2010
First Time Around Adoptive Parents
Posted by Karasel Kid under Adoption Links & Resources, Adoption Referrals, Adoptive Parents, Attachment & Bonding, Single Parent Adoption
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First Time Parents Get Ready!
Take the Rose Colored Glasses Off now! The most important element in adoption is understanding how to develop a Healthy Attachment with your new child no matter the age. Many say, “Babies don’t remember anything or they are a blank slate.” This is not true. Their bodies do remember, and their brains have developed according to their past sensory input and emotional experiences by the time you meet them. Be open to the fact that your new child has a first family or home or a beginning, and it was not with you. They are with you now, and you must understand that their is nothing glamorous about the transition from the child’s old environment to your new one.
As Dr. Ronald Federici, a well known post-institutionalized child specialist points out, “Structure equals Love*,” when a child first comes home. Keeping the child’s world very small is recommended. Choose a FEW age appropriate toys for them, and as for all those ones you may have already bought, well, put them up on a high shelf and introduce them slowly one at a time. Make sure that the toys are not babysitters, but that the primary caregiver(s) are the focus and building the emotional experiences that are couples with sensory input to get that brain development into its highest functioning to make up for the gaps from institutionalization.
Many adult adoptees say that the adoption, in an of itself, was a trauma because it shook their world upside down. If a child feels they have no control, and they really don’t, then that is life or death in their comprehension. This applies right down to the babies adopted at birth. Their “wonderful new home” is a result of a loss. Their inner selves, their brain development, has incorporated that feeling in many ways via their senses. It may feel like fear,loss, frustration, pain, lonliness, neglect, sadness, deprivation of love, touch, verbalization, attention, and even food.
Don’t expect them to act grateful, and if they do, then it will be a gift for you. The honeymoon period WILL wear off, and when they child feels safe enough to test you and every boundary you ever thought about having, then you know they are probably making progress! They trust you enough to test the waters. Having a well thought out and consistent discipline plan that is proactive and a daily schedule with consistent structure are some of the most loving acts you show to your new child.
*Help for the Hopeless Child: A Guide for Families, Dr. Rondald Federici
If you are considering adopting, please read the article titled: A Different Perspective…just imagine because it attunes you to the place your child will be in upon arrival.
A great website to read about bonding and healthy attachment comes from one of my favorite sites called RadZebra.org to find articles such as What is Healthy Attachment?
You will find a collection of other articles on this topic at AdoptionHarmony.com.
Sometimes, adoption has a dark side
By Ben Montgomery, Times Staff Writer
Published Friday, April 16, 2010
——————————————————————————–
Who on earth could return a human child like consumer goods?
That’s what we’re asking after a nurse from Tennessee sent her 7-year-old adopted son back to Russia last week.
In a note, the mother said the boy she cared for since September was unstable and violent.
“I no longer wish to parent this child.”
Since then, Torry Hansen has been vilified. She has been called “ignorant,” “sick” and “a monster.”
But psychiatrists, adoption lawyers and parents of adopted international children say Hansen’s desperation is not uncommon. They say that sometimes there’s a dark side to international adoption that doesn’t fit the rosy narrative.
“I’ve seen it happen dozens of times,” said Dr. Ronald Federici, a Virginia psychiatrist and father of seven internationally adopted children. “Parents escort them back to orphanages. They leave kids at baggage carousels. They leave them at Disney World. They leave them in my office and drive away.
“This is not an unusual situation.”
When Hansen sent her son back, prompting Russian officials to announce they were suspending American adoptions, she touched off a national debate.
Most Americans who adopt children from elsewhere find joy. But what about the others?
Why couldn’t Hansen and her son get the help they needed? How do we prevent this from happening again?
• • •
Linda Hagen was prepared.
She and her husband had saved money and read books and learned Russian phrases.
They knew the children they were going to love had spent 18 months in a dank orphanage, with little food, lax hygiene and scant medical care.
They knew the fables the orphans tell each other: If you’re adopted by an American, you’ll either live like a king, or your body parts will be used to heal sick American children.
So when they showed up in Russia in 2005 to adopt two siblings, 8 and 9, they were ready.
They would keep the kids close. Introduce them to undecorated bedrooms and not take them to stores or parties, to reduce the chance of over-stimulation. Choose their food for them. Set rules quickly.
Hagen was surprised as they left the Russian ministry of education when her new son wanted a balloon so badly he began screaming and banging his head on the ground. That evening, in a Moscow apartment, when she and her husband turned their backs for a second, the boy ran. They found him on the street trying to buy ice cream.
The first week home, the kids stuffed their pockets at the grocery store in the few seconds Hagen was paying the cashier. A few days later, the boy disappeared when they weren’t looking. They called the police. They found the boy in the attic.
Hagen, of Fort Lauderdale, laughs about those early days. The children are 12 and 13 now, and Hagen adopted their older brother, 17. She is hesitant to talk about recent issues but acknowledges they have maintained their family unit with the help of intensive counseling.
“To this day, my children sleep with baby monitors,” she says. “I need to know where they are.”
Hagen, 48, now participates in online support groups with about 3,000 similar adoptive parents. A recurring topic: How can I find residential treatment for my adopted child?
“They might say, ‘My child cannot remain in my home. He has already killed my dog and threatened me with a knife. We’ve been in psychiatric hospitals.’ ”
The answer?
Pay $3,000 to $4,000 a month to one of a handful of places that offer specialized residential treatment, she says.
And what if they can’t afford that?
• • •
The problems: Lax oversight of U.S. adoption agencies that don’t do legitimate home studies, don’t provide pre- or post-adoption assistance and charge $30,000 or more per adoption.
Corruption in countries trying to get rid of orphans and line their own pockets.
Naive parents and counselors who believe that enough love and time will cure all.
Federici says some in the adoption field have been calling for more oversight for years.
“The issue is far greater than one case. These parents are screaming. They’re desperate.”
Americans adopted 1,600 children from Russia last year. Institutionalized children from Eastern Europe, who spend years in bleak orphanages, often come to the United States with a load of mental health problems. Some are unattached from years with no parental figure. Some are traumatized by past abuse. Some are grossly undersocialized, cold, even feral.
And what happens when parents don’t know how to deal with those issues and can’t find help? Some turn them over to states. In 2006, the U.S. Department of Health and Human Services counted 81 children adopted overseas who were relinquished to officials in 14 states.
Sometimes it’s worse.
“M-U-R-D-E-R,” Federici spells (He’s with a young patient). “We’ve seen 21 cases. All are identical. All were beaten to death with objects by the mother.”
That number, 21, couldn’t be verified. Some put it at 16. Russian officials say more than 12.
Whatever the number, the cases are extreme. One mother caught her adopted daughter smearing feces on the wall and punched and kicked the child to death. Another beat her troubled child to death with a wooden spoon.
Dr. Myra McPherson, who has counseled desperate adoptive parents in Sarasota, says it’s no surprise. “A child in distress has a brain that’s been poisoned,” she says. “It’s like trying to bring a wild animal into your house.”
The children need attention, but reject it.
One local family adopted a 2-year-old from overseas, McPherson says. The little girl scratched and bit herself all the way back to America. She cried for hours, refused to sleep. Banged her head. The mother was afraid to take the girl out of the home for fear people would think she was abusing the child.
“These are well-meaning, loving families,” she said. “Professional folks that you and I would respect, but they say, ‘We can’t do this.’ ”
Florida doesn’t track the number of disrupted international adoptions, but the director of a family safety program for the Florida Department of Children and Families said he wouldn’t describe it as common. Sometimes it’s prevented when the parent finally finds help.
“I’ve seen many a parent who wants to give their child back,” says McPherson. “Many.”
And they’re afraid to step forward for fear they’ll be judged, like the woman who sent her child back to Russia.
Hagen doesn’t want to discourage adoption, because she has seen the rewards. But she also knows the cost.
“People need to know that it is not likely at all to get a kid who has no issues. You need to know that you can’t get into this unless you have the resources.”
Times staff writer Leonora LaPeter Anton and researcher Shirl Kennedy contributed to this report.
NEW YORK TIMES
Lawsuit over adoption raises disclosure issues
By Pam Belluck
New York Times
POSTED: 01:30 a.m. HST, Apr 28, 2010
ShareScores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.
Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.
The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.
They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.
After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.
Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.
Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.
The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.
After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.
The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)
Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.
“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”
No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.
But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.
Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”
Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”
Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.
“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”
As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.
Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.
Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.
While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)
“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”
In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.
In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.
The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.
Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.
“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.
But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”
The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.
“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”
The Therapeutic Value of Using Physical Interventions to Address Violent Behavior in Children
A quick review of the published information on physical interventions over the last three years would seem to indicate that a fundamental and universal shift has occurred, away from the use of therapeutic restraint, as well as the use of seclusion, to address violent behavior in children. However, this is somewhat deceptive. Treatment environments have been faced with increasingly violent and assaultive children in a continuing trend that was identified a decade ago (Bath, 1992; Crespi, 1990). This challenge must be considered along with the fact that young children most often present violent behavior in treatment settings (Miller, Walker & Friedman, 1989). Unlike the impression given by recent media, the reality is that most treatment centers for young children use physical interventions to address violent behavior in a safe and effective manner. It is true that physical interventions have been the subject of substantial training to insure they are done according to national crisis management guidelines, but it is not true that the mental health community has abandoned physical interventions for violence.
It is important to clarify the interchangeable terms therapeutic holding and physical restraint. This physical intervention is when a trained adult stops a child from hurting self or others by using approved crisis intervention holds to protect the child until the child is no longer a danger. There are a variety of approved holds but all of them restrain the child from being violent and causing damage to self or others. A distinction must be made between the type of holding discussed in this article and “holding therapy,” which is a physically intrusive method to produce a crisis in a child and force the child to experience physical or psychological pain. Holding therapy and other similar intrusive techniques are not sanctioned by any legitimate professional organization and in the opinion of the authors are not therapeutic and are not valid psychological treatment.
There is increasing pressure on these programs to become restraint and seclusion free, but is this direction in the best interests of the children? The answer will emerge only after a dialogue of the valid points on both sides of this issue, but to date only one point of view has been advanced. The purpose of this article is to provide another perspective on this issue, one that has not been previously put forward.
A variety of interventions have been used over the years to address violent behavior among children and adolescents (Troutman, Myers, Borchardt, Kowalski & Burbrick, 1998). In settings such as psychiatric hospitals and treatment programs, two of the most frequently used interventions are therapeutic holds (also called therapeutic restraint) and giving the individual a chance to regain self-control in a seclusion or quiet room. Interventions less often used to address violent behavior are mechanical restraints and using medications for chemical restraint (Measham, 1995). Over the last ten years the latter two interventions, mechanical and chemical restraint, have been criticized as excessive and too restrictive. Mechanical and chemical restraints have declined in some programs and have been eliminated in others, particularly in non-hospital settings.
More recently, in the last three years, restraint and seclusion have been the subject of considerable controversy. A host of arguments have been presented against the use of restraint and seclusion to address violent behavior in children (Wong, 1990). Most notable was an investigative series in a Connecticut newspaper, the Hartford Courant (Altimari, Weiss, Blint, Pointras, & Megan, 1998). This expose of injuries and deaths reportedly caused by the use of restraint and seclusion is often credited with starting the current wave of criticism for the use of restraint and seclusion. This controversy has run the gambit from media coverage to policy change and new federal legislation.
The array of criticism directed at the use of restraint and seclusion has one glaring absence, a review of the therapeutic benefits of physical holds to address violence among children. Although seclusion is often used interchangeably for therapeutic restraint, the two are very different interventions bringing up very different issues. The focus of this article will not be seclusion, but rather a review of the therapeutic components of physical restraint.
Before addressing the potential therapeutic components of physical restraint, it is important to briefly consider the most frequent criticisms of using this intervention. A recent nationally published article is a good example of the criticism being directed at the use of physical restraint (Kirkwood, 2003). The article calls restraint violent, dangerous, and even potentially deadly to children. The point is made that this intervention can actually cause further trauma due to concerns such as counter-aggression by adults and repeating abuse the child has experienced in the past. Restraint is called a violent means to maintain control and “rule over” children. Rather than use physical restraint, the article recommends negotiating with the child, understanding the reasons behind the behavior and giving the child choices. Some critics have gone so far as to say a physical restraint should be avoided at all costs and any use of physical restraint is a treatment failure.
In the face of such harsh criticism, is there any defense for physical interventions such as restraining violent children? The authors believe there is, but the starting point of discussing the therapeutic components of physical restraint must begin with an acknowledgement that even good interventions when done poorly, or at the wrong time, lose some or all of their therapeutic value. Rather than an indictment of all physical interventions, the criticisms outlined in the article mentioned above can serve to improve the quality of physical restraint and, for that matter, all other behavior management.
All behavior management can become ineffective, demeaning and even psychologically damaging if done poorly. It is safe to say that using a violence intervention to “rule over” children is poor behavior management. Like other types of behavior management, if physical restraint is done in a violent and dangerous way, it may be possible to replicate the past abuse of the child, at least in the child’s mind. However, physical restraint is not step one of any intervention with a child. Physical restraint should not be a shortcut to taking the time to understand the child and the reasons behind the child’s behavior. Restraint is also not the opposite end of the continuum from appropriate negotiations and setting out clear and meaningful choices. Physical restraint is properly used only when the adult is trying to understand the child and other limit setting techniques have failed to safely address the violent behavior of the child. Interventions are also not therapeutic when they are based on a power struggle or when the adult is out of control. Any behavior management approach loses its therapeutic value if used to merely control the child without supporting and understanding the child’s thoughts, feelings and goals for the behavior. This is true for all behavior management interventions such as: time outs, logical consequences, giving choices, negotiating as well as physical restraint. It is not necessarily the technique that makes an intervention therapeutic, it is more often the when, how, why and by whom the technique is employed that makes the difference.
If physical restraint is a legitimate part of any behavior management plan, it must have the potential of therapeutic value when used appropriately. Among nationally recognized crisis behavior management systems there are clear guidelines as to the appropriate use of physical restraint. Behavior management systems such as Crisis Prevention Institute (CPI) and Professional Assault Response Training (PART) are two well known examples. Both outline the safe and effective use of physical interventions after crisis de-escalation techniques have been used to address the situation.
National accreditation organizations such as the Council on Accreditation (COA) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) sanction the appropriate use of physical restraint. If any legitimate organization were to declare physical restraint a “treatment failure,” an expression currently being used by opponents of physical interventions (National Technical Assistance Center for Mental Health Planning, 2002), one would expect it to come from entities that hold organizations to the highest standards of the industry, and yet all major national accrediting bodies sanction the use of physical interventions. It is difficult to find any national professional organization, such as the American Academy of Pediatrics, that does not agree with the general statement, “Restraint and seclusion, when used properly, can be life-saving and injury sparing interventions” (American Hospital Association and National Association of Psychiatric Health Systems).
Here are some of the reasons why physical restraint, when done well, can be an important, effective and therapeutic intervention to address the violent behavior of children.
• Physical touch can be very therapeutic to children, particularly in a crisis. Long before a child learns English, Spanish or Swahili, the first language a child learns is the language of touch. Touch is considered a basic need for all children. When a young child is frightened, the first instinct is to hold on to a trusted adult. Children who demonstrate serious acting out often do not know how to ask for what they need, yet supportive, firm, and safe physical touch can give a child a message of reassurance. If touch is poorly used, such as slapping or striking a child, the message of such a touch can be very frightening. When a young child is in a crisis situation, touch can be one of the most reassuring interventions when the touch lets the child know that the adult will insure the situation will be managed safely for everyone.
• Emotionally defended children can become psychologically more real and available after an emotional release during a physical restraint. This dynamic is not restricted to children. It is often when our emotions overwhelm us that we open to learning something new that we have defended ourselves from. There is a parallel in psychotherapy to this dynamic when a client has a difficult but insightful experience that usually includes being catapulted beyond the individual’s ability to keep out important information. For some children it is difficult to get to this place without some form of emotional meltdown that often accompanies a physical intervention.
• Children need to know the adult will insure everyone’s safety. The adult is responsible to insure the child cannot hurt him or herself or others, if other management methods fail, physical interventions are important. The adult cannot put the responsibility on a child to regain inner control once it has been lost. The amount of time it takes for any crisis situation to be under control, during which time chaos reigns, is the amount of inner fear the child has. Children can regain their footing, but the assistance from a supportive adult can be critical.
• Young children with emotional disturbances need and often seek closeness with adults and violence is less threatening than other forms of intimacy. Behavior cannot always be taken at face value with children who experience violent rages. In fact, these children can often act counter-intuitively. They can push you away when they want closeness, they can strike at you when they are beginning to care about you, and they can act in ways to receive reassuring touch by becoming aggressive and violent to self or others. It is important to understand why a child is acting the way they are. At times, a frightened child seeks and needs the reassurance of physical touch when they can’t allow themselves to ask for physical comfort. It is often trusted adults that young children become violent with, because they know they are safe and they will get the reassurance they need. If they do not find the physical reassurance they need and seek, they will often raise the level of acting out until they get it.
• Physical restraint is the surest and most direct way to prevent injury and significant property damage when the child loses control. The above referenced article in Children’s Voice (Kirkwood, 2003) begins with a description of a child doing significant damage to a car with a rock. In this example the adults stood by and did not stop the child and the author called this a better, however more costly, intervention. This seems to defy common sense. Would any parent stand by as a child does thousands of dollars in damage to the family car? Recently, a child in our program picked up a rock, ran around a new car and heavily scratched it to the amount of $2,650 damage. Afterward the child felt badly for such out of control behavior and said good kids do not do such bad things. It is important to understand that kids, as well as adults, view themselves in relation to their own behavior. It only makes sense from a practical and therapeutic perspective to stop children from hurting others and doing damage they will use to feel worse about themselves. Physical interventions may be the best way to insure this.
• Traumatized children must learn that emotionally charged situations and all physical touch does not end in being used or abused. The human being has several types of memory, including factual (explicit), subjective (implicit), emotional, experiential and body memories (Ziegler, 2002). Early experiences of touch can establish a lifelong trajectory of meaning attributed to physical touch. It is common that children with emotional disturbances have difficulty with caring touch. Body memories need to be addressed while the child is still young or the child can avoid the very closeness they need. Abused children learn that when someone gets angry someone else gets hurt. Supportive physical restraint retrains the body not to fear touch from others.
• An intervention considered to be good parenting is likely to be good psychological treatment. Psychologists, family therapists and parent trainers would all call stopping a child from running into a busy street good supervision and effective parenting. They would also recommend a parent prevent an older and much larger sibling from physically harming a younger sibling. It is not hard to imagine the same parenting consultants suggesting that when an angry child is heading for the family car with a baseball bat, that the bat be taken away before the damage occurs. If these parenting interventions would be basic common sense to most everyone, why would some call these same interventions unhelpful and non-therapeutic to children with serious anger problems?
• Children with emotional disturbances need the assurance that adults are safely and appropriately in control of the environment. Serious acting out such as violence is often seeking this assurance. Most emotional problems in children have their source in chaotic, abusive and/or neglectful home environments at some point in the child’s life. To be in a home where the adults are not in control of themselves or the environment is like going down the road in the back seat of a car with no one driving, it is terrifying to a child who has been there. These children often push a new environment to the point that the child finds if the adults can safely and appropriately manage the challenges. Often when the child has such reassurance and can rely on others for basic needs, he or she can once again get back to the task of being a child.
