On my Skype screen is the video image of a 2-year-old Haitian child snuggled in the arms of a pretty blonde mother from Visalia, Calif. The child, Benicio, expresses curiosity about what’s happening on the computer screen. He seems comfortable and engaged with Catherine, his new adoptive mom. His eyes are bright and intelligent, his skin is clean and unmarked. He is a little small for his age — in the bottom quartile of 2-year-olds — but he moves fluidly in Catherine’s arms. As the Skype session wears on, he grows a little restless, beginning to squirm on his mother’s lap.
Benicio is one of 80 or so children from the God’s Little Angels orphanage flown out of Port Au Prince in the immediate aftermath of the earthquake that struck there on Jan. 12. The story of his coming to the United States is a dramatic one in itself.
Benicio was scheduled for adoption by Catherine and her husband, Kevin, around the time of the disaster. Kevin was en route to the Haitian capital when news of the earthquake caused him to be rerouted and put down in New York. Feverish negotiations with the airlines and the government of Haiti secured Benicio’s release along with 80 or so other children, who arrived in Miami to television cameras and tearful greetings from Kevin and other adoptive parents.
Now, six or so weeks later, Benicio has settled in somewhat with his new family, including a 1-year-old brother named Nathaniel. Catherine has agreed to speak with me because — well, frankly, because she’s my sister-in-law and feels a little obligated.
I have a set of questions for Catherine, and I ask them cautiously. “How does he respond to you?” “How is he with others, with strangers? With Kevin?” “How does he relate to his little brotherm Nathaniel?” These aren’t random questions. Benicio is a member of a select group of kids that development experts today are especially interested in: international adoptees with institutional backgrounds. These children have something important to tell us about human psychological development.
But first, of course, Benicio is Catherine’s newly adopted son. I’m reluctant to remind her of the difficulties that may lie ahead.
I don’t need to be so careful. Catherine is familiar with the kinds of problems faced by the parents of international adoptees. The Mayo Clinic has boiled it down to a list of behaviors for parents to look for if they suspect a serious attachment problem: Many of these kids are squirmy and avoidant and prefer not to be held, according to Mayo. Some are solitary little beings, who don’t seek the company of other kids as they play. If a child seems to be always escaping, turning away, avoiding your gaze or just disinterested in you, these are other possible signs of attachment problems brewing.
A Strange Situation
A final characteristic of attachment disorder is an unusual behavior confirmed by researchers doing long-term studies of Romanian orphans in the United Kingdom. It’s called social disinhibition, and it’s characterized by a tendency for these children to connect with strange adults as if they were parents or familiar caregivers.
Michael Rutter of Kings College in London describes this idiosyncratic social style as “a pervasive pattern of attention-seeking behavior associated with a relative lack of selectivity in social relationships.” For infants and toddlers, this might show up as merely a failure to check back with their parents as they begin to explore their environment. Older children may display a startling tendency to be open and friendly with strangers, and even go off with them. Social disinhibition is one of the most persistent effects of an institutional upbringing; it can linger throughout childhood and even determine styles of relating socially during adulthood.
Why would this particular behavior be such a common effect of an emotionally deprived childhood? The key to this understanding lies in the evolutionary purpose of the attachment mechanism in children. The attachment instinct in humans — and many other mammals — is nature’s device for motivating them to return quickly to the side of a protective adult at the first hint of danger or uncertainty. It’s easy to see how this instinct would be adaptive: A mother bear is the cub’s best defense against a hungry wolf pack or band of marauding teenage tourists. But if the mother bear is absent or injured (or depressed, drugged out or otherwise unavailable, in the case of humans), the best survival strategy may be to find another adult bear, act friendly and hope it feels friendly and protective toward you. Baby bears don’t think about this, of course, it’s built in as an instinct, as it seems to be for human children as well.
“We concluded that some form of biological programming was likely to be operating,” Rutter writes about the disinhibition he observed in his Romanian orphans. As the infant’s expectation for nurturance goes unfulfilled, the brain begins to wire itself for survival in a world without mom. And because children in our evolutionary past needed support through late childhood, this wiring may stay in place at least that long.
The Developing Brain
Catherine is familiar with social disinhibition and the other warning signs of attachment disorder, and answers easily. She is paying close attention, she tells me, and she is naturally concerned about Benicio’s development. “I know there may be problems on the road ahead,” she says, “but right now I’m just trying to stay close and available and be there whenever he reaches for me.” In this moment, Benicio looks entirely comfortable and happy in her lap. He looks up and reconnects with her repeatedly throughout the conversation.
