Searching to be Found: Understanding and Helping Adopted and Looked After Children with Attention Difficulties

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A practical, supportive book for adoptive parents, carers, teachers and other professionals who live and work with families and children whose happiness and behaviours are affected by attention difficulties and hyperactivity. The examples of real children and adults in everyday situations translate research findings into meaningful strategies for helping families, teachers and children to find more successful means of managing difficult behaviours and emotions.

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CHAPTER ONE: The adopted/looked after child with attention difficulties

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Daniel squirms in the chair, his small legs already running, while his large, sparkling eyes watch the tears dripping into Shirley's lap. He sees the wet stain growing wider on his new mother's summer skirt, and waits impatiently for her to talk, but she doesn't say a word. Before he can stop himself, Daniel moves impulsively toward the playroom door, knocking over the paint jar and splattering the brushes to the floor.

“Are all adopted children like this?” Shirley asks the therapist.

Meanwhile, Daniel's older sister, Christie, who is in long-term foster care, is a quiet, distant, inattentive child. Her carers question her suit-ability for adoption because she is so withdrawn and aloof.

“How can we brighten up this little girl?” they ask their therapist.

According to informal reporting, it would seem that a disproportionate number of foster carers and adopters live with children who manifest attention difficulties, usually, but not always, with hyperactivity. While it is clear that adoption or being in care does not cause a child to have Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder (ADHD/ADD), and while having ADHD/ADD does not determine whether or not a child will be taken into care, the association between children who are or have been in the care system and those with attention difficulties is frequently discussed. This relationship, whether clinically proven or just anecdote-based is an important one to understand as parents, carers, teachers, and professionals struggle to meet the needs of a group of children who are at high risk for academic and social failure. Both ADHD/ADD and adopted/looked after children who do not receive the creative intervention they require contribute to the tragic statistics currently describing these groups of children—young people who are vulnerable to loneliness, home-lessness, academic underachievement, difficulty getting along with peers, problems dealing with authority, use and abuse of substances, high rates of teen pregnancy, under-employment, and repetitive prison sentences.

 

CHAPTER TWO: Understanding the effects of maltreatment on early brain development and the consequences for ADHD/ADD and adopted/looked after children

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Christie sinks into her own quiet reveries, remembering the days when she would try to hide her brother from her mother's boyfriend. Christie was six at that time, Daniel not yet three. Sometimes she hid Daniel in the closet and other times she made him stay outside in the garage, even though it was cold and wet out there. She rubs her fingers over the scar on her own arm from the day the boyfriend found Daniel in the cupboard and beat Christie up for hiding him. Then the boyfriend was in her room that night and got into her bed. She tries to think about what happened next, but all she hears in her head is Daniel screaming—or maybe it was she who was screaming. Christie doesn't know where her mother was that night, and never allowed herself to “see” her mother again. Christie doesn't like to talk because she is afraid her voice might scream, so she stays quiet and blocks out much of what goes on around her.

In recent years, the focus on both adopted/looked after children I and on ADHD/ADD has been very much influenced by developing research on early brain development. Investigators in ADHD have focused attention on the neurobiology of the disorder and adoption studies have centred much of their attention on the effects of abuse and neglect on the developing brain during infancy and early childhood (National Clearing House on Child Abuse and Neglect Information, 2001). The research is providing biological explanation for what practitioners had been describing previously in psychological, emotional, and behavioural terms. Although there is still much to be learned about the brain, and newly unfolding information may yet alter our conceptions of how both genetics and injury to the brain could affect a child's development, it is currently proposed that the neonate is highly influenced by what happens in utero. The infant's neurological condition can then be improved or jeopardized dramatically, depending upon environmental input, in the next three years (at which point the brain will have acquired 90% of its ultimate size). Shonkoff and Phillips (2000) indicate that there is abundant evidence from the behavioural and neurobiolog-ical sciences that documents a wide range of environmental threats that can significantly affect the early childhood years and beyond.

