Newsletter #61 for Internationally Adopting Parents
May 17, 2007
PAL Center Inc.

Latest Articles
from the
International Adoption Articles Directory

Sara-Jane Hardman and Jean Mauro LCSW
Selecting a Therapist
How to find the most effective therapist for an adopted child. If your child displays behavioral, school or social problems it is important to find a professional who is experienced in working with adopted children and understands the complexity of the issues.

Determination 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.

Here is a situation described by a parent:
My 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 a difference.

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 issues first.
Analyze your child’s 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.

Step 1: Identify 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.
What does my child need: neuropsychological or psycho-educational assessment?

Gary Direnfeld, MSW, RSW
Assessing and Managing School-Age Children with Behavioral Problems

Step 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.
Notes on ADHD in internationally adopted children

Dr. Mark Lerner
ADHD and Adoption....

Step 3: If the child presents significant behavior issues at school, school-based IEP is created with the following components:

Educational classification,
Appropriate school placement,
Defined level of instruction,
School-based supportive services,
Classroom accommodations,
Test taking modifications,
Promotional criteria,
Proper teaching and remedial methodology,
Program modifications and support for school personnel,
Disability manifestation determination procedure.

Boris Gindis, Ph.D.
Know Your Rights: Disability Manifestation Determination for Your Child

Step 4: If the problem behaviors are mostly at home, family therapy or counseling may be effective.

Arthur Becker-Weidman, Ph.D.
Oppositional Defiant Disorders

Gary Direnfeld, MSW, RSW
Out of Control and Pseudomature Teens
Need 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 practice.

Step 5: If nothing else helps, and the parents can't cope any longer, specialized treatment centers for children may be an answer.

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