Thursday, November 8, 2012

Ukrainian And International Adoption: Post Adoption Depression And What You Can Do

Unfortunately too few people know or discuss the possibility of
post adoption depression. After years of working so hard to bring
this precious Ukrainian child home, you ask how you ever could
have these negative feelings. As this article notes, over 65% of
adopting mothers experience post adoption depression.

Learn about post adoption depression, its symptoms and what you
can do in this piece.


Post Adoption Depression: The Unacknowledged Hazard In Adoption

by Harriet McCarthy

There is a crisis of epidemic proportion within the International
Adoption Community. It has the potential to compromise the health
and well-being of many adoptive families. Known as Post Adoptive
Depression or PAD, it affects over 65 percent of adopting mothers
according to a recent survey by the Eastern European Adoption
Coalition (EEAC), yet goes unacknowledged or unrecognized by
agencies, social workers, and most of the medical community.

Post Delivery Depression, long recognized as an expected part of
normal pregnancy and delivery is an issue that is openly
discussed and well understood by the medical community and the
public. Estimates vary, but between fifty to eighty percent of
mothers who have given birth will experience the mildest form of
PDD called "The Baby Blues" according to Depression After
Delivery, Inc. Of those, approximately ten percent will suffer a
more serious form of Postpartum Depression which is of longer
duration and has moresymptoms. The cause of both these
manifestations is attributed to hormone changes and imbalances.
Families, physicians, and caretakers are alert forsymptomsand
offer unconditional support to new mothers during this usually
brief crisis.

The public and medical attitudes toward PDD are a far cry from
the silence and secrecy that surround a much more pervasive
problem - Post Adoption Depression Syndrome (PADS) which is a
term coined by June Bond in her Spring 1995 article for Roots and
Wings Magazine. For those of us who are part of the International
Adoption Community, in particular parents of orphanage children,
we have the added complication of adopting children who are
almost always older than newborns and have been in an
institutional setting. In many cases, our new children are
toddlers to school-aged, and their histories and language issues
add an extra dimension to the possibility of their new adoptive
mothers developing PADS.

Over the past seven years, I have been intimately connected to
the international adoption community as adoptive mother to three
older Russian boys, as a member of the Eastern European Adoption
Coalition (EEAC), as Co-Owner and moderator for the Parent
Education and Preparedness List at, and as
founder and Co-Chair of Piedmont Families Through International
Adoption. Post Adoption Depression has been a recurrent and
persistent issue in all my support experience. In the Fall of
1999, with the help of the EEAC which made our questionnaire
available on-line, I launched a survey to see just how prevalent
an issue PADS really is. The results were troubling. Our survey
was accessible by members of the AParentRuss-List and the
PEP-List whose combined membership now tops 3,100. Non-sufferers
of Post Adoption Depression were especially encouraged to answer
the survey. Of the 145 parents who responded, over 65% said they
experienced Post Adoption Depression, yet only 8 people reported
they had been advised by their social workers or agencies that
this syndrome even existed. Preparation by those agencies would
have been helpful, according to 61% of all respondents, sufferers
and non-sufferers.

Why does PADS exist among the adoption community in such high
numbers? There are a host of very concrete and understandable
reasons. Most newly adoptive parents have spent literally years
struggling to get to the point of having a child to parent. Their
protracted and unfulfilled hopes, dreams, and longing may cause
unrealistic expectations about exactly what it will be like to be
a parent, and they are unprepared for the grief they feel when
reality confronts the child of their imaginations. New parents
may feel guilty about their feelings of ambivalence, resentment,
or anger toward their new child. The belief in instant bonding or
"love at first sight" is often an unrealistic one. Falling in
love with a child is much like falling in love with a future mate
-initial infatuation and euphoria give way to the lengthy and
often difficult process of adjusting to the day to day presence
of another human being. It often takes from two to six months for
a real sense of attachment to blossom according to many of the
posts of families who belong to EEAC. Being unprepared and
unsupported, new adoptive mothers who become depressed often try
to "tough it out" without asking for any help whatsoever. Many
mothers worry that if they advise their agency or social worker
(the ones they have spent months or years convincing of their
superior parenting skills) that they are experiencing difficulty,
those same agencies and social workers will think of them as
unfit parents and, in the worst case scenario, remove the new
child from their care. Consequently, a bad situation becomes
worse because of lack of understanding and support. First line
extended family support available to new birth mothers (and
fathers) is often totally missing for adoptive parents. In many
cases, after enduring years of disappointment with infertility,
family members don't understand why the new mother isn't
completely happy and content now that she finally has what she's
wanted for so long. Rather than disappoint and confound her
family, many new adoptive moms simply suffer in silence, filled
with shame and guilt, feeling themselves imperfect or selfish.

