Typical Behaviors of Children Adopted From Foster Care or Internationally

What should you expect when adopting internationally or bringing a child into your home from foster care? Check out our discussion with Dr. Robin Gurwitch a licensed clinical psychologist with close to 30 years of experience in evidence-based treatments and the impact of trauma/disaster/terrorism on children. She is a professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center and the Director of Parent-Child Interaction Therapy (PCIT) and Child-Adult Relationship Enhancement (CARE) Training at the Center for Child & Family Health. She has been a National Child Traumatic Stress Network member since 2001.

In this episode, we cover:

• While there are some distinctions, children adopted from US foster care and children adopted internationally have much in common.
• We say that the vast majority of children adopted through foster care or internationally have special needs. In addition to the medical or physical needs we might see, there are also emotional and behavioral needs, and today, we will focus on those needs.
• What are some of the factors that influence the behaviors of children adopted from foster care or adopted abroad?
  • Neglect (lack of stimulation)
  • Abuse
  • Maternal substance abuse and subsequent prenatal exposure to alcohol and drugs
  • Multiple caregivers
  • Institutionalization (multiple caregivers, neglect, removal from birth family)
    • Does the length of time in the institution impact psychological and physical development?
    • May have entered the institution after having lived in a family first.
    • What different types of care are available, and how do these different types of care impact the child’s behavior and development? 
  • Lack of education
  • Child leaving familiar ties and surroundings
• What are some expected or typical behaviors common in children who have experienced these?
  • Attachment issues
  • Food insecurity-how does that look
  • Sleep issues
  • Attention Issues
  • Post-traumatic stress
  • Impacts of prenatal substance abuse
  • Specific Impact of Institutionalization
    • Lack of understanding of the meaning of family
• Parentified children and not seeing adults as a source of meeting needs
• Impacts of neglect
• Impacts of abuse (often, we don’t have reports of abuse in the child’s file)
• How common is sexual abuse in foster care or children in orphanages or institutions abroad? What are the behaviors that might result from sexual abuse?
• Impact of the child leaving familiar ties and surroundings
• What type of parenting is effective at helping kids adjust?
• Setting reasonable expectations.

Transcript

Please pardon any errors this is an automated transcript
Dawn Davenport  0:00  
Welcome everyone to Creating a Family. Talk about foster adopted and kinship care. Welcome back to our regular listeners. Thank you so much for rejoining us again and to our new listeners. I'm going to send out a special hello and thank you for joining us today. We're going to be talking about typical behaviors of kids adopted from foster care, or internationally. We'll be talking with Dr Robin Gurwitch. She is a licensed clinical psychologist with close to 30 years of experience in evidence based treatments and the impact of trauma, disaster and terrorism on children. She is a professor in the Department of Psychology and Behavioral Sciences at Duke University Medical Center and the director of parent child interactive therapy, which also goes by PCIT, and child adult relationship enhancement training at the Center for Child and Family Health. She has been a member of the National Child Traumatic Stress Network since 2001 and is currently their CO principal investigator for New Day, which stands for network, for enhancing wellness, for disaster affected youth, providing training, support and consultation to those working with youth impacted by disasters, terrorism, mass violence and or public health emergencies. Welcome, Dr Gurwitch, to Creating a Family. We are so glad to have you.

Speaker 1  1:24  
Thank you for having me. I look forward to this conversation. Well,

Dawn Davenport  1:27  
there are some distinctions, of course, between children adopted from us foster care and children adopted internationally, but they also have much in common. So today we're going to be talking about both, and much of what they have in common is that the vast majority of children adopted through foster care or internationally have some type of special need. And in addition to the medical or physical needs we might expect to see, there are also emotional and behavioral needs, and today we're going to focus more on those needs. So what are some of the factors that influence the behaviors of children adopted from foster care or adopted abroad?

Speaker 1  2:13  
You know, John, I think as we get ready to have this conversation, I just want to share a quick analogy, I guess. I think about when families get ready to adopt, no matter how that child's coming in, they have their ideas of what this adoption is going to be like and what life will be like with this child. And I think about it as you have planned for a year or more about this amazing trip to Italy, and you have figured out where you're going to go and where you're going to eat, and all the sights you're going to see as you travel through Italy, and you cannot wait to get on that plane to take you on this amazing trip of a lifetime adventure. And the plane takes off. You're so excited. You're going through your brochures. The plane lands, the doors open, and you're surrounded by tulips,

Dawn Davenport  3:04  
oops, and

Speaker 1  3:06  
you're in Holland. It's not that the tulips aren't beautiful, but it's not Italy.