• Treatment programs are responsible for directly addressing violent behavior and not just skillfully preventing the behavior from presenting itself during treatment only to reappear in the home or community after treatment. The argument that all physical restraints can and should be avoided at all cost may address the principle of prevention, but misses the point of treatment. In the extreme, all physical restraints could be avoided, this simply requires an adult to passively stand by and allow a child in a rage to do whatever he or she wants to do. One may call this “preventing” a restraint, but how did it address the responsibility of a treatment program to treat and extinguish serious violent and antisocial behavior? The role of prevention and treatment are quite different. Not intervening when a therapeutic response is called for is not so much prevention as it is abdicating adult responsibility. If someone needed treatment for a debilitating phobia of spiders, the symptoms could be prevented by having an insect free environment, but this would not be treating the phobia. Programs charged with treating violent behavior cannot simply insure that the symptoms never come up in the treatment environment because they will surely resurface once the child leaves that setting. In psychological terms, treatment often requires steps such as re-exposure to stimuli, cognitive reprocessing, skill development, practice and mastery, none of which have an opportunity to happen if preventing symptoms or preventing a particular intervention at all cost is the goal.
Are therapeutic benefits guaranteed by the appropriate use of physical interventions? No intervention comes with a guarantee. However, as one side of this debate offers sensational media stories and points to abuses of physical interventions (and there have been abuses), there exists research and professional literature that has found therapeutic value in physical restraint when used properly. Restraint has been found to shorten the crisis over other interventions (Miller et al., 1989). Research studies have found physical restraint effective in reducing severely aggressive behavior, self-injurious behavior and self-stimulatory behaviors (Lamberti & Cummings, 1992; Measham, 1995; Miller et al. 1989; Rolider, Williams, Cummings & Van Houten, 1991). Physical restraint has been found helpful in treating aggression with dissociative children (Lamberti & Cummings, 1992). Physical interventions have also been recognized in the role of re-parenting children who have not been taught limit setting due to absent parenting (Fahlberg, 1991). Physical restraint has been called an effective intervention to protect the child and others from harm and prevent serious destruction of property (Stirling & HcHugh, 1998).
A frequently cited criticism of restraint is that it takes away the ability of the child to learn and internalize self-control. However, research studies have found the opposite. In two studies nearly a decade apart, physical holding produced rapid gain in internal behavioral control (Miller, Walker & Friedman, 1989; Sourander, Aurela & Piha, 1997). Physical restraint has been called ethically sound (Sugar, 1994) and recognized for significant therapeutic benefits (Bath, 1994).
The arguments for and against the use of various interventions such as medications, institutionalization, physically intrusive therapies, seclusion, and physical restraint are important discussions. However, children are not served when only one point of view is expressed. Many interventions, including physical restraint, can have damaging consequences when improperly used, however, at times the consequences of not using serious interventions can be even more damaging to a child. A five-point evaluation of interventions for violent behavior has previously been recommended (Ziegler, 2001), 1. Was safety insured? 2. Was self control internalized? 3. Was the intervention individualized and based on understanding the child? 4. Was the intervention therapeutically driven? and 5. Was the intervention effective in producing the desired result?
If we are to meet the challenge of increasing numbers of violent children in our system of care, we must carefully consider how we can best meet the short and long term needs of these children, while insuring the safety of other children, their parents, and the community at large. A reasoned approach to this question would be careful consideration of all the issues and not a singular movement to reduce or eliminate physical interventions, which have been found to be safe, ethical, effective and therapeutic.
References
Altimari, D., Weiss, E.M., Blint, D.F., Poitras, C. & Megan, K. (1998). Deadly Restraint: Killed by a system intended for care. Hartford Courant, Hartford Connecticut (8/16/98).
American Academy of Pediatrics—Committee on Pediatric Emergency Medicine (1997). Pediatric, 99 (3), 497-498.
American Psychiatric Association, Arlington, VA.
Bath, H. (1994). The physical restraint of children: Is it therapeutic? American Journal of Orthopsychiatry, 64 (11), 40-48.
Council on Accreditation for Children and Family Services (2002). Accreditation Standards 7th Edition. New York, NY.
Crespi, T.D. (1990). Restraint and Seclusion with Institutionalized Adolescents. Adolescence, 25, (100), 825-828.
Crisis Prevention Institute, Inc. (2001). Nonviolent crisis intervention Training Manual. Brookfield, Wisconsin.
Fahlberg, V.I. (1991) A child’s journey through placement. Indianapolis: Perspective Press.
Joint Commission On Accreditation of Health Care Organizations (1996). Accreditation Manual for Hospitals: Volume 1 – Standards. Oakbrook Terrace, Il.
Kirkwood, S. (2003). Practicing Restraint. Children’s Voice, 12 (5), pp. 14-19.
Lamberti, J.S. & Cummings, S. (1992). Hands-on restraint in the treatment of multiple personality disorder. Hospital and Community Psychiatry, 43 (3), 283-284.
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Russia and the US are negotiating changes to overseas adoption procedures after a controversy last month sparked by an American adoptive mother who sent her son back to Moscow alone. The BBC’s Kim Ghattas met a Pennsylvania family with a unique perspective on US-Russia adoptions.
In a leafy town in Pennsylvania, four children and their parents are reunited after a day at school and work. Abby, 14, is showing off her purple nail polish, Lydia, nine, wants to rehearse on her cello.
Trevor, seven, and Hayden, 11, are wolfing down snacks prepared by their mother Julie, while father Mike asks about homework.
They appear the all-American family, but the children were all adopted in Russia and the transition has been a sometimes arduous journey for the Jones clan.
“It just seemed that the need was so great, that it really just pulled at our heartstrings, that it was the right place for us to be,” says Julie Jones, describing the decision to adopt the children from their homeland.
“ If we had seen the videos, in all honesty, we probably would have inquired about some other children ”
Mike Jones
Abby and Hayden were adopted first, in 1999. Six years later, Julie and Mike and the two children went back to the same orphanage in Russia to adopt Trevor and Lydia.
Russian orphans, especially when they are adopted as older children, are often damaged, mentally and physically, by life in orphanages and by the drinking and smoking of birth mothers.
In the first videos her future parents saw, Abby looked like a sweet timid child. The couple expected some challenges but didn’t realise how much Abby suffered from attachment disorder.
After the adoption was completed, the orphanage gave the couple more videos showing a very different child – much angrier, almost menacing.
“If we had seen the videos, in all honesty, we probably would have inquired about some other children,” Mike Jones says.
“It’s a challenge for the adoption agency because they want to get as many children adopted as they can. But at the same time, there probably are some instances where they’re putting the children in a little better light than they are.”
‘Failing system’
Mike and Julie are very happy Abby is in their life and, overall, satisfied with the US adoption agency they used. But they count themselves lucky that the problems the children had were not more serious, and that with the support of friends and family they were able to provide the right environment for the children.
But not all adoptive parents are able to cope and that’s where the system starts failing. Even young Abby knows it.
“Because I was raised in such a good family, it’s better here than it was in Russia,” she says, sitting on a swing in her parents’ garden.
“There’s a lot of kids who should be [allowed] to come, but I just think that [both] governments should just look at the families more closely.”
The case of seven-year-old Artyom Savelyev – sent back to Russia alone by his adoptive mother with a note saying she no longer wished to parent the child – sparked anger in Russia at the US.
There were calls for a total moratorium on adoptions with the US because this was not the first incident involving Russian orphans. Since the early 1990s, the Russian authorities say 18 orphans adopted internationally have died in their adoptive families, 17 of them in the US.
Just over two thirds of Russian orphans adopted abroad end up in the US. But 15 children also die every year under domestic Russian adoption, according to Russia’s children rights ombudsman Pavel Astakhov.
The Russian Duma eventually rejected the motion calling for a freeze on adoption in the US while the two countries negotiate a bilateral agreement to improve the process.
The failings are on both sides. Russia is one of only three countries that has yet to ratify the 1993 Hague adoption convention which regulates international adoptions.
US officials want the Russian side to give more information about children, and sooner, so parents can make an informed decision.
“The parents don’t see the complete medical status of the child until they show up to court for the final adoption,” said one US senior official who spoke on condition of anonymity because the negotiations with Russia are ongoing.
“In some cases that may be a little later than the parents would have wanted to see it depending on what it says.”
Dr Ronald Federici, a clinical neuropsychologist in Virginia, who has worked with adoptive families, tells a similar story.
He says the information is often only one or two pages of redacted information badly translated, given to the parents when they are in court, the child already in their arms.
Some parents, albeit overwhelmed by their new knowledge, feel obligated to bring the child home and then problems start. Others simply leave the children behind, according to Dr Federici.
That’s why the issue of matching children with the right family is so important.
“ We’re not getting a fifth – but we have no regrets ”
Adopting parents Mike and Julie
Some families are able and willing to deal with problem children, others are not and US adoption agencies are being urged to put in place a better vetting system. Many observers said Artyom should never have been adopted by the single mother he was matched with.
There are also concerns that families are not getting appropriate post-adoption support, after the adopted child arrives in the US.
This support is currently not mandated or enforced and because Russia is not part of the Hague process, the US state department cannot bar agencies that fail to provide it.
If things break down, there is little recourse for the families. So the sad, little known fact is that Russian adoptees are often simply sent back to Russia.
Not all of them make it into the news like Artyom. In the last 10 years, Dr Fedirici alone has seen 39 children sent back to Russia.
“[These children] have foetal alcohol syndrome, trauma, deprivation, neglect, abuse, malnutrition and illness. These things can be overcome, but it’s a very arduous process,” said Dr Federici.
But for the Jones family, back in Pennsylvania, it is a happy ending.
“We’re not getting a fifth,” said Julie, laughing, “but no, we have no regrets.”
The key now, for both the US and the Russian governments is to make sure other families too have no regrets about adopting from Russia.
Hi, Dr. Federici! It’s hard to believe that it was a year ago I first sent you an email regarding a family consult. I hope you and all of your family are doing well. From some of the listserves, it sounded like you went ahead and moved your office? If so, I hope that all went well for you too. I’m in the middle of opening a larger ABA center here in Southern Indiana, so I can appreciate the challenges!
Your help has proven invaluable with the children. While we continue to work through some issues with several of them as would be expected, they’ve all made huge strides forward this past year, in a large part because of your guidance and direction. Here’s a quick update on each child, plus a request below:
Kris is like a completely new person. He seems like a weight has been lifted and he’s doing extremely well. We’ve not seen the dark days for a long time from him and he’s worked through a lot of stuff with us. He just returned from his first mission trip (Jamaica) and that also has had a very positive impact, it seems.
Will’s change is incredible. We were able to explain to the school that we all had been operating under a misdiagnosis and convinced them to build him, Cary and Adam a language-based program within their existing school, customized in many ways for their specific needs based on your recommendations. Will went from starting the year reading at pre-K levels and nearly zero math ability to now reading at 80% proficiency on 3rd grade sight words, and large improvements in occupational math capability. Cary and Adam both had their best years ever, though both have a long way to go. Cary’s just so extremely hyper, it still it drives folks around him batty, plus he has a hair-trigger temper and has gotten a lot more mouthy. But it happens less frequently and in between, he’s actively trying to do things to improve his behavior and relationships. Thankfully, the darkness has abated quite albeit though it still shows up periodically. Adam still struggles, but the med trials on the Abilify didn’t go well, though the Welbutrin seems to help some. The local doc is trying him on a low dose of Risperdal, but we’re being very cautious given his earlier unusual reactions. It seems like his development – physically, mentally and emotionally has just stopped for the most part. It’s worrisome, as he seems totally out of touch with other people and is adamant his view of the world is accurate.
Ava is a pretty moody 13-year-old, but seems to be doing well most of the time. We try to get her out and involved in other things so she gets a break from the stress around here, but she still prefers to be a homebody, so we’ll keep working on that.
Kristie’s anxiety continues to be a major source of issues for her, but that seems to be improving some. She deals with some paranoia now too and the morning mania continues to be a major issue, but I’m doing some behavioral interventions with her that she finally seems to be responding to most days. We’re also seeing a lot more smiles, conversation and interest in what other people are doing, so that’s positive.
So that is the update. Again, I can’t really adequately express how much I appreciate all you’ve done for our family. You gave us the window we needed into our children so we could help them more appropriately and for most of them, it seems to be working. You also helped Jim and I take a very hard look at what was going on with us and that situation has improved dramatically over the past year also.
Thank you again for everything and may God bless you and your family…
With appreciation,
Kim Derk
“Dr. F: I had another thought about topic to include in Anna’s ‘needs/problems’ section of report: “She may reach puberty by ___ years of age, and will need direct teaching and hands-on assistance to manage self-care during menstrual periods, and cannot reliably relay menstrual pain due to high pain tolerance/thalamic pathway-sensory nerve involvement, which may create unpredictable moods and behavior”, or something akin to this. Hope it’s not too late. Off to take in sights with lots of layers to keep us Southerners warm. Everytime we leave hotel or restaurant or Metro stop, Anna announces “Dr ‘Rici is CLOSED, Mommy”. When we ask if she likes you, she says “Ye. . . . NOOOOOO!”. Guess that sums it up. Who really LIKED their drill sergeant, but am sure she has a love spot in her heart for you.
Thank you for everything. You met and exceeeded our every expectation, and we thank God for you. May you have blessed holiday season. Sincerely”
Lyn
“Dr. Federici. Thank you for everything. You met and exceeeded our every expectation, and we thank God for you. We have been to so many “experts” over the years, and you nailed it in two days, and have helped us see hope and a light at the end. We have learned more from you in these past days, than from years of ‘therapy”.
May you have blessed holiday season. Sincerely”
Jeri H. , Houston, Texas
“You are a life-saver, Dr. Federici! Your quality evaluation and comprehensive parent training has saved our family! We went through so many people, and you are the ONLY one who gets it with post-institutionalized kids. We owe you so much…thanks for helping all the families out there. God Bless!”
Will/Mary V., PA
“Hi. Just want to thank you for finding the time to meet with the Boyle child and the state department family/parents (from Africa). I read the report of your eval and just get blown away. This was the BEST evaluation and treatment plan we have ever seen for one of our state Department kids adopted from Ukraine. Actually, it was the best Neuropsychological Evlautaion we have seen altogether. This is a life long challenge for these parents. Your eval/recommendations was certainly something deeply needed and appreciated by them. Thanks for all the great support to our families serving abroad Thanks again”
D. Supervisor, Exceptional Programs, US Department of State
“May I ask what Dr. Federici does for….assessment?”
“Federici conducted 34 tests, held a diagnostic clinical interview and reviewed seven years worth of reports for my chld. I doubt that most other clinical psychologists are as thoroughly versed in the pre and postnatal challenges that confront Romanian children at least. In my experience, they don’t conduct as many tests.
My child was in his office from 8 in the morning until 6 p.m. Some children will receive additional testing; in our case, quite a bit had already been done, so Federici looked those results over and made sure to widen the testing to not duplicate (and/or to corroborate) what had been done before. Federici likes to do a great deal of testing by way of simulating a school day. He discovers what the mentally fatigued child does, what the low frustration child does, etc., what the “give up” child does, what the “dependent” child does…my child found it challenging, just like learning in school…
Within three weeks of our visit, Federici compiled and sent me a highly useful 37-page report. He also revised the few inaccuracies immedaitely when I made the request. Not only did his assessment provide the interconnected aspects of my child’s learning, pulled together to show how, for example, short term memory and attention were involved. He made sense of a complicated history, noting subtle and obvious issues in a way that made the report’s findings difficult to ignore in public school. Furthermore, because Dr. Federici has the credentials in psychopharmacology, he indicated which medications might help my child. I felt that I had received a thorough, competent evaluation.
I went to Federici because I was frustrated with the ignorance or “sluff off” factor I was encountering locally. …. I chose to go to Federici because of his knowledge base and the awareness that he could deliver a report (and revise it!) much more quickly than a hospital center.”
Hi Dr. Federici, sorry it has taken me so long to write back. You may recall I was struggling a couple of months ago with the Adults Only program. I reread your book, watched the tape (Saving Dane), and reread Wendy’s program. We got over the bumpy spots and things went relatively well.
Katie is able to be redirected verbally when she engages in body movements or “silly talk.” She returned to school in late August and has made a smooth transition to a new school, new teacher, and new classmates. Staff there is also finding her easy to redirect and Katie is now being mainstreamed again in the 3rd grade for math and some of the other subjects.
Katie has also transitioned to a new daycare setting (she is taken by bus to a different school) and has handled the change well. I am very pleased with the results I’ve seen as a result of implementing your program. I wish I could clone you and move you closer. Once I enjoy the fruits of our labors, I’ll be ready for the next steps! Thanks for providing such a wonderful service!”
Pat M.
“My daughter and I would not be where we are with peace in our home, and secure signs of attachment without the intervention and support of this team. My message to anyone adopting an older child is early intervention and consultation with this team of professionals.”
P.R., Indianapolis
“A great expert in the field of Child Psychology. We need him here in the U.K and Ireland”
J.R., England
” Extremely talented and skilled Clinician, Presentor and Parent!”
Mental Health Staff and Parents, Iceland
” Always a Professional we welcome here to lecture and train”.
Adoption Society, Australia
“Dr. Federici is the only neuropsychologist qualified enough to evaluate and treat the most complex children, especially post-institutionalized children”.
T.T., Founder, PNPIC
“Ron Federici and his group were the only ones that could handle my out of control child who had failed multiple treatments. His group has the best treatment team for the family in need”.
B.C., California
“This group of professionals evaluated and treated our situation, pro bono, because we were in dire need. The evaluation and program for my son helped immensely.”
K.C., New York
“If it weren’t for the most professional evaluation and intensive treatment program given our family with our adopted child, we would have been destroyed.”
K.J., Fort Worth, TX
“NBC-Dateline “Saving Dane–Saving a Family” which highlighted Dr. Federici’s expertise with the most disturbed children was an inspirational show of recovery.” Professional review, NBC Dateline June 2003.
“Dr. Ron Federici and his staff are an unmatched resource for families experiencing the challenges of parenting children with complex behavioral and learning problems. As an adoptive parent of a number of post-institutionalized children, Dr. Federici understands the emotional as well as the clinical issues facing each family. His superb diagnostic acumen is paired with an excellent track record of effective interventions.”
Dana E. Johnson, M.D., Ph.D., Professor of Pediatrics, University of Minnesota
“Given his extensive professional and personal experience with children of international adoption, Dr.Federici provides families with a uniquely informed and invaluable assessment of each child’s cognitive, academic and emotional strengths and weaknesses as impacting children’s functioning in home, school and other settings. His comprehensive neuropsychological assessments and expertise with post-institutionalized children, offered in conjunction with practical strategies, provides parents with tools and a much needed and individualized road map to identify the critical educational, medical and behavioral supports known to be essential for the promoting the wellbeing of these often misunderstood children and their families.”
Lisa M.H. Albers, MD, MPH, Director, Adoption Program, Children’s Hospital/Harvard Medical School
“I have worked with Dr. Federici for 10 years and have traveled with him to Romania on many medical missions. I learned about the plight of orphans from Dr. Federici and he inspires me daily. I send families to him because he knows the intricacies of the mind of an orphan mentally maimed by the harsh and unimaginable conditions of orphanages all over the world. He saves the souls of children. He is a creative and daring psychologist who drains his soul to help the hopeless!”
Dr. Jane Aronson, International Pediatric Health Services, PLLC
“Hello Dr. Federici and Leslie: I just wanted you to know that we have turned a HUGE corner! I called in desperate need 2 weeks ago and only 1 1/2 days later Michael decided to begin to comply.
