Your social life, the quality of it, was wired into your gray matter by the age of 3, according to current thinking on child development. After a minute of contemplating that statement, the immense impact of early childhood caregivers becomes clear. This subject comes to mind after reading a recent news story about Artyom Saleviev.

Artyom was first in the news in 2010. He is the Russian boy who was adopted by a U.S. couple, the Hansens, 3 years ago. After being part of the Hansen family for 5 months, Artyom was put on a plane bound for Russia by his adoptive mother. Artyom carried a letter which stated the Hansen’s no longer wanted him because of his disruptive behavior related to psychological problems. The recent news article states that Artyom is now living in a foster home (in Russia) and his behavior there is not disruptive.

In the United States, the number of children in the foster care system is close to 500,000. One-quarter of them are infants when they enter the system; 15% are age 3 or younger, some only infants. The most common reasons for removing them from a parent or relative’s home are an absence of supervision (36%) and a failure to provide (31%). What affect does this have on a baby or toddler? Are they so young they will not remember neglect or abuse by early caregivers? If only that were true.

Caregiver Influence

To understand the effect early caregivers have on infants and toddlers, we can look at the implications of attachment theory. This theory, which has been substantiated by research, states that interactions with our initial caretakers determine our future capacity to build emotional bonds with others.

By the age of 3 years, children are either secure in their attachments to their caregivers or insecure. Children who are secure have the benefit of responsive caregivers that consistently meet their needs for food, safety, and affection. In adulthood, they can form lasting emotional connections with others.

There are three types of insecure attachment: avoidant, ambivalent, and disorganized.

When caregivers discourage expressions of a child’s distress or affection, an avoidant style of attachment develops. The child learns to discourage his or her own feelings, which damps down the child’s capacity to feel loved by others. Avoidant children typically withdraw from social interaction and grow into adults who are extremely uncomfortable with feelings and intimacy.

Ambivalent attachment occurs when early caregivers give comfort inconsistently. They sometimes respond to the child’s needs and sometimes do not. With this kind of care, children become unsure whether their needs will be met. As adults, they are slow to trust and at risk for mood and eating disorders.

When a child’s needs are not responded to, or the child is abused, a disorganized pattern of attachment can lead to delayed development, social withdrawal, and aggressive or disruptive behavior. Adults with disorganized attachment are susceptible to personality disorders and chronic mental health problems. Their relationships are often chaotic or short-lived.

Our attachment style sticks with us for life, although alternative behaviors and ways of thinking can be learned to improve relationships.

Not All Memory Is Conscious

When Artyom Saleviev arrived in the United States, was he secure, avoidant, ambivalent, or disorganized in relation to others? The Hansens painted a picture of a very disorganized child, although his current foster mother in Russia does not. Regardless, his experience with the Hansens, and the ill-conceived way he was sent back to Russia, are not stand-alone events. They rest on the foundation of interactions he had, or did not have, very early in life.

Even if a school-age child like Artyom is adopted or finds his way to a nurturing foster caregiver, a pattern of connection with others is already established. It begins before the child enters foster care, as a result of the child’s experience with his first caregivers, and the pattern continues after he leaves the system.

Around one-third of those 18 to 24 who age out of foster care are homeless within 18 months (in the U.S.). Up to one-half are unemployed within 4 years of leaving, and approximately 30% to 40% have a mental disorder and likely no health insurance. More than three-fourths will become parents.

Perspective

To keep these sobering numbers in perspective, we can consider that people with less than stellar starts in life can, and do, lead productive lives and find a share of happiness. Humans are highly adaptable and resourceful. It is also a fact that people from “good” homes enter adulthood with mild to severe attachment issues, usually the avoidant or ambivalent type.

Difficulty trusting and connecting with others is not just a single family issue. It is part of the human condition and drives the drama we call history.

The foster care system is imperfect, but it is a nested problem. Looked at as a whole, the problem begins with the child’s experience of insufficient early caregiving and is later aggravated by the lack of support for these children during the transition to adulthood. The system is situated in a disorganized world where, unfortunately, such institutions are necessary. The best we can do is to strive to keep making improvements based on what we continue to learn about the special needs of these children.

