Friday, October 15, 2010

If You Could "Return" Your Challenging ADHD Child, Would You?

Like many parents in the attention deficit hyperactivity disorder (ADD/ADHD) community, the adoption community (the two overlap more often than you might realize), and the general 24/7-news-consuming world, I've been following -- with mixed emotions -- the heartbreaking saga of the 7-year-old Russian boy, Artyem Saviliev, whose adoptive mother, Torry Hansen, sent him back to his country of origin all alone on a plane.

On the surface Hansen's actions seem heartless, thoughtless -- the way she shipped him back, almost as if he were an impulse buy, a foreign good that arrived damaged. Would-be adoptive mother Hansen has explained her actions by citing the Russian child's "severe psychopathic issues," violent behavior, and mental instability. Since then ABC news has reported that the Russian officials who examined the boy upon his return to the country question whether these mental health and behavioral issues exist.

Regardless of Hansen’s claims -- and whether they are truthful or not -- is a child's challenging behavior enough of a reason to do what she did? Would we have done the same thing in her shoes? Is it our place to judge her?

Although I can’t claim to understand this woman’s experience, as the adoptive mother of a 9-year-old Russian daughter who came to this country at age two and a half with then-undiagnosed ADD/ADHD, anxiety, sensory processing disorder, and prenatal exposure to alcohol, I do understand exhaustion. I understand desperation. I never for a moment entertained fantasies of sending Natalie back to Russia, but I certainly had moments when I believed that nothing short of an army of nannies and housekeepers could get me through another day. Each of these conditions have since presented many real parenting challenges (which I blog about).

Still, this woman's actions have left me just...speechless...floored...and overwhelmed by complex, unanswered questions. After days of rumination, these are the questions that linger in my mind:

On the Diane Rehm show last week, Thomas DiFilipo, president and C.E.O. of Joint Council on International Children's Services, said that Hansen had contacted an expert in attachment disorder, but had failed to recognize her responsibilities as a parent.

If she did seek assistance, I wonder what services were available and easily accessible in her area. One would hope, but couldn’t assume, that she had options to help with everything from expected adjustment and attachment problems (therapy) to middle-of-the-road, but still likely issues (outpatient evaluation by a mental health professional, medication, and therapy) to a “worst-case-scenario” (inpatient evaluation and treatment and residential treatment), and that an adoption professional was there to help her through the process.

It can be difficult to navigate the system. Even with 16 years of experience working in human services, it took me forever to find the right resources for our family. I remember more than once dropping my daughter Natalie off at pre-school in tears (mine, not hers!) and crying to her special ed consultant or teachers that I needed help, just to be told, again and again, that we didn’t qualify for any services. It was several years before Natalie’s occupational therapist said to me, “What do you mean? There is help. I think you’d qualify,” and told me about Iowa's Children’s Mental Health Waiver, which, as I've blogged about, has saved my sanity.

Danette Schott, an adoptive parent whose struggles to find diagnosis and treatment for her Russian child led her to write a series of guides to help parents in similar situations, confirmed that figuring out how to find help is a common problem for parents. "It’s tragic that this mother thought this was her best option. Although I do not condone her actions, I can understand her [apparent] feelings of being confused and overwhelmed. Outsiders looking in may wonder in this 'information age' how something like this can happen. But I found that although there is an abundance of available information, most parents do not know where to start. When I started searching for help for my child, I couldn't find any resource that stepped special needs parents (both adoptive and biological) through the problem-solving process."

Do any parents who adopt? Do any parents who give birth? As a mother to a biological son, and an adopted daughter, I can say that to some extent, adopting gives the illusion that the parent has a degree of choice about the characteristics of the child they are adopting. When we adopted Natalie, we specified that we wanted a three- to four-year-old girl with no special needs. Well, one (her gender) out of three ain’t bad! When Natalie was referred to us, she was identified as having a special need, but it was labeled a "medical issue" -- not a psychological or behavioral one. The referral information did describe developmental delays, but that was to be expected in an orphanage environment, we thought.

When we met Natalie for the first time, we realized that her problems were very serious, but we were still mistaken about what they were or would become. We judged her to be an intellectually disabled child who we feared would never learn to talk, read, or write. But, my husband Don and I agreed that we wanted this child, and already loved this child.

By this point we had already waited several months longer for our referral than was the norm at that time. Then, when we first set eyes on Natalie, wearing a silly purple dress, her eyes big and sad, with scratches on her face from a fight with another child, it really was a case of “love at first sight.” I literally watched Don fall in love with her when he held her for the first time, and felt that same love inside. Neither of us had a second thought about accepting this referral. When we did so, we believed it was with our eyes wide open.