I did have an emergency visit with his Psychiatrist, but we only decided to increase his Tenex to 1 mg b.i.d. I am very glad that is the only change we made because the difference in Michael and his behaviors is like nothing I have ever seen!
I have a new analogy for you to use. When I was pregnant people would tell me about their labor and delivery pains, but because I have never been through this I could only imagine. And, of course, my own labor and delivery would be my own personal experience. This is how I perceive explaining “extinction burst”. If you have never been through it, or seen it, you can only imagine what it will be like. And, of course, it is different for every child. I now understand that what Michael was doing on that Wednesday (hurting himself and me) was a true “extinction burst” (UGLY) (and perhaps a little something else). He was fighting for his life to try to get his old behaviors to work!
Well, I am happy to say that his old behaviors did not work
We are committed to the program and now even more so. The changes are so unbelievable!
Thank you, thank you. The work that Dr. Federici and you do is invaluable to families like ours.
Will keep you posted, and I’m sure have additional questions along the way. We just wanted you to hear some GOOD NEWS!”
Kelly F. (Rick, John and Michael too)
“did they determine over the phone before you traveled which of your children would need the extensive evaluation ?”
We knew that Kat was either on the way out or we needed to do something “really different”. When we made an appointment for Kat, we were willing to pay what ever was needed for peace (what price do I put on that).
We sent (our other children) to stay with my brother for the 4 days we were in DC with Federici. When we came home and started to work the Federici program with Kat, our youngest son’s Autistic behaviors were amplified. He displayed very stereotypical behaviors. We decided to take him to Federici for a full evaluation. After it was all said and done; the biggest suggestion was to try and reduce stress in his life and redirect him whenever he displayed stereotypical behaviors and get him around better role models (Kat was not a good role model for him). Our son was diagnosed as above average intelligence and many other positive dx’s.
“I’m also wondering if there is any testing that can be done locally through the child’s pediatrician that can help to minimize Federici’s cost.”
We could not face another person that was not willing to believe us. We were not willing to waste another nickel on “She’s Cute, She’s Adorable”.
We had tried local stuff only to be told that “everything was fine” and “she’s cute and getting better”. This was not the case at home. I video taped what was going on in our home and the therapist was beside herself stating “I had no idea it was like this”. We gave up on local’s and decided to try something extreme.
The result has been extraordinary. Kat is not a perfect, normal 4 year old however, she is nowhere near the behavior monster she was last year. She can sit and eat dinner, she can play with her brother, she will use the toilet for its intended purpose. This is priceless! We had lost all hope for Kat until we saw Federici.
Many may disagree with his tactics and call it barbaric or something along those lines. They may say that I have violated my child’s rights. I can tell you that my child has a right to life. The path she was on was a suicidal path, self mutilation, running into traffic, throwing herself into moving cars, the fireplace, the wall, the doors. We have done all we could do to save her from herself.
She is a different person today. I know this helps. I think very Highly of Dr Federici and his staff because “it worked for us” and “saved our family” on many fronts.”
B.D., New Jersey
“Hi Dr. Federici, We thought we would touch base with you and give you an update as to how things are going with W and D since our visit with you two years ago.
We still speak and enforce your level program EVERYDAY. Of course, we have made revisions from time to time to keep up with development, responsibilities and privileges, but the basics are the same. The kids are very used to this in their lives by now. Tracking their token count is a daily part of their lives, much like brushing their teeth! They have had their ups and downs, mostly due to lying – but we seem to have gotten a better grip on that lately.
W has come a long way. He thrives on his schedule and is quite self-directed. He doesn’t like bumps in his road or unexpected transitions, but he’s doing better at accepting them when they happen.
D struggles with many thinking errors as well, especially when it comes to relationships. She will continue to be a handful, for us and for whoever else in her future!
Overall they (we) are doing wonderful compared to where we were two years ago. On your 50-80% improvement scale, we give W a 75% and D a 60%. We expect more…still lots of room for improvement.
They even get themselves up with their own alarm clocks, get dressed, make their beds, feed our pets, get their own breakfast all on their own! Sounds a tad different from their experience in your waiting room two years ago!
Thank you again for all you did for us. We still hope to come back some day so you can see the progress for yourself. I’m sure you could put W’s anger control skills to a mighty test, but hopefully he would show improved survival skills! Sincerely,”
TJ & K., Boise, Idaho
“When we brought home our daughter Grace from Ukraine in March of 2004, we wondered if we would be able to parent her. She was 17 months old, 13 pounds and one big bundle of nerves. Grace has fetal alcohol syndrome, a disorder prevalent in the Eastern European orphan population. We are so grateful to have had that diagnosis which is necessary to getting her the proper help. Giving her love and time was not going to unwind the condition she was in.
It wasn’t just FAS that brought Grace to this level of stress, but a combination of unfortunate life stunting scenes. She was the 6th child born to a 26yr old alcoholic in Crimea. Born full term she weighed 4 pounds and micro cephalic. At three days she was taken from the hospital to the orphanage where she lay wrapped tightly swaddled in a blanket. Over the course of the following year and a half she would experience a constant set of illnesses including acute bronchitis, pneumonia, chicken pox, measles, salmonella poisoning as well as malnourishment that kept her too ill to be kept with the healthy orphans. Her main stay would be in the infirmary, a small dim room with a few cribs, no toys, and no stimulation day after day.
When we met Grace for that very first time we could hardly hold her because her body literally didn’t want to bend. It’s like picking up a wet, mad cat out of the bath tub- legs stick out everywhere. While she didn’t scream at us, she didn’t really look at us either. She had been deprived of so much that she couldn’t understand people. And deprived as she was, she was most content to be left in her crib where she could rock and bang her head and flick her fingers on metal screws. That was how she knew the world. So imagine her reaction when we took her away from that existence.
R and I were sure that she would thrive and be excited at discovering her new world. We couldn’t have been more wrong. Her behavior deteriorated more so upon our arrival home. She wanted to be able to continue what R and I termed “zoning out.” If she could sit and gaze or stick her finger in a hole and stare at it all day, she would have. We tried everything you could imagine. We left her alone to do it; in the case she might feel comfortable enough to enter our world. That didn’t work. We put socks over her hands so she couldn’t cram them up her nose anymore but then she’d only gaze or enter into another activity with her feet. Pretty soon, we realized there was no chance at bonding because we were so focused on how to get her into our world.
Looking back we were beyond clueless. While we had the diagnosis of fetal alcohol syndrome, there was nobody in our community to train us in how to parent her. And even if we found someone who understood FAS, we needed someone who would also understand the type of conditions she existed under in the orphanage. Love alone would not heal this little girl. As the first months passed, R and I were becoming the bundle of nerves that Grace was. Admittedly, I wondered if I could do this parenting thing with Grace and more selfishly, I was exhausted.
A friend of ours gave us some information about Dr. Federici and his practice in Alexandria, VA and we contacted them. By then I had been on all of the adoption forums on the internet and was convinced Grace had reactive attachment disorder as well as a host of other disorders. I had contacted a few different therapists through email explaining our situation only to be encouraged to disrupt the adoption. We felt at the end of our rope. What Dr. Federici and our occupational therapist, Wendy Schmidt were able to explain to us is why Grace was this way and what we needed to do to help her.
The severe lack of stimulation and neglect from her stay in the infirmary in addition to her malnourishment caused her to enter into a pseudo autistic state; a dissociative state where she used these maladaptive self soothing coping behaviors to exist. Dr. Federici has written on the subject calling it institutional autism. In order to bring her out of these “basement” behaviors, it would take minute to minute daily structure with me, her mom by her side. We needed to recreate a new world and in order to do that she needed consistency and repetition. And further, I would have to stop her “zoning.” Life in our home for those months was a bit like the movie Groundhog Day. Each day was a replicate of the day before. For a few weeks I think I must have cursed Dr. Federici and our therapist a few times a day. Each time she withdrew into her “zone,” I held her in my arms in what is called a “settle hold.” This is not to be confused with holding therapy techniques. I simply held her in a cradle like you would a small baby so that she couldn’t continue the maladaptive behaviors. She screamed and screamed. Days went by like this. I seriously questioned if any of this was working. Slowly she stopped the screaming and then began to look around, still refusing to look at me. Eye contact was particularly difficult. I wanted to put her down on the floor so many times and to be able to go on with my life.
I admit that I became so frustrated, I wondered if this was going to be what life would be like forever. If only I could set her down on the floor. She would have been happy to have been left alone to continue her “zone” and I could be sure of some quiet time. Isolation was setting in for me. Not only was I staying home everyday with a screaming child in my arms, but most of my community didn’t understand what it was I was doing or why I was doing it. I was tired of the explanations and the strange looks. I know they meant well but the best thing friends and family can do is be a support and not offer advice based on the normal healthy child they are raising at home.
Ever so slowly, as we inched ahead day by day, we began to see the unraveling of this tightly wound bundle of nerves we met that first day. She began to look at my face, only to glance away if our eyes met. And then she began touching my face while I held her. I began to add something new to our schedule as she was ready for it. Nearly three months passed before I left the house to take her out to public places. I realize now how vital that time was for her to be able to feel safe. She began to giggle and understand “silliness.” She no longer reached for strangers as if they were equal to me.
We even had to teach Grace what it meant to feel pain. For all of the times she felt pain and cried as an infant and nobody came to soothe her, she ceased “feeling” the pain. Crying and acknowledging hurt for her was useless. We taught her this by each time she fell we ran and scooped her up and made a big deal about what happened and told Grace she was hurt and cried with her. Basically the exact opposite of what we did with our two biological boys. But it worked! She needed to have her feelings validated and to be able to once again connect her physical pain and appropriate emotional response. This was key to helping cure the “zone out” periods. Grace learned that Mommy and Daddy fixed pain not gazing, hair pulling, eye poking or any one of her other coping mechanisms.
Today Grace is three years old and we have had her with us for 18 months. In that period of time she has truly blossomed reaching more goals than we ever imagined for this short period of time. For a child that had to learn to suck from a bottle when we brought her home, she is now learning to chew solid foods. A child that couldn’t walk until 21 months is now running and jumping a year later. A girl that didn’t understand what a Mommy and Daddy was, now calls out to them for hugs and kisses. A babe that didn’t know what smiling was for, now laughs heartily at a tickle or the cat’s tail brushing across her skin.
There is no greater joy than watching the emergence of life in a child that was in many ways lifeless. She only existed and now she is exuberantly alive! And you know what, I wouldn’t change a thing. It’s easy to say now of course, but in many ways her special needs humbled me, carving in me, a new patience and a whole new compassion for what many children experience in the orphanage setting.
Grace will never be cured of fetal alcohol syndrome and the secondary effects of it. She is frustrated easily with not being able to talk and to communicate her needs and wants. She will slowly achieve more goals as the time passes but she will forever have to live with the brain damage that cannot be reversed and we her family will need to adjust with her. R and I never set out to adopt a child with special needs, we only trusted that God would take us to the child He wanted us to have. And in doing so, we have received His grace and our Grace.”
T&R, Arkansas
Hi Dr Federici:
Just a quick update on Kristina: Heavy metals (blood and urine) were negative. Risperidol is GREAT! We now have a child psychiatrist managing the meds and doing fine at 0.25 BID. Her voice is not as loud, less rocking, crashing, banging, less agitation, staying on task/focused, especially at school. Unfortunately last weekend, we had 4 days of hell (she acted like she did pre-risperidol). I called child psych and she upped the dose to 0.25 TID (8 am- 4 pm/ after school- and bedtime). Things are better now.
Child psych ordered a fasting lipid panel which was abnormal. Note it was ordered/drawn 3 weeks after starting drug. Kristina must have crappy genes as she is not diabetic or obese. Her cholesterol is 197. Her HDL is 38 (low) and LDL is 145 (high). As you know, the HDL should be high and the LDL low. Hers are reverse and indicative of “moderate CHD risk”. Child psych doubts it is from the risperidol as she has not been on it long enough. We are redrawing labs in 6-8 weeks, if lipids are higher, she will pull her off resperidol and try another drug. Any thoughts on abnormal labs and/or drug effect?
Peds endo at Childrens Mem’l Hosp won’t see Kristina unless she is off the growth chart. She is at 10% now.
Peds neuro at Childrens is admitting her next week for a 24 hour EEG and comprehensive neuro exam, per your recommendations. Do u want results?
By the way, liked your commentary in PEOPLE mag last week. Both Kristina’s teacher and principal stopped to tell me they recognized your name in the magazine.
IEP implementation meeting is Monday with the whole team. School district has ABA trainer that will work with Kristina’s school and us to put behavioral program in place (finally). They are following your recommendations and for that we are eternally grateful to you. Feel free to use us a a reference for other families. We think you are terrific! Regards,
Karen J.
Hello Dr. Federici,
I just wanted to say thanks again a million times for your help with Irina. We took your advice on the Risperdal and kept her on it. It has been 2 weeks now on the medication and 1 month out of school and she is like a different child. She is so much better. She is sleeping good and her mood swings, hyperness and anger have greatly improved. We can see some hope now! Just wanted to share with you the good news about her and say thank you so very much for doing what you are doing for the kids.
Lori and Mike, VA Beach, VA
Hello Dr. Federici!
I am writing you to share good news about a former patient — D.S.. We visited you in August of 1999 from Cleveland, Ohio … and have corresponded several times since them. D. was selected to be the valedictorian of his confirmation class at our synagogue. Today he delivered his speech in front of the congregation. It was a moving and meaningful experience. The entire congregation was crying …the cantor said it was the most powerful confirmation speech she had heard in her 25 years at the synagogue. We thought you might enjoy reading it. And … you should know … that you were included in his first version of the speech as one of the reasons why he has reached the point he has. (the first version of the speech was more like a book … and needed editing). Thank you again for your guidance and expertise.
H.S., Ohio
Dr. Federici,
I was very moved by the Episode of Dateline “Saving Dane” I think your program is wonderful, and I can’t tell you how wonderful I think Dane’s parents are. I can only hope that all parents would be so patient with there children. They were amazing. Please if you are still in contact with them. They did a wonderful job on Dane. I couldn’t get over what a happy little boy he was towards the end of the show. I’m just hoping that his road has gotten easier and that he is just as happy if not happier these day . . . . My name is Allison, i’m from Tracy, California and I was very moved by this story.
Dr. Federici:
On behalf of Debbie and myself and especially little Miss Kelly, thank you not only for attending today’s meeting but for using your expertise to make the meeting a done deal in our favor before it even started. Today was the polar opposite of the meeting 3 months ago, which was a done deal against us before it even started, and the chair of the meeting was even condescending and rude, refusing to even consider your test results. But when the meeting started today I sensed a change in attitude within the first five minutes. The “educational establishment” was in our corner after looking at the data and wanted to work with us “in good faith,” as they put it. As I told Debbie after today’s meeting, when the odds are stacked against you, it is time to bring in superior firepower: Dr. Ronald Federici. Cordially,
Stuart
Just a note to say that Mihaela is doing really well since we started Sensory Processing Therapy and implemented all your recommendations. We have been in therapy for almost a year and the change in her is unbelievable. Can you tell me is Sensory Processing something that needs to be continued for a long time with children from Romania? I am sure that it depends on the child. What books can you recommend on the treatment at home for SPI? We have also seen an endocrinologist for her as well. I don’t know what we would have done without your help with Mihaela. You have been a life saver to us Dr. Federici and I just want to tell you THANKS!
Mihaela’s Mom
Dr. Ron:
We want to tell you that Dane continues to excel all around since we completed the “program” featured on “DateLine NBC” over 4 years now. NO MORE rages and uncontrollable episodes! Never a dull moment at our house! On a happy note, the kids are doing great!!! Megan is making A’s in her honors college program and enjoying her new apartment and roommates nearby. Dane is a speedy cross country runner (carrying the team’s first place trophy) on the JV team at his new high school. Both love us at this point in time, Praise God!!! Our family is blessed and has been restored thru so much.
Dear Dr. Federici,
Four years ago I contacted you about my then 9 year old son, Joshua. Although I had to modify your program due to Josh being my foster son at that time, your program still worked. Josh is now happy & healthy and learning to enjoy life after being abused and neglected for the first 8 1/2 years before he came ‘home’ to us. He still suffers permanent brain damage (FAS/E) but he is completely mainstreamed now and last quarter he made the honor roll! And today Josh won three out of his four of his wrestling matches and won 2nd place in his division! Not bad for a kid I was told may never heal who used to bite me, kick me, spit on me and try to kick the windows out of the van. THANK YOU, THANK YOU, THANK YOU!
Again, I can’t thank you enough for helping us save Josh. I need another miracle now to save Justin. Thank you so much for helping our family, again.
Carol
HI DR FEDERICI
DAVID IS DOING GREAT. HE HAS HIS MOMENTS BUT HE IS LISTENING AND FOCUSING BETTER. ON MONDAY I AM MEETING WITH THE SPECIAL NEEDS SCHOOL TO SEE IF WE CAN BYPASS THE WAITING LIST. AS WELL I AM SPEAKING WITH POTENTIAL ABA THERAPIST RECOMMENDED BY THE SCHOOL BOARD. DO YOU WANT TO SEE US IN MARCH. IF SO, DAVID HAS SCHOOL BREAK THE WEEK OF MARCH 5. LETS US KNOW. DR FFEDERICI IT IS GREAT HAVING A SON NOW INSTEAD OF AN ANIMAL.
STANLEY
Dear Dr. Federici,
We really enjoyed the opportunity to work with you and we both sensed a genuine desire on your part to help children. What you do for children and their families is amazing and your strength of character and knowledge was truly apparent throughout our visit. Your perspectives on parenting Andrew were insightful and we can clearly see benefits in the short period of time we have tried to implement the techniques. In a sense, the methods you taught are liberating in that we now understand that it is not necessary to constantly cater to Andrew’s wants and needs. Best Regards,
J & D from Connecticut
Hi Dr. Federici and Nadya,
We wanted to follow up with you and inform you on how our son, Sam , is doing. We had met with both of you back around May 2007.
Dr. Federici, after all your testing, your conclusion was that Sam had depression and you recommended that we put him a low dosage of an anti-depressant. Well we finally found a child psychiatrist in New Jersey which was no easy task. We showed her your report and she acceded to prescribe a very low dosage of Prozac, which she recommended.
Well we are so happy to tell you that is exactly what Sam needed. He is a completely different boy now. He’s generally happy and acts like a normal boy. His self esteem has markedly increased and it has had an incredibly positive impact on the whole family!
We are still working on bonding issues, but after dealing with four years of his depression, we feel the bonding will come in time. We are trying to incorporate some of Nadya’s recommendations regarding this issue.
We do thank the Lord that he is doing so much better now.
Thank you and may you continue to assist so many families that are in such difficult situations.
HEADLINE on GOOGLE: ACT, also known as Advocates for Children in Therapy, a for-profit organization, has recently made a rather large public statement saying they can prove that Attachment Therapy, Holding Therapy and Therapeutic restraints always hurt kids and always are lethal. Nothing could be further from the truth! I disagree with this statement on many levels, and find it incredulous that ACT is willing to make this statement and yet gives NO acceptable alternatives for adoptive parents and adoptees that has the power to replace the aspect of touch therapies and properly applied attachment therapies for severely affected victims of childhood abuse and neglect. In addition, ACT has no creditials for making such an assertion and has made a smear campaign against professionals who are aiding adoptive families in working with their severly unattachment children on bonding issues that are life-threatening if left untreated. Whomever authorized such statements within the ACT community has not done their homework and must have a personal vendetta against an individual in the attachment community. But why put out such statements that may prevent many victimized children a chance at a cure? I believe more attention needs to be paid to the false blanket statements of such organizations as ACT that proclaim to be reaching for an audience of adoptive parents who have children with attachment disordered children.
