Adoption: Hope for Healing

Courtney L. Boren

Milligan College

Master of Science in Occupational Therapy

 I dedicate this book to the Anderson family.
May you realize the blessing and inspiration you have been to me and many others.

Welcome
The idea for this project was born out of many conversations with a friend of mine. She
had recently adopted two boys from Ethiopia and I was following her stories of success,
difficulties, triumphs, and disappointments on her blog. As I read her blog, I wondered if her
boys were receiving occupational therapy. I emailed her out of curiosity and thus my passion
for advocating occupational therapy services to adoptive parents was ignited. If you have
further questions after reading this material, please feel free to email me at
CourtneyLBoren@gmail.com.

To gather information for this project, I created an online survey. I distributed the link via
Facebook and email to families that I knew had adopted. I also asked these families to pass the
link on to others that they knew. The results of those surveys are presented here. I hope you
enjoy reading about the amazing journey these families have made. For those of you that are
beginning the adoption process, I hope you find this as a helpful and inspiring resource. And, to
occupational therapists, I hope that this book gives you a new insight into the challenges that
these children and their families face.
 Chapter 1
Sensory Processing Disorder

Asher

Asher was adopted from

southwestern Ethiopia when he was
7 months old, and joined a family
that included 3 other children. For
Asher’s new siblings, his arrival was
most difficult for the youngest.
Asher’s youngest sibling was a nearly
5 year old sister that LOVED being
the center of attention, so she
needed about a 9 month adjustment
period. Asher’s adoptive parents
know little about his environment in
Ethiopia other than he lived in a mud
hut in the countryside and was
malnourished.

Asher is described by his parents as a “sensory seeker.” Examples of this behavior

include his love for walking over air vents and taking the co cover
ver off the vent to
place his face into the vent to feel the air. In another instance, Asher bent down
beside an iron rod fence while standing in line at an amusement park and licked it
all the way up. Asher’s parents were unaware that these and other behaviors
were anything other than “cute” until he had aged out of free county services. At
this point, Asher has received 6 months of occupational therapy for sensory
related issues and fine motor delays.
For Occupational Therapists:

When working with a child like Asher, it is encouraging to their parents when their
behaviors can be explained in a positive manner and provide an at-home sensory
diet. A simple at-home program is empowering to these parents. Collaborate
with the parents asking for specific examples of behavior. Ask the parents to jot
down problem areas they see between treatment sessions and follow up on
those. Lastly, what Asher’s parent’s found impressive was their OT’s compassion
and accessibility.

For Parents:

Sensory Processing Disorder is a complex disorder that requires a full evaluation

in order to pinpoint each child’s unique and individual needs. It is important to
realize that typically children are not sensory seekers OR sensory avoiders rather
they tend to have a combination of sensory needs. Due to the environments that
many orphans live in for the first part of their life, it is important for parents to be
aware of how their child may processes sensory information differently.

“Although most infants do not enjoy their noses being wiped or clothing
being changed, they should recover quickly from their fussiness. Babies
who respond to sensations with more intensity and take a long time to
recover may have a sensory processing problem known as over-
responsiveness. In comparison, some babies who are described as being
overly good may also have poor sensory processing as noted by being
under-responsive to sensations. These babies are described as "laid-
back" and may not cry much or be interested in interacting with toys
and/or people. This can result in delays in development especially in the
areas of language and motor skills (www.sense-ablebaby.com).”
Red flags for Sensory Processing Disorder:
TOUCH:
• Dislikes hugs and may arch when not held "just right"
• Touches everything and everyone. May seem to have no awareness of personal space
exhibited by touching or hanging on others all day
• Irritable during diaper changes, getting dressed, and/or bathing. Sock seams and
clothing tags may constantly be bothersome.

