Product Description

Over 200,000 children live in foster homes in America today. 40-60% of these children have been severely and permanently damaged by their pasts, resulting in behavioral, psychiatric, emotional and neurological disorders. Large numbers of previously adopted children (both domestic and international) suffer from similar problems. In the past, these children would have been cared for in specialized facilities staffed 24 hours a day by professionals. Today they are placed in inadequately prepared adoptive or foster homes where they often become uncontrollable, and forcefully reject those who want only to love and help them. Yet, in the past when families sought understanding and help, they found that there was little or none available. Now there is.

Can This Child Be Saved? Solutions for Adoptive and Foster Families... Offers parents help and hope, encouragement and support. It examines what causes children to act and react the way they do, and why conventional strategies and approaches often fail to reach them. It explores and validates parents feelings and offers struggling families clearly detailed and easy to understand parenting techniques and therapeutic approaches that DO succeed with disturbed children.

Product Details

• Amazon Sales Rank: #768609 in Books
• Published on: 1999-02-15
• Original language: English
• Number of items: 1
• Binding: Paperback
• 357 pages

Review
At last we are presented with a book of directions that can help families heal. -- Don Taylor, adoption rights advocate, adoptive parent, adoptee

Now no matter how bad things get, now parents have some options. And as long as they have options, they can "hang in there". This book will save families... -- Beth Meadows, America Online Adoption Forum Team Leader, adoptive and foster parent

About the Author
Foster W. Cline, M.D. - Dr. Cline is an internationally renowned adult and child psychiatrist, lecturer, and author of eight books on parenting and working with difficult children. His best selling Love and Logic parenting series, co-authored with Jim Fay, has been translated into several foreign languages. Hope for High Risk and Rage Filled Children has become the classic reference on understanding and treating Reactive Attachment Disorder in children. Dr. Cline is the cofounder of two clinics that specialize in the treatment of severely disturbed children. He is a popular speaker at workshops and seminars throughout the United States and has spoken in eleven foreign countries. Dr. Cline and his wife Hermie have three children by birth, one by adoption and several foster children. They live in the mountains of northern Idaho.

Cathy Helding - Cathy is a nationally known consultant, writer, and speaker in the field of special needs adoption and parenting of special needs children. Cathy comes from a background in special education and taught cognitively disabled middle school students in the 1970s. She is a former America Online Community Leader and newsletter editor for the Adoption Forum. She is a sought-after speaker for parent groups, agency trainings, and teacher in- service programs. In 1998 she testified before a State Senate committee on fetal alcohol syndrome and was instrumental in the passage of legislation that recognizes the rights of unborn children of drug- and alcohol-addicted mothers. Cathy and her husband John have four children, three of whom were adopted as a sibling group with special needs. They live in a replica turn-of-the-century farmhouse on eight acres of restored native prairie in southeastern Wisconsin.

Excerpt. © Reprinted by permission. All rights reserved.
Chapter 1 Overview of Disturbed Children

Who are the special needs children to whom we refer? Where do they come from? What causes them to behave the way they do? They are children who:

Have been exposed to early environmental deprivation.
Have been exposed to toxins in utero.
Have been exposed to excessive violence.
Have been abused.
Have been neglected or abandoned.
Have fragile genetics.
Have suffered neurological damage.
Have behavioral disorders.
Have attachment disorder.
Have (PTSD) Post-Traumatic Stress Disorder.
Have had early years characterized by inconsistent parenting or multiple moves and caregivers.

A child exposed to any one of these problems is at risk of becoming an extreme behavior and management problem for parents. Although their circumstances are different, their resulting childhood and adult disturbances are more dependent on when and for how long the abuse, neglect, or loss occurred than on the details of what occurred.3 And it is estimated that approximately 80 percent of the children who enter the child welfare system today are affected by at least one of these factors.4

At the end of 1990, according to data from the American Public Welfare Association, there were approximately 406,000 children in out-of-home placements in the U.S. About three-quarters of these were in adoptive or foster placements. This adds up to 324,000 special needs children already in placement by 1995. Do All Children Belong in Families? Life without parents is a difficult sentence to pronounce upon a child, but it's happening more and more often. According to a 1994 Atlantic Monthly article entitled "When Parents Are Not in the Best Interests of the Child," " Sometimes children have gone beyond the opportunity to go back and capture what needed to be done between the ages of three and eight. Sometimes the thrust of intimacy that comes with family living is more than they can handle. Sometimes the requirement of bonding is more than they have the emotional equipment to give. As long as we keep pushing them back into what is our idealized fantasy of family, they'll keep blowing it out of the water for us.6 "

Unfortunately, not all children thrive in traditional family settings. Our present child welfare system, however, is designed around a goal of permanency for all children, and permanency, by default, usually refers to a traditional family setting. Institutional care has virtually been abolished as a government-sponsored option in this country. This means that even the most disturbed children often end up in families ill-equipped and unprepared to manage them. Richard J. Delaney and Frank R. Kunstal, in their excellent book, Troubled Transplants, write " Some children placed with adoptive families have been so injured by their abusive pasts that they are simply `family phobic.' These unfortunate victims are too traumatized, their selfhood annihilated by parents who committed `soul murder' on them. " They go on to tell us that efforts to raise these children in traditional families are in vain. The children do not desire families, are uncomfortable with them, and even fear them. They defend heavily against any efforts at intimacy, and wreak havoc in their homes.7