Dawn Davenport  3:12  
It's not what you planned for.

Speaker 1  3:14  
It's not what you planned for. So it's, how do we enjoy Holland? How do we say, well, welcome to Holland. So how do we better understand so yes, it would be absolutely normal that we have some adjustment and a little grief about here was what I thought would happen, and here's what it actually is. But that doesn't mean we can't see the beauty in the tulips. That doesn't mean we can't see the possibilities and create this now to build on and have the child, as well as the family, reach their potential, whatever it is. But when children are adopted from foster care or they come to you internationally, something has happened, right? You don't say my life has been so great. I think I'm going to try that foster care system over there. So right off the top, we have to appreciate that children that come to us through those systems already have likely experienced some type of traumatic event,

Dawn Davenport  4:31  
regardless of whether they come to us from international adoption or foster care, something has gone wrong for them to be available To be placed outside of their family, and

Speaker 1  4:42  
we know at least from the foster care system. We know from some pretty startling numbers that when children are coming to us from the foster care system, over half have likely been. Sexually abused before going into the system, almost 50% have been physically abused. Only about 18% don't have abuse coming in. But then across all of those statistics, we know that. I think the last statistic I saw was something like 75 or 80% of cases involving foster care children also involve parental substance use, whether prenatal or postnatal. So that overlays the other and so I think when we look at that and we recognize that over 80% of children coming from foster care have a higher risk of also having mental health challenges, behavior challenges. That's the country that we're entering.

Dawn Davenport  5:48  
And I think that the same can be said for international adoption. The numbers may shift slightly one way or the other. Children the world over interstate care for the very same reasons, neglect, abuse, maternal substance abuse. The demographic of the children that we're seeing is very similar, regardless whether they are coming from abroad or whether they're coming from the US system.

Speaker 1  6:17  
And what we know is that when there's been trauma or when there's been extreme stressors placed on the child, that it impacts their brain development, it impacts relationships, it impacts how they see the world around them. So all of that is happening, we know that with these kinds of experience, children are much more likely to experience significant challenges in the educational system, because I'm struggling with what's happened and now trying to figure out how to manage geometry or how to manage my letters or things like that. And so we know that children that have had trauma, children that have had extreme stressors, if I say, Wow, this child has problems with attention and problems with concentration and problems with relationships, and their moods go up and down and they're disorganized and they're very hyperactive. Right away, we think, Oh, this child probably needs to be evaluated for attention deficit hyperactivity disorder. And while yes, some children may actually have that for children that we're talking about today, the better explanation for all of those symptoms, as much as the pharmaceutical company would would want us to ask doctors for free sample of adolescentericans. What we also know is that those are all of things that we see in children that have experienced trauma or excessive, extreme stressors, and all the medication in all the land is not going to address those problems, if the problem is because of the latter, rather than ADHD. And you still, you do have those kids that have ADHD, plus you could have boats right. But to recognize that, and actually, until you're an older adolescent, medication for trauma is contraindicated. So when we think about the children that have come into our hearts through foster care and or international adoption, we know that their challenges may show up as something else. They don't come with signs that say, Hey, I've had trauma. So they may come to us with things that show up as something else. It may show up as anger, it may show up as oppositional and defiant behavior. It may show up as sleep disturbances. It may show up as problems with attention and concentration. It may show up as extreme anxiety. So it can look like many different things. So part of what we're doing is trying to think about okay. We know that something has happened that put a child into the foster care system, that put a child in the international adoption pool. Something happened. So maybe the reason for these issues is because of what happened to them, and that's where we need to at least acknowledge and think about now, what do we do with it? How do we better understand it?

Dawn Davenport  9:49  
Okay, some of the other commonalities that we might see between children the world over who are in state care, be they us foster care or be they an orphanage in Columbia. Have multiple caregivers. Absolutely often see that something that's unique, perhaps, well, not completely, because we do have group care here we see more often in international adoption is institutionalization, meaning that they are raised in an orphanage or a child welfare facility, or whatever does the length of time in an institution impact the psychological and physical development of kids?