 

CHAPTER THREE: The ADHD/ADD adopted/looked after child at home and in the community

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“I want to make a new start but don't know where to begin. I wish things could have been done different, no matter how loud I talk, no one seems to listen.” (Seventeen-year-old boy in care)

My father always told me that the best way to lose weight is to push yourself away from the table. That was, indeed, a good strategy as long as I did not then closet myself in my room with a box of chocolate biscuits. I point this out because it is my strong contention that there is no single strategy that works for everyone, and there are no absolute recipes that any of us can follow successfully to improve the behaviour and concentration of an ADHD child, of an adopted/looked after child or of any other child.

My own “recipe” for making things better is for each parent/ carer to try to know what makes his/her individual child tick. It is important to try to figure out when a child will go off the rails, will respond positively, will be able to succeed, and will quite definitely not be able to handle the situation. While this may be similar for some ADHD/ADD adopted/looked after children, the circumstances, especially for the adopted/looked after child, are so individualized and unique that generalities do not always apply. There is no magic formula.

 

CHAPTER FOUR: The ADHD/ADD adopted/looked after child at school

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Daniel has already been to four different schools in his young life. He has not been to school regularly though, and is not sure just what he is supposed to do in a classroom because all his schools and teachers have been so different. Daniel can remember his last school because he had a nice teacher who didn't mind when he looked out of the window a lot. She also let him clean the blackboards at lunch-time when he didn't want to stay out on the playground. In his first school, Daniel knew one other girl because she was in foster care with him. They were allowed to sit next to each other in class when Daniel wasn t sitting by himself for being in trouble for his behaviour or for talking when he wasn't supposed to. He doesn't remember the next school because he wasn't allowed to go there for very long. He says, “I talked too much and threw too many pencils at that school.”

Christie s school experiences have been equally inconsistent, although for the most part she has worked out how to be the kid in the corner that nobody pays attention to. Christie doesn't actually pay much attention either because she doesn't understand a lot of what is being taught, and she finds it hard to keep her mind on what the teacher is talking about. She likes numbers, though, as they make more sense to her, so she does well in maths and sometimes even raises her hand to volunteer an answer during maths class. Christie finds it hard to make friends at school and rarely has anyone to be with at playtime. She says, “I suppose I don't know what to say to anyone.”

 

CHAPTER FIVE: Social development in the ADHD/ADD adopted/looked after child

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Daniel engages easily with adults, much more so than with peers, and enjoys one-to-one attention with an adult who shows interest in him. At six years old, he still prefers to play with the toys in his own way and without anyone else joining in. If another child comes near him, it makes him lose his concentration and he becomes irritable.

“I've only had toys since I was adopted,” he says. “It's too hard to share them, and I can't stand it if anyone else changes my stuff around. If I set something up, it has to be up to me, not anyone else, to decide whether it gets moved or not … it makes me too mad when it can't be my way.”

Like a much younger child, Daniel “needs” to determine the rules of the game and he “has” to play with toys when and how he wants them to be played with. His dad says that he intellectually understands this, but it keeps him from being able to spend quality time with Daniel because there is so little interaction possible.

***

Christie, still in a foster home, doesn't have anything to play with that she can call her own. “I tend not to play too much with other kids’ stuff,” she says, “because I don't want to get blamed for it if something gets broken. I stay to myself and don't mess with the other kids because I feel safer that way.

 

CHAPTER SIX: Conclusions

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The power of the past

As a teenager, Christie began to come to terms with the fact that her childhood may not have been ideal, but that it was over. She also started to appreciate that both she and Daniel have attention deficits, probably genetically, and certainly aggravated by their chaotic and abusive early lives. Although never adopted, after several moves, Christie is living in long-term foster care very satisfactorily. She has worked for years with a therapist who has been able to help her close some of the chapters of her former life. While she does not throw away the key to those chapters, they are, nevertheless, put away and locked up, enabling her to move forward more successfully. She eventually connected with a caring occupational therapist who mentors her as well as helping her with her sensory integration difficulties. School was not Christie's greatest achievement, but she did stay through GCSEs and subsequently has been able to go to college, learning to become a book-keeper, as her facility with numbers stayed with her throughout her school years.