Until his recent retirement, David Fanshel was a professor at the Columbia University School of Social Work. A leader in the field of social work, and foster care in particular, Fanshel was the principal investigator in two major longitudinal studies on foster children in homes and institutions. At a time when many experts are questioning the value of residential treatment and promoting family preservation, Fanshel goes against the tide. Fanshel, for decades one of the leading proponents of permanency planning, has modified his views. He now believes that permanency placement with a family is not an appropriate goal for about a quarter of the older, more seriously damaged and criminally inclined children in the system.8

Is it possible, then, to determine if children are good candidates for traditional family placement? How can families determine if children offered to them will be a good match, or if they are prepared to undertake a lifetime commitment to meet the children's needs? A thorough evaluation is helpful, although not foolproof. The bottom line is, if a family is not prepared to live with the children the way they are, regardless of whether they are able to heal or make positive behavioral changes, they should think twice about adopting.

The Process of Building the Dream
Our dreams are so important to how we define success and satisfaction in life. The mental images that we carry in our minds of what our future should look like, do much to shape our actions and color our feelings. When reality does not match the pictures we have in our heads, we may feel anything from upset and vulnerable to resentful and angry. In special needs adoption, this can result in anything from disappointment to disruption. The decision to adopt is a complex one. In this section, we are going to examine some typical adoption scenarios.

Everyone's adoption experience is unique. Factors as diverse as the temperament of the prospective adoptive parents, the social workers assigned to the case, and the area of the country they live in combine to make every story different. In the not too distant past, having other chidren put most families out of the running for adoption. As the numbers of adoptable children worldwide multiply, and the culture insists on adoption as the only viable option for these orphaned children, more families who already have birth children are entering into the process. They often feel that they have additional resources and love to share with other children, and having already experienced success and satisfaction in being parents they may feel better equipped to cope with children who need more but give less back. They enter the process with expectations based on previous experiences-expectations that may have little to do with the reality of special needs parenting, but that have tremendous influence on the dream.

As these families begin to formulate thier dream, they may spend considerable time thinking about and discussing the possibility of adoption. In a partnership, one partner often initiates the idea, or feels more strongly motivated than the other. The exploration process ideally includes gathering as much information about the process and the children who are available as possible, but often it does not. By the time families contact an agency to begin the adoption process, they have usually been thinking and talking about it for several months.

Now they have decided to go ahead, and they are very eager to get on with it. Very often the first opportunity for education is during the application process. We cannot stress enough the need for families at this point to be given realistic education about the differences between adopting a special needs child and raising a birth child. For infertile couples and childless singles, the dream has most likely been taking shape for even longer. By the time a childless couple decides to adopt, they may have spent several years and a tremendous amount of money on fertility treatment. Much of their emotional and physical energy has been devoted to having a child. The infertility treatment process is grueling. The pressure of time passing them by becomes increasingly difficult to bear. Bringing home a baby becomes the urgent and immediate goal that usurps all others in life.

For many of these families, adoption is a second choice option. They may struggle with whether it will be able to fulfill their dream at all. They may go through a healthy period of mourning the loss of the child they will never have, or they may try to avoid that pain by substituting an adopted child for the birth child who never will be. As one family told us:

"We had this dream of having three children, each two years apart. We'd live on a street with sidewalks with a park on the corner. The kids would play together and eventually walk to a neighborhood school. I'd join the PTA and Bob would coach Little League. Then we found out we were infertile. By the time I was 32 we had been through half a dozen fertility clinic programs. Our relationship was suffering and all we could think about was what good parents we could be and how happy children would make us. We had so much love to give to children. Why didn't God give us any? Maybe, we thought, because we did love children so much, maybe He wanted us to give that love to children who had no one. Kids who were already here but unloved or unwanted. We began to see that is was God's plan for our lives-to adopt. Once we saw that, there was no talking us out of it. Now that we knew what we were meant to do, it seemed like it would never happen fast enough. Our focus shifted from getting pregnant to adopting a baby, almost overnight."

For most families, infant adoption is no longer a possibility. There are not enough healthy infants to go around. The private adoption process-about the only timely way to adopt a healthy infant today-is expensive and emotionally draining. Many families decide that rather than take their chances with this system or wait seven to nine years for an infant through an agency, they will adopt a special needs child. This may be the second remaking of the original dream and may carry with it some grief and/or anger and resentment.

The desire to have all of the struggle and waiting behind them makes these families especially eager to expedite the adoption process and accept placement of a child. Unfortunately, we have met more than a few families who feel that they were taken advantage of at this point. Social workers and agencies have a practice called "stretching" that they often use when interviewing couples who have applied to adopt. Stretching looks like this:

"Have you considered a child a bit older than infancy? Well, not really. I mean . . . we haven't talked about it. Well, there are so few babies available. It could take several years if you want to wait for a baby. Several years? But we're already in our 40s. We thought there were so many kids out there. Teenage mothers, you know? Well, a lot of people think that, but it's just not true. But there are lots of toddlers. Two- and three-year-olds. They are considered special needs kids because they are over the age of six months. Two- or three-year-olds are still pretty little. And they are awfully cute at that age. I guess we'd be willing to look at some."