Speaker 1  10:28  
So the short answer is yes, and the long winded answer, which is those I tend to give, is but it doesn't have to define them. So when you have children that have multiple caregivers, or are in institutional care, which is usually multiple caregivers taking care of them as

Dawn Davenport  10:49  
well, when I turn over, even if they have three in a day, those three may only stay a month, and then they've got another one coming in. So it's a round robin, it's

Speaker 1  10:59  
a revolving door, or children in foster care that go from foster care to foster care to foster care, right? So when we look at that again, going back to how does the child see relationships and how do they see the world around them, two of the things that take a big hit, if you will, is challenges with a sense of safety, security, predictability. So I don't know who I can trust. I can't count on my needs being met. So when I think about the world around me, I don't see it as a place that is going to be warm and fuzzy with people that care about me. It's more if I'm crying, if I'm distressed. I can't guarantee that my needs going to get met, because maybe that's not feeding time yet. And so we recognize that the other thing that often happens with these children is they have an extreme challenge about reading emotions in others, which can create relationship problems, which leads to attachment issues, I will say, and this is Robin, not anybody else I'm going to own this. I think one of the things that oftentimes accompanies children that have had multiple foster care homes or international adoptions, one of the labels that is often placed on this child is reactive attachment disorder.

Dawn Davenport  12:28  
Very common, very common, that the label this place is

Speaker 1  12:31  
what you meant. I will tell you I personally abhor that label. I've been a psychologist for more decades than I want to count, I've seen hundreds and hundreds of children, most of them coming out of homes with prenatal drug and alcohol use, most of them coming out of the foster care system or international adoptions, and I can count on less than my one hand, the number of children that I have seen that truly have reactive attachment disorder. And I want to say that to those people that are listening, because if you Google it, it is the scariest diagnosis on the face of the earth. It really is, because what it says is this child is so damaged that there is nothing you can do. And I don't believe that, and I've seen too many children that come in with that diagnosis, and then with the right interventions, it's gone well. If you really have it, it's not something that disappears. It will stay with you for your life. So I think if you're worried about that, or somebody has mentioned that diagnosis, take it with a not just a grain of salt. Take it with a whole shaker, because the likelihood is what you're seeing is exposure to extreme trauma, extreme stress. And that doesn't have to define the outcome with the right interventions. We can change the trajectory. We can help children have that secure attachment. We can build relationships. We can change their ability to help them reach their potential. If I really believe there were children out there that we couldn't help, then I should get out of my field. I really don't believe that there are children that we just have to say, Oh, well, too bad

Dawn Davenport  14:27  
before we leave, the talk of institutionalization, and we are going to talk more about some of the expected and typical behaviors here in just a moment before we leave that I do want to mention that there are different types of care available internationally. I think there is a myth that thinks that all children adopted internationally are coming from large child welfare institutions, orphanages, or whatever we call them. Some countries have a have a robust foster care systems, not that many. And you will know before you adopt what type of. Care your child has had before they come to you, but the type of care they have will impact some of the behaviors that you expect and sometimes, and there is a movement towards, even if they don't have a robust foster care system in the country, they may have a family centered approach to their institutions, so they're reducing the size. They have one or two caregivers in charge of 10 kids or whatever. Not ideal, but it's not necessarily the large institutions that you may be thinking of. Again, these are questions you need to ask,

Speaker 1  15:37  
and I would also add when you ask that question, because I think that's really important. If you have a child coming from the foster care system, for example, in the US ask what happened to that child, so that you have as much information as possible when that child comes to you, because sometimes it's just this child needs a home. But if you don't know that this is a child that's coming from a mom that drank throughout her pregnancy, or this is coming from a child that's six but has had 15 foster care placements, and that's not unusual, then that leaves you in the dark. So I agree Dawn ask the questions from international adoption. They

