A throw away line on a show* last night got me thinking about this… I’ve heard several horror stories about kids adopted from countries that simply warehoused kids eventually being discovered to have attachment disorder after several misdeeds because of how they were treated when they were very small. But none of these stories follow the troubled kids into adulthood.
What’s the adult prognosis? Is it as grim as I imagine and they never recover enough to have meaningful relationships? Do they grow up to become amoral criminals? Or can they learn to care for others and be productive members of society?
I have friends who adopted a girl with AD. Even with extensive therapy, she had a very rocky adolescence but seemed to have leveled off. Then she went through a rough patch and attempted suicide. She just finished her first semester of college and is doing pretty well, but her parents would be the first to say that she’s nowhere near cured.
One of my half-siblings adopted a 6-year-old child who wasn’t being taken care of by the birth-mom. (Bio-dad was not present in the child’s life.)
As the girl grew, it was obvious she had problems with trust and believing she was loved. She acted out as a way of “testing” her family. She was convinced they didn’t love her and kept escalating the bad behavior. If they got mad at her, it “proved” to her she was right: they didn’t love her.
As far as I know, no medical professional diagnosed her with attachment disorder, but during the time she and I were in frequent contact, she displayed many of the symptoms. As a teenager, she began to cut herself. She also suffered from nightmares. She was an indifferent student and never graduated from high school. She got involved with guys who weren’t good for her. She quit one low-wage job after another. She capped things off by marrying a much older man who was plagued by his own demons.
I wish she would go for counseling, but she’s very religious and her husband is “old-fashioned” and “doesn’t believe in that”. The extended family wishes she would leave him, but there are children involved and it’s best not to go into detail about that on a public form. My heart breaks for her.
This is a really broad response so if you take offense well go easy on me, this doesn’t apply to everyone of course.
I’ve known several kids that had serious mental and emotional issues, I don’t remember any of them being diagnosed with attachment disorder but I think thats a fairly new term, a few of them would probably be diagnosed if they were growing up today instead of personality disorder, bi polar, anti social personality etc.
The teen years are rough, more than usual anyway. Most got heavier into drugs including alcohol than is usual. The early to mid twenties is the hardest part, most either turn around enough to function as an adult(for the most part) or commit suicide or OD or go to prison. At some point in your twenties you realize no one cares about you anymore, there is no one to “test” because in the adult world no one cares. If you want to have a job or have sex/a relationship you have to swallow some resentment and anger and play along enough to get along.
One of my friends has a sister with this condition. (Don’t know if it’s ever been formally diagnosed, but that’s the terminology friend uses.) Sister was adopted from SE Asia (sorry, can’t remember which country), and she spent the first six months of her life in an orphanage where she was kept in her crib at all times, only taken out when it was her turn in the rotation to be fed and diapered. When her parents adopted her, the back of her skull was completely flat, requiring medical care to correct.
This girl was never right. Discipline problems all through childhood, became sexually active extremely young (like 11 or 12), jumped from guy to guy, dropped out of high school. Drug and alcohol abuse, multiple divorces, several children all from different fathers, time spent in prison, etc.
And I can’t say for sure it wasn’t the home environment, because who knows for sure what goes on behind closed doors, but the parents always seemed like very nice people to me. They had a stable marriage and a stable home. My friend was also adopted, but unlike her sister she went home with her parents straight from the hospital, and spent no time in an orphanage. She was a normal kid. Good grades, no discipline troubles beyond the norm. In fact, she was more on the goody two-shoes side of the equation if anything. Grew up and has a good job, nice husband, beautiful child and another on the way.
So same home environment, two very different outcomes.
A read a very sad story of a local (to me) family who adopted two Rumanian girls. They never really integrated into family life and as they grew into teenagers drifted into crime and living on the street, it being almost impossible to keep them in the family home with anything less than physical restraint. They would hang out with streetkids most of the time, living off petty crime and prostitution, and come home from time to time for clean clothes and food when they had no other choice.
One of them was killed in a street fight and the other ended up in prison, probally never to be able to have a normal life outside of an institution. A sad end for parents who wanted nothing but to provide them with a loving home.
Romanian orphans adopted in the UK have been well studied over the last 20 years. Those who were adopted when under 6 months old caught up and recovered almost completely. Of those who were older than 6 months, 2/3rds recovered. 1/3rd did not, and at 15 still showed significant emotional/social behaviour disturbance. There were some great BBC radio shows covering this topic last year - worth a listen if you can get the BBC iPlayer.
This ties in with recent studies showing that there are two genetically determined responses to childhood environment. Orchid children will react badly to childhood adversity, but thrive if encouraged. Dandilion children cope well with childhood adversity, but do not achieve quite as well in good conditions (within the normal range of human variability). This gives a basis for why some children survive mistreatment almost unscathed, and some do not.
I wasn’t any kind of discipline problem - except maybe self- . But I think some of this applies to me as an only child with social issues. My early 20s were very resentful, and my heart was never in playing along. I eventually gave up completely, and in my mid 40s I am still paying a price.
By time a kid with ‘attachment disorder’ grows up, that term will be superseded with another bit of psychobabble. Therefore they won’t have ‘attachment disorder’ any more.
