of the Causes of Behavioral Issues
Behavioral issues among internationally
adopted children seem to be on the rise and, despite often enormous
(emotionally and financially) efforts to cope with them, the parents
often see no significant results.
is a situation described by a parent:
boy is now 11, came just after he turned 2. He has anger which I think
is directly related to fear. As he gets older it is becoming more difficult
to manage this behavior. We have seen 3 psychologists, none of which
have had any impact. I am getting very concerned about how to manage
this before he becomes an independent teenager and uses this anger in
the wrong way. He is a very self centered child who ensures his needs
are met first. He can be very disrespectful to women in that he wields
his strength and can be very very defiant. We have tried rewards, bribing,
punishment etc etc to no avail. Who can help us, as I do not want to
subject my son to any more services unless I am convinced it will make
Dr. B. Gindis answers:
If you were in NY, I would suggest an interview and an a neuropsychological
assessment of your son. Based on this evaluation, a treatment program
would be developed. What you described in your message, is present as
a symptom in PTSD, anxiety, attachment, or a combination of them
only differential diagnosis can tell (and it is not an easy task!) Because
you do not live in the US and it's impossible, I would suggest the following:
Rule out all gross neurological
Analyze your childs behavior to see if there
are any environmental triggers for his defiant and oppositional behavior.
Usually a combination of the following is helpful: medical management
(to control high anxiety level), a package of parental techniques
to manage behavior at home, and an individual or family therapy to
address specific issues.
We are far from suggesting that there is
any one "correct" method to straighten up an out of control
child and give back the adoptive family their normal and manageable
life, but developing a plan of working on a problem is a start. We asked
Dr. Gindis about his methodology of addressing his patients' issues
- a planned approach which he calls a "road map to recovery".
The plan is based on consistent exclusion of the most generic, neurological/psychiatric
conditions of abnormal behavior first, followed by more specific and
localized issues, or, figuratively speaking, it's based on "searching
for the forest before you start looking at a separate tree."
Below is a compilation of the basic steps
in Dr. Gindis' methodology with commentary and links to relevant publications
from our database.
the leading syndrome and concentrate on determining its origin.
It may be a neurological impairment, or a psychiatric disorder, or a
pattern of learned orphanage behavior, or defective parental technique.
It may be a combination of several problems, but what is the underlying
issue? A thorough neuropsychological assessment will give you a definitive
answer if your child's neurology is compromised and at the center
of your issues. This kind of assessment can help to rule neurological
impairment out as well.
Boris Gindis, Ph.D.
does my child need: neuropsychological or psycho-educational assessment?
Direnfeld, MSW, RSW
and Managing School-Age Children with Behavioral Problems
2: If the
leading syndrome is a psychiatric disorder or neurological impairment
(from ADHD to Asperger's, to child's depression, etc.), an effective
medical management must be involved. Medication, medical monitoring
and on-going consultation with a psychiatrist are the key.
Boris Gindis, Ph.D.
3: If the
child presents significant behavior issues at school, school-based IEP
is created with the following components:
Defined level of instruction,
Test taking modifications,
Proper teaching and remedial methodology,
modifications and support for school personnel,
Boris Gindis, Ph.D.
Your Rights: Disability Manifestation Determination for Your Child
4: If the
problem behaviors are mostly at home, family therapy or counseling may
Arthur Becker-Weidman, Ph.D.
Gary Direnfeld, MSW, RSW
of Control and Pseudomature Teens
help parenting a teen?
In more intense cases referral to a respite agency
for parents may be due. Remember the old safety rule on aircraft: in
case of emergency, put the oxygen mask first on yourself and then on
your child. Estimate your tolerance for frustration when dealing with
these behaviors. Ask for respite. Ask for help. Talk to fellow adoptive
parents. Talk to professionals. Sometimes just a discussion with an
experienced professional may be therapeutic in nature and helpful in
5: If nothing
else helps, and the parents can't cope any longer, specialized treatment
centers for children may be an answer.