Dawn Davenport  16:15  
may not have a lot of information. They may not have the answer, but you can they have some, they have some, they have some. And what they will know, usually, is where the child is currently living. What they might not be able to tell you is where they came from. And one thing to keep in mind is that, how long has this child lived in the institution? They may have been living with their grandmother prior to placement, less than a year placement. So there's a lot of information that you can gather. Ask, you ask exactly yes, but you must ask, let me interrupt this interview briefly to tell you about a wonderful resource that we have at creating a family. It is a prenatal substance exposure workshop. It is three sessions. It is for parents. In total, is about four and a half hours. It's interactive. It is facilitated. It is online. We have small groups, discussions, work through scenarios. It is just a terrific resource. You can get more information about joining one of the workshops at Bitly slash prenatal, dash exposure, dash training, that's B, i, t, dot, l, y slash prenatal dash exposure, dash training, moving into some of the expected or typical behaviors that we would see are common for those who have experience those children, neglect, abuse, prenatal exposure to alcohol and drugs, multiple caregivers, institutionalization, the lack of education and also, and this applies to children through international adoption, as well as children who come to us through foster care, children leaving everything it's familiar, all their familiar ties, their surroundings, and internationally, they might be even foster care. They may be leaving their culture, they may be leaving their language. So all of these things impact, as you said before, the behaviors we would expect to see. So I'm going to ask you about a couple of the typical behaviors that we might see it. Let's start with one you've already brought up, and I was so glad you had, and that is attachment issues. You've talked about the diagnosis of reactive attachment disorder and your suspicion of that. Let's talk about what type of attachment issues you might typically see for children who have experienced the whole host of things we just listed, abuse, neglect, exposure,

Speaker 1  18:44  
absolutely, it is probably more common than not that children will have attachment challenges. That doesn't mean attachment disorders. That just means attachment problems, and they generally come to us with more insecure attachment, meaning that I can't count on the world around me that leaks out into every aspect of relationships. So they may have problems with, like I said, reading emotions with trust. For some of these children, they may have been extremely parentified, meaning they were responsible of taking care of younger I just heard a history yesterday with four children, 432, and an infant, and the four year old was responsible for parenting the other three, and then they were all adopted in four different homes. So for that child now to figure out, how do I fit into my new family when I used to be taking care of everybody and they're not here anymore. So we may see challenges with behaviors. We may see post traumatic stress. We may see significant anxiety or withdrawal, if I just don't even know where to begin. So when we have attachment problems, the biggest challenge is, how do I see the world around me? And the answer to that is, I see the world around me as a scary place. I see the world around me as a place that I can't trust. So I'm constantly scanning for when is it going to let me down. I remember seeing a child in the foster care system that asked his foster to be adopt Mom, when are you going to hit me? What do I have to do before you hit me? Because his behavior kept getting more and more out of control, and he finally looked at her and said, What do I need to do before you hit me? Because he needed to figure out what was the line, because that's what he was coming out of. And when the foster parents said, we don't hit in this family, there was first, incredulity, and second, I don't trust that, because I was always told, I'm so sorry. I won't ever do it again until the next time it happened. So recognize that children are coming in with expectations that are usually different than the kind of home you're providing to this child from foster care or through an international adoption. And so we do see more risk for PTSD, more risk for learning challenges, being able to keep up at school. Some of that is I may be behind because of all my moves, but some of it may be because I'm not concentrating and focusing like the other kids in the class, and I can't learn it the same way. So

Dawn Davenport  21:36  
I'm going to go through a list of a couple of the typical behaviors. So we've talked about attachment issues. We'll have a lack of trust in adults. And so those are the things you would be expecting to see. Another typical behavior would be food insecurity. So how might that look?

Speaker 1  21:53  
Sure. So sometimes when children have not had those basic needs met, of food, you will see sometimes hoarding. So you may see kids stashing food under their bed or in their closets because they don't know when their next meal is going to happen. And if I've had food insecurity before, then if I see food, then I'm going to assume if I don't get it now, I may not have it when I need it. So you may see that hoarding of food, even though you may tell them, Don't worry about it, we will have meals every day. I don't trust that yet. So I need to plan, or if I am used to moving from place to place, I can't guarantee there's going to be food in the next place, so I need to sort of stock up so I can take it with me. When, when you tell me that I'm going to have to pack up my garbage bag and move again.