Hmmm…shows lack of empathy and scorn for other people’s emotional pain… <Thelma looks over the top of her glasses at Jerry and makes a note in Her Book>
Yes, attachment disorder is real. It has to do with learning at the very earliest age that there is such a thing as love and safety in the world. Not that the World at Large is a loving and safe place (which it clearly isn’t), but that you can find love and safety enough to survive. In my disordered heart, I do not believe there is any “cure.” There is simply learning to get along and faking happiness. The smart ones do that. Therapy can help, but the damage done at a time when the child is truly physically and emotionally helpless cannot be undone, just worked around. Some people with this problem go on to be very successful externally but always have the hole in their hearts.
I’m worried about this too. Can a person recover from abuse and neglect done at 6-36 months of age? I have no idea. My understanding is neglect after 3 years will still damage a kid, but by that time attachment patterns are pretty much set.
If EMDR doesn’t help, I can try to find an AEDP therapist. Those are supposedly good with attachment disorders. But fundamentally we don’t understand the brain or how to change it enough to say for sure if there is a cure. I doubt it, deep inside I know that the best I can do is manage symptoms for the forseeable future.
While there is still much to learn about how the brain processes and retains traumatic and/or abusive situations (and I wish we didn’t have to do so at all, particularly childhood trauma), there is hope that therapies can be developed that can “unfix” traumatic memory patterns. Recent research shows that inhibiting some memory related neurochemicals during memory maintenance can erase them - at least in rodents. Hopefully these techniques will have applicability to things like PTSD and Attachment Disorders in humans in the future.
Wesley Clark, I certainly wish you well as you seek some resolution for the issues you struggle with. While I personally am not sure that the proposed mechanism for EMDR is valid, the EMDR process as a whole appears to work at least as well as other similar therapies, and the structured approach may well have value for some patients. Good luck.
I’ve never heard of a family adopting a child from eastern Europe or any of the old Soviet republics who didn’t have very serious problems with them.
The neighborhood I grew up in has a residential treatment center for kids who were at that time dubbed “emotionally disturbed”. The higher functioning kids went to school with us, and most of the time, we didn’t know they were from that facility until they told us. One thing they ALL had in common was that no matter how intelligent they were, they were always several grade levels behind where they should have been. Most of them had spent time in foster care, and I’m guessing most of them had what we would now call Reactive Attachment Disorder. There were two exceptions who really stand out in my mind, and I believe those two kids were on the autistic spectrum, which wasn’t recognized at that time.
Same to you. I wish you the best, I know how insidious this problem is.
Other things to look into are schema therapy and the works of AJ Mahari. Mahari writes alot on BPD (which also has some roots in abuse/neglect when young) but she talks alot about the consequences of child neglect in your formative years.
In the last few years I’ve tried breaking down my ‘false self’ (the self you invent to compensate for, deny and suppress your inner pain) and letting my authentic identity out. Doing so is incredibly painful at times since I have to feel the pain I’ve been denying. And it feels endless. I’ve been doing this for 4 years, and I honestly don’t know if/when it will ever end. Part of me worries if this is just my new normal of always carrying a gaping, festering wound in my heart. I’m glad I was in denial about my pain for so long, I never could’ve handled college if I had let my pain out when I was in my 20s.
As a pediatrician I have seen good outcomes among some adopted from eastern Europe and the old Soviet republics. And not good ones. In general troubled kids are at high risk of becoming troubled adults. Not rocket science this.
A major problem is the label assumes a cause, sometime presumptuously. The same child with the same exact behaviors who had not been initially institutionally raised would get a different label - be it autistic spectrum or oppositional defiant disorder or bipolar or ADHD or whatever. If the same child was being raised in a household by a mother who had drunk a fair amount of alcohol during pregnancy with a very involved grandparent who was caring for the child well from infancy on, or adopted at birth, then the child might be labeled more as fetal alcohol syndrome.
Let’s face it, these kids have lots of strikes against them. Statistically they are more commonly prenatally exposed to alcohol and some other drugs of abuse. Mothers who are alcoholics and/or drug abusers and becoming unintentionally pregnant are also a bit more likely to be at risk of having genetic risk factors for behavior disorders such as addictions and impulse control issues. Bad prenatal environment, not the best geness, bad infant/toddler and possibly older environment. To put all the blame on the last one alone seems a bit much.
But whatever the label (and maybe JerrySTL is right and the label will change in another generation of naming) the pain and dysfunction is very real. The risk that a child whose behavior is such that they earn a reactive attachment disorder label in childhood will have adult dysfunction seems very high even if the cause is not exclusively the early neglect. Writ in stone? I highly doubt but I cannot find any good long term outcome studies in my admittedly limited search attempt and frankly doubt they have yet been done.
My suspicion, FWIW, is that the outcomes are likely similar for those with the same behavior patterns wheether they come out of neglect or not. If they act like autistic spectrum disorder (ASD) then they likely have the same prognosis those with ASD; if they act like ADHD then they likely have the same prognosis as those kids; and so on. Treatment should perhaps be less based on a presumption of cause and more on the nature of the particular child’s behavioral patterns.
Most of them had spent time in foster care, and I’m guessing most of them had what we would now call Reactive Attachment Disorder. There were two exceptions who really stand out in my mind, and I believe those two kids were on the autistic spectrum, which wasn’t recognized at that time.