Our survey didn't ask for gender specifics from our respondents,
but we assume that most of the questionnaires were from women. An
unknown but very important issue is Post Adoptive Depression in
new fathers. Stress plays a major role in what we suppose to be
an equally prevalent issue. New adoptive fathers are usually the
ones to return to work sooner, and they have the added issue of
juggling job and new fatherhood simultaneously.

While all of the above issues pertain to all adoptive parenting,
our international community has additional components which load
the deck. In almost no case are we adopting newborns. Among other
things, we deal with grief over the loss of unknown histories and
missed bonding opportunities. We see our children for a very
brief time before the adoption is finalized and we often
"discover" disturbing surprises about our children's backgrounds
after the fact. Our older children come equipped with distinct
personalities, some of which meld smoothly into our families,
others of which are a jarring and daily reminder of our
differences. We adopt children who have experienced an almost
unimaginable amount of loss. We adopt children who have suffered
the effects of institutionalism, hospitalism, and global neglect.
We often adopt children with hidden academic, emotional,
neurological and medical needs. Frequently, newly adopted
children attach themselves to only one of the two parents,
leaving the other parent saddened and disappointed. Add to all
that the stress of out-of-country travel, jet lag, communication
difficulties with our older kids and foreign country hosts, sleep
depravation, and cultural shock. Our decks come loaded with the
potential for frustration, powerlessness, and worry - a perfect
prescription for the onset of depression.

When I reviewed the data concerning the length of time adoptive
parents suffered from PAD, a very disturbing picture emerged.
While most post delivery "Baby Blues" are of very short duration
(less than two weeks), 77% of survey participants with PAD
reported that they suffered theirsymptomsfrom two months to over
one year with 45% suffering for six months or more. 85% of
sufferers reported that their depression affected their health in
some way (serious weight gain/loss was followed by sleep
disturbances and headaches), 70% felt that PADS had interfered
with smooth transitions and bonding with their new children.
Clearly, Post Adoption Depression is a significant, multi-faceted
issue that needs to be acknowledged, better understood, and
unconditionally counseled and supported by the entire adoption

How To Weather The Storm

Knowing that the probability of having PADS is significant will
give you a chance to prepare in the event that you are among the
majority who suffer with this syndrome. Preparation might include
discussing the possibility with your primary care provider as
well as your child's future pediatrician. Make sure your agency
is aware of the PADS and that they understand the dynamics and
prevalence of this issue. They should be prepared to support your
need to locate help and/or services should you need them. If you
have previously suffered from depression in your life, you are at
greater risk. Make sure your mental health care provider is
standing by in the event that you need support with medication
and counseling. Alert and educate your family and spouse. Explain
that you may all need extra emotional support the same way new
birth families do.

Dr. Bill and Martha Sears, The Baby Book lists several excellent
suggestions for the Postpartum family which are equally relevant
to Postadoptive families. When you finally arrive home from your
international trip with your new child(ren), make sure that you
have sufficient "nesting" time. Without guilt, hold visitors at
bay for a few weeks. The exception to this rule would be the one
designated family member or close friend who can provide domestic
help and support in order to give time for the new nuclear family
to learn about each other and start the bonding process. Before
you travel, investigate your company's adoption benefits and
maternity leave policy. Take the maximum allowable time before
trying to go back to work. Be sure to get plenty of sleep and
exercise. Fresh air and a brisk walk do wonders to mitigate mild
depression. Taking a child for a walk is one of life's greatest
inexpensive pleasures - fun for you, fun for your child, good for
bonding. If you are single or if your spouse is unavailable to
provide child care while you rest, arrange for a sitter who can
come in while you nap, run errands, or simply take care of
personal grooming.

