Newsletter
#90 for Internationally Adopting Parents
June 5, 2008
PAL Center Inc.
 Ask Dr. Gindis a Question |
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Q. I've recently adopted twin 4 year old boys from Russia. They were in an orphanage for almost 4 years. They both are much more delayed in speech, intellect (borderline range), PT and OT, behavioral and social skills than I expected. Do kids typically recover from these kinds of delays once they are in a "normal" home setting and receiving services? A. There is no generic answer for your question: a lot depends on the following factors:
Generally, the earlier and more comprehensive remediation is available, the better the results will be. The children will definitely catch up to some extent, but any meaningful prediction can be made only when their proper diagnoses are established. Children are very resilient. We have seen the cases when, with an appropriate support and remediation, even some borderline/MR children grew up to attend special programs in colleges. What's important, though, is that these children are emotionally very fragile and the parents need to be sensitive not to push them beyond their limits. B. Gindis, Ph. D.
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Self-Harming Behavior in Children
Recently the doctors and therapists at the BGCenter became involved with treatment of a number of self-cutting cases in the adoptive families - a disruptive and scary experience for the parents and school personnel searching for the explanation and the right approach to solving this problem.
We collected some data below with the initial overview and directions for parents and teachers who are usually the first responders in such cases.Types of self-harm (Fiona Gardner from Community Care)
- Cutting, ripping or tearing the skin or pinching the skin to cause bleeding or a mark. Cutting is the commonest form of self-harm used by more than two-thirds of those who harm themselves. The cutting can make superficial, delicate and designed incisions that can heal to leave no visible scar, or can cause deeper cuts which leave permanent scars and lumpy flesh.
- Banging or punching parts of the body (usually the head or knuckles).
- Branding - burning self with a hot object: iron, matches, cigarettes, cigarette lighters, hot water or cooker hot plates.
- Friction burn - rubbing a pencil eraser on your skin.
- Carving signs or words onto the skin (usually arms, thighs, or stomach).
- Pulling out large clumps of hair.
- Re-opening wounds.
- Deliberate overdosing on over-the-counter drugs when this is not consciously intended as suicide.
Who harms themselves and why?
Epidemiological findings show that self-harming behavior usually begins in children over the age of 11 and increases in frequency in adolescence. An Oxford study in 2000 found that approximately 300 out of 100,000 males aged between 15 and 24 years, and 700 out of 100,000 females of the same age, were admitted to hospital following an episode of self-harm during that year.
The following are the principal factors associated with increased risk of self-harm among children and adolescents: mental health or behavioral issues, such as depression, severe anxiety and impulsivity; a history of self-harm; experience of an abusive home life; poor communication with parents; living in care or secure institutions.
Those who harm themselves usually see it as a way of dealing with an immediate anxiety. Some see it as a way of feeling in control. They may also believe that the wounds, which are now physical evidence, prove their emotional pain is real.
Wikipedia explains: Many self-injurers report feeling very little to no pain while self-harming. They face the contradictory reality of harming themselves while at the same time obtaining relief from this act. For some self-injurers this relief is primarily psychological while for others this feeling of relief comes from the beta endorphins released in the brain (the same chemicals that are thought to be responsible for the "runner's high"). Endorphins are endogenous opioids that are released in response to physical injury, act as natural painkillers, and induce pleasant feelings and would act to reduce tension and emotional distress. In individuals with developmental disabilities, occurrence of self-injury is often related to its effects on the environment, such as obtaining attention or desired materials or escaping demands. As developmentally disabled individuals often have communication or social skills deficits, self-injury may be their way of obtaining these things which they are otherwise unable to obtain in a socially appropriate way (such as by asking).
The diagram depicts a psychological mechanism of self-injurious behavior.
In general, the attention of a mental health professional is needed in every case, but a lot can be done by parents and school personnel:
- Self-harm serves a function for the person who does it, so observing the child and finding the real cause for this occurrence is essential.
- Self-harmers lack the necessary skills to express strong emotions in a healthy way; thus behavior therapy that teaches socially appropriate ways to express feelings is helpful.
- Self-harming behavior is an attempt to maintain a certain amount of control, which in and of itself is a way of self-soothing; teach the child to control things through detailed planning, writing down things to do and checking them out as they are accomplished, and other techniques.
- Self-harming may be caused by excessively strict and "cold" treatment in the family: let the child know that you care about them and are available to listen.
- Encourage expressions of emotions including anger via socially acceptable channels.
- Involve the child in activities that can enhance their sense of worth and control.
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