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The early life experiences of many internationally adopted children greatly increase the likelihood of attachment problems. Prenatal exposure to stress may influence the hormonal regulation of attachment. After birth, few children, with the exception of most Korean and some Guatemalan children, go directly from the maternity hospital to loving, consistent foster care until adoption. Most children experience institutionalization for months or years. The orphanage experience may be one of impersonal, inattentive care with few caregivers, so that the children experience deprivation and neglect. (This was the situation in Romania, about which much of the recent research on attachment after adoption is based.)

Other orphanage environments may have adequate staff numbers, but the structure and staffing arrangements expose the children to inconsistent caregivers. Caregivers work rotating shifts, and children must adjust to various personal styles or care giving at different hours and different days. Staff turnover may be high. Children are often moved to new groups as they age, leaving beloved caregivers (and peers) behind. The lack of a consistent caregiver is the most common experience in the institution. In one study, it was estimated that by the age of 2 years, the child in a well-staffed orphanage has encountered 20 different caregivers; by 4 years, 40 caregivers and by 8 years, 80 different caregivers.

Although many children attach to their caregivers, these attachments are frequently disrupted and do not have the same depth or quality as attachments developed in a loving family. Thus it is not surprising that after adoption some post-institutionalized children display behaviors characteristic of attachment disorder. These behaviors overlap with many other entities common in post-institutionalized children. (Grief, adjustment reaction, post-traumatic stress disorder, sensory integration disorder, language delay, developmental delay, learning disabilities). Such behaviors are expected in the first days and weeks after adoption. In most cases, they do not indicate permanent attachment problems but reflect the extraordinary psychological adjustments to adoption. Conversely, many behaviors seen after adoption may be rooted in insecure attachment.


From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.


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