 

APPENDIX I: Characteristics of Attention Deficit (Hyperactivity) Disorder

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Criteria extracted primarily from the DSM-IV (which differs slightly from the DSM-IV-TR 2000), with updated modifications from Russell Barkley's Attention-deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (3rd edn) 2005. New York: Guilford Press.

In order to receive a diagnosis of ADHD/ADD a child must exhibit at least six to eight of the following characteristics for a duration of a minimum of six months, and prior to the age of seven years. Although the criteria tend to vary somewhat, according to the researcher and author, and depending upon the country in which one is diagnosed, nevertheless, all concur that the symptoms of inattention must have persisted to a degree that is maladaptive and inconsistent with the child's developmental level. Moreover, the symptoms must manifest themselves pervasively across settings, causing impairments in major domains of life functioning—home, school, work. Difficulty with behaviour inhibition is considered central to the diagnosis of the disorder.

 

APPENDIX II: ADHD/ADD adults who are adopted or who grew up in care

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Throughout this book, I have emphasized that many ADHD/ADD adopted/looked after children do well as adults, but I T have also alluded to the fact that most of them still need some sort of adjunct help such as secretaries, partners, technology, and so forth. Below are some examples of why they do.

Kevin, aged thirty-three, and Brian, aged thirty-six, have left for their summer holiday at a beach resort. Upon arriving, they discover that neither has brought a brush or comb. Kevin remembered to bring sandals, but no shorts; Brian has shorts, but neither sandals nor swim-ming trunks. Brian has “lost” his toothbrush and toothpaste between home and the resort.

At the end of his four-day visit with a cousin who lives across the country, Larry, aged twenty-nine, is about to get out of the car at the airport when he discovers that he does not have his flight information with him. He knows the airline, but neither the time it leaves nor the flight number.

Georgia, aged thirty-seven, is due to go to a formal dinner directly from work. Half hour before the end of the work day, her secretary mentions that she hasn't seen Georgia's dress for the evening and asks where it is. Georgia, who lives forty-five minutes away from work—and from the location of the dinner—remembers that she has left the dress and all accessories on her bed at home.

 

APPENDIX III: Helpful suggestions for teachers and parents/carers

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The following suggestions represent an amalgamation of the kinds of lists one usually sees pertaining to the ways in T which parents, carers, and teachers can help ADHD/ADD adopted/looked after children.

•  Be aware not to over-stimulate or over-exhaust.

•  Limit possibilities of distraction and diversion, but keep things moving and engaging.

•  Prioritize one or two target behaviours for immediate management.

•  Contain negative behaviours rather than attempting to eliminate them all at one time.

•  Be consistent and predictable about rules and routines, causes and consequences.

•  Reward what is specifically well done—use positive reinforcement frequently.

•  Provide structure and planned programmes that help children to organize and monitor their own behaviours.

•  Establish schedules that build in frequent and physically active breaks.

•  Offer choice, and allow for flexibility within the structure.

•  Prepare the child for “what happens next”.

•  Have a personal code system between the teacher and the child or the parent and the child for monitoring in-class or other social behaviours.

 

APPENDIX IV: Resources

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The books and resources listed below are all independent of those in the References of this book as the references include T only sources that were cited in the text. Above and beyond those books and articles, there is much of value to read. A difficulty with listing additional materials is that one will inevitably leave out particular resources that are equally as important and useful as those which have been included—or which some readers may feel are even more valuable than the citations I have selected. I apologize for this, and emphasize that the following lists are made up of authors, organizations, and other reading materials that have been particularly important to me as I have searched, read, learnt, and talked about attention disorders and about adoption and fostering.

Professional Reading

Barkley, R. All or any of his work on ADHD/ADD.

Cattanach, A. (1992). Play Therapy with Abused Children. London: Jessica Kingsley.

Fahlberg, V. All or any of her work on adoption issues.

Gil, E. (1991). The Healing Power of Play: Working with Abused Children. New York: Guilford.

 

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