For children with severe reactive attachment disorder due to post traumatic stress disorder, the power of touch is the only modality of therapy that can reach these children’s psych where abuse and neglect is often stored in the preverbal mind, which is the deepest and hardest to reach place later on in life. Does ACT not know that Traditional talk-therapy does not begin to address in a 3-5 year old the level of hurt that the child has experienced? Does ACT propose that parents do nothing? or use therapies that are known NOT to be effective? ACT seems to be putting adoptive parents in a catch-22. And after reading the ACT website, I am serioulsy wondering if any of the author’s have ever actually seen attachment therapy in action or if any authors have even stopped to consider their actions on the children that will be denied help or treatment due to their negative and unthinkable words of ignorance.
There are no words to heal this predicament called attachment disorder. Only touch. There were no words for the 3 month old in a Romainian orphanage of understaffed and untrained poverty-ridden staff when no one came when he cried in hunger or pain. There were no words for the 6 month old girl a a Russian babyhouse for orphans who itched from scabies so deep in her skin that only unconsciousness was relief and even though it went on for months. There were also no words for the infant who was left in a dark closet full of nibbling rats while the birth parents were passed out drunk in the backyard of their summer shack in Ethiopia. Words don’t heal attachment disorders. The pain is stored deeply within the child’s most primitive bodily memories-which are 100 % sensory, and 100% unreachable without touch. Memories of the smell in that dark rat infested closet or the freezing temperature the child experienced are all stored in a cluster along with the misery. Once one preverbal memory is activated it lets loose the whole chain reaction-even though this happened long before the adoption into a new family. Muliply these traumatic episodes over any period of time, and you have the basis for a few early traumatic memories. Muliply these instances over periods of years-and you have severe post traumatic stress disorder that effects the mind of a child and causes reactive attachment disorder in full swing. It is no wonder.
Attachment therapy requires getting inside the hard shell of these kids’ outer attitudes and emotions, getting to a vulnerable space where new memories of safety and security can begin crowding out the old, traumatic ones. There is no complete cure, only increments of recovery and better quality of life. In most cases, families have seen at least five professionals to help their child with his/her strange behaviors and attachment problems before they find out about or stumble upon a reference for a psychologist, counselor or social worker who has any experience in working with adopted children exclusively or with any expertise. Through trial and error, and usually desperation, a family will be relieved to find out:
A: the right diagnosis
B: that they aren’t the only ones with this situation
C: there is documented evidence that shows the number of recoveries from RAD and PTSD
D: that their child has hope of not ending up in prison, dead or on drugs
It’s also worth noting that ACT does not exclusively state in their literature that RAD is a problem only for adopted children. Rather, it states no knowledge of the special needs of children that have lived in institutions and what the post orphanage behaviors have done to them. although they are the largest group of children with known attachment disorders. Therefore, by saying ACT advocates for children in therapy, they are actually doing the opposite. It condemns the very type of therapies that specifically has been known by adoptive parents and professional attachment therapists to do wonders in healing. It is as if ACT has picked a cause to advocate for just because deaths and sensationalism has occurred in the misuse of attachment therapies used by unqualified individuals. It is a case of “contempt prior to investigation.”
In all fields of medicine there are truly horrible situations that arise from extreme use of any method-including medications, surgeries, psychological therapies and even using “NO therapies.” By using the extreme negativism of a handful of fatal cases of so-called rebirthing therapies, ACT stands that ALL therapies that include attachment therapies and the professionals that work with them are bad. ACT is fine with NO therapies or therapies that don’t work, such as traditional talk-therapy.
Orphans who are adopted that were exposed to alcohol and/or drugs or other lethal toxins during pregnancy are more prone to be severely traumatized by orphanage living due to their lack of appropriate or available coping mechanisms. These children can develop a hard, aggressive stance toward anyone who might hurt them—even if that means love and protect them. The severe form of personality disorder that develop out of this state is called borderline or antisocial personality disorder. Once into later teens and adulthood, the prognosis for adoptees with this label, personality disorder, is practically bleak. Prisons and insane asylums are full of personality disordered adults. These people often lead extremely lonely and isolated existences (and even committ suicide) because of a lack of early intervention strong enough to change the course of the reactive attachment disorder. Yet some type of attachment therapy gives an extremely good prognosis when intervention happens early in life.
Do parents want to do nothing as ACT suggests? Or are they willing to try what has worked for many other RAD and PTSD adpted children? In our case, we opted for hope. My wife and I became attachment therapy adocates ourselves as we watched and learned while our children grew beyond their pasts. Not only did I, personally, sit in on every single session with the attachmenent therapist, I was always asked to hold my child in a loving, gentle and safe way at all times even when I was being punched in the face repeatedly by my 5 year old son. Did I have to be strong enough to watch my child struggle when his comfort level was getting busted? Of course. Was it easy to see my son cry out in rage that he hated me for no reason? Yes. Did I look him in the eye and tell him over and over that I loved him and needed to keep him safe no matter what? I had to. When my son spit in my face and told me he wanted to go back to Russia (even though they’d abused him) because I was worse, did it shock me? No. He would say anything to keep intimacy out of his heart and mind. Truly, it is fear that held my son captive, not the work of attachment therapy. Intense feelings of fear of loving, being loved, trusting, caring, and needing another human being were paramount and highly subconscious in my son. Once those feelings were activated by any number of triggers known and unknown he would run or fight even if it meant self-sabotaging himself over and over. It was a no-win situation that held him prisoner and us, as parents, the wardens. Neither my son nor I could have told you any of this before we went through a year of attachment therapy with a qualified attachment therapist. Fast forward seven years ahead and you will see a boy who DOES NOT have these issues! He is still overly sensitive and sometimes jealous if he thinks we love the cat more than him, but there is no overt symptoms of a child who we were once told had brain damage, RAD, PTSD, Conduct Disorder, ADHD, Pervasive Developmental Delay and Fetal Alcohol Syndrome. The attachment factor is key!
The good news I want adoptive parents and adoptees to know is this. Once the attachment issue was resolved, everything else got better. That’s the testimony of a parent who’s been in the trenches, but this was an area I knew nothing about when we adopted our son. What would we have done without a qualified attachment therapist, like Dr. Ronald Federici, to take our case? Who would we have turned to if it weren’t for the work of Dr. Bryan Post and the Post Institute, or Heather Forbes? What if Bowlby had never written about the controversial attachment theory due to fear of whether groups like ACT would end his career by ruining his reputation? Where would we be now? Would our son be in a group home or juivenile delinquint facility? Yes, left to his own devices, we believe he would have had to be locked up and supervised carefully around the clock to keep from hurting himself or others when he was “activated” with PTSD triggers, which was constant and growing when we started attachment therapy with him.
Without being taught and actively working with our son by using behavioral and attachment therapy and therapeutic restraints that were age appropriate to limit his aggression, would we have eventually just let him run away or beat us up? He was trying his utmost at the time to get away and torment us. Should we have just let nature take it’s course? Hell no! My son was worth saving, and so is every other kid out there who suffers. We must do whatever it takes, while thoroughly doing our homework, to make sure we are using the utmost safety and latest standards of proven therapy modalities and qualified experts to give our children what they never had-ADVOCACY. I would advocate to the very end for my children and so would Dr. Federici, Bowlby, Forbes and Post! I pray these professionals don’t take an ounce of flack from organizations that promote NOT curing our kids. I pray adoptive parents will not delay early intervention using attachament therapy by a qualified attachment or behavioral specialist to get into the solution NOW before it’s too late. As for ACT, I wish they could have walked a mile in our shoes for just one day before they made such liable comments about attachment and holding therapy and the pros who helped us. Its a personal insult.
So why any organization or group would advocate against the work of a type of therapy that changes so many lives for the better, that enables so many severely disturbed children to recover over time, or that lends itself to the quality of persons teaching and delivering the therapy, I don’t understand. Why throw out the baby with the bathwater, so to speak? Show me some other equally effective treatment for RAD and PTSD in adopted children that works and I will certainly eat my words. Until then I pray ACT will rethink their wrongful propositions about what kids need in attachment therapy—especially if you haven’t had a child with RAD, aka. the raddishes.
Thank God for Dr. Ronald Federici
In 2008 my son turned 3. I kept thinking the terrible two’s would phase out. I even named our adoption playgroup The Terrific Two’s and Three’s in hopes of a future life without screaming meltdowns and temper tantrums with fists. I had learned to expect the unexpected with my son adopted in Russia 1.5 years prior. Yes, he’d been sick frequently, and yes, he took medications that had ugly side effects. But I would never have been able to admit then that he had a permanent problem, a disorder that might be jumbling up his mind.
After attending several FRUA conferences, that is Families for Russian and Ukrainian Adoptions, I had heard many other stories of adopted children from the far Eastern European orphanages that struggled with many of the symptoms my son had—only his seemed more severe. He could not make eye-contact with me, but he could with others. He wouldn’t be still long enough to let me rock or hold him much without becoming very agitated and throwing a fit to get away. He broke all his toys and played so rough that he hurt other kids. He locked onto other boys in a vise-like grip and couldn’t seem to let go even when they would wail. He had an hour long meltdown when told no. He flat refused to hold my hand even to cross the street.
Even though my boy was very much loved, he could not return any affection. I thought he had a very hard shell around him and likened him to a feral cat that could not be domesticated. I was so disappointed that I would probably never be able to have a normal relationship with my son because he might be autistic or beyond help.
At a little of 3 years old he was kicked out of the 2nd mother’s day out program. He’d bitten a bigger boy on the face and left a huge wound. I quit my job and decided to do whatever it would take to get my son professional help. My first call was to a professional child therapist and attachment specialist referred by several families in our FRUA group. My second call was to a well-known child psychologist in our city who worked with adopted children’s issues also. I had both doctors do independent evaluations on my son to determine what plagued him. Both doctors came back with the exact same diagnosis in their reports-Fetal Alchohol Effects or Syndrome, Post Traumatic Stress Disorder, Reactive Attachment disorder caused most likely by the PTSD and possibly ADHD.
One doctor was a man and one was a woman. The woman suggested that my son would need to be medicated to make it through a treatment program. Since my son had such great rapport with men and not women, mainly me, and since he’d been passed around in the orphanage mainly by women caretakers, he had a much more severe reaction the the woman therapist. So I decided to go with the man for therapy. We started attachment therapy to help him learn to self-soothe and work on the preverbal trauma first. Every week we went and sometimes twice a week. Things were always calmer for a day or two after the doctor had had a session of holding time with my son-with me right there next to him-to allow an entire cycle of rage to complete. JJ always had a full body shutter after a cycle, and that was one way to know he was done. This cycle would take an hour to go through with screaming, biting, flatulating, kicking and flailing all over the doctor. The screaming could be heard through the office walls for at least a floor.
After the cycle the doctor would ask JJ to go sit on my lap. He would do that, and he would look at me. He would make eye contact. We started to see shorter rage cycles and more mommy holding time with JJ. It was hopeful. Then the rage would come back within a few days and never for any main triggering reason. Nothing would make the child happy.
I read every book I could get my hands on regarding bonding and attachment disorders in adopted children, early childhood trauma and sensory integration disorders. I tried everything I could to try to help my son short of medication.
At some point my misery won out and I started asking to see a psychiatrist. I was then told JJ had conduct disorder and possibly Aspergers. I got a second opinion, and that time I got pervasive developmental disorder and severe ADHD diagnosis. Since his case was so complex and overlapping in so many symptoms, I really wanted the doctors to take into account the orphanange situation. JJ had rickets from malnutrition. His medicals from the orphanage said he was weened from the bottle at 6 months, toilet trained at 13 months out of necessity and that he’d been moved from hospitals to several orphanages in a short amount of time due to overcrowding and poverity in his village. He had been neglected, very possibly abused physically since he flinched and ducked when I’d first met him and came near him with my hands, and he rocked and head banged in his crib every single night at bedtime. He woke up early but never ever called out from his crib. He’d been adopted at 19 months old. His first year and 7 months were not a picture of health or nurture. He lived in a survial of the fittest environment.
I heard about a doctor, a neuro-pscyhologist who worked exclusively with adopted children and had 7 little JJ’s of his own. I called him, and was put through to him on my first call! He was in Virginia, and I was in Texas. I told him my situaion and asked if he was qualified to do an evaluation on my child. He said, “just get to my office as soon as you can.” I worked with his secretary to get an appointment for the following week. I had to fly my wildchild to Virginia to see Dr. Ronald Federici. I couldn’t afford it. I was scared to death of taking him on the plane-after he’d screamed bloody murder all the way home from Moscow for 10 hours on our last plane ride. But I was desperate for professional help by someone who was competent about adopted children’s issues.
Dr. Federici came out and said hello to me and JJ, and then promptly took JJ by the hand and went into his office to do some testing for everything from auditory processing to Asberger’s. They took breaks and came out, we went to lunch together, and walked around the office building. Dr. Federici wanted to see JJ in action. He wanted to see JJ’s attitude toward me. I’d been asked to bring all my Russian medical records and video to Dr. Federeici for a review. I had copies made and had sent them a few days before we arrived. That evening after an all day appointment, Dr. Federici asked JJ to wait in the play area so he could give me the rundown on what he thought.
Dr. Federici first brought out my medical records that were in Russia and had English translations. He asked if I knew that JJ had been a preemie baby? No. Did I know his record from the hospital say he was born in withdrawal from opiates? He had alcohol in his system. His birthmother had had also tested positive for drugs and alcohol. The combination of problems had caused JJ to have a stroke of some type in his first few days, and he’d been on a breathing machine. “No-this is not what the medical said,” I told Dr. Federici. So Dr. Federici read to me word for word what the medical statements said, and it was all in there. It just had never been translated. The orphanage nor judge, not my agency, not even the caregivers ever said a word about any of these things that had made JJ a very special needs baby. But there it was in black and white. Thank God, Dr. Federici could read the Russian chicken scratching. Later I would send those pages off to a Russian-American physician who would fully translate all of the record for me and tell me he was so sorry for my very sick child.
Dr. Federici gave me the bad news first-the medical record information and the results of the low low scores on all the testing. The only good news he said would come the next day as we made a plan for treatment for JJ. All the information I had gotten from the day made me very sad, but it also validated my deepest intuition that the severity of JJ’s rage and fear had not been coming from simply a behavioral problem. He truly was brain damaged by his birth mother’s in utero choices to drink and do drugs and the hospital and orphanange neglect and trauma after birth.
On day 2 of our intervention with JJ we had a session called intensive family therapy. Dr. Federici showed me how to make a safety plan for JJ, a daily visual schedule. At one point Dr. Federici was giving me some private information and asked JJ to wait right outside the door. I knew that was a shot in the dark and after two minutes of total quiet had gone on, I said I needed to check on JJ. He was no where to be found. We finally found him running into the street on the busy road in front of Dr. Federici’s office building! This was a perfect example of what I meant about me feeling that I couldn’t keep him safe for even a minute if I wasn’t watching him closely. We found out that through an auditory processing dysfunction, JJ had interpreted “stand outside the door for one minute” as GO STAND OUTSIDE THE DOOR-AS IN THE OUT-SIDE DOOR-OUT SIDE THE BUILDING. So he did what was asked of him except that there were so many interesting things going on in the streets that he wandered off that way.
Dr. Federici and I put our hearts back into our chests and proceeded with putting together an applied behavioral analysis system based JJ’s problems and my parenting style for us to take home and immediately put into action. He put the 7-8 part plan on large poster boards for me to tack up to my walls and follow to the letter. He wrote out every piece of the plan for me, and told me to call him when I got home after a week for a consultation.
I have done exactly as he told me to do. Retraining my son has taken bundles of patience, medication, occupational therapy, ABA therapy and work within our home to provide him the proper type of attention for attachment. JJ started sleeping on a futon in my room, earning all privilages and repeating with me daily-over and over our safety plan, our home rules, our good words list, our privilages list, doing chores….and slowly but dramatically over one year’s period of time, I truly met my son’s real personality for the first time. He was more smiley than pouty. He obeyed out of respect and felt proud of himself for earning his likes. The longer we are on this journey into the solution, the closer we have gotten in attachment.
Since attachment had not truly taken place by JJ when we met Dr. Federici, it started when the program started. It took on a life of its own. And the more attached, trusting and open JJ can be the happier he is. We continued with the local attachment doctor who worked with us on our treatment goals with Dr. Federici. The last time we were in the doctor’s office, my son got up on his lap with not even a frown and said he’d rather sit with mommy. At that point I saw a boy who’d come full circle with attachment. The RAD is gone, and my son was considered a severe case. The PTSD symptoms are gone-except for the insecurity of abandonment which may always be a part of JJ’s emotional baggage. He tried to fake a temper tantrum the other day-and we both laughed.
Dr. Federici has never not returned an email or phone call within 12 hours to me-ever. He has never not given me his honest opinion even when he knew it was going to hurt. He has offerred to fight for us with the school board to get JJ the special services we thought he’d need (and now doesn’t require). He’s offerred to see JJ for free. He’s kept in touch and put me in touch with many professioanls who are following our case and hoping for JJ’s continued success. Dr. Federici took pity on this single mom and gave me a discount on office fees. He changed the quality of our lives. He gave to me and to my son hope and tools to find the way out of the darkness out into the light. We both will always be so grateful to Dr. F for his dedication to his work and clients. He has been an excellent role model for both my son and me. In our last talk, he asked when I was going to get on my my own work as a pediatric counselor….I’d already done the time….and other kids need the kind of experience I now have lived through. So now it is me who is rising to the challange to meet the great expectations of a wise doctor, Dr. F.
Posted by Karasel Kid at 10:13 AM on the AdoptionHarmonyBlog@blogspot.com
1.
Dr Ronald Federici | April 19, 2010 at 6:54 pm
2010
First Time Around Adoptive Parents
Posted by Karasel Kid under Adoption Links & Resources, Adoption Referrals, Adoptive Parents, Attachment & Bonding, Single Parent Adoption
1 Comment
First Time Parents Get Ready!
Take the Rose Colored Glasses Off now! The most important element in adoption is understanding how to develop a Healthy Attachment with your new child no matter the age. Many say, “Babies don’t remember anything or they are a blank slate.” This is not true. Their bodies do remember, and their brains have developed according to their past sensory input and emotional experiences by the time you meet them. Be open to the fact that your new child has a first family or home or a beginning, and it was not with you. They are with you now, and you must understand that their is nothing glamorous about the transition from the child’s old environment to your new one.
As Dr. Ronald Federici, a well known post-institutionalized child specialist points out, “Structure equals Love*,” when a child first comes home. Keeping the child’s world very small is recommended. Choose a FEW age appropriate toys for them, and as for all those ones you may have already bought, well, put them up on a high shelf and introduce them slowly one at a time. Make sure that the toys are not babysitters, but that the primary caregiver(s) are the focus and building the emotional experiences that are couples with sensory input to get that brain development into its highest functioning to make up for the gaps from institutionalization.