Still, Benicio’s life in a Haitian orphanage before the evacuation raises important questions: How will he be affected as he reaches school age? What will Catherine and Kevin have to deal with in terms of developmental delays, adjustment problems and other difficulties as Benicio grows up? What are the long-term effects of losing his first primary caregiver at 3 months of age, and then being raised by a group of caregivers in the orphanage who were clearly well-intentioned, but stretched thin in their efforts to care for the large number of babies under their protection?
How early childhood experiences of affection and care — or the loss of them — affect children’s emotional states are far better understood today than 20 years ago, as are the effects on later development. The infant brain is growing at a phenomenal pace in the first two years — far faster than at any other time of life. More important than how fast it’s growing is the sequence of developing brain functions. These various systems must mature and connect up during certain critical time windows or the opportunity is lost. Why evolution designed babies to mature in this sequence is the subject of ongoing speculation, but experiments with many animal species, including humans, seem to bear out this idea of “critical windows” that have a sort of use-it-or-lose it characteristic. This process begins at birth and probably continues throughout childhood and adolescence in some form or other, but the first six months or year seem to be particularly important for certain kinds of development. However, researchers now believe that even as late as 2 or 3 years of age, emotional development can “catch up” relatively easily through a kind of neural growth and rewiring associated with good mothering.
This doesn’t mean that children are doomed if — like many of the children from overseas orphanages — they receive inadequate care during the first few years of life. But they most likely will be changed, in ways whose outlines we can crudely predict, but the specifics of which vary dramatically from child to child, and parent to parent. For some families, however, the difficulties of raising these children seem overwhelming.
The Challenge of Treatment
Parents can become distressed by the behavior patterns of their children with attachment disorder — withdrawal, aggressiveness, educational struggles and problems with friends. We categorize these symptoms as attachment disorders because — in this group of kids — they stem from a lack of either desire or competence related to emotional connection. While there is increasing clarity and even agreement on at least the broad description and causes of these disorders, there remains a lot of confusion and controversy around their treatment.
In April 2000, a nurse practitioner named Jeanne Newmaker traveled with her 10-year-old adoptive daughter, Candace, to Evergreen, Colo., to enroll her in a two-week, $7,000 course of treatment for a severe attachment disorder that, according to the mother’s later testimony, had precipitated violent and aggressive behavior in Candace. During the second week of therapy, which included practices of “holding” and restraining the patient, Candace was smothered to death during a birth re-enactment technique called “rebirthing.” The details of the accident, recorded on videotape, supported the prosecutor’s claim that the child had begged to be released from a blanket wrapped around her and cried out that she was dying — and that her pleas had been ignored.
The resulting national outcry created tremendous concern among the professional community regarding appropriate treatment for attachment disorders, and huge confusion among parents seeking treatment for these children. Because these kids’ behavior is often extreme and challenging, parents are looking for solutions beyond the range of standard psychotherapeutic treatment models. As a result, there is a great divide between treatment specialists advocating more measured, “evidence-based” approaches and those promoting more aggressive treatment that may include confrontation or “holding” practices involving gentle restraint. Professional groups and established medical institutions such as the Mayo Clinic fall mostly into the camp of those recommending standard psychotherapeutic, psycho-educational and parent-training approaches.
While much is yet unknown, researchers have established a few principles that seem fairly constant:
» The better the care at the institution, the more likely the child will develop normal attachments.
» An early adoption — up to six months or so — results in attachment relations more or less equal to a child born into a family.
» After six months, up to about age 2, children’s abilities to form secure attachments to adoptive parents stay relatively stable. This doesn’t predict how normally a child’s development will progress, just that it doesn’t seem to be dramatically affected by the age of entry or exit from the institution.
» The likelihood of severe attachment disorder is higher when adoption occurs after six months; but still, in most cases, with proper care, these children develop normally.
» What constitutes proper care will vary from child to child. In general, these children need more proximity, more physical attention and more patience with their attachment-related behavior, whether it manifests itself as withdrawal, disinterest or anger toward their new, adoptive family.
While much depends on the individual child — their genetics and their experience at the orphanage — much also depends upon the new caregiver’s feeling toward the child. Training and education of new parents can impact these children’s futures in a big way, as they learn to interpret their adoptive children’s aggressive or avoidant behaviors as ineffectual attempts at connection — not a rejection of their love.
The children of international adoption have brought new understanding of the role that early childhood development may play in the problems of later life. The wave of Haitian orphans like Benicio finding their way to the United States after the earthquake may represent a new opportunity to study maternal attachment and its developmental consequences. We’ll be watching with interest.
— Russell Collins is a Santa Barbara psychotherapist and divorce mediator. Click here for more information.