It wasn’t until we left the orphanage with Natalie that her ADD/ADHD wild side started to emerge, along with her resilience, determination, and smarts. In other words, we had no idea what we were getting into! Had we known what Natalie’s challenges were -- we wouldn’t have changed our minds, our resolve to be her parents, but, it would have been helpful to know!

So, what about parents who don’t desire the lifestyle changes required to raise a child with special needs, or aren’t equipped -- emotionally, intellectually, financially -- to do so? (Like I am?) Does their desire to parent only "normal," "healthy" children make them bad people? Isn’t it a positive that they know their limitations? Or, is there such a thing as "typically American parents," who are by-products of a larger global consumer culture?

If so, what can be done to move the adoption culture from a consumer mentality (providing a satisfactory child to every potential parent) to a humanitarian one (finding the right family for every child)? Have the international adoption guidelines set forth by The Hague Convention on the Protection of Children and Co-operation in Respect of Inter-Country Adoption (put into practice in the United States in early 2008) started the ball of change rolling around the world? Will The Hague Convention requirement for potential parents to receive 10 hours of pre-adoption training make a difference? One would hope. Although I read every related book I could get my hands on, that requirement wasn’t in place when we adopted.

And that research didn't prevent me from experiencing what I would call the "hurt child vs. unsatisfactory product" mindset demonstrated by Hansen's story. During one of our post-adoption-placement visits with a social worker, in the first year or two after Natalie joined our family, I was sharing our family’s challenges. I was talking about my continuous exhaustion. Describing my daughter’s hyperactivity. Her frequent tantrums. The social worker stopped me, and said, “Well, you knew she had special needs when you adopted her, didn’t you?”

I was a little insulted. I hadn't been complaining. Well, maybe I had been, but not about Natalie. I wasn’t expressing dissatisfaction that I was assigned a difficult child. Couldn’t I admit that life with Natalie was terribly hard and still want her and love her? Wasn’t it appropriate for me to admit -- to our adoption social worker of all people -- that maybe I needed help? Couldn’t I tell the truth without being lumped in the camp of the dissatisfied consumer?

As I was listening to the Diane Rehm show cover this topic I was surprised to hear one of the guests, Jane Aronson, M.D., a pediatrician and well-known expert in international adoption medicine, say that she knows of many similar cases -- of parents returning “unsatisfactory” kids to their country of origin. This case, for some reason, just happened to make the news.

Dr. Aronson stressed that every child in an orphanage will have issues related to that experience, not to mention the potential for mental health problems due to other factors such as lack of prenatal care.

I don’t have answers to these questions, or any others. The world may never come to know the whole truth of this particular situation. But, hopefully, some good will come of it -- conversations, realizations, evolving attitudes, better information transfer between adoption agencies and prospective parents, easier access to mental health care -- a counterweight to all the bad.

My thoughts are with all of the families in the process of adopting, and I’m sure I speak for the whole ADDitude community when I say I hope you will soon be given the honor of bringing your children -- however “special”-- home. (And once you do, if your child turns out to be as “special” as ours, we’ll be here if you need us!)

ADDitude asked, "How have you been reacting to the news coverage of the adoptive mother who sent the Russian boy she adopted back to his country of origin alone on a plane -- citing 'behavioral' and psychiatric issues as her reason? As parents of ADD/ADHD children, or adults with ADD/ADHD, what do you make of this story and how people are covering it?"

Denise Moreau said, "I find this whole story incredibly sad, that poor child. If he did have problems before this, I can only imagine how traumatized he is now. I hope that he finds a family who is willing to love and care for him, whatever his needs may be."

Lisa Crandall said, "This is heartbreaking to me, having ADD/ADHD and [being] an adoptee. Thank God my adoptive parents had unconditional love and realistic [expectations] about what they were getting into."

Kris Ferro Manes said, "The story made [me] sad. Both my sons are adopted and I would not dream of sending them back for any reason. The day I adopted them they became mine. I think when you are a parent and you are having difficulties with your child you have to keep seeking help. There is someone who is going to be able to help your child."

Theresa Nagle said, "I adopted [two] daughters. The first was and is everything [and] more, even with her special needs, that any parent could wish and hope for. The second, we were told in writing, was quiet and sweet -- she wasn't and isn't. She has emotionally attacked my [two] younger children. The social worker who interviewed us before the [second] adoption also knew that we were in the midst of marital problems, but recommended us anyway. After [one and a half] years of trying with her, I knew she needed different parents and contacted many people and agencies, the adoption agency included. Looking for help, I was ostracized, demoralized, threatened, and received no help, whatsoever. I could have found her a good home in my own town, [but] no one would lift a finger. Now she is with my [now] ex-husband, who takes very poor care of her to the lowest acceptable level required by the county...I take care of all of the special needs and beyond of my [two] other children... There are several parts of the system that need to be addressed."

If you could somehow reverse your child's ADD/ADHD diagnosis, without medical consequences, would you?


View the original article here