Many adult adoptees say that the adoption, in an of itself, was a trauma because it shook their world upside down. If a child feels they have no control, and they really don’t, then that is life or death in their comprehension. This applies right down to the babies adopted at birth. Their “wonderful new home” is a result of a loss. Their inner selves, their brain development, has incorporated that feeling in many ways via their senses. It may feel like fear,loss, frustration, pain, lonliness, neglect, sadness, deprivation of love, touch, verbalization, attention, and even food.
Don’t expect them to act grateful, and if they do, then it will be a gift for you. The honeymoon period WILL wear off, and when they child feels safe enough to test you and every boundary you ever thought about having, then you know they are probably making progress! They trust you enough to test the waters. Having a well thought out and consistent discipline plan that is proactive and a daily schedule with consistent structure are some of the most loving acts you show to your new child.
*Help for the Hopeless Child: A Guide for Families, Dr. Rondald Federici
If you are considering adopting, please read the article titled: A Different Perspective…just imagine because it attunes you to the place your child will be in upon arrival.
A great website to read about bonding and healthy attachment comes from one of my favorite sites called RadZebra.org to find articles such as What is Healthy Attachment?
You will find a collection of other articles on this topic at AdoptionHarmony.com.
2.
Dr Ronald Federici | April 19, 2010 at 6:57 pm
Sometimes, adoption has a dark side
By Ben Montgomery, Times Staff Writer
Published Friday, April 16, 2010
——————————————————————————–
Who on earth could return a human child like consumer goods?
That’s what we’re asking after a nurse from Tennessee sent her 7-year-old adopted son back to Russia last week.
In a note, the mother said the boy she cared for since September was unstable and violent.
“I no longer wish to parent this child.”
Since then, Torry Hansen has been vilified. She has been called “ignorant,” “sick” and “a monster.”
But psychiatrists, adoption lawyers and parents of adopted international children say Hansen’s desperation is not uncommon. They say that sometimes there’s a dark side to international adoption that doesn’t fit the rosy narrative.
“I’ve seen it happen dozens of times,” said Dr. Ronald Federici, a Virginia psychiatrist and father of seven internationally adopted children. “Parents escort them back to orphanages. They leave kids at baggage carousels. They leave them at Disney World. They leave them in my office and drive away.
“This is not an unusual situation.”
When Hansen sent her son back, prompting Russian officials to announce they were suspending American adoptions, she touched off a national debate.
Most Americans who adopt children from elsewhere find joy. But what about the others?
Why couldn’t Hansen and her son get the help they needed? How do we prevent this from happening again?
• • •
Linda Hagen was prepared.
She and her husband had saved money and read books and learned Russian phrases.
They knew the children they were going to love had spent 18 months in a dank orphanage, with little food, lax hygiene and scant medical care.
They knew the fables the orphans tell each other: If you’re adopted by an American, you’ll either live like a king, or your body parts will be used to heal sick American children.
So when they showed up in Russia in 2005 to adopt two siblings, 8 and 9, they were ready.
They would keep the kids close. Introduce them to undecorated bedrooms and not take them to stores or parties, to reduce the chance of over-stimulation. Choose their food for them. Set rules quickly.
Hagen was surprised as they left the Russian ministry of education when her new son wanted a balloon so badly he began screaming and banging his head on the ground. That evening, in a Moscow apartment, when she and her husband turned their backs for a second, the boy ran. They found him on the street trying to buy ice cream.
The first week home, the kids stuffed their pockets at the grocery store in the few seconds Hagen was paying the cashier. A few days later, the boy disappeared when they weren’t looking. They called the police. They found the boy in the attic.
Hagen, of Fort Lauderdale, laughs about those early days. The children are 12 and 13 now, and Hagen adopted their older brother, 17. She is hesitant to talk about recent issues but acknowledges they have maintained their family unit with the help of intensive counseling.
“To this day, my children sleep with baby monitors,” she says. “I need to know where they are.”
Hagen, 48, now participates in online support groups with about 3,000 similar adoptive parents. A recurring topic: How can I find residential treatment for my adopted child?
“They might say, ‘My child cannot remain in my home. He has already killed my dog and threatened me with a knife. We’ve been in psychiatric hospitals.’ ”
The answer?
Pay $3,000 to $4,000 a month to one of a handful of places that offer specialized residential treatment, she says.
And what if they can’t afford that?
• • •
The problems: Lax oversight of U.S. adoption agencies that don’t do legitimate home studies, don’t provide pre- or post-adoption assistance and charge $30,000 or more per adoption.
Corruption in countries trying to get rid of orphans and line their own pockets.
Naive parents and counselors who believe that enough love and time will cure all.
Federici says some in the adoption field have been calling for more oversight for years.
“The issue is far greater than one case. These parents are screaming. They’re desperate.”
Americans adopted 1,600 children from Russia last year. Institutionalized children from Eastern Europe, who spend years in bleak orphanages, often come to the United States with a load of mental health problems. Some are unattached from years with no parental figure. Some are traumatized by past abuse. Some are grossly undersocialized, cold, even feral.
And what happens when parents don’t know how to deal with those issues and can’t find help? Some turn them over to states. In 2006, the U.S. Department of Health and Human Services counted 81 children adopted overseas who were relinquished to officials in 14 states.
Sometimes it’s worse.
“M-U-R-D-E-R,” Federici spells (He’s with a young patient). “We’ve seen 21 cases. All are identical. All were beaten to death with objects by the mother.”
That number, 21, couldn’t be verified. Some put it at 16. Russian officials say more than 12.
Whatever the number, the cases are extreme. One mother caught her adopted daughter smearing feces on the wall and punched and kicked the child to death. Another beat her troubled child to death with a wooden spoon.
Dr. Myra McPherson, who has counseled desperate adoptive parents in Sarasota, says it’s no surprise. “A child in distress has a brain that’s been poisoned,” she says. “It’s like trying to bring a wild animal into your house.”
The children need attention, but reject it.
One local family adopted a 2-year-old from overseas, McPherson says. The little girl scratched and bit herself all the way back to America. She cried for hours, refused to sleep. Banged her head. The mother was afraid to take the girl out of the home for fear people would think she was abusing the child.
“These are well-meaning, loving families,” she said. “Professional folks that you and I would respect, but they say, ‘We can’t do this.’ ”
Florida doesn’t track the number of disrupted international adoptions, but the director of a family safety program for the Florida Department of Children and Families said he wouldn’t describe it as common. Sometimes it’s prevented when the parent finally finds help.
“I’ve seen many a parent who wants to give their child back,” says McPherson. “Many.”
And they’re afraid to step forward for fear they’ll be judged, like the woman who sent her child back to Russia.
Hagen doesn’t want to discourage adoption, because she has seen the rewards. But she also knows the cost.
“People need to know that it is not likely at all to get a kid who has no issues. You need to know that you can’t get into this unless you have the resources.”
Times staff writer Leonora LaPeter Anton and researcher Shirl Kennedy contributed to this report.
fast facts
Resources
on adoption
. U.S. Department of State: adoption.state.gov
. Florida Governor’s Adoption Initiative: adoptflorida.org
. Families for Russian
and Ukranian Adoption: frua.org
3.
Dr Ron Federici | May 2, 2010 at 2:00 pm
NEW YORK TIMES
Lawsuit over adoption raises disclosure issues
By Pam Belluck
New York Times
POSTED: 01:30 a.m. HST, Apr 28, 2010
ShareScores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.
Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.
The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.
They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.
After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.
Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.
Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.
The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.
After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.
The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)
Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.
“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”
No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.
But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.
Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”
Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”
Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.
“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”
As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.
Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.
Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.
While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)
“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”
In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.
In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.
The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.
Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.
“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.
But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”
The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.
“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”
4.
Dr Ron Federici | May 2, 2010 at 6:53 pm
The Therapeutic Value of Using Physical Interventions to Address Violent Behavior in Children
A quick review of the published information on physical interventions over the last three years would seem to indicate that a fundamental and universal shift has occurred, away from the use of therapeutic restraint, as well as the use of seclusion, to address violent behavior in children. However, this is somewhat deceptive. Treatment environments have been faced with increasingly violent and assaultive children in a continuing trend that was identified a decade ago (Bath, 1992; Crespi, 1990). This challenge must be considered along with the fact that young children most often present violent behavior in treatment settings (Miller, Walker & Friedman, 1989). Unlike the impression given by recent media, the reality is that most treatment centers for young children use physical interventions to address violent behavior in a safe and effective manner. It is true that physical interventions have been the subject of substantial training to insure they are done according to national crisis management guidelines, but it is not true that the mental health community has abandoned physical interventions for violence.
It is important to clarify the interchangeable terms therapeutic holding and physical restraint. This physical intervention is when a trained adult stops a child from hurting self or others by using approved crisis intervention holds to protect the child until the child is no longer a danger. There are a variety of approved holds but all of them restrain the child from being violent and causing damage to self or others. A distinction must be made between the type of holding discussed in this article and “holding therapy,” which is a physically intrusive method to produce a crisis in a child and force the child to experience physical or psychological pain. Holding therapy and other similar intrusive techniques are not sanctioned by any legitimate professional organization and in the opinion of the authors are not therapeutic and are not valid psychological treatment.
There is increasing pressure on these programs to become restraint and seclusion free, but is this direction in the best interests of the children? The answer will emerge only after a dialogue of the valid points on both sides of this issue, but to date only one point of view has been advanced. The purpose of this article is to provide another perspective on this issue, one that has not been previously put forward.
A variety of interventions have been used over the years to address violent behavior among children and adolescents (Troutman, Myers, Borchardt, Kowalski & Burbrick, 1998). In settings such as psychiatric hospitals and treatment programs, two of the most frequently used interventions are therapeutic holds (also called therapeutic restraint) and giving the individual a chance to regain self-control in a seclusion or quiet room. Interventions less often used to address violent behavior are mechanical restraints and using medications for chemical restraint (Measham, 1995). Over the last ten years the latter two interventions, mechanical and chemical restraint, have been criticized as excessive and too restrictive. Mechanical and chemical restraints have declined in some programs and have been eliminated in others, particularly in non-hospital settings.
More recently, in the last three years, restraint and seclusion have been the subject of considerable controversy. A host of arguments have been presented against the use of restraint and seclusion to address violent behavior in children (Wong, 1990). Most notable was an investigative series in a Connecticut newspaper, the Hartford Courant (Altimari, Weiss, Blint, Pointras, & Megan, 1998). This expose of injuries and deaths reportedly caused by the use of restraint and seclusion is often credited with starting the current wave of criticism for the use of restraint and seclusion. This controversy has run the gambit from media coverage to policy change and new federal legislation.
The array of criticism directed at the use of restraint and seclusion has one glaring absence, a review of the therapeutic benefits of physical holds to address violence among children. Although seclusion is often used interchangeably for therapeutic restraint, the two are very different interventions bringing up very different issues. The focus of this article will not be seclusion, but rather a review of the therapeutic components of physical restraint.
Before addressing the potential therapeutic components of physical restraint, it is important to briefly consider the most frequent criticisms of using this intervention. A recent nationally published article is a good example of the criticism being directed at the use of physical restraint (Kirkwood, 2003). The article calls restraint violent, dangerous, and even potentially deadly to children. The point is made that this intervention can actually cause further trauma due to concerns such as counter-aggression by adults and repeating abuse the child has experienced in the past. Restraint is called a violent means to maintain control and “rule over” children. Rather than use physical restraint, the article recommends negotiating with the child, understanding the reasons behind the behavior and giving the child choices. Some critics have gone so far as to say a physical restraint should be avoided at all costs and any use of physical restraint is a treatment failure.
In the face of such harsh criticism, is there any defense for physical interventions such as restraining violent children? The authors believe there is, but the starting point of discussing the therapeutic components of physical restraint must begin with an acknowledgement that even good interventions when done poorly, or at the wrong time, lose some or all of their therapeutic value. Rather than an indictment of all physical interventions, the criticisms outlined in the article mentioned above can serve to improve the quality of physical restraint and, for that matter, all other behavior management.
All behavior management can become ineffective, demeaning and even psychologically damaging if done poorly. It is safe to say that using a violence intervention to “rule over” children is poor behavior management. Like other types of behavior management, if physical restraint is done in a violent and dangerous way, it may be possible to replicate the past abuse of the child, at least in the child’s mind. However, physical restraint is not step one of any intervention with a child. Physical restraint should not be a shortcut to taking the time to understand the child and the reasons behind the child’s behavior. Restraint is also not the opposite end of the continuum from appropriate negotiations and setting out clear and meaningful choices. Physical restraint is properly used only when the adult is trying to understand the child and other limit setting techniques have failed to safely address the violent behavior of the child. Interventions are also not therapeutic when they are based on a power struggle or when the adult is out of control. Any behavior management approach loses its therapeutic value if used to merely control the child without supporting and understanding the child’s thoughts, feelings and goals for the behavior. This is true for all behavior management interventions such as: time outs, logical consequences, giving choices, negotiating as well as physical restraint. It is not necessarily the technique that makes an intervention therapeutic, it is more often the when, how, why and by whom the technique is employed that makes the difference.
If physical restraint is a legitimate part of any behavior management plan, it must have the potential of therapeutic value when used appropriately. Among nationally recognized crisis behavior management systems there are clear guidelines as to the appropriate use of physical restraint. Behavior management systems such as Crisis Prevention Institute (CPI) and Professional Assault Response Training (PART) are two well known examples. Both outline the safe and effective use of physical interventions after crisis de-escalation techniques have been used to address the situation.
National accreditation organizations such as the Council on Accreditation (COA) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) sanction the appropriate use of physical restraint. If any legitimate organization were to declare physical restraint a “treatment failure,” an expression currently being used by opponents of physical interventions (National Technical Assistance Center for Mental Health Planning, 2002), one would expect it to come from entities that hold organizations to the highest standards of the industry, and yet all major national accrediting bodies sanction the use of physical interventions. It is difficult to find any national professional organization, such as the American Academy of Pediatrics, that does not agree with the general statement, “Restraint and seclusion, when used properly, can be life-saving and injury sparing interventions” (American Hospital Association and National Association of Psychiatric Health Systems).
Here are some of the reasons why physical restraint, when done well, can be an important, effective and therapeutic intervention to address the violent behavior of children.
• Physical touch can be very therapeutic to children, particularly in a crisis. Long before a child learns English, Spanish or Swahili, the first language a child learns is the language of touch. Touch is considered a basic need for all children. When a young child is frightened, the first instinct is to hold on to a trusted adult. Children who demonstrate serious acting out often do not know how to ask for what they need, yet supportive, firm, and safe physical touch can give a child a message of reassurance. If touch is poorly used, such as slapping or striking a child, the message of such a touch can be very frightening. When a young child is in a crisis situation, touch can be one of the most reassuring interventions when the touch lets the child know that the adult will insure the situation will be managed safely for everyone.
• Emotionally defended children can become psychologically more real and available after an emotional release during a physical restraint. This dynamic is not restricted to children. It is often when our emotions overwhelm us that we open to learning something new that we have defended ourselves from. There is a parallel in psychotherapy to this dynamic when a client has a difficult but insightful experience that usually includes being catapulted beyond the individual’s ability to keep out important information. For some children it is difficult to get to this place without some form of emotional meltdown that often accompanies a physical intervention.
• Children need to know the adult will insure everyone’s safety. The adult is responsible to insure the child cannot hurt him or herself or others, if other management methods fail, physical interventions are important. The adult cannot put the responsibility on a child to regain inner control once it has been lost. The amount of time it takes for any crisis situation to be under control, during which time chaos reigns, is the amount of inner fear the child has. Children can regain their footing, but the assistance from a supportive adult can be critical.
• Young children with emotional disturbances need and often seek closeness with adults and violence is less threatening than other forms of intimacy. Behavior cannot always be taken at face value with children who experience violent rages. In fact, these children can often act counter-intuitively. They can push you away when they want closeness, they can strike at you when they are beginning to care about you, and they can act in ways to receive reassuring touch by becoming aggressive and violent to self or others. It is important to understand why a child is acting the way they are. At times, a frightened child seeks and needs the reassurance of physical touch when they can’t allow themselves to ask for physical comfort. It is often trusted adults that young children become violent with, because they know they are safe and they will get the reassurance they need. If they do not find the physical reassurance they need and seek, they will often raise the level of acting out until they get it.
• Physical restraint is the surest and most direct way to prevent injury and significant property damage when the child loses control. The above referenced article in Children’s Voice (Kirkwood, 2003) begins with a description of a child doing significant damage to a car with a rock. In this example the adults stood by and did not stop the child and the author called this a better, however more costly, intervention. This seems to defy common sense. Would any parent stand by as a child does thousands of dollars in damage to the family car? Recently, a child in our program picked up a rock, ran around a new car and heavily scratched it to the amount of $2,650 damage. Afterward the child felt badly for such out of control behavior and said good kids do not do such bad things. It is important to understand that kids, as well as adults, view themselves in relation to their own behavior. It only makes sense from a practical and therapeutic perspective to stop children from hurting others and doing damage they will use to feel worse about themselves. Physical interventions may be the best way to insure this.
• Traumatized children must learn that emotionally charged situations and all physical touch does not end in being used or abused. The human being has several types of memory, including factual (explicit), subjective (implicit), emotional, experiential and body memories (Ziegler, 2002). Early experiences of touch can establish a lifelong trajectory of meaning attributed to physical touch. It is common that children with emotional disturbances have difficulty with caring touch. Body memories need to be addressed while the child is still young or the child can avoid the very closeness they need. Abused children learn that when someone gets angry someone else gets hurt. Supportive physical restraint retrains the body not to fear touch from others.
• An intervention considered to be good parenting is likely to be good psychological treatment. Psychologists, family therapists and parent trainers would all call stopping a child from running into a busy street good supervision and effective parenting. They would also recommend a parent prevent an older and much larger sibling from physically harming a younger sibling. It is not hard to imagine the same parenting consultants suggesting that when an angry child is heading for the family car with a baseball bat, that the bat be taken away before the damage occurs. If these parenting interventions would be basic common sense to most everyone, why would some call these same interventions unhelpful and non-therapeutic to children with serious anger problems?
• Children with emotional disturbances need the assurance that adults are safely and appropriately in control of the environment. Serious acting out such as violence is often seeking this assurance. Most emotional problems in children have their source in chaotic, abusive and/or neglectful home environments at some point in the child’s life. To be in a home where the adults are not in control of themselves or the environment is like going down the road in the back seat of a car with no one driving, it is terrifying to a child who has been there. These children often push a new environment to the point that the child finds if the adults can safely and appropriately manage the challenges. Often when the child has such reassurance and can rely on others for basic needs, he or she can once again get back to the task of being a child.
• Treatment programs are responsible for directly addressing violent behavior and not just skillfully preventing the behavior from presenting itself during treatment only to reappear in the home or community after treatment. The argument that all physical restraints can and should be avoided at all cost may address the principle of prevention, but misses the point of treatment. In the extreme, all physical restraints could be avoided, this simply requires an adult to passively stand by and allow a child in a rage to do whatever he or she wants to do. One may call this “preventing” a restraint, but how did it address the responsibility of a treatment program to treat and extinguish serious violent and antisocial behavior? The role of prevention and treatment are quite different. Not intervening when a therapeutic response is called for is not so much prevention as it is abdicating adult responsibility. If someone needed treatment for a debilitating phobia of spiders, the symptoms could be prevented by having an insect free environment, but this would not be treating the phobia. Programs charged with treating violent behavior cannot simply insure that the symptoms never come up in the treatment environment because they will surely resurface once the child leaves that setting. In psychological terms, treatment often requires steps such as re-exposure to stimuli, cognitive reprocessing, skill development, practice and mastery, none of which have an opportunity to happen if preventing symptoms or preventing a particular intervention at all cost is the goal.