References:

1. Child Welfare Information Gateway. Available from: http://www.childwelfare.gov
2. U.S. Department of Health and Human Services, Administration for Children and Families. Abuse, Neglect, Adoption & Foster Care Research: National Survey of Child and Adolescent Well-Being (NSCAW), 1997-2010. Available from: https://acf.gov/opre/project/national-survey-child-and-adolescent-well-being-nscaw-1997-2014-and-2015-2024
3. Radia, K. Adopted Russian boy rejected by U.S. mother adjusts in foster care. Available from: http://gma.yahoo.com/blogs/abc-blogs/adopted-russian-boy-rejected-u-mother-adjusts-foster-110037054–abc-news-topstories.html

Related articles:
Patterns of Attachment in Adults
Understanding Difficult Behavior – For Foster and Adoptive Parents

According to a new study led by A.C. Burnett of the Department of Psychology at the University of Melbourne in Australia, children born prematurely and with low birth weights (LBW) are three-and-a-half times more likely to develop mental health problems such as depression and anxiety than normal birth weight (NBW) children. Children born prematurely are already at increased risk for physical health problems, learning disabilities, and other cognitive challenges. Some research has provided evidence that children who are born prematurely are at a higher risk for behavioral problems and even attention-deficit hyperactivity disorder (ADHD). But until now, there has been little evidence suggesting that these children are also more vulnerable to mood disorders and mental health problems later in life.

In order to examine the relationship between LBW and mental health problems, Burnett analyzed previous studies and looked specifically at prematurity/LBW and how it influenced the development of anxiety and depression in adolescence and young adulthood. Burnett assessed data that was published between 1995 and 2010 and included individuals born prematurely with LBW, ranging in age from 10 to 25 years old. After review, Burnett discovered that children who were born prematurely and had LBW had a significantly higher risk than NBW peers, for the development of psychiatric problems later in life. In particular, the study revealed that the LBW participants were three times more likely to develop an anxiety or depressive disorder in adolescence or young adulthood than those who were born full-term.

The results of this study, the first of its kind, have significant clinical implications. Burnett believes that professionals treating the physical and cognitive impairments in LBW children should be aware of the negative psychological predisposition that these children possess, paying particular attention to mental health needs during adolescence and young adulthood. Burnett added, “The studies reviewed here indicate that, in addition to monitoring and management of medical and cognitive sequelae, the psychological well-being of formerly preterm individuals should be a key part of ongoing care in collaboration between clinicians, individuals and their families.”

Reference:
Burnett, A. C., Anderson, P. J., Cheong J., Doyle, L. W., Davey, C. G., Wood, S. J. Prevalence of Psychiatric Diagnoses in Preterm and Full-term Children, Adolescents and Young Adults: A Meta-analysis. Psychological Medicine 41.12 (2011): 2463-474. Print.

Last week, I had the honor of attending and speaking at Postpartum Support International’s 25^th Annual Conference in Seattle, WA. I was moved and inspired by the amazing work gestating and being born in the perinatal world by so many compassionate professionals. (Refresher: “perinatal” refers to the time from conception, through pregnancy, on through the first year after having a baby.)

My dear colleague Gabrielle Kaufman, BC-DMT, NCC and I presented a workshop on special needs parenting as relates to the family experiencing perinatal challenges. Both Gabrielle and I have found in our practices a large number of women and families who are impacted by the double whammy of a perinatal mood/anxiety disorder (PMAD), coupled with parenting a special needs child. We felt it was important to highlight this population of folks who are in great need of resources and support. Although this subject could be an entire week-long conference, we discussed the following highlights that are pertinent for special needs families and the people that support them.

It’s hard to define special needs, as we all are special and we all have challenges. We choose to define special needs as a child in a family system who is experiencing the challenge of a neurological, emotional, behavioral, developmental, or physical disability. This challenge affects the entire family system on several levels.