This kind of subtle stretching of the family's acceptance levels over time may eventually result in a couple who originally wanted to adopt one infant taking in a sibling group of three children, ages two, three, and six. Later on, the parents wonder "how did this happen?"

Whether prospective parents are infertile, single, or want more children in addition to their birth children, the dream evolves through predictable stages that create a growing sense of urgency in the waiting family. This urgency makes prospective adoptive parents extremely vulnerable to stretching and can lead to impulsive and uninformed decisions. A subtle and rapid shift in the balance of power takes place once the decision is made to abandon the original dream and begin the adoption process. Prior to this, the couple was able to make their own decisions and chart their own path. The timing was up to them. This will no longer be the case. Someone else has just crawled into the family bed-the adoption caseworker. A stranger now has the power to make the dream happen, and many families feel they must begin a courtship process with the agency or worker. This is not really the case at all, but having had no previous experience, most families do not know this.

The selection/approval process is understandably very intimate and one that many families find uncomfortable if not downright intrusive. There are excellent reasons for this, of course, which we will discuss later. Nonetheless, after expending enormous amounts of emotional energy trying to have a baby and coming to terms with infertility, many couples do not welcome further intimate intrusions into their lives. Families who have already successfully parented birth children may resent having to prove themselves "worthy" to strangers in that respect. It takes a tremendous amount of courage to turn one's fate over to a stranger. Parents describe their feelings in public forums on-line:

"They told us it would be six months until the next orientation class. We can't even apply for six whole months! Is that fair to the kids who are out there waiting for a home?"

"We've taken the classes and passed the home-study process, and now they say it could be up to two years before a child is found for us. With all these children waiting, why does it take months to find a child?!"

"We wanted to adopt an infant but the wait in our state is seven years. And there is a rule that you can only be 40 years older than the child you adopt. I am 35. In seven years I will be too old to meet the criteria. So I guess we have to settle for an older child then, right?"

"We have been told that if we want to wait for a normal child, we might never actually get chosen. But if we are willing to adopt a child with special needs, there is a better chance. We decided a kid with emotional problems would be better for us than a physically handicapped child. After all, with enough love, most kids can heal from emotional wounds."

"We want to adopt one child at a time. You know, like you usually only have only one baby at a time. But there is a really cute group of siblings that are disrupting from another adoptive placement, and the worker said they would place them with us next week as foster kids while we were doing the adoption home study. Then as soon as the paperwork is ready, we could adopt them. She said there were lots of families who would take the kids, so we have to decide by tomorrow. What should we do? It all seems to be happening so fast! But we've waited for seven months already. Maybe if we say `no' they won't call us again."

"When couples decide to have a birth child, there are absolutely no competency, financial, personal or social requirements by the state. Anyone capable of having sex is deemed able to have and raise a child, so how come we have to go through all of this?"

The home-study process is a stressful one for many families. One mother asked Cathy, "Should I bake something special when the worker comes? I mean, are you supposed to serve tea or something? Or would that be too obviously trying to please?" Another adoptive parent notes, " I always keep my house neat. On the fifth home visit our worker said, `I have some doubts about whether you will do well with children. Your house is always as neat as a pin and children need the freedom to be somewhat messy.' I thought, `Yeah, but the kids aren't here yet! And I knew you were coming. Of course I picked up and tried to make things look nice.' How do you know what you are supposed to do? If we had a big mess when she came would she have judged us too messy? Help! " As drawn out and intrusive as the process usually is, speeding it up could have disastrous results for the children and the families who adopt them.

Fast-Tracking, a result of curent state and federal mandates designed to clear out children back-logged in the crowded foster care system, may result in diminished screening and education of families. If the quality of placement declines, it makes sense to assume that disruptions will increase due to poor selection and preparation of adoptive parents. In the winter of 1998, an adoption worker in Texas wrote to us, saying: " I continue to work with pre- and post-adopt kids and their families. DHS (Department Of Human Services) here is "dumping" kids in care into unprepared and untrained adoptive families with lots of disruptions as a result.

The laws in Texas have changed. The intent now is to have kids in a permanent placement (either return home or adoption) within one year of the date of removal. There seems to be no accountability. " The answer is not to speed up or slow down placements, but to make better- informed placement decisions and to educate families about the realities of parenting special needs children and the impact they can have on family systems. It does not benefit children when they are placed in families ill-prepared to cope with their problems. It certainly makes little sense to fast-track a kid into another disruption and ultimately more upheaval. If families are educated about the process and helped to establish a realistic dream and reasonable expectations, much stress and anxiety can be avoided, leaving families with some reserves to carry them through the next step in the process and beyond.