VISION:
• Does not give eye-contact when spoken to even when there aren't many distractions
• Stares into bright lights or the sun
• Sensitive to the sun and certain types of lighting (florescent lighting especially), high
contrast (black and white), or a cluttered environment

HEARING:
• Fussy in or sensitive to loud environments particularly vacuum cleaners, school bells,
flushing toilets, and crowd noise
• Turns the volume way up, places speaker to ear, or loves “noisy toys”
• Doesn't babble or make baby noises or does so on a limited basis or has difficulty using
an inside voice

TASTE/SMELL:
• Picky eater- picky about formula or baby food and dislikes textures such as stage 3 baby
food or certain finger snacks
• May "pocket" food and not feel it in the roof of the mouth or inside of cheek, especially
with blander tasting foods

PROPRIOCEPTION:
• Described as “always on the move.” Running, falling, crashing into objects, wall, floor, etc
• Gets stuck in postures and unsure of how to move, such as when rolling one way, then
can't roll back the other way
• Decreased exploration of body parts such as sucking on fingers or playing with toes

VESTIBULAR:
• Dislikes head tilted backwards such as for a diaper change or when washing hair
• Dislikes unexpected movements such as being tossed in air or bounced
• Could swing on a swing set for hours, described as a “dare devil”
 Home Interventions
TOUCH:
• If the child avoids touch, prior to introducing a new texture, explain what is going to
happen, give permission to watch first, model appropriate reactions, and be patient - do not
force touching.
• If the child craves touch, provide small textured objects they can carry with them
throughout the day. Attach the object (koosh ball, textured fabric, pipe cleaner, etc) to a
key chain that can be clipped on their belt loop or kept in their pocket

VISION:
• If the child avoids visual input, de-clutter their environment and allow them to wear
sunglasses or hat to reduce the glare on objects in the room.
• If the child seeks visual input, prevent obsessive behaviors (i.e. running finger across blinds
repeatedly) by providing a visually stimulating area for play or light up toys (even as simple
as a flash lights with colored bulbs).

HEARING:
• If noise is avoided by a child, it is best to prepare them before a loud noise is going to
happen and provide them with the opportunity to escape it. Additionally, wearing earplugs
or ear muffs in crowds will reduce the overall noise level but still allow for direct
conversation.
• If the child seeks auditory stimulation, allow the child to listen to their favorite music
through headphones during car rides or while playing. Also, “noisy” art supplies such as
bubble wrap, cellophane, and newspaper, provide opportunities for creativity, fine motor
manipulation, and auditory input.

TASTE/SMELL:
• For the picky eater, allow the child to play first then eat. This allows the child to experience
the texture in their hands prior to their mouth. Playing with food can consist of painting
with pudding, building with jello blocks, or driving cars through cracker crumbs.

PROPRIOCEPTION:
• A child that avoids proprioceptive input will seem to not know what their body is doing
therefore begin with identifying basic body parts on self, dolls, and through drawing.
• A child that loves forceful movement will benefit from “heavy work” such as pushing and
pulling objects, stomping, jumping, crashing, and opening heavy doors.

VESTIBULAR:
• For a child that avoids movement, provide movement activities that provide the child with a
sense of control such as low to the ground swings or riding toys.
• A child that craves movement needs appropriate movement opportunities in order to
prevent injury. These opportunities include: spinning on a tire swing or Sit ‘n Spin, swinging,
jumping on a mini-trampoline, hula hoops, and riding toys.
If a child receives too much vestibular stimulation, the follow signals may occur:

• Sweating or clamminess
• Turning pale or blushing
• Headache
• Nausea
• Excitability or excessive giggling
• Crying
• Drowsiness

If any of these signs occur, immediately discontinue the activity.

Remember! It is important to vary the sensory stimuli

you provide for your child. Once the child becomes bored
with the stimuli it is no longer effective.

Information in this chapter was adapted from www.sense-ablebaby.com and Sensory Integration: A Guide for Preschool Teachers
 Chapter 2
Post Traumatic Stress Disorder
Reagan McKenna AiShao