Dawn Davenport  22:51  
And another thing you might see is overeating, absolutely if you haven't had food, it is tempting to get while the getting's good, and you might see that as well. All right, let's talk about some sleep issues that would be typical for kids from international adoption or foster care.

Speaker 1  23:10  
Yeah, so sleep is probably one of the most common problems that are present in adults or children across the age span. So let's think about it, if I'm an infant and I'm not sleeping well, that means I am crying more. I seem to have almost colic type symptoms for months, which puts a lot of stress on families. I may not eat well, and if I lost a pound because I didn't eat. Well, I'd probably go out and celebrate. But if that baby loses a pound, that may put them in a medical challenge, right? And when I'm not sleeping well, I generally have challenges with eating. As kids get older, we may see problems falling asleep. We may see problems staying asleep with younger children. It may take the form of nightmares that maybe don't have anything to do with what happened to them, but we expect nightmares and night terrors as normal development. This is above and beyond. As children get older that sleep problems may be more related to what happened to them. And I think as we get into school age and adolescents don't underestimate the impact of social media on sleep. I'm so worried that I might miss something, or I don't know what's happening, and I need to figure out the world around me so I'm not sleeping well. And when I'm not sleeping well, what it turns into is problems with academic success, behavior challenges, because I'm just not making good choices and I'm not able to learn when I don't sleep well.

Dawn Davenport  24:59  
Another thing that we. Will often see is that children, the typical American family, expects children to sleep in their own bed, and very often in their own room. And for children who are coming through internationally or from the US foster care system, they may never have slept by themselves, and certainly may never have slept in a room by themselves. Scary. It is scary, and resistance to those issues would be another typical behavior that we might see. But

Speaker 1  25:26  
that doesn't mean you have to keep them in your bed till they go off to college, right? But just acknowledging that that is going to be different, that oh my gosh, I have my own room. Just having my own room may be a completely novel experience,

Dawn Davenport  25:40  
it would be. And so knowing that you might go into the situation where the child is resistant, coming up with some solutions that you and the child can live with, and then gradually transition into if it's important to you that the child stays in their bed, another typical behavioral challenge or Learning Challenge, which you've already addressed is attention issues, and you've addressed the fact that attention issues can come from trauma. It can come from prenatal substance exposure to alcohol or drugs. It can come from just the upheaval and everything in their lives when they move into you, which stress in addition to trauma, and you've already talked about that medication may or may not be successful. A child could have ADHD and need them and need the meds. But some of the attention issues may also be caused by all the issues that we had talked about, the trauma, the institutionalization, the prenatal substance exposures,

Speaker 1  26:41  
absolutely and what we know about those children is they are two and a half times more likely to have to repeat a grade. They're six times more likely to have behavior problems in school if they've had three or more of these types of traumatic events. And children coming in from the foster care or international adoption. You can probably pick three before you ever get out the door. Multiple placements, needs not being met, caregivers that you know, some abuse or neglect, all of those things. And what we know, which is boggles my mind in the United States, children that are most likely to be suspended or kicked out of school in the United States are kindergarteners, highest rates. I know so it is. There's probably lots of reasons that we can talk about why they're most likely to be kicked out, but that creates problems and stress in the family, because if my child is suspended or expelled, my job may not give me unlimited time off to stay at home, so that creates stress in the relationship

Dawn Davenport  27:56  
with child. Chances are good they won't, in fact, exactly.

Speaker 1  27:59  
So it just that stress just gets shared across all family members. All

Dawn Davenport  28:06  
right, another thing that impacts our typical behaviors we might see for children in foster care or adopted internationally, and we've alluded to it several times, and that is the impact of prenatal substance exposure to alcohol and drugs. Very, very common in both children adopted from abroad as well as foster care. Upwards of 80% of children adopted through foster not adopted but who are connected with the foster care system have been exposed depending on the country, and it does matter significantly depending on the country, and that's a question that you again, you would ask your agency, but it is also in many countries, the children will have a significant risk. Can you just give us there are so many impacts, particularly for alcohol exposure, but for both, can you just hit some of the high points, like the top couple that you can think of Sure,