A Child at Last!
Once families complete the home-study process, the home, marriage, psychological, and financial examinations are completed and criminal background checks are done, all that is left is to wait for a call from the worker saying "we have a child for you." Usually a period of transition follows, during which families and children get together to get to know each other a little before the children are moved into the adoptive home. This is called "visitation." Many adopting families are unsure of what this time means to the final placement decision. They may feel they must first make a good impression on the child, and second demonstrate excellent child management techniques to make a good impression on the worker. In essence, they may feel they must also pass some kind of a parenting test before the children are really theirs. However, many report that they do not feel empowered to parent, to set rules, impose standards of behavior, or consequence bad behavior. They fear that any negative reaction or disapproval from the children might lose them the placement. They feel they must demonstrate to all that they are fun people to be around and desirable parents from a child's standpoint. Yet most parents intuitively know that this "Disneyland" approach is not a healthy way to establish a new relationship with the children. With disturbed children especially, it is important to let them know from the beginning that "we are the parents. We are in charge until you demonstrate for us that you are capable and mature enough to make good decisions for yourself." One mother's story regarding visitation:

"I remember when we first went to the foster home to meet our three children. We drove 350 miles with a young caseworker just out of social work school. When we got to the home, we went in, met the foster parents, and sat around the living room chitchatting about the weather, kids in general, and so forth. In the back bedrooms, we could hear the kids laughing. We heard the door open and voices, saying, `you go' or `stop pushing' and then the door would slam again. All the while we continued to sit in the living room making small talk and going crazy with wanting to see the children. All of the adults seemed to be uncomfortable `wishing' the kids would come out, and every so often the worker would make half-hearted comments like, `They are naturally a little shy about coming out,' or `This must be a scary experience for them.' This was making me absolutely crazy. We did not drive all that way to turn around and go home without even seeing the kids. And the poor kids. They were too little and too uncertain to muster up the courage to come out by themselves. Why didn't someone go get them for heaven's sake? So finally, without knowing if I was breaking some unwritten rule or not, I went down and played around in the hall, and started to play a little game with the kids who were on the other side of the door: `You-know-that-I-know-that-you-are-in- there'; and soon they came running out a tumbling mass of giggles and squirms. I do firmly believe that if I hadn't taken the initiative, we would have driven another 350 miles home that day and the case worker would be saying, `These things take time.' She was heavy into the theory that says you have to respect kids' timeframes. But heck, they were only two, three, and six years old and facing a meeting with a bunch of strangers. What would they have thought about our ability to manage and take care of them if we couldn't even get them to come out of the bedroom?"

Parents should be made to feel empowered from the moment the children are selected for them. From that point on, they must have all of the rights and privileges of "real" parents, including the right to decide what is the best way to handle visitations.

"Our daughter was in treatment in Texas. We lived in Colorado. The agency wanted us to make three visitation trips to Texas to `transition' her into our home. Luckily, we weren't in the position of many adoptive parents-'needing' a child. This was a child we were willing to work with and adopt if we felt we could be helpful to her. So we just refused to make two more expensive and emotionally draining visits. She wasn't seeing the real us anyway. She was seeing people who `lived' at a Holiday Inn. So we told them we would only make one trip and if that was not going to be good enough they could look for another family to adopt her. What do you know?-it turned out that one visit was sufficient. She's 25 now and doing just fine."

Parents must act like parents from the start. This includes giving the children reasonable expectations and discipline.

"Because it was so far to the foster home, we always met our kids at a hotel between our town and theirs. Whatever the kids wanted to do, they got to do. Hotels can be a lot of fun. When they first came to our home, their first question was, `Hey, you live here? Where's the swimming pool and hot tub?' And chores? Forget it! They expected nothing but play plans and room service. When I showed them the coat pegs that they were to hang their coats on when they came in the door, they threw them on the floor and said `you do it.' It took many unhappy weeks of doing daily battle to undo the damage those visits did to our authority."

Following placement, there is often a period of time when children and parents are both looking each other over, and all are on their best behavior. That time, when it occurs, is often referred to as the "honeymoon period." But therapists and parents wise to the ways of disturbed children have half kiddingly referred to it as the child's time of "stalking the prey." Disturbed children, because of the inconsistent and unreliable responses they have received in their early life, almost always attempt to be in control of things. They will test the limits in every new situation, and try to establish dominance and control. Because prospective adoptive parents do not always feel as empowered as they should be during the initial visitation, the children (consciously or unconsciously) begin to feel that they have all the control. This locks in unhealthy family dynamics that are very hard to change after the children move in.

"Our worker said that having another child in the home would change the tone of our family. Change the tone!!! Those kids changed the whole musical score! What surprised us was that we all turned into sour notes with those kids around. But I think our being prepared with a few specialized parenting techniques, and knowing that we must be open to their feelings while showing them that we have expectations and will set and stick to firm limits, helped us get back on key sooner. "

Greg Keck, a well-known child psychologist who works with attachment disordered children, tells parents to assign chores to children during visitation and establish the same expectations and authority you intend to make a regular part of family life in your home. Making the visitation or honeymoon period akin to a trip to Disneyworld is a big mistake according to Keck. Good teachers "like to joke that they never smile until after Thanksgiving." The old adage "It is easier to lighten up than to tighten up" applies doubly to children who come from inconsistent and chaotic backgrounds.

Are We Prepared? We certainly agree with Senator and astronaut John Glenn when he says " The greatest antidote to worry, whether you're getting ready for spaceflight or facing a problem of daily life, is preparation . . . the more you try to envision what might happen and what your best responses and options are, the more you are able to allay your fears about the future. " The very fact that you are reading this book means you are interested in doing your best to meet the needs of your family. Whether you are just thinking about adopting, or have already done so, this book and some of the resources we suggest at the end of it will prove invaluable. With realistic expectations, the right tools and techniques, the correct attitudes and philosophies, and adequate professional resources, you have as much chance at success and satisfaction as anyone. The optimum time to prepare to be a special needs parent is before the children arrive, when most prospective adoptive parents have the time and energy to devote to reading and discussion. Although it is never too late, once the children arrive, the overwhelming nature of their needs will take precedence. We recommend that families approach this process in logical stages.