New competence as a parent often means a deterioration of
competence in other areas of your life. Don't allow yourself to
feel guilty about less than perfect housework or a reluctance to
cook your usual gourmet fare. Plan to put most of your life "on
hold" while you settle in those first several weeks. If you know
letting things go might drive you mad with anxiety, have
alternate plans in place for others to take over for you with
housework or chores. Have a store of good frozen foods on hand to
help with meal preparation.

If you are married, one of the most profound changes that comes
with parenting is the change in your relationship with your
spouse. Prepare for that change and mitigate the negative impact
by setting aside some special times for the two of you to be
together without the new child. This is a vital part of
successful parenting - important to both of you, but also
important in the message it sends to your child. Your strong,
dependable relationship with one another is one of the greatest
gifts you provide to your new child. If you are fortunate enough
to have a secure and happy marriage prior to adoption, spend the
effort it takes to nurture and sustain it.

Preparation for PADS is the key to surviving it and shortening
its duration. Accept the fact that adoption carries some risk.
Expect surprises, frustrations, and setbacks with your new child
as part of international adoption. Celebrate if there are none!
Before your child comes home, take as many parenting classes as
you can. Expect to be a therapeutic parent. Bonding and
attachment are slow processes. Learn to be patient and give
yourself and your child the one-on-one time required for
attachment and bonding to grow. Your adoption journey doesn't
stop the day you bring your child home. That day is really only a
beginning. Plan for the continuation of your pre-adoption
emotional roller coaster ride for at least the first year. If you
have adopted a severely challenged child, plan on riding for two
years! Reach out for help. Be honest with your social worker and
agency. If you are having difficulties, tell them! You might be
pleasantly surprised at how helpful they can be, but they can't
help you if they don't know you're suffering. Join a support
group such as those available at HTTP://EEADOPT.ORG, or locally.
There are literally thousands of people ready to help and lend
support. Provide private time for yourself, your spouse, and your
other children. Keep stimulation, social, and work pressures to a
minimum for as long as you can. Ask your extended family and
friends for understanding and support. Accept your limitations
and don't be afraid to fail. We learn by making mistakes. If your
adoption situation proves particular difficult, remember to tell
yourself everyday that tomorrow will be better, because it
probably will be.

Most of all, know that what you are feeling is a normal response
to stress, that you are not alone, and that there is help for
this difficult phase of your adoption experience

Symptoms of Depression

Diagnostic Criteria From DSM-IV

Five or more symptoms in a two week period.

1. Depressed mood most of the day, everyday (feeling sad,
empty, or tearful) or feeling exceptionally irritable.

2. Markedly diminished interest or pleasure in all or almost
all activities.

3. Significant weight loss or weight gain, increase or
decrease in appetite.

4. Insomnia or hypersomnia nearly every day.

5. Psycho motor agitation or retardation nearly every day
observable by others(restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate
guilt nearly every day.

8. Diminished ability to think or concentrate, or
indecisiveness nearly every day.

9. Suicidal thoughts or ideation.

Adoption Services International unites loving US families with
Ukrainian children. We provide a unique combination of
professional, individualized, quality service (including a
maximum guaranteed adoption fee), personal adoption experience,
affordable local cost and 20 years Ukrainian experience.

If you or someone you love would like to expand your family,
provide a permanent home for a needy orphaned child, welcome a
sibling for an existing child or discover an alternative for
infertility treatments - contact us to learn more about Ukrainian
adoption, Adoption Services International can help.


Upcoming Events:

Ukrainian Adoption 101:

Conversation On International Adoption: Opportunity, Process,
Concerns and Questions

Monday, November 12, 2012 6:00-7:00PM

Location: Califon Book Store: 72 Main Street, Califon, New Jersey

Ukrainian Adoption Information Meeting

Wednesday, November 28, 2012 7:00-8:00PM

Location: Wellness Rocks: 133 Rupell Road, Clinton, New Jersey

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