Speaker 1  29:02  
I think all substance use during pregnancy is to be avoided. So let me go on the record as saying drug use during pregnancy bad, but if you're going to pick something, it's better you do meth than drink alcohol, heroin, better to do heroin, better to do heroin than do alcohol. Alcohol is the number one most poisonous substance a pregnant woman can ingest in terms of the impact on the brain, and it's if I'm using some of those harder substances, the likelihood that I also drink is pretty high, but I can't test for it right, unless the mom comes in and she's drunk when she delivers. But I think the big issues we see, particularly with children that have been exposed to alcohol, which is really frustrating if I don't understand it, is I don't learn the same way. So I may. Seem to have that information that I'm supposed to put my backpack by the door, and I did it yesterday, and I did it the day before, but the next day, I didn't, and it may not have anything to do with being defiant or oppositional. It's like I went to sleep and it fell out of my head. So it takes much longer to learn and retain the information, and this is for children that may have average IQs or children with low IQs. It's how the brain gets wired. When I've been exposed to alcohol with other substances, you may see a higher risk for ADHD or behavior problems. But in general, that doesn't seem to sort of stick, like the problems with alcohol, which are highly related to diagnosis of ADHD, that are highly related to more behavior challenges and memory and focus questions. So with those other substances, no, they're not good, but in terms of long term problems, not even in the same league as if I've been exposed to alcohol prenatally,

Dawn Davenport  31:11  
yeah, and so many children who have been exposed to alcohol have a diagnosis of oppositional defiant disorder, and that's really frustrating, but absolutely true.

Speaker 1  31:22  
There's new diagnoses that are coming out of the diagnostic classification for children zero to five, and I really like it because they've they've done away with the idea of oppositional defiant, although that's still a crosswalk for insurance, and they really put those behaviors as a mood regulation disorder, that the children aren't purposefully pressing your buttons, but they really struggle with being able to regulate their moods, and it comes out as oppositional behavior. It comes out as defiant behavior, but it's not in so they meet all the same criteria as that oppositional defiant disorder, but we begin to think of it as a child's inability to regulate themselves, to be able to manage all those emotions and all their mood and I like that with little children, because it's saying I can't Help this. So help me. Help me.

Dawn Davenport  32:21  
Yeah, exactly. Did you know that we now have a new podcast called weekend wisdom. That's our short form. It's usually about five minutes, maybe 10 if I get particularly wording, or if the question is particularly gnarly. But that is our opportunity to answer your questions. So we need you to send us your questions. You can send them to info@creatingafamily.org they will wind their way to me, and I will answer it on the next weekend wisdom. So send us your questions, everyone and listen that one drops, as you would imagine, on the weekend. In fact, it drops on Sundays. I want to specifically talk about one impact of institutionalization, which, again, more often happens with children adopted internationally, rather than the foster care system, and that is, many of these children have never lived in a family, right? And they don't really understand the meaning of family. How might that look? What would be some of the behaviors that we would see for a child who simply is in a recent institution doesn't get that this is a family and things are done differently. What might we expect to see? It

Speaker 1  33:31  
all comes down to the underlying I don't trust what's in front of me. I can't count on this. So they may come in feeling like there are responsibilities that are way above their age range. So they may not follow your rules because I've been responsible for having to take care of myself, raise myself and raise the other children that are in the institution with me. So I may not follow rules because they don't apply to me and how I see my world, it may show up in terms of very much a lack of trust. So when you tell me something's going to happen, I'm not going to count on it, so I'm going to do my own thing. You tell me food will be there, but I can't trust that. So I may overeat or I may hoard that food. So we see that coming out more in children that have been in institutions, but we also see it in children coming into the foster care system. Well, what am I going to do before you give up on me, before you throw me away, before you move me to another home? And so we see some of those same kinds of things, and sometimes we see post traumatic stress symptoms. So I may I may be constantly on a high alert for something happening to me. I may constantly startle when I hear a loud noise. I don't understand a family. I don't understand how that works, and I don't trust yet that when you say I'm here for you, that you really are. I really don't trust that yet. So it. It, it may take a hot minute the good news, the good news is we absolutely have interventions that can start turning the ship around and help that child meet their potential. So helping families meet their potential too.