Prior to Placement:

Assessment: Is special needs adoption for me? (See the next section, "Think About Adopting or Foster Parenting Special Needs Children")

Assessment: How many and what kind of children am I best suited to parent?

Assessment: What are this particular child's needs? (See the section on the CHAFCA assessment tool.)

Assessment: Am I capable of meeting the needs of this particular child without sacrificing others in the family?

Parenting tools and techniques
Professional resources (physicians, mental health professionals, educators, pastors)
Support systems (groups, Internet, respite care) After Placement (if not done earlier)

Assessment: What are this particular child's needs? (See the section on the CHAFCA assessment tool.)

Parenting tools and techniques
Professional resources (physicians, mental health professionals, educators, pastors)
Support systems (groups, Internet, respite care)

Think About Adopting or Foster Parenting Special Needs Children: A Self-assessment Tool for Prospective Adoptive or Foster Parents This workbook-style course is a self-examination tool that we highly recommend to families considering adoption or foster care. It is designed to be thought-provoking and to stimulate discussion in many areas of critical importance to success in parenting special needs children. Several states have now made this a part of their adoption education process. Individuals can purchase the workbook and use it on their own. (To order call: 1-816-453-9792 or see the resources section in the back of the book for additional ordering information.) The Cline/Helding Adopted and Foster Child Assessment (CHAFCA) We have found that adoptive parents feel more secure and empowered to help their children when they have an accurate definition of what the children's problems are and what options they have for managing and treating those problems. A first step in this direction is a thorough evaluation. We have developed an effective tool that parents can use to make an accurate and complete initial assessment of their children, the Cline/Helding Adopted and Foster Child Assessment (CHAFCA). It is a preclinical evaluation that can be easily taken and scored by the average parent, and also can be used by professionals as an early diagnostic and intake tool. The CHAFCA can help determine the future therapeutic and parenting needs of the children and assess "goodness of fit" issues prior to placement. CHAFCA consists of two parts. The first obtains basic identifying information, complete medical history of the child and the family, and background information unique and relevant to adoptive/foster children. It provides an easy way to record and remember important details that are often lost or forgotten as time passes, but may simplify diagnosis and assist with treatment decisions many years later. The second part consists of twelve subtests specific to problems frequently seen in special needs adopted children. The CHAFCA can be taken in its entirety, or each subtest can be taken and scored individually when needed. The CHAFCA Subtests: Subtest 1: Emotional Health Subtest 2: Reactive Attachment Disorder Subtest 3: Oppositional Defiant Disorder Subtest 4: Attention Deficit Disorder with Hyperactivity (ADHD), with Subtest for Attention Deficit Disorder without Hyperactivity (ADD) Subtest 5: Conflict and/or Depression Subtest 6: Neurological Disorder, Learning Disabilities, and/or Developmental Delay Subtest 7: Sensory Integrative Dysfunction Subtest 8: Sex Abuse Indicators Subtest 9: Predictors of Violent, Aggressive, or Dangerous Behavior Subtest 10: Fetal Alcohol Syndrome (FAS/FAE) Subtest 11: Giftedness Subtest 12: Substance Abuse Accurate identification of the problem and early intervention are often the keys to success in parenting and in treatment. CHAFCA can help families avoid large investments in time and money, as well as potential harm to the child that can result from a trial and error approach. Parents and professionals alike are encouraged to adapt the use of CHAFCA to their individual needs. (To order CHAFCA, see the order form in the back of this book or call: 1-800-854-2344). Coming to Terms with Terminology As authors, our tools of our trade are words. Inherent in the use of words is the potential for misunderstanding. Terminology can be misleading. Both intent and meaning can be misinterpreted unless clear and precise language is used. When talking about children and emotionally charged issues, it is tempting to try to pretty up the language, to be "politically correct." It sounds less offensive that way, and it becomes easier to hide from or ignore the harsh realities. After all, when we hear about atrocities, we feel a tug of conscience if we do not attempt to do something about them. When we hear about abused children, those of us with healthy psychological makeups recoil in horror. We have been told by child welfare workers and adoption proponents that if precise terminology were used to describe today's adoptable children, prospective adoptive families might be scared away and not consider adopting at all. As a matter of fact, we have worked with agencies to design orientation materials for adoptive families that honestly describe the children who are available and the kinds of adaptations families must make in order to parent those children. Such materials are often criticized by the very families they attempt to educate. "Why would you put negative labels on these poor homeless kids? Are you deliberately trying to discourage families? Don't you know you are scaring away potential parents for kids who have no one?" We know that if families are frightened off by terminology, they probably lack the stamina and strength necessary to raise and advocate for the difficult and challenging children of today's special needs system. No one is served by placing children in families who have been misled or deceived about the child's potential or problems. Ironically, the same families who criticize our honesty often come back after adopting and say we were not honest enough! When agencies and organizations talk about adoptable children, or waiting children they tend to use the same ambiguous and misleading terminology:

Difficult to place child: This may mean simply that there are not enough families interested in adopting any child other than a healthy, same race infant, or it may mean children who are difficult to place because they will need the energy and effort of about eight parents.