1. One in 10 children have a disability (neurological, emotional, behavioral, developmental, physical)
2. Parents of special needs children are more at risk for depression and anxiety
3. Couples (parents) of special needs children benefit from support such as psychotherapy and regular date nights (50% or more of all special needs couples divorce)
4. “Neurotypical” siblings benefit from support in the form of sibling support groups, one-on-one attention from parents, and open-ended discussion of feelings/solutions to concerns associated with being a special needs family (i.e., role-playing how to handle being in public with special needs sibling, preventing parentification, etc.)
5. Stigma is real and exists, even in the 21^st century. Therefore, family discussions need to happen to address this concern and to build social support networks.
6. Family/couple/individual therapy and support groups were found to be helpful in buffering the effects of stress and lowering depression/anxiety in these family systems in several studies
7. The special needs family is exposed to chronic stress and therefore requires an ongoing stress management program that will lower the effects of cortisol and adrenaline (the fight or flight response) that develop. For example, self-care, yoga, psychotherapy, respite care, support groups.

Below are some helpful resources we found to be beneficial.

Resources

• Americans with Disabilities Act Home Page – Extensive information about the Americans with Disabilities Act
• The Arc of the United States – Chapters across U.S. offer information, support, and advocacy for people with developmental disabilities
• The Arc’s Information for Siblings – Provides information and training to start sibling support groups
• ARCH National Respite Network
• Easter Seals Southern California – After-school activities for children with disabilities using public school sites and community settings
• Family Voices, Inc. – Offers information, support, advocacy, and workplace information for families of children with special health care needs; many publications available to download for free
• Fussy Baby Network – Resources for families with fussy babies
• National Alliance for the Mentally Ill (NAMI) – Offers interactive “Special Needs Estate Planning Guidance System”
• National Autism Association – Clearinghouse of resources on autism spectrum disorders
• National Dissemination Center for Children with Disabilities – Online clearinghouse providing information and links on all matters related to childhood disabilities, resources, laws, research
• Sensory Planet – Clearinghouse of information for sensory processing disorders
• Sensory Processing Disorder Foundation – Information on sensory processing disorders

Organizational Aids:

• Children’s Hospital and Regional Medical Center/Center for Children with Special Needs – Offers “CARE Organizer” (forms to document child’s activities, therapies, medical bills, etc.) and the “CARE Notebook” (an expanding file folder to organize forms)
• Children’s Medical Organizer – Online organizer to keep track of family’s medical information, from immunization records to doctor appointments
• The National Center of Medical Home Initiatives for Children with Special Needs – Provides links to various types of organizers and health care notebooks
•  Think College – Has information and searchable database on special college training, courses, and assistance for young adults with disabilities

Books:

• Baskin, A., & Fawcett, H. (2006). More than a mom: Living a full and balanced life when your child has special needs. Bethesda, MD: Woodbine House.
• Celebi, J. (2008). Overwhelmed no more!: The complete system for balanced living for parents of children with special needs. Joan Celebi.
• Domar, A. (2001). Self-nurture: Learning to care for yourself as effectively as you care for everyone else. New York, NY: Penguin Books.
• Fogel Schneider, E. (2006). Massaging your baby. New York, NY: Square One.
• Gil, B. (1998). Changed by a child: Companion notes for parents of a child with a disability. Pella, IA: Main Street Books.
• Meyer, D. (1997). Views from our shoes. Bethesda, MD: Woodbine House.
• Seligman, M. (2004). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfillment. New York, NY: Free Press.
• Seligman, M. (2006). Learned optimism: How to change your mind and your life. New York, NY: Vintage.

Parental Self-Care:

• America On the Move Foundation – Information about healthy-eating and fitness; can register to work toward achieving health goals
• American Trails – State-by-state list of trails and greenways, groups, and hiking agencies
• Special Olympics – Opportunities for adults and children with intellectual disabilities for sports training and competition
• World Laughter Tour – Lists laughter clubs around the U.S. and Canada
• Global Family Yoga – Yoga resources for special needs families

Other Materials:

• Children with Special Needs and the Workplace: A Guide for Employers by the Center for Child and Adolescent Health Policy at the MassGeneral Hospital for Children
• Commonly Asked Questions About Child Care Centers and the Americans with Disabilities Act
• A Family Handbook on Future Planning edited by Sharon Davis, PhD
• Open Arms: Embracing a Bright Financial Future for You and Your Child with Disabilities and Other Special Needs by Easter Seals Disability Services and the National Endowment for Financial Education

This list of resources is far from comprehensive, as every day the Web has new sites on the special needs family. We chose to highlight a few websites and books which we found to be helpful for our clients and our practice, as perinatal psychotherapists.