Dawn Davenport  35:22  
Are there specific behaviors or impacts that are caused by neglect? The majority of children who we are talking about, either through international adoption or foster care, have experienced neglect. They may have also experienced abuse. We're going to talk about that in just a minute. But the experience of neglect, we tend to think of neglect as being the better of the well, they weren't abused, you know. So at least you know there was no abuse. So this, this child shouldn't be as impacted. Is that? In fact, the truth?

Speaker 1  35:55  
No, no, because with severe neglect means that my needs were completely dismissed, not taken care of. I couldn't count on it. So with neglect, I really do not understand how the world around me works, and I only have me, and I can't count on anybody else around. So with physical abuse, if there's not neglect, then I know that somebody's going to be taking care of me. I can't tell when the abuse is going to happen, which is a whole other set of issues. But my needs are met with neglect. My needs are not met at all. I can't count on, it is completely unpredictable. So I'm basically trying to raise myself and figure out how the world around me works. So for children with neglect, I'm going to be much more likely to push back on any rules because I only have me to count on. I don't need to follow your rules because I can't count on your rules and you don't care about me anyway. And so that's the biggest is that oppositional type behavior, that defiant behavior, can come out. You may also see in children with neglect, extreme withdrawal. I give up. I give up. I can't count on any needs being met, I'm pulling back. I can't count on you. I can't count on the world around me, so I'm just going to basically pull the covers up over my head and withdraw completely.

Dawn Davenport  37:31  
Now, with abuse, it's a little different. And you mentioned, first of all, we often do not know when a child has been abused, and that's the case whether you are adopting from some other country, or whether you are adopting from the US foster care system, or fostering, not just adopting, but fostering, if the child comes to you, you may well not know, because it is often not included in their files,

Speaker 1  37:55  
or you may not know the extent. So there's been one incident that brought them to the attention of the system, but you don't know about the 10 other ones that never got

Dawn Davenport  38:04  
reported. There is a built in incentive for you not to know, because whomever was the caregivers for that child, the parents of that child or the institution, if adopting internationally, it's not in their best interest to report that. But one of the natures of abuse is it's not constant, it's intermittent, and that's insidious in many ways. Yeah,

Speaker 1  38:25  
I think you're exactly right. So what that means for children is they are on a constant state of high alert. And when the body is on a constant state of high alert, it is draining. It makes it harder for me to learn, it makes it harder for me to interact appropriately with others, but the biggest thing for those children that are on that high state of alert, I've got to scan always for where the danger is, because it comes out of nowhere. Seemingly, I have a harder time reading emotions in others, so I jump to conclusions when they really might not be there. So in some of the studies that have been done showing children that have been physically abused a series of faces that are computer morphed to show anger or anxiety, children that have been abused can't recognize the anxiety until it's like 20% angry and 80% anxious. I'm still reading anger, because if I'm coming from a home with physical abuse, I have to be able to read anger in the smallest, smallest dollop. And so when I'm seeing friends that may show a face and they're not angry at me, but that's how I read it. I am. I am looking for that everywhere, so that can lead to relationship problems, because I'm misinterpreting and for some kids, particularly as they get older, I am going to lash out at you before you have a chance to lash out at me, because I'm expecting it

Dawn Davenport  39:59  
a particularly. Insidious form of abuse is sexual abuse, and as you mentioned earlier, it is common in both children adopted from abroad, as well as in the US foster care system. It is very often not in the child's files. Especially, I think that is the case when a child is adopted internationally, that it won't be in the files, and you may not know about it until the child is more comfortable in your home and feels that they can share that information, or it may come out in therapy. So what are some of the behaviors that might result from sexual abuse? So

Speaker 1  40:38  
with sexual abuse, one of the things associated with sexual abuse is secrecy and threats. So you can't tell anybody. If you tell anybody what's happened, then they're going to take your siblings away. Or if you tell somebody what happens, then you're going to get moved to another home, or I'm going to have to go to jail, because children that have been sexually abused generally still have some very positive feelings about the perpetrator. And when the perpetrator is somebody who's supposed to meet their needs, it can create much more complex trauma, because that's the person that was supposed to take care of me. So we see significant problems with relationships. If there's a history of sexual abuse that child, particularly, mostly girls, are more likely to enter into abusive relationships. As they get older, that they begin to believe the only way that people will like me is if I am this little sexual being. And so they may have difficulties with boundaries. They may have difficulty with understanding how people may or may not see them, so they may show some sexualized behaviors, and that's really uncomfortable. That's one of the main reasons children actually fail their placements, be it international or foster it doesn't matter which is that sexualized behaviors because it's so uncomfortable for us,

Dawn Davenport  42:08  
and oftentimes kids coming from institutions, the sexual abuse may be caused by older children in

Speaker 1  42:13  
the institution. And now I'm coming into your home and you have a teenage son, I don't trust this or I'm assuming what's going to happen.