Are therapeutic benefits guaranteed by the appropriate use of physical interventions? No intervention comes with a guarantee. However, as one side of this debate offers sensational media stories and points to abuses of physical interventions (and there have been abuses), there exists research and professional literature that has found therapeutic value in physical restraint when used properly. Restraint has been found to shorten the crisis over other interventions (Miller et al., 1989). Research studies have found physical restraint effective in reducing severely aggressive behavior, self-injurious behavior and self-stimulatory behaviors (Lamberti & Cummings, 1992; Measham, 1995; Miller et al. 1989; Rolider, Williams, Cummings & Van Houten, 1991). Physical restraint has been found helpful in treating aggression with dissociative children (Lamberti & Cummings, 1992). Physical interventions have also been recognized in the role of re-parenting children who have not been taught limit setting due to absent parenting (Fahlberg, 1991). Physical restraint has been called an effective intervention to protect the child and others from harm and prevent serious destruction of property (Stirling & HcHugh, 1998).
A frequently cited criticism of restraint is that it takes away the ability of the child to learn and internalize self-control. However, research studies have found the opposite. In two studies nearly a decade apart, physical holding produced rapid gain in internal behavioral control (Miller, Walker & Friedman, 1989; Sourander, Aurela & Piha, 1997). Physical restraint has been called ethically sound (Sugar, 1994) and recognized for significant therapeutic benefits (Bath, 1994).
The arguments for and against the use of various interventions such as medications, institutionalization, physically intrusive therapies, seclusion, and physical restraint are important discussions. However, children are not served when only one point of view is expressed. Many interventions, including physical restraint, can have damaging consequences when improperly used, however, at times the consequences of not using serious interventions can be even more damaging to a child. A five-point evaluation of interventions for violent behavior has previously been recommended (Ziegler, 2001), 1. Was safety insured? 2. Was self control internalized? 3. Was the intervention individualized and based on understanding the child? 4. Was the intervention therapeutically driven? and 5. Was the intervention effective in producing the desired result?
If we are to meet the challenge of increasing numbers of violent children in our system of care, we must carefully consider how we can best meet the short and long term needs of these children, while insuring the safety of other children, their parents, and the community at large. A reasoned approach to this question would be careful consideration of all the issues and not a singular movement to reduce or eliminate physical interventions, which have been found to be safe, ethical, effective and therapeutic.
References
Altimari, D., Weiss, E.M., Blint, D.F., Poitras, C. & Megan, K. (1998). Deadly Restraint: Killed by a system intended for care. Hartford Courant, Hartford Connecticut (8/16/98).
American Academy of Pediatrics—Committee on Pediatric Emergency Medicine (1997). Pediatric, 99 (3), 497-498.
American Psychiatric Association, Arlington, VA.
Bath, H. (1994). The physical restraint of children: Is it therapeutic? American Journal of Orthopsychiatry, 64 (11), 40-48.
Council on Accreditation for Children and Family Services (2002). Accreditation Standards 7th Edition. New York, NY.
Crespi, T.D. (1990). Restraint and Seclusion with Institutionalized Adolescents. Adolescence, 25, (100), 825-828.
Crisis Prevention Institute, Inc. (2001). Nonviolent crisis intervention Training Manual. Brookfield, Wisconsin.
Fahlberg, V.I. (1991) A child’s journey through placement. Indianapolis: Perspective Press.
Joint Commission On Accreditation of Health Care Organizations (1996). Accreditation Manual for Hospitals: Volume 1 – Standards. Oakbrook Terrace, Il.
Kirkwood, S. (2003). Practicing Restraint. Children’s Voice, 12 (5), pp. 14-19.
Lamberti, J.S. & Cummings, S. (1992). Hands-on restraint in the treatment of multiple personality disorder. Hospital and Community Psychiatry, 43 (3), 283-284.
Measham, T.J. (1995). The acute management of aggressive behaviors in hospitalized children and adolescents. Canadian Journal of Psychiatry, 40 (6), 330-336.
Miller D., Walker, M.C. & Friedman D. (1989). Use of a holding technique to control the violent behavior of seriously disturbed adolescents. Hospital and Community Psychiatry, 40 (5), 520-524.
National Association of Psychiatric Health Systems, Washington, D.C.
National Technical Assistance Center for State Mental Health Planning (2002). Networks , Alexandria, VA.
Rolider, A., Williams, L., Cummings, A. & Van Houten, R. (1991). The use of a brief movement restriction procedure to eliminate severe inappropriate behavior. Journal of Behavioral Therapy and Experimental Psychiatry, 22 (1), 23-30.
Smith, P.A. (1993). Training Manual for Professional Assault Response Training Revised.
Stirling, C. & McHugh, A. (1998). Developing a non-aversive intervention strategy in the management of aggression and violence for people with learning disabilities using natural therapeutic holding. Journal of Advanced Nursing, 27 (3), 503-509.
Troutman, B., Myers, K., Borchardt, C., Kowalski, R. & Burbrick, J. (1998). Case study: When restraints are the least restrictive alternative for managing aggression. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (5), 554-555.
Wong, S.E. (1990). How therapeutic is therapeutic holding? Journal of Psychiatric Nursing & Mental Health, 28 (11), 24-28.
Ziegler, D. (2001). To Hold, or Not to Hold…Is That the Right Question? Residential Treatment for Children & Youth, 18 (4), 33-45.
Ziegler, D. (2002). Traumatic Experience and the Brain, A handbook for understanding and treating those traumatized as children. Phoenix: Acacia Press.
5.
Ron Federici,Psy.D. | May 16, 2010 at 8:14 pm
The risks of adopting from Russia
Russia and the US are negotiating changes to overseas adoption procedures after a controversy last month sparked by an American adoptive mother who sent her son back to Moscow alone. The BBC’s Kim Ghattas met a Pennsylvania family with a unique perspective on US-Russia adoptions.
In a leafy town in Pennsylvania, four children and their parents are reunited after a day at school and work. Abby, 14, is showing off her purple nail polish, Lydia, nine, wants to rehearse on her cello.
Trevor, seven, and Hayden, 11, are wolfing down snacks prepared by their mother Julie, while father Mike asks about homework.
They appear the all-American family, but the children were all adopted in Russia and the transition has been a sometimes arduous journey for the Jones clan.
“It just seemed that the need was so great, that it really just pulled at our heartstrings, that it was the right place for us to be,” says Julie Jones, describing the decision to adopt the children from their homeland.
“ If we had seen the videos, in all honesty, we probably would have inquired about some other children ”
Mike Jones
Abby and Hayden were adopted first, in 1999. Six years later, Julie and Mike and the two children went back to the same orphanage in Russia to adopt Trevor and Lydia.
Russian orphans, especially when they are adopted as older children, are often damaged, mentally and physically, by life in orphanages and by the drinking and smoking of birth mothers.
In the first videos her future parents saw, Abby looked like a sweet timid child. The couple expected some challenges but didn’t realise how much Abby suffered from attachment disorder.
After the adoption was completed, the orphanage gave the couple more videos showing a very different child – much angrier, almost menacing.
“If we had seen the videos, in all honesty, we probably would have inquired about some other children,” Mike Jones says.
“It’s a challenge for the adoption agency because they want to get as many children adopted as they can. But at the same time, there probably are some instances where they’re putting the children in a little better light than they are.”
‘Failing system’
Mike and Julie are very happy Abby is in their life and, overall, satisfied with the US adoption agency they used. But they count themselves lucky that the problems the children had were not more serious, and that with the support of friends and family they were able to provide the right environment for the children.
But not all adoptive parents are able to cope and that’s where the system starts failing. Even young Abby knows it.
“Because I was raised in such a good family, it’s better here than it was in Russia,” she says, sitting on a swing in her parents’ garden.
“There’s a lot of kids who should be [allowed] to come, but I just think that [both] governments should just look at the families more closely.”
The case of seven-year-old Artyom Savelyev – sent back to Russia alone by his adoptive mother with a note saying she no longer wished to parent the child – sparked anger in Russia at the US.
There were calls for a total moratorium on adoptions with the US because this was not the first incident involving Russian orphans. Since the early 1990s, the Russian authorities say 18 orphans adopted internationally have died in their adoptive families, 17 of them in the US.
Just over two thirds of Russian orphans adopted abroad end up in the US. But 15 children also die every year under domestic Russian adoption, according to Russia’s children rights ombudsman Pavel Astakhov.
The Russian Duma eventually rejected the motion calling for a freeze on adoption in the US while the two countries negotiate a bilateral agreement to improve the process.
The failings are on both sides. Russia is one of only three countries that has yet to ratify the 1993 Hague adoption convention which regulates international adoptions.
US officials want the Russian side to give more information about children, and sooner, so parents can make an informed decision.
“The parents don’t see the complete medical status of the child until they show up to court for the final adoption,” said one US senior official who spoke on condition of anonymity because the negotiations with Russia are ongoing.
“In some cases that may be a little later than the parents would have wanted to see it depending on what it says.”
Dr Ronald Federici, a clinical neuropsychologist in Virginia, who has worked with adoptive families, tells a similar story.
He says the information is often only one or two pages of redacted information badly translated, given to the parents when they are in court, the child already in their arms.
Some parents, albeit overwhelmed by their new knowledge, feel obligated to bring the child home and then problems start. Others simply leave the children behind, according to Dr Federici.
That’s why the issue of matching children with the right family is so important.
“ We’re not getting a fifth – but we have no regrets ”
Adopting parents Mike and Julie
Some families are able and willing to deal with problem children, others are not and US adoption agencies are being urged to put in place a better vetting system. Many observers said Artyom should never have been adopted by the single mother he was matched with.
There are also concerns that families are not getting appropriate post-adoption support, after the adopted child arrives in the US.
This support is currently not mandated or enforced and because Russia is not part of the Hague process, the US state department cannot bar agencies that fail to provide it.
If things break down, there is little recourse for the families. So the sad, little known fact is that Russian adoptees are often simply sent back to Russia.
Not all of them make it into the news like Artyom. In the last 10 years, Dr Fedirici alone has seen 39 children sent back to Russia.
“[These children] have foetal alcohol syndrome, trauma, deprivation, neglect, abuse, malnutrition and illness. These things can be overcome, but it’s a very arduous process,” said Dr Federici.
But for the Jones family, back in Pennsylvania, it is a happy ending.
“We’re not getting a fifth,” said Julie, laughing, “but no, we have no regrets.”
The key now, for both the US and the Russian governments is to make sure other families too have no regrets about adopting from Russia.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/americas/8684093.stm
Published: 2010/05/16 11:40:22 GMT
© BBC MMX
6.
Dr Ronald S. Federici | July 5, 2010 at 8:54 pm
Hi, Dr. Federici! It’s hard to believe that it was a year ago I first sent you an email regarding a family consult. I hope you and all of your family are doing well. From some of the listserves, it sounded like you went ahead and moved your office? If so, I hope that all went well for you too. I’m in the middle of opening a larger ABA center here in Southern Indiana, so I can appreciate the challenges!
Your help has proven invaluable with the children. While we continue to work through some issues with several of them as would be expected, they’ve all made huge strides forward this past year, in a large part because of your guidance and direction. Here’s a quick update on each child, plus a request below:
Kris is like a completely new person. He seems like a weight has been lifted and he’s doing extremely well. We’ve not seen the dark days for a long time from him and he’s worked through a lot of stuff with us. He just returned from his first mission trip (Jamaica) and that also has had a very positive impact, it seems.
Will’s change is incredible. We were able to explain to the school that we all had been operating under a misdiagnosis and convinced them to build him, Cary and Adam a language-based program within their existing school, customized in many ways for their specific needs based on your recommendations. Will went from starting the year reading at pre-K levels and nearly zero math ability to now reading at 80% proficiency on 3rd grade sight words, and large improvements in occupational math capability. Cary and Adam both had their best years ever, though both have a long way to go. Cary’s just so extremely hyper, it still it drives folks around him batty, plus he has a hair-trigger temper and has gotten a lot more mouthy. But it happens less frequently and in between, he’s actively trying to do things to improve his behavior and relationships. Thankfully, the darkness has abated quite albeit though it still shows up periodically. Adam still struggles, but the med trials on the Abilify didn’t go well, though the Welbutrin seems to help some. The local doc is trying him on a low dose of Risperdal, but we’re being very cautious given his earlier unusual reactions. It seems like his development – physically, mentally and emotionally has just stopped for the most part. It’s worrisome, as he seems totally out of touch with other people and is adamant his view of the world is accurate.
Ava is a pretty moody 13-year-old, but seems to be doing well most of the time. We try to get her out and involved in other things so she gets a break from the stress around here, but she still prefers to be a homebody, so we’ll keep working on that.
Kristie’s anxiety continues to be a major source of issues for her, but that seems to be improving some. She deals with some paranoia now too and the morning mania continues to be a major issue, but I’m doing some behavioral interventions with her that she finally seems to be responding to most days. We’re also seeing a lot more smiles, conversation and interest in what other people are doing, so that’s positive.
So that is the update. Again, I can’t really adequately express how much I appreciate all you’ve done for our family. You gave us the window we needed into our children so we could help them more appropriately and for most of them, it seems to be working. You also helped Jim and I take a very hard look at what was going on with us and that situation has improved dramatically over the past year also.
Thank you again for everything and may God bless you and your family…
With appreciation,
Kim Derk
“Dr. F: I had another thought about topic to include in Anna’s ‘needs/problems’ section of report: “She may reach puberty by ___ years of age, and will need direct teaching and hands-on assistance to manage self-care during menstrual periods, and cannot reliably relay menstrual pain due to high pain tolerance/thalamic pathway-sensory nerve involvement, which may create unpredictable moods and behavior”, or something akin to this. Hope it’s not too late. Off to take in sights with lots of layers to keep us Southerners warm. Everytime we leave hotel or restaurant or Metro stop, Anna announces “Dr ‘Rici is CLOSED, Mommy”. When we ask if she likes you, she says “Ye. . . . NOOOOOO!”. Guess that sums it up. Who really LIKED their drill sergeant, but am sure she has a love spot in her heart for you.
Thank you for everything. You met and exceeeded our every expectation, and we thank God for you. May you have blessed holiday season. Sincerely”
Lyn
“Dr. Federici. Thank you for everything. You met and exceeeded our every expectation, and we thank God for you. We have been to so many “experts” over the years, and you nailed it in two days, and have helped us see hope and a light at the end. We have learned more from you in these past days, than from years of ‘therapy”.
May you have blessed holiday season. Sincerely”
Jeri H. , Houston, Texas
“You are a life-saver, Dr. Federici! Your quality evaluation and comprehensive parent training has saved our family! We went through so many people, and you are the ONLY one who gets it with post-institutionalized kids. We owe you so much…thanks for helping all the families out there. God Bless!”
Will/Mary V., PA
“Hi. Just want to thank you for finding the time to meet with the Boyle child and the state department family/parents (from Africa). I read the report of your eval and just get blown away. This was the BEST evaluation and treatment plan we have ever seen for one of our state Department kids adopted from Ukraine. Actually, it was the best Neuropsychological Evlautaion we have seen altogether. This is a life long challenge for these parents. Your eval/recommendations was certainly something deeply needed and appreciated by them. Thanks for all the great support to our families serving abroad Thanks again”
D. Supervisor, Exceptional Programs, US Department of State
“May I ask what Dr. Federici does for….assessment?”
“Federici conducted 34 tests, held a diagnostic clinical interview and reviewed seven years worth of reports for my chld. I doubt that most other clinical psychologists are as thoroughly versed in the pre and postnatal challenges that confront Romanian children at least. In my experience, they don’t conduct as many tests.
My child was in his office from 8 in the morning until 6 p.m. Some children will receive additional testing; in our case, quite a bit had already been done, so Federici looked those results over and made sure to widen the testing to not duplicate (and/or to corroborate) what had been done before. Federici likes to do a great deal of testing by way of simulating a school day. He discovers what the mentally fatigued child does, what the low frustration child does, etc., what the “give up” child does, what the “dependent” child does…my child found it challenging, just like learning in school…
Within three weeks of our visit, Federici compiled and sent me a highly useful 37-page report. He also revised the few inaccuracies immedaitely when I made the request. Not only did his assessment provide the interconnected aspects of my child’s learning, pulled together to show how, for example, short term memory and attention were involved. He made sense of a complicated history, noting subtle and obvious issues in a way that made the report’s findings difficult to ignore in public school. Furthermore, because Dr. Federici has the credentials in psychopharmacology, he indicated which medications might help my child. I felt that I had received a thorough, competent evaluation.
I went to Federici because I was frustrated with the ignorance or “sluff off” factor I was encountering locally. …. I chose to go to Federici because of his knowledge base and the awareness that he could deliver a report (and revise it!) much more quickly than a hospital center.”
Hi Dr. Federici, sorry it has taken me so long to write back. You may recall I was struggling a couple of months ago with the Adults Only program. I reread your book, watched the tape (Saving Dane), and reread Wendy’s program. We got over the bumpy spots and things went relatively well.
Katie is able to be redirected verbally when she engages in body movements or “silly talk.” She returned to school in late August and has made a smooth transition to a new school, new teacher, and new classmates. Staff there is also finding her easy to redirect and Katie is now being mainstreamed again in the 3rd grade for math and some of the other subjects.
Katie has also transitioned to a new daycare setting (she is taken by bus to a different school) and has handled the change well. I am very pleased with the results I’ve seen as a result of implementing your program. I wish I could clone you and move you closer. Once I enjoy the fruits of our labors, I’ll be ready for the next steps! Thanks for providing such a wonderful service!”
Pat M.
“My daughter and I would not be where we are with peace in our home, and secure signs of attachment without the intervention and support of this team. My message to anyone adopting an older child is early intervention and consultation with this team of professionals.”
P.R., Indianapolis
“A great expert in the field of Child Psychology. We need him here in the U.K and Ireland”
J.R., England
” Extremely talented and skilled Clinician, Presentor and Parent!”
Mental Health Staff and Parents, Iceland
” Always a Professional we welcome here to lecture and train”.
Adoption Society, Australia
“Dr. Federici is the only neuropsychologist qualified enough to evaluate and treat the most complex children, especially post-institutionalized children”.
T.T., Founder, PNPIC
“Ron Federici and his group were the only ones that could handle my out of control child who had failed multiple treatments. His group has the best treatment team for the family in need”.
B.C., California
“This group of professionals evaluated and treated our situation, pro bono, because we were in dire need. The evaluation and program for my son helped immensely.”
K.C., New York
“If it weren’t for the most professional evaluation and intensive treatment program given our family with our adopted child, we would have been destroyed.”
K.J., Fort Worth, TX
“NBC-Dateline “Saving Dane–Saving a Family” which highlighted Dr. Federici’s expertise with the most disturbed children was an inspirational show of recovery.” Professional review, NBC Dateline June 2003.
“Dr. Ron Federici and his staff are an unmatched resource for families experiencing the challenges of parenting children with complex behavioral and learning problems. As an adoptive parent of a number of post-institutionalized children, Dr. Federici understands the emotional as well as the clinical issues facing each family. His superb diagnostic acumen is paired with an excellent track record of effective interventions.”