Children who wait: Taken at face value, this may mean children who wait for any reason at all. Perhaps they wait because the system processes their paperwork slowly. Who knows? An ambiguous and unclear identification.

At-risk children: At risk of what, or from what? At risk of abuse? At risk of not finding a family? At risk of being lost in the system? At risk of becoming drug addicts or criminals? A very vague term.

Vulnerable children: Tugs at the heart, but if you think about it, aren't all children vulnerable in some situations? So what exactly this means is left to the imagination. Most prospective adoptive parents do not have the background and knowledge to imagine the unfortunate truth.

Special needs children: To most people this phrase conjures up an image of a child in a wheelchair or perhaps a retarded child. Many states define any child older than six months, disabled, health impaired, or part of a sibling group as having special needs. A very broad definition. However, today's special needs population consists mostly of children who have been severely damaged emotionally and/or neurologically.

The Population We Refer To and the Words We Use When writing about adopted children, we prefer not to use misleading or vague euphemisms that refer only to something outside the child. Instead, to make sure that our meaning is clear, we use terms that refer to what is going on inside the child. By using such words as "disturbed," "neurologically damaged," or "disabled," we mean no disrespect to the children. We do not wish to attach labels that will stigmatize children for life, or lock them into diagnostic categories. We do want to make sure that the reader knows exactly what type of child we mean. And we think it crucial to the best interests of the children and families affected by the tragedies of which we write that there be no sugarcoating of their problems for the sake of political correctness. Legally speaking, adoption is tighter than marriage. You can divorce your spouse, but you cannot divorce your child. Unfortunately many adoptive parents have told us they spent far less time contemplating "goodness of fit" issues before adopting than they did before choosing their spouse. Children are quite literal and concrete in their thinking. They know when we are attaching fancy labels to down-to-earth problems. They usually handle terminology the way the important adults in their environment handle them. If we are not afraid of words, they are not either. If we do not shrink from discussing disabilities, they do not either. When we speak honestly and with respect to our children about their disabilities and handicaps, they learn to rely on our honesty and openness, and know that they can be direct, straightforward, open, and honest with us in return. No subject is too hard to talk about. Even their disabilities. One of our fetal alcohol affected children became involved in an effort to pass legislation mandating treatment for pregnant women who drink or abuse drugs during the third trimester of their pregnancies. At age nine, even with severe learning disabilities, this child was able to tell others "When my mom was pregnant with me, she drank a lot of alcohol and it infected my brain, so now I have trouble learning and doing things other nine year olds can do easily. That makes me have to work harder and feel different. I think this law is important so other kids don't have to be born with damaged brains like mine." This child has excellent self-esteem, is happy, and is as well adjusted as any child with her limitations could be. But she has struggled more than most, and knows it. Terminology does not worry her. She is more interested in truth and in helping others. Out of the mouths of babes . . . ! When talking about some special needs children, we may refer to them as "mentally ill," or as having a "psychiatric disorder." It is important, especially for prospective adoptive parents, to recognize and accept that this term does apply to many of these children. For example, children who are described as "having difficulty attaching," or "having trouble bonding," or more ambiguously "may take some time learning to trust," may have a psychiatric disorder called Reactive Attachment Disorder of Early Childhood. This is a diagnostic category found in the American Psychiatric Association's Diagnostic and Statistical Manual, the book used to define mental illness. Although it has its roots in early childhood, it is a serious disturbance that has lifelong implications for children and families. The bottom line is that children with attachment disorder are seriously mentally ill. Effects of Infant Abuse and Neglect Few Americans understand the lasting effects of infant abuse and neglect. To understand the corrective responses disturbed children must receive, and parents or caretakers must apply, it is necessary to understand the basics of how early trauma plays such a pivotal role in their problems. The importance of the first year of life for both cognitive and personality development cannot be overemphasized. It has been estimated that half a lifetime's knowledge is gained during the first year of life. During the first year the infant organizes visual perception and auditory reception, learns reciprocal response, develops loving and/or conflicted relationships, forms the basis for cause and effect reasoning, and lays the foundation for gross motor skills. What a year!9 University of Chicago pediatric neurologist Dr. Peter Huttenlocher has chronicled this extraordinary epoch in brain development by autopsying the brains of infants and young children who have died unexpectedly. The number of synapses in one layer of the visual cortex, Huttenlocher reports, rises from around 2,500 per neuron at birth to as many as 18,000 about six months later. Other regions of the cortex score similarly spectacular increases but on slightly different schedules. And while these microscopic nerve fibers continue to form throughout life, they reach their highest average densities (15,000 synapses per neuron) at around the age of two. By the age of two, a child's brain contains twice as many synapses and consumes twice as much energy as the brain of a normal adult.10 This organic circuitry enables our brains to organize and use information, to produce and process the chemicals we need to remain emotionally stable and healthy. Once in place, it cannot be rewired. Flaws in this structure affect our ability to think, feel, move, see, and hear for the rest of our lives.11 During the early years, there is an almost magical dance that takes place between the developing brain and the child's environment. This interaction is responsible for much of what makes us human. Studies have shown that if the environment does not provide the right stimulation, if a child is neglected, abused, or otherwise deprived at this critical time, that child will grow up functionally retarded.12 At each early stage of brain growth, there is neurological readiness for internalizing particular concepts.13 Thus, in a stage-specific and critical window of time, the brain is ready to learn trust, to learn causal thinking, to learn language, and so on. If the developing child's environment does not provide the essential stimulation at the critical period, the optimal time for learning that concept, the ability to learn that concept may be irreversibly lost. The theory holds, for instance, that language development best takes place in the second and third years of life. It is not that some people cannot learn a foreign language at a later time, but that it is much more difficult once past that critical window of opportunity.14 The brain must use adaptive functioning, which is successful in varying degrees in different people. Adaptive functioning is never as good as learning something the right way at the right time. The brain rapidly weeds out unused connections during this time as well. It is known, for example, that if Asian children do not learn how to pronounce the English r sound, it becomes almost impossible for them to pronounce it later, and "Roger" will always be "Lodger." The Asian languages do not use this sound, the child does not hear it spoken, and so the brain eliminates the ability to pronounce it as it structures for efficiency. The complexity of such simple skills cannot be underestimated. For example, learning disability specialists have discovered that there are 45 individual brain functions associated with telling time, ranging from the interpretation of the visual- itself a complex task-to understanding spatial and mathematical concepts.15 A glitch in the neural wiring anywhere along the way will eliminate that ability permanently and an adaptive substitution will have to be found. The longer the environment deprives the individual of critical input, the more difficult or even impossible it will be to learn the concept or skill later. In our collective years of research and work with children and families, we have found that deprivation during the first years of life may be nearly impossible to overcome later, despite years of excellent therapeutic and educational intervention.16 This may be one of the hardest realities for families of special needs children to face-the irreversibility of this damage.