Born in Gaozhou, China, Reagan was adopted when she was one year old by loving parents and
twin big sisters. Abandoned when she was a day old, Reagan was wrapped in an overcoat and
left at the gate of a hospital. From that time on, she spent the next year in an orphanage. She
was one of three babies in one crib. The crib had no mattress. It was only a board and their
legs were tied to the crib to keep them from climbing out. There were 36 babies in the room
and 2 caregivers. For the first year of her life, she received powdered milk and no solid
supplementary food. Reagan did not know how to swallow anything with texture or chew.
When her parents met her, she had double pneumonia and was severely dehydrated because
she had never been taken to the doctor. Reagan was diagnosed with post traumatic stress
disorder. This is largely thought to be a result of never having the opportunity to bond to
anyone. These children quickly realized that no one would respond to their cries, so they
stopped crying. Once Reagan was home, she was very tolerant of pain and didn’t cry much
because she was so used to it. As a result, Reagan did not know how to bond to anyone, so her
family had to bond with her on her time and in her way. This was most difficult for her big
sisters who expected her to love them and be comfortable with them right away. Most
importantly, adoptive families must remember that this transition will not happen overnight, so
patience is crucial.
According to the National Center for Post Traumatic Stress Disorder, PTSD is
defined as "an individual who experienced an event that involves a threat to their
own or another's life or physical integrity and that this person responded with
intense fear, helplessness, or horror (www.ncptsd.va.gov).” Reactions of very
young children may be displayed as anxiety separation. A school-age child may
compulsively repeat aspects of the trauma through drawings, verbalizations or
play acting. “Multiple sources such as the American Psychological Association and
the National Center for PTSD relate that the most common interventions include
cognitive/ behavioral therapy, relaxation techniques, play therapy and sometimes
medications such as antidepressants and anti anxiety drugs” (Cantu, 2009).

Occupational therapy can prove to be beneficial for adopted children

experiencing PTSD signs and symptoms. Through consultation with the parents,
the OT can assist in finding ways to help the family bond with their child.
Additionally, OTs can help stressed parents develop a schedule for consistent
daily routines such as meals, school, family time, community activities, and a
sleep schedule as well as constructive ways of handling outbursts or melt downs.

Warning signs for Post Traumatic Stress Disorder:

Anxiety

Fear

Confusion

Aggression

Depression

Self destructive behaviors
*PTSD is usually diagnosed after signs and symptoms have been present for more than a month.
 Chapter 3
Attachment
Dear Friends,
Life at home has been somewhat of a scramble! We’ve juggled jet lag, doctor and occupational
therapy visits, blood work, a developmental screening, and some visits from family and friends.
I’ve learned that Solomon cannot tolerate unknown people (especially women) paying too
much attention to him, particularly the “goo goo gaa gaa - ooooh look at the baby - cuchi cuchi
coo” type. It tends to scare him, and then he’s up at 3:30 am, 4:00 am, 4:30 am, 5:00 am (I can
keep going). It’s fun all around, especially for Mama. One night he was up every half hour. That
was extra pleasant! Solomon generally does considerably better when he is just another
spectator and is not the center of attention. Mostly, he is thriving with a routine of quiet days
at home.

I learned that after children leave an orphanage setting, they may have a big jump in
development. Truly, I cannot even believe how much Solomon has integrated in a month. In a
few weeks, he learned how to roll over, push himself up and sit independently. He used to only
cry for two reasons: hunger or pain. Now, he has raised his expectations, and will cry for many
causes: if he is wet, wants to be held, or even if he is simply bored, and wants to see the room
from another angle. It’s amazing.

Solomon is delighted by every bit of attention, enrichment, care and love that we provide, and
shows that by smiling and giggling. Last week, baby learned how to sit up without support, and
he would spend an hour at a time playing independently. This week, he is bored with simply
sitting, and wants to progress, mainly to jumping. If I try to sit him down, he will straighten his
knees, and just refuse. Then I have to hold him or get out a big blue exercise ball
(recommended by an OT), put baby on my knee, and start a jumping exercise with him. He
loves it, and if he is tired, the exercise will put him to sleep in about 10 minutes.
Been There, Done That….
Bonding strategies from other parents and their stories.
Set up “attachment rules” such as only immediate family and health
care providers can touch or hold your child.

“Our child would scream whenever I touched him because he did not
want another mommy who would hurt him or leave. Whenever we
would be in public he would act up to get attention from strangers. He
did cute things and such to get attention and take the attention away
from those having the conversation. The thing he got for that was
mommy holding him – which he hated. Now he expects it and does not
act up in public much anymore. He also likes me now the he knows he
is safe, but still struggles with past abuse and fear.”