Dana E. Johnson, M.D., Ph.D., Professor of Pediatrics, University of Minnesota
“Given his extensive professional and personal experience with children of international adoption, Dr.Federici provides families with a uniquely informed and invaluable assessment of each child’s cognitive, academic and emotional strengths and weaknesses as impacting children’s functioning in home, school and other settings. His comprehensive neuropsychological assessments and expertise with post-institutionalized children, offered in conjunction with practical strategies, provides parents with tools and a much needed and individualized road map to identify the critical educational, medical and behavioral supports known to be essential for the promoting the wellbeing of these often misunderstood children and their families.”
Lisa M.H. Albers, MD, MPH, Director, Adoption Program, Children’s Hospital/Harvard Medical School
“I have worked with Dr. Federici for 10 years and have traveled with him to Romania on many medical missions. I learned about the plight of orphans from Dr. Federici and he inspires me daily. I send families to him because he knows the intricacies of the mind of an orphan mentally maimed by the harsh and unimaginable conditions of orphanages all over the world. He saves the souls of children. He is a creative and daring psychologist who drains his soul to help the hopeless!”
Dr. Jane Aronson, International Pediatric Health Services, PLLC
“Hello Dr. Federici and Leslie: I just wanted you to know that we have turned a HUGE corner! I called in desperate need 2 weeks ago and only 1 1/2 days later Michael decided to begin to comply.
I did have an emergency visit with his Psychiatrist, but we only decided to increase his Tenex to 1 mg b.i.d. I am very glad that is the only change we made because the difference in Michael and his behaviors is like nothing I have ever seen!
I have a new analogy for you to use. When I was pregnant people would tell me about their labor and delivery pains, but because I have never been through this I could only imagine. And, of course, my own labor and delivery would be my own personal experience. This is how I perceive explaining “extinction burst”. If you have never been through it, or seen it, you can only imagine what it will be like. And, of course, it is different for every child. I now understand that what Michael was doing on that Wednesday (hurting himself and me) was a true “extinction burst” (UGLY) (and perhaps a little something else). He was fighting for his life to try to get his old behaviors to work!
Well, I am happy to say that his old behaviors did not work
We are committed to the program and now even more so. The changes are so unbelievable!
Thank you, thank you. The work that Dr. Federici and you do is invaluable to families like ours.
Will keep you posted, and I’m sure have additional questions along the way. We just wanted you to hear some GOOD NEWS!”
Kelly F. (Rick, John and Michael too)
“did they determine over the phone before you traveled which of your children would need the extensive evaluation ?”
We knew that Kat was either on the way out or we needed to do something “really different”. When we made an appointment for Kat, we were willing to pay what ever was needed for peace (what price do I put on that).
We sent (our other children) to stay with my brother for the 4 days we were in DC with Federici. When we came home and started to work the Federici program with Kat, our youngest son’s Autistic behaviors were amplified. He displayed very stereotypical behaviors. We decided to take him to Federici for a full evaluation. After it was all said and done; the biggest suggestion was to try and reduce stress in his life and redirect him whenever he displayed stereotypical behaviors and get him around better role models (Kat was not a good role model for him). Our son was diagnosed as above average intelligence and many other positive dx’s.
“I’m also wondering if there is any testing that can be done locally through the child’s pediatrician that can help to minimize Federici’s cost.”
We could not face another person that was not willing to believe us. We were not willing to waste another nickel on “She’s Cute, She’s Adorable”.
We had tried local stuff only to be told that “everything was fine” and “she’s cute and getting better”. This was not the case at home. I video taped what was going on in our home and the therapist was beside herself stating “I had no idea it was like this”. We gave up on local’s and decided to try something extreme.
The result has been extraordinary. Kat is not a perfect, normal 4 year old however, she is nowhere near the behavior monster she was last year. She can sit and eat dinner, she can play with her brother, she will use the toilet for its intended purpose. This is priceless! We had lost all hope for Kat until we saw Federici.
Many may disagree with his tactics and call it barbaric or something along those lines. They may say that I have violated my child’s rights. I can tell you that my child has a right to life. The path she was on was a suicidal path, self mutilation, running into traffic, throwing herself into moving cars, the fireplace, the wall, the doors. We have done all we could do to save her from herself.
She is a different person today. I know this helps. I think very Highly of Dr Federici and his staff because “it worked for us” and “saved our family” on many fronts.”
B.D., New Jersey
“Hi Dr. Federici, We thought we would touch base with you and give you an update as to how things are going with W and D since our visit with you two years ago.
We still speak and enforce your level program EVERYDAY. Of course, we have made revisions from time to time to keep up with development, responsibilities and privileges, but the basics are the same. The kids are very used to this in their lives by now. Tracking their token count is a daily part of their lives, much like brushing their teeth! They have had their ups and downs, mostly due to lying – but we seem to have gotten a better grip on that lately.
W has come a long way. He thrives on his schedule and is quite self-directed. He doesn’t like bumps in his road or unexpected transitions, but he’s doing better at accepting them when they happen.
D struggles with many thinking errors as well, especially when it comes to relationships. She will continue to be a handful, for us and for whoever else in her future!
Overall they (we) are doing wonderful compared to where we were two years ago. On your 50-80% improvement scale, we give W a 75% and D a 60%. We expect more…still lots of room for improvement.
They even get themselves up with their own alarm clocks, get dressed, make their beds, feed our pets, get their own breakfast all on their own! Sounds a tad different from their experience in your waiting room two years ago!
Thank you again for all you did for us. We still hope to come back some day so you can see the progress for yourself. I’m sure you could put W’s anger control skills to a mighty test, but hopefully he would show improved survival skills! Sincerely,”
TJ & K., Boise, Idaho
“When we brought home our daughter Grace from Ukraine in March of 2004, we wondered if we would be able to parent her. She was 17 months old, 13 pounds and one big bundle of nerves. Grace has fetal alcohol syndrome, a disorder prevalent in the Eastern European orphan population. We are so grateful to have had that diagnosis which is necessary to getting her the proper help. Giving her love and time was not going to unwind the condition she was in.
It wasn’t just FAS that brought Grace to this level of stress, but a combination of unfortunate life stunting scenes. She was the 6th child born to a 26yr old alcoholic in Crimea. Born full term she weighed 4 pounds and micro cephalic. At three days she was taken from the hospital to the orphanage where she lay wrapped tightly swaddled in a blanket. Over the course of the following year and a half she would experience a constant set of illnesses including acute bronchitis, pneumonia, chicken pox, measles, salmonella poisoning as well as malnourishment that kept her too ill to be kept with the healthy orphans. Her main stay would be in the infirmary, a small dim room with a few cribs, no toys, and no stimulation day after day.
When we met Grace for that very first time we could hardly hold her because her body literally didn’t want to bend. It’s like picking up a wet, mad cat out of the bath tub- legs stick out everywhere. While she didn’t scream at us, she didn’t really look at us either. She had been deprived of so much that she couldn’t understand people. And deprived as she was, she was most content to be left in her crib where she could rock and bang her head and flick her fingers on metal screws. That was how she knew the world. So imagine her reaction when we took her away from that existence.
R and I were sure that she would thrive and be excited at discovering her new world. We couldn’t have been more wrong. Her behavior deteriorated more so upon our arrival home. She wanted to be able to continue what R and I termed “zoning out.” If she could sit and gaze or stick her finger in a hole and stare at it all day, she would have. We tried everything you could imagine. We left her alone to do it; in the case she might feel comfortable enough to enter our world. That didn’t work. We put socks over her hands so she couldn’t cram them up her nose anymore but then she’d only gaze or enter into another activity with her feet. Pretty soon, we realized there was no chance at bonding because we were so focused on how to get her into our world.
Looking back we were beyond clueless. While we had the diagnosis of fetal alcohol syndrome, there was nobody in our community to train us in how to parent her. And even if we found someone who understood FAS, we needed someone who would also understand the type of conditions she existed under in the orphanage. Love alone would not heal this little girl. As the first months passed, R and I were becoming the bundle of nerves that Grace was. Admittedly, I wondered if I could do this parenting thing with Grace and more selfishly, I was exhausted.
A friend of ours gave us some information about Dr. Federici and his practice in Alexandria, VA and we contacted them. By then I had been on all of the adoption forums on the internet and was convinced Grace had reactive attachment disorder as well as a host of other disorders. I had contacted a few different therapists through email explaining our situation only to be encouraged to disrupt the adoption. We felt at the end of our rope. What Dr. Federici and our occupational therapist, Wendy Schmidt were able to explain to us is why Grace was this way and what we needed to do to help her.
The severe lack of stimulation and neglect from her stay in the infirmary in addition to her malnourishment caused her to enter into a pseudo autistic state; a dissociative state where she used these maladaptive self soothing coping behaviors to exist. Dr. Federici has written on the subject calling it institutional autism. In order to bring her out of these “basement” behaviors, it would take minute to minute daily structure with me, her mom by her side. We needed to recreate a new world and in order to do that she needed consistency and repetition. And further, I would have to stop her “zoning.” Life in our home for those months was a bit like the movie Groundhog Day. Each day was a replicate of the day before. For a few weeks I think I must have cursed Dr. Federici and our therapist a few times a day. Each time she withdrew into her “zone,” I held her in my arms in what is called a “settle hold.” This is not to be confused with holding therapy techniques. I simply held her in a cradle like you would a small baby so that she couldn’t continue the maladaptive behaviors. She screamed and screamed. Days went by like this. I seriously questioned if any of this was working. Slowly she stopped the screaming and then began to look around, still refusing to look at me. Eye contact was particularly difficult. I wanted to put her down on the floor so many times and to be able to go on with my life.
I admit that I became so frustrated, I wondered if this was going to be what life would be like forever. If only I could set her down on the floor. She would have been happy to have been left alone to continue her “zone” and I could be sure of some quiet time. Isolation was setting in for me. Not only was I staying home everyday with a screaming child in my arms, but most of my community didn’t understand what it was I was doing or why I was doing it. I was tired of the explanations and the strange looks. I know they meant well but the best thing friends and family can do is be a support and not offer advice based on the normal healthy child they are raising at home.
Ever so slowly, as we inched ahead day by day, we began to see the unraveling of this tightly wound bundle of nerves we met that first day. She began to look at my face, only to glance away if our eyes met. And then she began touching my face while I held her. I began to add something new to our schedule as she was ready for it. Nearly three months passed before I left the house to take her out to public places. I realize now how vital that time was for her to be able to feel safe. She began to giggle and understand “silliness.” She no longer reached for strangers as if they were equal to me.
We even had to teach Grace what it meant to feel pain. For all of the times she felt pain and cried as an infant and nobody came to soothe her, she ceased “feeling” the pain. Crying and acknowledging hurt for her was useless. We taught her this by each time she fell we ran and scooped her up and made a big deal about what happened and told Grace she was hurt and cried with her. Basically the exact opposite of what we did with our two biological boys. But it worked! She needed to have her feelings validated and to be able to once again connect her physical pain and appropriate emotional response. This was key to helping cure the “zone out” periods. Grace learned that Mommy and Daddy fixed pain not gazing, hair pulling, eye poking or any one of her other coping mechanisms.
Today Grace is three years old and we have had her with us for 18 months. In that period of time she has truly blossomed reaching more goals than we ever imagined for this short period of time. For a child that had to learn to suck from a bottle when we brought her home, she is now learning to chew solid foods. A child that couldn’t walk until 21 months is now running and jumping a year later. A girl that didn’t understand what a Mommy and Daddy was, now calls out to them for hugs and kisses. A babe that didn’t know what smiling was for, now laughs heartily at a tickle or the cat’s tail brushing across her skin.
There is no greater joy than watching the emergence of life in a child that was in many ways lifeless. She only existed and now she is exuberantly alive! And you know what, I wouldn’t change a thing. It’s easy to say now of course, but in many ways her special needs humbled me, carving in me, a new patience and a whole new compassion for what many children experience in the orphanage setting.
Grace will never be cured of fetal alcohol syndrome and the secondary effects of it. She is frustrated easily with not being able to talk and to communicate her needs and wants. She will slowly achieve more goals as the time passes but she will forever have to live with the brain damage that cannot be reversed and we her family will need to adjust with her. R and I never set out to adopt a child with special needs, we only trusted that God would take us to the child He wanted us to have. And in doing so, we have received His grace and our Grace.”
T&R, Arkansas
Hi Dr Federici:
Just a quick update on Kristina: Heavy metals (blood and urine) were negative. Risperidol is GREAT! We now have a child psychiatrist managing the meds and doing fine at 0.25 BID. Her voice is not as loud, less rocking, crashing, banging, less agitation, staying on task/focused, especially at school. Unfortunately last weekend, we had 4 days of hell (she acted like she did pre-risperidol). I called child psych and she upped the dose to 0.25 TID (8 am- 4 pm/ after school- and bedtime). Things are better now.
Child psych ordered a fasting lipid panel which was abnormal. Note it was ordered/drawn 3 weeks after starting drug. Kristina must have crappy genes as she is not diabetic or obese. Her cholesterol is 197. Her HDL is 38 (low) and LDL is 145 (high). As you know, the HDL should be high and the LDL low. Hers are reverse and indicative of “moderate CHD risk”. Child psych doubts it is from the risperidol as she has not been on it long enough. We are redrawing labs in 6-8 weeks, if lipids are higher, she will pull her off resperidol and try another drug. Any thoughts on abnormal labs and/or drug effect?
Peds endo at Childrens Mem’l Hosp won’t see Kristina unless she is off the growth chart. She is at 10% now.
Peds neuro at Childrens is admitting her next week for a 24 hour EEG and comprehensive neuro exam, per your recommendations. Do u want results?
By the way, liked your commentary in PEOPLE mag last week. Both Kristina’s teacher and principal stopped to tell me they recognized your name in the magazine.
IEP implementation meeting is Monday with the whole team. School district has ABA trainer that will work with Kristina’s school and us to put behavioral program in place (finally). They are following your recommendations and for that we are eternally grateful to you. Feel free to use us a a reference for other families. We think you are terrific! Regards,
Karen J.
Hello Dr. Federici,
I just wanted to say thanks again a million times for your help with Irina. We took your advice on the Risperdal and kept her on it. It has been 2 weeks now on the medication and 1 month out of school and she is like a different child. She is so much better. She is sleeping good and her mood swings, hyperness and anger have greatly improved. We can see some hope now! Just wanted to share with you the good news about her and say thank you so very much for doing what you are doing for the kids.
Lori and Mike, VA Beach, VA
Hello Dr. Federici!
I am writing you to share good news about a former patient — D.S.. We visited you in August of 1999 from Cleveland, Ohio … and have corresponded several times since them. D. was selected to be the valedictorian of his confirmation class at our synagogue. Today he delivered his speech in front of the congregation. It was a moving and meaningful experience. The entire congregation was crying …the cantor said it was the most powerful confirmation speech she had heard in her 25 years at the synagogue. We thought you might enjoy reading it. And … you should know … that you were included in his first version of the speech as one of the reasons why he has reached the point he has. (the first version of the speech was more like a book … and needed editing). Thank you again for your guidance and expertise.
H.S., Ohio
Dr. Federici,
I was very moved by the Episode of Dateline “Saving Dane” I think your program is wonderful, and I can’t tell you how wonderful I think Dane’s parents are. I can only hope that all parents would be so patient with there children. They were amazing. Please if you are still in contact with them. They did a wonderful job on Dane. I couldn’t get over what a happy little boy he was towards the end of the show. I’m just hoping that his road has gotten easier and that he is just as happy if not happier these day . . . . My name is Allison, i’m from Tracy, California and I was very moved by this story.
Dr. Federici:
On behalf of Debbie and myself and especially little Miss Kelly, thank you not only for attending today’s meeting but for using your expertise to make the meeting a done deal in our favor before it even started. Today was the polar opposite of the meeting 3 months ago, which was a done deal against us before it even started, and the chair of the meeting was even condescending and rude, refusing to even consider your test results. But when the meeting started today I sensed a change in attitude within the first five minutes. The “educational establishment” was in our corner after looking at the data and wanted to work with us “in good faith,” as they put it. As I told Debbie after today’s meeting, when the odds are stacked against you, it is time to bring in superior firepower: Dr. Ronald Federici. Cordially,
Stuart
Just a note to say that Mihaela is doing really well since we started Sensory Processing Therapy and implemented all your recommendations. We have been in therapy for almost a year and the change in her is unbelievable. Can you tell me is Sensory Processing something that needs to be continued for a long time with children from Romania? I am sure that it depends on the child. What books can you recommend on the treatment at home for SPI? We have also seen an endocrinologist for her as well. I don’t know what we would have done without your help with Mihaela. You have been a life saver to us Dr. Federici and I just want to tell you THANKS!
Mihaela’s Mom
Dr. Ron:
We want to tell you that Dane continues to excel all around since we completed the “program” featured on “DateLine NBC” over 4 years now. NO MORE rages and uncontrollable episodes! Never a dull moment at our house! On a happy note, the kids are doing great!!! Megan is making A’s in her honors college program and enjoying her new apartment and roommates nearby. Dane is a speedy cross country runner (carrying the team’s first place trophy) on the JV team at his new high school. Both love us at this point in time, Praise God!!! Our family is blessed and has been restored thru so much.
Dear Dr. Federici,
Four years ago I contacted you about my then 9 year old son, Joshua. Although I had to modify your program due to Josh being my foster son at that time, your program still worked. Josh is now happy & healthy and learning to enjoy life after being abused and neglected for the first 8 1/2 years before he came ‘home’ to us. He still suffers permanent brain damage (FAS/E) but he is completely mainstreamed now and last quarter he made the honor roll! And today Josh won three out of his four of his wrestling matches and won 2nd place in his division! Not bad for a kid I was told may never heal who used to bite me, kick me, spit on me and try to kick the windows out of the van. THANK YOU, THANK YOU, THANK YOU!
Again, I can’t thank you enough for helping us save Josh. I need another miracle now to save Justin. Thank you so much for helping our family, again.
Carol
HI DR FEDERICI
DAVID IS DOING GREAT. HE HAS HIS MOMENTS BUT HE IS LISTENING AND FOCUSING BETTER. ON MONDAY I AM MEETING WITH THE SPECIAL NEEDS SCHOOL TO SEE IF WE CAN BYPASS THE WAITING LIST. AS WELL I AM SPEAKING WITH POTENTIAL ABA THERAPIST RECOMMENDED BY THE SCHOOL BOARD. DO YOU WANT TO SEE US IN MARCH. IF SO, DAVID HAS SCHOOL BREAK THE WEEK OF MARCH 5. LETS US KNOW. DR FFEDERICI IT IS GREAT HAVING A SON NOW INSTEAD OF AN ANIMAL.
STANLEY
Dear Dr. Federici,
We really enjoyed the opportunity to work with you and we both sensed a genuine desire on your part to help children. What you do for children and their families is amazing and your strength of character and knowledge was truly apparent throughout our visit. Your perspectives on parenting Andrew were insightful and we can clearly see benefits in the short period of time we have tried to implement the techniques. In a sense, the methods you taught are liberating in that we now understand that it is not necessary to constantly cater to Andrew’s wants and needs. Best Regards,
J & D from Connecticut
Hi Dr. Federici and Nadya,
We wanted to follow up with you and inform you on how our son, Sam , is doing. We had met with both of you back around May 2007.
Dr. Federici, after all your testing, your conclusion was that Sam had depression and you recommended that we put him a low dosage of an anti-depressant. Well we finally found a child psychiatrist in New Jersey which was no easy task. We showed her your report and she acceded to prescribe a very low dosage of Prozac, which she recommended.