Dawn Davenport  42:23  
There is a myth that most children who have been sexually abused will grow up to be perpetrators of sexual abuse. I've already given the hint when I said it's a myth, so I should have just said, is that true? Let me back up. Is it true that most children?

Speaker 1  42:37  
No, it's not, but what we do see is a higher risk for entering more abusive relationships, not necessarily as a perpetrator, but as a victim.

Dawn Davenport  42:49  
Children coming into our homes, be it through foster care or through adoption, internationally, as I had mentioned earlier, are leaving everything they know, all the familiar smells, the food that they're used to. The people, of course, the language certainly coming internationally and even some in foster care. They're leaving their language. They're leaving their cultural they're leaving everything. I often say, their world has been turned totally upside down. What behaviors do we see for a child who, I mean, it's almost unimaginable. It's not like when we travel to another country. Yes, we're leaving everything familiar. We are number one, adults. Number two, we plan for it. We understand what's happening, and we're coming home and we're coming home. Perfect Point. Yes. So what would be some of the behaviors we might see from a child who is struggling with this upheaval?

Speaker 1  43:41  
I think it's all those behaviors we've already talked about. They're going to have problems with trust and a sense of security when they're moving from place to place to place. I think they are going to have significant adjustment challenges. I mean, if I have to change schools, the schools may have different rules. I may enter classes at a different level, I may have to leave all my friends behind. So it's those secondary adversities that are also part of that move that I am leaving behind. And I think again, all of the behaviors, the problems with attention, the problems with focus, learning new materials, sleep issues, feeding issues, all of those things are going to travel with them as they move from place to place to place. It is not a positive thing at all. And I don't know you tell me I'm going to be here, but that's what you told me last time, and I immediately had to move.

Dawn Davenport  44:35  
And we have at creating a family, lots of resources on the type of parenting that is effective to help children who have experienced all the host of issues, neglect, abuse, prenatal substance exposure, institutionalization, multiple caregivers, all of these things. There are specific parenting techniques, but perhaps one of the most important. Things, and this ties us back into what you said at the very beginning, when you gave us the story about planning on Italy and ending up in Holland, and that is the importance of setting realistic expectations before the child arrives.

Speaker 1  45:16  
I think you're exactly right. And the good thing is we have come a long way in the last few decades about understanding how to support families and also how to support these children, whether it's through international adoption or whether it's through the foster care system, we've come a long way of learning what is effective, and those resources are out there. Creating a family has many, many but there are such amazing treatments, starting at little little bitty all the way through transition age youth. So no matter where the child enters your life, there are really effective, grounded intervention programs for these children and parenting skills and parenting ideas as you bring them in, because Holland's a beautiful country, and so we just need to figure out, how do we now navigate through the tulips? How do we now look at what we need and make sure that we have the best resources to help meet the potential for the children that are coming with us to Holland

Dawn Davenport  46:22  
and the National Child Traumatic Stress Network as well has tremendous resources, as well as specific information about evidence based therapies and interventions that are effective. So thank you so much, Dr Robin gurwich for being with us today to talk about the typical behaviors we might see for children coming into our homes through foster care or international adoption, I truly appreciate it.

Unknown Speaker  46:47  
Thank you for having me.

Dawn Davenport  46:50  
Wait, wait, wait before you leave, before you turn off this podcast. Let me tell you about some free courses that we have thanks to the jockey being Family Foundation, they are free. We have 12 of them. They're focused on parenting, not how to adopt or how to foster, but they are focused on when you're actively parenting. They are wonderful. You can get a certificate of attendance if you need that. If you're a foster parent, you might need it. Otherwise you probably don't, but the information is still excellent. Check them out at Bitly slash JBf, support. That's B, i, t, dot, l, y, slash, JBf support. You.