 2013).
The research, however, –Berastegui stated- shows that adopted children often exhibit behavioral problems, cognitive, social
and educational, to a greater extent than their
peers not adopted, but if you compare them
with their peers institutionalized or other living situations of hardship the comparison is
reversed into opposite parameters.10 (Brodzinsky, Palacios, 2011).
Facing the risks and trauma in childhood,
we can highlight the significant differences
between protection (when there is no harm
in situations of risk), reversibility or recovery (recovers the normal path), resilience
(with the resumption of development path
Malaguti, E., Research on resilience and prospects
for inclusive education. Adoption and beyond, Abstract intervention at European Conference - Florence
8-9 June 2010.
9
For further information on post-adoption, cf. [19].
For further information on the theories of attachment
applied to the field foster, of custody and residency,
cf. [20].
10
Very similar to the conclusions of two of the leading experts of adoptions worldwide (David Brodzinsky and Jesus Palacios) in their fundamental book on
research and practices. Cf. ChildOnEurope, 2008)
8
89
that keeps track of the suffered pain) and executive functions (despite the problems, the
child reaches a certain functionality in everyday life).
As specific insights, the three themes explored in the national training during the
previous year - the school integration in the
post-adoption, the adoption of sibling groups
and the specificity of adolescents in adoptionwere developed with a specific focus on resilience and autobiographical approach.
4Searching a shared area
In conclusion, I would use a methodological cue usefully applied in the analysis of
educational models to verify the assonance
or the dissonance between ‘education’ and
‘therapy’. There is no doubt, in fact, that there
are characteristics of the specific educational
and there are others definitely attributable to
the therapeutic area.
It is also true that there is a common area
where the identified characteristics apply
both to education and therapy. And yet, some
other features and tools that have a priority in
the educational effectiveness sometimes facilitate therapeutic outcomes, while the contrary is true even when therapeutic interventions mainly involve non-negligible changes
in education.
The intention is not so much to make long
lists, but to keep in mind, on a qualitative level,
that there is a resilient approach (section 3rd)
and autobiographical approach (section 2nd).
Both of these fields of study and research have
led to a particularly close relationship with
the practice and to identify specific target -in
this case the adoptive context- that can help to
operate in a limited area, and then to compare
those different fields of intervention.
Alongside the adoptive area, for example,
90
it’s possible to cite the hospitality of residential boys and girls. An interesting reflection
is the one developed by Andrea Canevaro on
educating the resilience that weaves in various ways also autobiographical references
(Canevaro, 2008).
These are some references to the elements
necessarily unsaturated and deepened, located in the shared area:
• The EMPOWERMENT, like exploitation the potential of the individuals, certainly
within their contexts;
• The SELF-EMPOWERMENT, which allows the expression of new desires, opinions
and possibilities;
• The NARRATION, as a tool that gives
meaning to personal paths (for the construction of their own path in life, to the search
for origins, for overcoming traumatic experiences, etc.).
• The CENTRALITY OF INDIVIDUALS, such as re-centering on the individual
(both the adopted child as well as the adoptive parent) in the network of relationships
and social context (current membership and,
possibly, of origin);
• The SELF-TRAINING, like equidistant
perspective between self-centered and dependency, ‘vitality’ factor, the ability to capture
the support and advice they need.11
I’ll entrust the closing, in line with the
spirit of this contribution, to an adoptive parent a bit special, Leo Ortolani, creator of Ratman, a well-known Italian comic book character, which describes a path adopted that last
nearly a decade.
Some of the items shown are from a first systematization edited by the author in the section ‘The role of
Training’ contained in the Guidelines on post-adoption services. Cf [23].
11
Ortolani says, describing the flight to Colombia to get to know the two girls Lucy and
Johanna:
“And then I feel that I still do a lot of
things that I did not just in time, I had to prepare myself better, that everything is going
well suddenly, that 2001 was yesterday and
you cannot do things so fast, I still need a bit
‘of time, a month, a few days, it cannot happen now, not me, not so, do not ....
Passengers are requested to fasten their
seat belts (...) we are landing at the airport in
Cali.” (Ortolani, 2011).
The effectiveness autobiographical-narrative interpreted in an humoristic - resilient way.
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raccontarsi”.
Scabini, E., Cigoli, V.(2010). Il legame
adottivo: una forma radicale di genitorialità,
in R. Rosnati, (a cura di), Il legame adottivo.
Contributi internazionali per la ricerca e
l’intervento, Unicopli, pp. 17-34.
Schofield, G., Beek, M., (2013). Adozione
affido accoglienza. Raffaello Cortina Editore
Edizione originale: Schofield, G., Beek, M.,
(2006), Attachment Handbook for Foster
Care and Adoption. BAAF.
TODAY’S CHILDREN ARE
TOMORROW’S PARENTS
INSTRUCTIONS FOR AUTHORS
Short description of the journal
The Journal Today’s Children are Tomorrow’s Parents (TCTP) started in Romania,
in 1999. The journal is an useful resource of
information for professionals working in the
childhood area. Each issue of the Journal is
based on a specific topic concerning the prevention of any kind of violence against the
child. After more than 15 years of appearance, TCTP journal, arrived at 37-38 issue,
included in the international data bases EBSCO, Index Copernicus, Norwegian Social
Science Data (NSD), is bringing into the author’s attention few recommendations.
Types of contributions:
Papers will be considered providing that
they have not previously been published or
admitted simultaneously elsewhere for publication.
Original, Theoretical, and Empirical
Contributions: The paper should conform
the APA (Publication Manual of the American Psychological Association) standards,
with a legible abstracts of 100 to 280 words).