“Your child may present with what seems to be exaggerated normal

behavior for their age, possibly more mature in some ways. This is
NOT good. It is important to realize the child NEEDS to be dependent
on the parent for everything for a time in order to bond well. Children
often resist this and try to take care of themselves. They also do not
ask for help when needed and will go without rather than ask for their
need to be met. The parents need to meet all the needs. The child
should not attach to the therapist. Kids from other cultures often have
advanced skills in care taking and have under developed skills in play.
This is because childhood there does not look like it does here, and
they have never had a childhood by our standards. So, self feeding by
age 1 is not uncommon, but a 5 year old may not be able to figure out
how to play with some toys. The child needs to feel safe enough to
learn a new skill and not to control the situation or others.”

“Our son used to call every female “mother” and every male “father”
now he is beginning to understand a family unit.”
“Both our Russian adoptions took a little while to bond with our other
kids. Both of them were institutionalized from very early, but both our
Ethiopian adoptions bonded rather quickly. Our daughter from our first
Russian adoption has high anxiety and needs medication for it. She
was constantly fearful and worried too much so for a 5 year old. She is
doing wonderfully on her anxiety and ADHD medication. When she
misses a dose it is VERY apparent that she needs them. That is
reassuring for me because I often grapple with her being on
medication, but now, I know it is what is best for her.

“Attachment is 100% key, so pay attention to the cues to make sure

they are forming nice attachment and progressing over time.
Recognize that with adoption there is always loss and grief, no matter
what the child says. It only depends on the magnitude and the
personality of the child as to how the heal and process it.”

“When our second daughter first came home as an infant, I would run a
warm bath and lay her on me, turn the lights low and gently dip the
water over her and talk to her softly. I don’t know if it did anything but
she seems very well adjusted and bonded with us.”

We brought Elijah home from the hospital, but his

in-utero environment wasn’t the healthiest. Mom
was homeless, and incarcerated for 6 months of
her pregnancy. This, in fact, was a blessing
because she was receiving prenatal care, 3 square
meals a day, and a roof over her head. She was
incarcerated because she was unable to pay the
child support required for giving up a previous
child to foster care.

It is important for OT’s to recognize that adoption

brings much “newness” to a family. New roles as
parents, new schedules, new environment for the
child, perhaps a new culture in a trans-racial
adoption, new challenges, new joy, new
everything! Patient listening and therapeutic use
of self are so important.
 Chapter 4
Family Adjustment

Aliana Grace JiuLi & Maia Faith Lan-Thi

Aliana and Maia have recently become sisters joining three other
siblings. Aliana is from China and Maia is from Vietnam.
“My oldest daughter was 12 when we brought Maia home and she had some
struggles with the transition. I feel like this was due to her having been the only
girl in our home and the fact that she was going through adolescent changes at
the same time. Our youngest son had some issues with being knocked out of the
“baby” spot which caught us by surprise since he was 9 years old.”

“We actually started the China adoption process before we started the Vietnam
process. The China process took 4 ½ years, so we went to Vietnam while we were
waiting. When Aliana arrived, our older children were fine with the transition
since it was the second adoption. However, Maia showed typical 2 ½ year old
behaviors of being clingy and wanting to be held constantly. At the same time,
she noticed right away that her new baby sister looked just like her. She would
tell people that Aliana had black hair and black eyes just like her.”
 Preparing your family for adoption is as important as the adoption itself. Once
the decision to adopt has been made, it may be met by a host of responses from
family and friends. Additionally, one’s birth children may have questions and
concerns about adoption and act out as a result of fear. Presented below are tips
on handling a myriad of situations following your adoption.

Tolerate no ethically or
racially biased comments.
Surround yourself
"I find your remark “Reading books about
with supportive offensive. Please don't say adoption, role playing
family and that type of thing again." responses to intrusive
friends. questions, and using
positive adoption language
helped us prepare our
“You couldn't daughter for questions
be deliberately from family and friends.”
"Surely you don't “Sometimes saying such an
mean to be critical; it’s really hard inappropriate
you just don't have to share Dad comment in
experience with . . ." with a new front of a child. Enlist your other children in helping
baby, isn’t it?” You must mean you imagine what it will be like to
something be a larger family.
“Babies can be
else.”
a lot of hard “How will we arrange the chairs
work, can’t around the dinner table?”
they?”
“Who will sit behind me in the car?”

