Spring 1999 Issue

Raising Adopted and Biological Children
by Laura Ellman, LSW

Many different factors shape the relationship between a parent and child. These may include birth order, gender, mutual interests and personality compatibility. When a couple or individual decides to adopt, they sometimes wonder what effect the adoption will have upon their relationship with their child. Prospective parents often raise the following questions: “Will it be different raising an adopted child instead of a biological one? How will the absence of a genetic bond effect our relationship?” Although it may be difficult to ever answer these questions, adoptive parents still may think about them.

In an effort to gain insight into parenting children who have entered a family in different ways, several parents agreed to share their thoughts on this subject. All parents interviewed are raising both a biological and an adopted child whose ages range from 3 to 12 years.

Parents uniformly described the initial bonding process with their adopted child as different from that with their biological one. “Patience and realistic expectations” were repeated phrases as parents remembered the first few months with their adopted child. One mother said “My daughter came with a past life. I had to learn to be sensitive to her cues both physically and emotionally for the first month at home. She did not like too much hugging and seemed to withdraw the more we worked to engage her.” In retrospect, she feels that her daughter was grieving for her past and was frightened and confused in her new home. Over time she began to trust and bond with her parents and is now comfortable with all types of attention.

The lack of information about their children’s time in the orphanage was frustrating for several parents. One father said that it was harder to set limits with his adopted son because he felt guilty about his time in the orphanage. A mother said that when her adopted son had tantrums and was physically aggressive, she and her husband worried that these behaviors were a result of his 15 months in the orphanage. She said that it was helpful to talk with other parents of male toddlers and to learn that her son was pretty typical. After their first year together, she and her husband no longer speculated as much about his past.

All parents agreed that on a daily basis, they do not view their children differently, nor do they think in terms of adopted or biological. Parents of verbal children talk with them about adoption, but all stated that they do not dwell on the topic. Most parents anticipated that as all of their children mature, their questions and understanding of the adoption will increase. Several parents said that they work hard to be honest with their children and to answer their questions in an age-appropriate way.

One mother emphasized that the time she and her husband have spent honestly discussing their feelings about infertility was extremely beneficial. Their years of infertility were very difficult for them and they involuntarily reacted with mixed emotions when thinking and talking about their son's adoption. She said that while she may not be able to control her memories, understanding them has allowed her to focus more on her children's needs.

In our sample, parents report that there is not a difference in the quality and depth of their relationships with their children, regardless of how they came into their family. Parents acknowledged that different children will at times require varied amounts of parental attention, and that all children, biological and adopted, have unique profiles and needs. The ability to be honest with oneself, to respond to the individual needs of a child, and to communicate openly seem to be common values in individuals that state that their families are doing well.

 

From the Director's Desk: Sonya Girel

Adopt-A-Child has enjoyed a busy fall and winter, and while we like to be busy, we are looking forward to spring.

Our Parent Network hosted a gymnastics and roller blading party at the Sewickley YMCA in December. Over 100 children and parents visited, played, tumbled, and roller-bladed to lively music and good company. Delicious pizza was provided by the brother of Guy and Tammy Celeste, who is also the Godfather of Kristina Celeste. Many thanks to Guy and Tammy Celeste, Terri Cook, Carolyn Kunkle, and Diane Thomas for making this party such a success.

I would like to thank our parents for all of the beautiful letters that were submitted in support of Adopt-A-Child in the last few months. Your letters and the pictures of your children have been sent to Russia where they will be reviewed by various government officials.

Our Parent Network Speaker Series continues to attract a large number of our clients. In the fall, parents enjoyed discussions on effective parenting and Russian history and culture. Sherry Anderson, the adoptive parent of 8, recently spoke to a group of over 30 people about talking to their children about adoption. If anyone has ideas about future discussions, please let us know.

 

Understanding the Medical Report
Part 1
by Laura Ellman, LSW

When deciding to adopt a particular child, prospective parents will receive a written medical report with specific information about the child. The following information from articles by Dr. Dana Johnson, Dr. Jane Ellen Aronson and the Russian Adoption Medical FAQ will aid in the understanding of this written document. It is also important to have the medical report evaluated by a knowledgeable medical professional.

Each child is examined by a physician in the country of his/her birth. The report is the written record by the examining physician. When one interprets information from a different culture, one must look at it through a different lens than one would use if the report were from the United States. Taking into account the medical system in the country of the child's birth is a must when reading the report. According to Dr. Eric Downing, "Russian physicians practice medicine differently from most physicians in the United States. Diagnostic categories are different, concepts of pathophysiology are different, methods of assessment are different, the psychology of physicians is different, etc."

Another difference in the Russian Medical System is that the children are examined by pediatric neurologists rather than pediatricians as in the United States. This may be the reason that usually there are vague, but rather alarming references to Central Nervous System diagnoses such as perinatal encephalopathy, pyramidal insufficiency, etc. Generally a detailed history and description of physical findings to explain the diagnoses are lacking. All together these diagnoses indicated that at least 85 percent of the kids had developmental delays or neurological diagnoses according to their records. Any child growing up in an orphanage is going to have developmental delays, but the vast majority of these other diagnoses are indiscriminately applied. An analogy: If a physician examines 100 children and diagnoses ear infections in all of them, he or she will be right some of the time. Likewise, if a physician diagnoses perinatal encephalopathy all the time, he or she will be right sometimes. Parents and their physician must look beyond these diagnoses to ascertain whether a child has a significant condition.

If a diagnosis is verifiable, parents and their physician must try to determine the duration of the problem: is it an acute illness? Is it a chronic illness? In some countries children will be hospitalized for weeks or even months with relatively minor conditions for which they would never be admitted here-thus duration of hospitalization often has no bearing on the severity of the problem.

In addition to the above diagnoses, facts about growth make up the first part of the medical report. Because weight, height, and head circumference are often the only objective information present in the child's medical record, prospective parents and their physicians are commonly confronted with assessing the health of a child based solely on this information. However, growth may not be optimal prior to the child's arrival in this country.

Plotting the height, weight and head circumference that appear on the medical abstract is a key facet of the medical evaluation. How the child looks on a standard growth curve is very important. Development and growth are based on conceptual age, not chronological age. Most children in orphanages are undernourished and even if they start out a birth at an average weight and height, they generally do not maintain that growth velocity due to poor nutrition and institutionalization. One of the common errors physicians make in trying to assess a child’s growth in the country of origin is forgetting to correct for prematurity. It should also be understood that the birth weights of children in Russia are well below the average weight of a newborn in the U.S. Parents need to recognize that measurement can be unreliable. Babies are notorious for squirming and measuring lengths is problematic even in the U.S.A. If the child is failing to thrive by the weight and height parameters, Dr. Aronson writes that she is “still optimistic since the vast majority of these children catch up.”

In the next newsletter, medical report coverage of psychological/cognitive issues and general state of health will be addressed.

 

1. “Medical Issues in International Adoption,”
by Dana Johnson, M.D., Reprinted with permission from Adoptive Families, Jan/Feb 1997
2. www.imc.ru/adoptionFAQ.ht
3. “Guidelines in understanding and interpreting medical and video reviews from Russia,” Dr. Ellen Aronson, Director, International Adoption Medical Consultation Services