First-year Development Briefly Explored
Contrary to what we thought in the past, the earlier the developmental year, the more important it is for later cognitive and personal development.17 The experiences of the first three years of life are critical in this regard.18 The first year lays the foundation for four essential and related human thought and personality traits:

1. Causal thinking
2. Conscience
3. Basic trust
4. The ability to delay gratification

The first year plays an essential role in laying the foundation of these four basic personality variables. Upon these variables, civilization is built, love is exchanged, people live happily or unhappily together, relationships last or crumble. If we meet a person walking the streets at night who lacks these, we're dead. Without these critical elements, civilization as we know it is lost! Without these elements, critical thinking is impossible and intellectual and emotional growth is permanently stunted.

Among the first circuits the brain constructs are those that govern the emotions. Beginning around two months of age, the distress and contentment experienced by newborns start to evolve into more complex feelings, such as joy, sadness, envy, empathy, pride, and shame. Abuse or neglect at this stage can produce heightened anxiety and abnormal stress responses that can become hard-wired for life.19

Causal Thinking
All of childhood responsibility and responsiveness is based on causal thinking. It is necessary for understanding and learning from consequences, and for delaying gratification. It plays an important role in respect, responsibility, reciprocity, and all tasks that call for planning ahead. It provides the foundation for most learning and for appropriate identification of and response to emotion.

Conscience Development
Conscience development can only take place with the development of causal thinking. The rudimentary foundation of conscience takes place in the first months of life when a child learns that "My actions can make mom happy. When she's happy, things turn out well for me." Conscience is based on the ability to put ourselves in another person's shoes and imagine what they might be feeling. This can only occur if there is consistent early nurturing from a mother figure. If an infant is treated inconsistently, the developing brain circuitry wires chaotically.

This is very often the case with drug or alcohol-abusing caretakers who, depending on whether they are drunk, stoned or sober, respond with appropriate love and nurturing or with inappropriate anger and abuse-to the same situation. The baby cries, and mother picks her up and feeds her. Or, the baby cries, and mother smacks her. The infant brain can make no logical sense of this input. So when the child attempts to use its `logic circuits' later in life, the response is just as chaotic and inconsistent.20 Abuse and neglect destroy the development of both causal thinking and conscience without which a child cannot understand why things are right or wrong, empathize, feel remorse, have a positive self-image, feel guilt, or want to mend their ways.

Basic Trust
Eric Erickson, a noted psychologist, remarked in his pivotal essay, The Eight Stages of Man, that the primary task of the first year of life was the development of "basic trust."21 This, too, can only develop in a consistent, responsive, and loving environment. Basic trust, upon which all functional human relationships are based, is the knowledge that people are generally well intentioned and worthy of trust, and that there is a logic to the world that also can be counted on. When a child, after early traumatic experiences, is unable to learn to trust his parents and rely on their logical consistency, he becomes a constant control problem. He does not trust others to make good decisions for him, or to have his best interest at heart. Therefore he feels he must always control things himself, must always do things his way, or he will lose (or die).

The Ability to Delay Gratification
The foundation for this is laid in the first year of life, when a mother says "Wait a minute honey, I'm coming," or when the child quits crying as he watches his food being prepared, knowing he is about to be fed. When a person has to be gratified instantly, when waiting is impossible, then almost all higher order thinking, from accepting responsibility to avoiding AIDS to planning a chore or homework, does not exist. The ability to save money and hold a job is lost.