“When we adopt, we become her

family forever.”

“Siblings, like husbands and

wives, develop relationships not
because of blood but because
they are raised together.”

(Dalton, 2002), (Racial, 2010)

 Chapter 5
Success Stories

Morgan was adopted from

Morgan
Vidnoye, Russia [suburb of
Moscow] when she was 17 months
old. She lived in an orphanage
with a lot of other kids – many
with physical, emotional and
mental delays. Conditions were
not great and essentials like
diapers and food were mostly
dependant on foreign
reign donations.
The building itself was in much
need of repairs. Lack of nutrition
in her early years was cited as
reasons why it took nearly two
years before she finally grew a full
head of hair. However, Morgan
had no trouble adjusting to food.
She apparently never got full in
the time before she was adopted.
The day the adoption became final Today, Morgan is an active 12 year old
in Russia, it was about 6:00 p.m. young lady.
dy. She enjoys playing basketball
local time before we were able to
get to the orphanage and get her.
and has taken piano lessons for the past 5
Morgan fussed and cried for the years. She is very involved with the
entire 45 min drive back to main
church youth groups in her community.
part of Moscow. When we got
back to the hotel room and Morgan is a wonderful big sister to her 3
offered her some food, she younger brothers and
nd takes pride in caring
completely changed. No doubt
she had not been fed at all that for the youngest.
day since they knew she was
leaving. The food was rationed
without her included.
 Imre

Imre was adopted from Hungary at the age of two. Imre is deaf and has

Attention Deficit Disorder. However, his environment in Hungary was

excellent. Today, Imre is sixteen and a very gifted horseman. He and his

horse are both deaf and have won state champion titles in both the hunter

and jumper classes. Imre uses American Sign Language to communicate, but

as a surprise gift to his mother one day in words said, “I love you, Mama,”

perfectly. Having received both occupational and speech therapy, this was a

huge success and boost for Imre’s self-esteem.

 Ellen
Ellen was diagnosed with auditory processing disorder when she was in elementary school, and
she was unable to ride a bicycle. We had tried since she was small with no success. When she
was probably 12 or 13 years old the “low to the ground with handle-bar scooters” became
popular. It was absolutely incredible to see her gain confidence as she improved her balance
and began to ride without fear. I think the low base of gravity gave her the feeling of safety in
order for her to try, whereas the bicycle just overwhelmed her. I feel that improving her
balance helped her to integrate information better.

I pulled Ellen out of traditional school (she was in a small private school with small classes) after
2nd grade and began home-schooling. She was reading well and making good grades, but
something wasn’t connecting. We worked very hard on reading comprehension, hands on
manipulatives in math, and a quiet environment in which to work. We did this for 3rd, 4th and
5th grade. She also took piano lessons. I feel confident that integrating music into her
“curriculum” was instrumental in her academic success. I had always read that music “works” a
part of the brain that helps math and reasoning skills, and I know that this was true in her
situation. She continued her music by playing the flute when she entered public school in 7th
and 8th grade. This helped her integrate several senses at once physically by playing the
instrument, visually by reading the music, and incorporating auditory stimulation all at the
same time. She had to work hard at it, but she was successful. She also was in her high school’s
chorus which continued the musical element.

In summary, a parent, whether of an adoptive or birth child, should go with their “gut feeling.”
If something doesn’t seem right it probably isn’t. It’s OK to explore alternative methods of
learning and do what might even seem unconventional if necessary. A parent only has a small
window of time to provide and meet their child’s needs. One must be a good steward of the
time given.
 Chapter 6
Tid-Bits

Parent’s Advice to Occupational Therapists

LEARN APPROPRIATE ADOPTION LANGUAGE!

It is a very big deal.