Furthermore the paper should include a clear
introductory statement of purpose; historical
review when desirable; description of method
and scope of observations; full presentation
of results; brief comment/discussion on the
significance of the findings and any correlation with others in the literature; section on
speculation and relevance or implications;
summary in brief which may include discussion. Section of references is required.
Brief Communications: Shorter articles
of 5 to 7 pages (abstracts and/or references
optional).
Articles on Clinical Practice: Authors
should provide an account of previous clinical theory in an organized and up-to-date
manner distinct from the clinical case material. Further, the clinical case material should
occupy no more than a third of the paper. The
first third should include only relevant background theory, while the final third should
aim to discuss the descriptive presentation
of the clinical case material against the background of existing theories and/or modifications needed to accommodate the clinical
material.
Invited Reviews: Plans for proposed reviews and invited in draft outline in the first
instance. The editors will commission reviews on specific topics. Reviews submitted
without invitation or prior approval will be
returned.
Submission Requirements:
All submissions should include an abstract, and ordinarily be 15 to 20 pages in
length, though occasionally longer papers are
considered. In order to facilitate blind peer
review, authors are encouraged to prepare a
cover sheet that includes identifying details
not included in the manuscript which will be
sent out for review, less the cover sheet.
E-mail submission to the Editor is preferred; please send an electronic copy of your
manuscript to: anamuntean25@yahoo.com.
All correspondence, including notification of
the Editor-in-Chief’s decision and requests
for revision takes place by e-mail.
Manuscripts may be submitted in Romanian, French, or English and the author will be
informed about the languages of the publica-
93
tion. The Romanian Authors will be asked for
providing the translation into the language of
publication.
Authors are responsible for obtaining
written permission from copyright owners to
reprint any previously published material included in their article.
The editors reserve the right to refuse any
manuscript submitted, whether by invitation
or otherwise, and to make suggestions and
modifications before publication. Submitted
papers must be in final form when submitted;
manuscripts will be returned for reworking or
retyping that do not conform to required style
and format.
Abstract: A structured abstract (objective, method, results, conclusions, practical
implications) should not exceed 360 words in
length covering the main factual points is required. Use complete sentences, and spell out
acronyms at first mention.
References: Style and formatting of bibliographic citations in the text and the reference section must adhere to the guidelines of
APA (Publication Manual of the American
Psychological Association). The Journal uses
an alphabetical style rather than a numeric
style both in the text and bibliography. No
abbreviations of journal titles or use of et al.
is permitted in the bibliography.
Tables/Figures: Cite each table/figure
clearly in text. Tables should be arranged one
to a page with a self – contained title that is
understandable without reference to the text.
Figures should be computer generated one
per page, with legends. Tables and figures
should be submitted as separate files named
Tables of Figures.
Citations in text:
Citations in text must match reference citations exactly. Groups of citations with the
94
text must be in alphabetical order within the
group.
List all authors the first time a work is
cited unless there are six or more authors. In
bibliography use et al. after the sixth author’s
name and initial to indicate the remaining authors of the article. In text list the first author
et al year (Jones et al., 2009) for first and subsequent citations.
For citations with three or more authors,
list all authors the first time the work is cited, then author et al. for citations thereafter.
When two authors list both and do so every
time reference are cited. If two or more citations with the same authors for the same year,
list as many authors as needed to differentiate
citations followed by et al.
If two or more citations with exactly the
same authors in exactly the same order for
exactly the same year, use 2009a, 2009b etc.
to clearly link text citations to correct reference citation.
If reference is within parentheses, use ampersand. If not within parentheses, use and.
Citations in the references:
The use of et al. is not permitted in the reference section under any circumstances. Abbreviations of journal titles is not permitted.
Please write out completely. Citations should
be in correct alphabetical order. Watch punctuation closely, particularly in strings of authors (and initials), and in journal volumes,
issues, and page numbers.
Examples of citations in Reference section:
Journal articles:
Egeland, B. (2009). Taking stock: Childhood emotional and developmental psychopathology. Child Abuse and Neglect. Vol. 33,
Nr 1, pp. 22-27
Authored books:
Sroufe, L. A., Egeland, B., Carlsson, E A.
& Collins, W. A. (2005). The Development
of the Person. The Minnesota Study of Risk
and Adaption from Birth to Adulthood. New
York: The Guilford Press.
Edited books:
George, C. & Solomon, J. (2008). Attachment and caregiving behavioral system. In
J. Cassidy & P.R. Shaver (Eds.), Handbook
of attachment: Theory, research, and clinical applications.Second edition. New York:
Guilford Press.
Chapters in books:
Cicchetti, D. & Valentino; K. (2006). An
Ecological-Transactional Perspective on
Child Maltreatment: Failure of the Average
Expectable Environment and Its Influence
on Child development I D. Cicchetti & D.,J.
Cohen (Eds.). Developmental Psychopathology. Volume 3: Risk, Disorder and Adaptation. Second Edition. New York: John Wiley
& Sons, Inc.
On-line citations:
Ascione, F. R. (2001). Animal abuse and
youth violence. Juvenile Justice Bulletin.
Washington, DC; Departement of Justice. Office of Juvenile Justice and Delinquency Prevention. Retrieved September 26, 2003 from
http://www.ojjdp.ncjrs.org
Presentations at conferences:
Lundén, K. (2007). To identify children at
risk for maltreatment Paper presented at the
Second International Forum on Psychological safety, Resilience and Trauma, September
2007, Timisoara, Romania.
95
96
Parteneri:
Organizator :
Partener media:
25-26 septembrie 2014, București
ADOPŢIA, O NOUĂ
PERSPECTIVĂ
Conferința națională pentru adopție