We live in an increasingly violent society. Much of this violence stems from a need to receive instant gratification without expenditure of effort. Entitlement is rampant in schools, labor and job disputes, welfare programs, and the justice system. The nature of violent crime has changed over time, and its current state is far more dangerous to society than ever before. Today we face much more senseless violence then ever. Or, as one Denver policeman put it, "It used to be that when somebody was killed, it was because `somebody done somebody wrong.' But now people shoot into a house simply to see the bullets fly."

In the mid-1990s, for the first time in history, Americans were more likely to be killed by a stranger than someone they knew. The problem will not be solved by tighter gun control. Americans have always had guns. The root of the problem lies in the hardwiring of the brain of the person pulling the trigger, not the hardware in the holster. In Evergreen, Colorado, at a large mental health clinic that works with severely disturbed children from all over the world, one therapist notes, "If a child has had a good first three years of life, and there is no substance abuse in pregnancy, even if the symptoms are severe we can almost always reach the kid. If there has been early abuse and neglect, even if the symptoms are mild, all bets are off."

Neurological Changes
Even more fundamental, says Dr. Bruce Perry of Baylor College of Medicine in Houston, is the role parents play in setting up the neural circuitry that helps children regulate their responses to stress. Children who are abused early in life, Perry observes, develop brains that are exquisitely attuned to danger. At the slightest threat, their hearts race, their stress hormones surge, and their brains anxiously track the nonverbal cues that might signal the next attack. Because the brain develops in sequence, with more primitive structures stabilizing their connections first, early abuse is particularly damaging. Says Perry: "Experience is the chief architect of the brain." And because these early experiences of stress form a kind of template around which later development is organized, the changes they create are all the more pervasive.22 Neurological changes stemming from early abuse and neglect may be even more devastating than psychological changes, and in many cases have a direct effect on emotional responsiveness. Animal studies show that mammals neglected and deprived in their infancy show neurological changes that can be seen on brain scans. EEG results appear with abnormal spiking, and the pattern is predictable.23 Thus, children who have suffered from early abuse and/or neglect often have a combination of psychological problems and neurological deficits. Many are diagnosed with a learning disability.24

Second-year Development Briefly Explored
The major task of the second year of life is for the child to learn "Basic German Shepherd." Children learn to obey "Come, sit, go, no, stay" messages from loving authority figures, and to take "no" for an answer. In other words, to accept control and authority. It is only this ability to respond lovingly to the requests of others that allows parents to encourage and permit autonomy and independence, which are the goals of the second year of life.

A disobedient toddler who doesn't respond to his parent's requests, lives in an anxiety- filled world where he is the boss; a world where limits are uncertain, and where parental frustration mirrors the toddler's anxiety. Knowing instinctively that he is unable to control and take good care of himself, he feels unsafe and threatened by others. Not knowing who, if anyone, can be trusted, he relies on his impulses to govern his behavior. Weighted down by stress and emotion, the child is generally slow to learn, impulsive, has no boundaries, and appears hyperactive.

Thus, the "normal" first year with its foundation of basic trust, and a "normal" second year with its essential elements of control, limits, and rules which the child must internalize, are essential for the development of a child who can focus, learn, and interact normally with others. At the end of this time, if all goes well, the foundation for socialization, productivity, and civilization is set. The seeds of responsibility and respect have been planted.

Poor experiences in the first two years may be at the root of many problems faced by our schools today. These problems include learning disabilities, behavioral disorders, ADD or ADHD, and to a lesser extent many control issues, impulsivity and attention problems, and motivational deficits. Input very much equals output during these years, and it behooves us to look closely at the quality and consistency of input our children receive long before they enter Head Start or other types of early childhood programs. Many such children live in poverty-stricken neighborhoods where poverty erroneously gets the blame for the dysfunction in the family and the disability in the child. In our fairly extensive experience with impoverished parents, we have seldom found a lack of monetary resources to be the primary problem. These families are socially impoverished, and the financial poverty that is so easily recognized and measured is merely a secondary problem. It arises from the parent's own inability to focus and sustain attention, think causally, take responsibility, and maintain lasting reciprocal or loving relationships. It is a generational cycle that is being repeated in the child.

Customer Reviews

Can This Child Be Saved
This book is an excellent resource for both parents and direct care-givers. Although a lot of space is given to adoption and foster care concerns, it is helpful for anyone dealing with reactive attachment disorder or children who are not adopted but have attachment issues. Ann Kelley, LCSW, Tulsa Boys Home.

Full of hopeful realisim.
Here is a book that shows some of the difficult sides of adoption, and yet offers MUCH hope for those who love and parent them. It is honest, and thoughtfully written, with practical advice and guidance.

A Real eye-opener
For anyone thinking about adopting an older child, this book is a must read but put it LAST on your list. If I had read it first, I probably would have dropped the idea altogether. It is full of frightenning examples of how adopting an older child can lead you and your family down a path to ruin. It does give techniques to deal with and hopefully change some of the disturbing behaviors you may encounter. Most important, it tells you what issues a child has that may lead him to these behaviors.

It will arm you with knowledge needed so when you're given a referral, you'll have a much better chance of choosing a child who will grow and thrive in your family instead of tear it apart. There are so many kids waiting for adoption that CANNOT be saved no matter how you try. You owe it to yourself and your family to read this book. It can help you make the right choice that could literally save your lives.