Phrases such as: “is she your “real” child or is she adopted”
“do you know who her real parents are” are unacceptable.
DO NOT refer to the parent as the “adoptive mom/dad”.

The main need for discussing the adoption is to

provide a more complete history of the child.

An “adopted child” is deeply seeded in a

family’s home and in their hearts. The child
should be given the same respect as any other
child in the family.

Do not rely on the parents to be
your sole source for “country
information.” Be prepared to do
some research on your own.
Many times the parent knows
very little about their child’s
background and are overwhelmed
and stressed.
Do not repeatedly ask the child,
“Do you like living in
America?”
“Are you glad to have a
family?”
Do not be overly touchy. The
child is just learning what a
family unit is and this can be
very confusing and send
mixed messages about what
is appropriate touch outside
of the home.
 Available Services and How to Receive Them
Although in most states one can receive occupational therapy services without a
doctor’s order, most insurance companies require the order if the service is going
to be billed to them.

Screen versus Evaluation: A screen is a 5-10 minute observation of the child by

the OT. At the completion of the screen if the OT feels that the child would
benefit from a further evaluation, the OT can a request an order for an evaluation
from your pediatrician. An evaluation is typically an hour long assessment
including parent interview, observation, and standardized testing. The evaluation
provides a baseline for the therapist and helps narrow the focus of therapy.

Requesting services from your pediatrician: One does not necessarily need to
have an OT screen their child in order to get a doctor’s order. If you are
concerned about your child meeting developmental milestones or if they are
exhibiting signs of sensory processing disorder, you may request the order
yourself. You may say, “I am concerned about my child’s development and would
like to have an occupational therapy evaluation, what do you think?”

Early Intervention Services: All states are required by law to provide early
intervention services. Early intervention services are provided at no or low cost to
qualifying children. Services provided include home or outpatient visits by an
early interventionist, occupational therapist, physical therapist, speech and
language pathologist, and early learning preschool programs.

“Early Intervention,” according to the law that created it, is: “a statewide,
comprehensive, coordinated, multidisciplinary, interagency system that provides early
intervention services for infants and toddlers with disabilities and their families.” In
simpler terms, it is a range of services designed to intervene at the early stages of an
infant or toddler’s disability. Early intervention is designed to serve children with
disabilities under the age of three, and the families who care for them.”

“Infants or toddlers with disabilities in one or more of the following areas of

development may qualify for Early Intervention: physical, cognitive, adaptive,
communicative, or social and/or emotional development (Early Intervention, 2010).”
 Resources
Everyday Play: Develop the Fine Motor Skills Your Child Needs for School Success
Sensory Integration: A Guide for Preschool Teachers
By Christy Isbell, Ph.D, OTR/L

The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder
The Out-of-Sync Child Has Fun: Activities for Kids with Sensory Processing Disorder
By Carol Stock Kranowitz, M.A.

The Sensory Sensitive Child: Practical Solutions for Out-of-Bounds Behavior

By Karen A. Smith, Ph. D. & Karen R. Gouze, Ph. D.

The Connected Child: Bring Hope and Healing to Your Adopted Family
Dr. Karyn Purvis

References
Cantu, Carolyn. (2009). Identifying and treating pediatric PTSD. Advance for
Occupational Therapy Practitioners. Retrieved March 31, 2010 from
http://occupational-
therapy.advanceweb.com/Editorial/Content/Editorial.aspx?CC=61238

Dalton, J. M. (2002). Preparing your child for a sibling. Adoptive Families. Retrieved
April 12, 2010, from http://www.adoptivefamilies.com/articles.php?aid=372

Early Intervention. (2010). First Signs. Retrieved April 11, 2010 from
http://www.firstsigns.org/treatment/EI.htm

Isbell, C. & Isbell, R. (2007). Sensory Integration: A Guide for Preschool Teachers.
Gryphon House, Inc.: Beltsville, MD.

Racial, Cultural Identity. (2010). Adoption Media, LLC. Retrieved April 12, 2010 from
http://transracial.adoption.com/interracial/racial-cultural-identity.html

Sense-able Baby. (2010). Sense-able Beginnings, Inc. Retrieved April 11, 2010 from
http://www.sense-ablebaby.com/