Well we are so happy to tell you that is exactly what Sam needed. He is a completely different boy now. He’s generally happy and acts like a normal boy. His self esteem has markedly increased and it has had an incredibly positive impact on the whole family!
We are still working on bonding issues, but after dealing with four years of his depression, we feel the bonding will come in time. We are trying to incorporate some of Nadya’s recommendations regarding this issue.
We do thank the Lord that he is doing so much better now.
Thank you and may you continue to assist so many families that are in such difficult situations.
God Bless,
Paul and Vicky B
7.
Jon Goodman | September 25, 2010 at 3:17 pm
Author: Jon Goodman, AdvocateForTherapy@blogspot.com
September 5, 2010
HEADLINE on GOOGLE: ACT, also known as Advocates for Children in Therapy, a for-profit organization, has recently made a rather large public statement saying they can prove that Attachment Therapy, Holding Therapy and Therapeutic restraints always hurt kids and always are lethal. Nothing could be further from the truth! I disagree with this statement on many levels, and find it incredulous that ACT is willing to make this statement and yet gives NO acceptable alternatives for adoptive parents and adoptees that has the power to replace the aspect of touch therapies and properly applied attachment therapies for severely affected victims of childhood abuse and neglect. In addition, ACT has no creditials for making such an assertion and has made a smear campaign against professionals who are aiding adoptive families in working with their severly unattachment children on bonding issues that are life-threatening if left untreated. Whomever authorized such statements within the ACT community has not done their homework and must have a personal vendetta against an individual in the attachment community. But why put out such statements that may prevent many victimized children a chance at a cure? I believe more attention needs to be paid to the false blanket statements of such organizations as ACT that proclaim to be reaching for an audience of adoptive parents who have children with attachment disordered children.
For children with severe reactive attachment disorder due to post traumatic stress disorder, the power of touch is the only modality of therapy that can reach these children’s psych where abuse and neglect is often stored in the preverbal mind, which is the deepest and hardest to reach place later on in life. Does ACT not know that Traditional talk-therapy does not begin to address in a 3-5 year old the level of hurt that the child has experienced? Does ACT propose that parents do nothing? or use therapies that are known NOT to be effective? ACT seems to be putting adoptive parents in a catch-22. And after reading the ACT website, I am serioulsy wondering if any of the author’s have ever actually seen attachment therapy in action or if any authors have even stopped to consider their actions on the children that will be denied help or treatment due to their negative and unthinkable words of ignorance.
There are no words to heal this predicament called attachment disorder. Only touch. There were no words for the 3 month old in a Romainian orphanage of understaffed and untrained poverty-ridden staff when no one came when he cried in hunger or pain. There were no words for the 6 month old girl a a Russian babyhouse for orphans who itched from scabies so deep in her skin that only unconsciousness was relief and even though it went on for months. There were also no words for the infant who was left in a dark closet full of nibbling rats while the birth parents were passed out drunk in the backyard of their summer shack in Ethiopia. Words don’t heal attachment disorders. The pain is stored deeply within the child’s most primitive bodily memories-which are 100 % sensory, and 100% unreachable without touch. Memories of the smell in that dark rat infested closet or the freezing temperature the child experienced are all stored in a cluster along with the misery. Once one preverbal memory is activated it lets loose the whole chain reaction-even though this happened long before the adoption into a new family. Muliply these traumatic episodes over any period of time, and you have the basis for a few early traumatic memories. Muliply these instances over periods of years-and you have severe post traumatic stress disorder that effects the mind of a child and causes reactive attachment disorder in full swing. It is no wonder.
Attachment therapy requires getting inside the hard shell of these kids’ outer attitudes and emotions, getting to a vulnerable space where new memories of safety and security can begin crowding out the old, traumatic ones. There is no complete cure, only increments of recovery and better quality of life. In most cases, families have seen at least five professionals to help their child with his/her strange behaviors and attachment problems before they find out about or stumble upon a reference for a psychologist, counselor or social worker who has any experience in working with adopted children exclusively or with any expertise. Through trial and error, and usually desperation, a family will be relieved to find out:
A: the right diagnosis
B: that they aren’t the only ones with this situation
C: there is documented evidence that shows the number of recoveries from RAD and PTSD
D: that their child has hope of not ending up in prison, dead or on drugs
It’s also worth noting that ACT does not exclusively state in their literature that RAD is a problem only for adopted children. Rather, it states no knowledge of the special needs of children that have lived in institutions and what the post orphanage behaviors have done to them. although they are the largest group of children with known attachment disorders. Therefore, by saying ACT advocates for children in therapy, they are actually doing the opposite. It condemns the very type of therapies that specifically has been known by adoptive parents and professional attachment therapists to do wonders in healing. It is as if ACT has picked a cause to advocate for just because deaths and sensationalism has occurred in the misuse of attachment therapies used by unqualified individuals. It is a case of “contempt prior to investigation.”
In all fields of medicine there are truly horrible situations that arise from extreme use of any method-including medications, surgeries, psychological therapies and even using “NO therapies.” By using the extreme negativism of a handful of fatal cases of so-called rebirthing therapies, ACT stands that ALL therapies that include attachment therapies and the professionals that work with them are bad. ACT is fine with NO therapies or therapies that don’t work, such as traditional talk-therapy.
Orphans who are adopted that were exposed to alcohol and/or drugs or other lethal toxins during pregnancy are more prone to be severely traumatized by orphanage living due to their lack of appropriate or available coping mechanisms. These children can develop a hard, aggressive stance toward anyone who might hurt them—even if that means love and protect them. The severe form of personality disorder that develop out of this state is called borderline or antisocial personality disorder. Once into later teens and adulthood, the prognosis for adoptees with this label, personality disorder, is practically bleak. Prisons and insane asylums are full of personality disordered adults. These people often lead extremely lonely and isolated existences (and even committ suicide) because of a lack of early intervention strong enough to change the course of the reactive attachment disorder. Yet some type of attachment therapy gives an extremely good prognosis when intervention happens early in life.
Do parents want to do nothing as ACT suggests? Or are they willing to try what has worked for many other RAD and PTSD adpted children? In our case, we opted for hope. My wife and I became attachment therapy adocates ourselves as we watched and learned while our children grew beyond their pasts. Not only did I, personally, sit in on every single session with the attachmenent therapist, I was always asked to hold my child in a loving, gentle and safe way at all times even when I was being punched in the face repeatedly by my 5 year old son. Did I have to be strong enough to watch my child struggle when his comfort level was getting busted? Of course. Was it easy to see my son cry out in rage that he hated me for no reason? Yes. Did I look him in the eye and tell him over and over that I loved him and needed to keep him safe no matter what? I had to. When my son spit in my face and told me he wanted to go back to Russia (even though they’d abused him) because I was worse, did it shock me? No. He would say anything to keep intimacy out of his heart and mind. Truly, it is fear that held my son captive, not the work of attachment therapy. Intense feelings of fear of loving, being loved, trusting, caring, and needing another human being were paramount and highly subconscious in my son. Once those feelings were activated by any number of triggers known and unknown he would run or fight even if it meant self-sabotaging himself over and over. It was a no-win situation that held him prisoner and us, as parents, the wardens. Neither my son nor I could have told you any of this before we went through a year of attachment therapy with a qualified attachment therapist. Fast forward seven years ahead and you will see a boy who DOES NOT have these issues! He is still overly sensitive and sometimes jealous if he thinks we love the cat more than him, but there is no overt symptoms of a child who we were once told had brain damage, RAD, PTSD, Conduct Disorder, ADHD, Pervasive Developmental Delay and Fetal Alcohol Syndrome. The attachment factor is key!
The good news I want adoptive parents and adoptees to know is this. Once the attachment issue was resolved, everything else got better. That’s the testimony of a parent who’s been in the trenches, but this was an area I knew nothing about when we adopted our son. What would we have done without a qualified attachment therapist, like Dr. Ronald Federici, to take our case? Who would we have turned to if it weren’t for the work of Dr. Bryan Post and the Post Institute, or Heather Forbes? What if Bowlby had never written about the controversial attachment theory due to fear of whether groups like ACT would end his career by ruining his reputation? Where would we be now? Would our son be in a group home or juivenile delinquint facility? Yes, left to his own devices, we believe he would have had to be locked up and supervised carefully around the clock to keep from hurting himself or others when he was “activated” with PTSD triggers, which was constant and growing when we started attachment therapy with him.
Without being taught and actively working with our son by using behavioral and attachment therapy and therapeutic restraints that were age appropriate to limit his aggression, would we have eventually just let him run away or beat us up? He was trying his utmost at the time to get away and torment us. Should we have just let nature take it’s course? Hell no! My son was worth saving, and so is every other kid out there who suffers. We must do whatever it takes, while thoroughly doing our homework, to make sure we are using the utmost safety and latest standards of proven therapy modalities and qualified experts to give our children what they never had-ADVOCACY. I would advocate to the very end for my children and so would Dr. Federici, Bowlby, Forbes and Post! I pray these professionals don’t take an ounce of flack from organizations that promote NOT curing our kids. I pray adoptive parents will not delay early intervention using attachament therapy by a qualified attachment or behavioral specialist to get into the solution NOW before it’s too late. As for ACT, I wish they could have walked a mile in our shoes for just one day before they made such liable comments about attachment and holding therapy and the pros who helped us. Its a personal insult.
So why any organization or group would advocate against the work of a type of therapy that changes so many lives for the better, that enables so many severely disturbed children to recover over time, or that lends itself to the quality of persons teaching and delivering the therapy, I don’t understand. Why throw out the baby with the bathwater, so to speak? Show me some other equally effective treatment for RAD and PTSD in adopted children that works and I will certainly eat my words. Until then I pray ACT will rethink their wrongful propositions about what kids need in attachment therapy—especially if you haven’t had a child with RAD, aka. the raddishes.
Jon Goodman, Adoptive Dad
8.
Kery S. | September 25, 2010 at 5:52 pm
Thank God for Dr. Ronald Federici
In 2008 my son turned 3. I kept thinking the terrible two’s would phase out. I even named our adoption playgroup The Terrific Two’s and Three’s in hopes of a future life without screaming meltdowns and temper tantrums with fists. I had learned to expect the unexpected with my son adopted in Russia 1.5 years prior. Yes, he’d been sick frequently, and yes, he took medications that had ugly side effects. But I would never have been able to admit then that he had a permanent problem, a disorder that might be jumbling up his mind.
After attending several FRUA conferences, that is Families for Russian and Ukrainian Adoptions, I had heard many other stories of adopted children from the far Eastern European orphanages that struggled with many of the symptoms my son had—only his seemed more severe. He could not make eye-contact with me, but he could with others. He wouldn’t be still long enough to let me rock or hold him much without becoming very agitated and throwing a fit to get away. He broke all his toys and played so rough that he hurt other kids. He locked onto other boys in a vise-like grip and couldn’t seem to let go even when they would wail. He had an hour long meltdown when told no. He flat refused to hold my hand even to cross the street.
Even though my boy was very much loved, he could not return any affection. I thought he had a very hard shell around him and likened him to a feral cat that could not be domesticated. I was so disappointed that I would probably never be able to have a normal relationship with my son because he might be autistic or beyond help.
At a little of 3 years old he was kicked out of the 2nd mother’s day out program. He’d bitten a bigger boy on the face and left a huge wound. I quit my job and decided to do whatever it would take to get my son professional help. My first call was to a professional child therapist and attachment specialist referred by several families in our FRUA group. My second call was to a well-known child psychologist in our city who worked with adopted children’s issues also. I had both doctors do independent evaluations on my son to determine what plagued him. Both doctors came back with the exact same diagnosis in their reports-Fetal Alchohol Effects or Syndrome, Post Traumatic Stress Disorder, Reactive Attachment disorder caused most likely by the PTSD and possibly ADHD.
One doctor was a man and one was a woman. The woman suggested that my son would need to be medicated to make it through a treatment program. Since my son had such great rapport with men and not women, mainly me, and since he’d been passed around in the orphanage mainly by women caretakers, he had a much more severe reaction the the woman therapist. So I decided to go with the man for therapy. We started attachment therapy to help him learn to self-soothe and work on the preverbal trauma first. Every week we went and sometimes twice a week. Things were always calmer for a day or two after the doctor had had a session of holding time with my son-with me right there next to him-to allow an entire cycle of rage to complete. JJ always had a full body shutter after a cycle, and that was one way to know he was done. This cycle would take an hour to go through with screaming, biting, flatulating, kicking and flailing all over the doctor. The screaming could be heard through the office walls for at least a floor.
After the cycle the doctor would ask JJ to go sit on my lap. He would do that, and he would look at me. He would make eye contact. We started to see shorter rage cycles and more mommy holding time with JJ. It was hopeful. Then the rage would come back within a few days and never for any main triggering reason. Nothing would make the child happy.
I read every book I could get my hands on regarding bonding and attachment disorders in adopted children, early childhood trauma and sensory integration disorders. I tried everything I could to try to help my son short of medication.
At some point my misery won out and I started asking to see a psychiatrist. I was then told JJ had conduct disorder and possibly Aspergers. I got a second opinion, and that time I got pervasive developmental disorder and severe ADHD diagnosis. Since his case was so complex and overlapping in so many symptoms, I really wanted the doctors to take into account the orphanange situation. JJ had rickets from malnutrition. His medicals from the orphanage said he was weened from the bottle at 6 months, toilet trained at 13 months out of necessity and that he’d been moved from hospitals to several orphanages in a short amount of time due to overcrowding and poverity in his village. He had been neglected, very possibly abused physically since he flinched and ducked when I’d first met him and came near him with my hands, and he rocked and head banged in his crib every single night at bedtime. He woke up early but never ever called out from his crib. He’d been adopted at 19 months old. His first year and 7 months were not a picture of health or nurture. He lived in a survial of the fittest environment.
I heard about a doctor, a neuro-pscyhologist who worked exclusively with adopted children and had 7 little JJ’s of his own. I called him, and was put through to him on my first call! He was in Virginia, and I was in Texas. I told him my situaion and asked if he was qualified to do an evaluation on my child. He said, “just get to my office as soon as you can.” I worked with his secretary to get an appointment for the following week. I had to fly my wildchild to Virginia to see Dr. Ronald Federici. I couldn’t afford it. I was scared to death of taking him on the plane-after he’d screamed bloody murder all the way home from Moscow for 10 hours on our last plane ride. But I was desperate for professional help by someone who was competent about adopted children’s issues.
Dr. Federici came out and said hello to me and JJ, and then promptly took JJ by the hand and went into his office to do some testing for everything from auditory processing to Asberger’s. They took breaks and came out, we went to lunch together, and walked around the office building. Dr. Federici wanted to see JJ in action. He wanted to see JJ’s attitude toward me. I’d been asked to bring all my Russian medical records and video to Dr. Federeici for a review. I had copies made and had sent them a few days before we arrived. That evening after an all day appointment, Dr. Federici asked JJ to wait in the play area so he could give me the rundown on what he thought.
Dr. Federici first brought out my medical records that were in Russia and had English translations. He asked if I knew that JJ had been a preemie baby? No. Did I know his record from the hospital say he was born in withdrawal from opiates? He had alcohol in his system. His birthmother had had also tested positive for drugs and alcohol. The combination of problems had caused JJ to have a stroke of some type in his first few days, and he’d been on a breathing machine. “No-this is not what the medical said,” I told Dr. Federici. So Dr. Federici read to me word for word what the medical statements said, and it was all in there. It just had never been translated. The orphanage nor judge, not my agency, not even the caregivers ever said a word about any of these things that had made JJ a very special needs baby. But there it was in black and white. Thank God, Dr. Federici could read the Russian chicken scratching. Later I would send those pages off to a Russian-American physician who would fully translate all of the record for me and tell me he was so sorry for my very sick child.
Dr. Federici gave me the bad news first-the medical record information and the results of the low low scores on all the testing. The only good news he said would come the next day as we made a plan for treatment for JJ. All the information I had gotten from the day made me very sad, but it also validated my deepest intuition that the severity of JJ’s rage and fear had not been coming from simply a behavioral problem. He truly was brain damaged by his birth mother’s in utero choices to drink and do drugs and the hospital and orphanange neglect and trauma after birth.
On day 2 of our intervention with JJ we had a session called intensive family therapy. Dr. Federici showed me how to make a safety plan for JJ, a daily visual schedule. At one point Dr. Federici was giving me some private information and asked JJ to wait right outside the door. I knew that was a shot in the dark and after two minutes of total quiet had gone on, I said I needed to check on JJ. He was no where to be found. We finally found him running into the street on the busy road in front of Dr. Federici’s office building! This was a perfect example of what I meant about me feeling that I couldn’t keep him safe for even a minute if I wasn’t watching him closely. We found out that through an auditory processing dysfunction, JJ had interpreted “stand outside the door for one minute” as GO STAND OUTSIDE THE DOOR-AS IN THE OUT-SIDE DOOR-OUT SIDE THE BUILDING. So he did what was asked of him except that there were so many interesting things going on in the streets that he wandered off that way.
Dr. Federici and I put our hearts back into our chests and proceeded with putting together an applied behavioral analysis system based JJ’s problems and my parenting style for us to take home and immediately put into action. He put the 7-8 part plan on large poster boards for me to tack up to my walls and follow to the letter. He wrote out every piece of the plan for me, and told me to call him when I got home after a week for a consultation.
I have done exactly as he told me to do. Retraining my son has taken bundles of patience, medication, occupational therapy, ABA therapy and work within our home to provide him the proper type of attention for attachment. JJ started sleeping on a futon in my room, earning all privilages and repeating with me daily-over and over our safety plan, our home rules, our good words list, our privilages list, doing chores….and slowly but dramatically over one year’s period of time, I truly met my son’s real personality for the first time. He was more smiley than pouty. He obeyed out of respect and felt proud of himself for earning his likes. The longer we are on this journey into the solution, the closer we have gotten in attachment.
Since attachment had not truly taken place by JJ when we met Dr. Federici, it started when the program started. It took on a life of its own. And the more attached, trusting and open JJ can be the happier he is. We continued with the local attachment doctor who worked with us on our treatment goals with Dr. Federici. The last time we were in the doctor’s office, my son got up on his lap with not even a frown and said he’d rather sit with mommy. At that point I saw a boy who’d come full circle with attachment. The RAD is gone, and my son was considered a severe case. The PTSD symptoms are gone-except for the insecurity of abandonment which may always be a part of JJ’s emotional baggage. He tried to fake a temper tantrum the other day-and we both laughed.
Dr. Federici has never not returned an email or phone call within 12 hours to me-ever. He has never not given me his honest opinion even when he knew it was going to hurt. He has offerred to fight for us with the school board to get JJ the special services we thought he’d need (and now doesn’t require). He’s offerred to see JJ for free. He’s kept in touch and put me in touch with many professioanls who are following our case and hoping for JJ’s continued success. Dr. Federici took pity on this single mom and gave me a discount on office fees. He changed the quality of our lives. He gave to me and to my son hope and tools to find the way out of the darkness out into the light. We both will always be so grateful to Dr. F for his dedication to his work and clients. He has been an excellent role model for both my son and me. In our last talk, he asked when I was going to get on my my own work as a pediatric counselor….I’d already done the time….and other kids need the kind of experience I now have lived through. So now it is me who is rising to the challange to meet the great expectations of a wise doctor, Dr. F.
Posted by Karasel Kid at 10:13 AM on the AdoptionHarmonyBlog@blogspot.com