BEHAVIORAL AND MENTAL DISORDERS
MENTAL AND BEHAVIORAL DISORDERS AT ADOPTION
In the orphanage
Depression is probably the most underdiagnosed condition among institutionalized children. The earliest clinical descriptions of childhood depression derive from observations of institutionalized children. "Anaclitic depression" describes the behavior of infants left without maternal care: characteristics include "withdrawal, weight loss, insomnia, weeping, and developmental retardation." Less dramatic symptoms of depression may be readily observed among children in most orphanages, and clearly relate to the lack of a consistent primary caregiver.
Some children display symptoms of depression after adoption. Withdrawal, anorexia, lack of eye contact, limited motor activity, and limited language production are normal reactions to the drastic change in environment experienced by the children. Parents must be prepared for this reaction and accept that their children may grieve for lost caregivers and the loss of the familiar environment. Sleep disturbances and feeding difficulties are common.
While such behaviors are generally transient, some symptoms of depression may persist. In some children, symptoms may emerge some time after the adoption, even if the initial adjustment was smooth. Memories of lost friends, caregivers, and places may be triggered by comments, books, movies, school projects, or other events in the child's life. Months and years after adoption the child's interpretation of this experience may lead to depression, shame, and sense of worthlessness ("if I had been good, my birthmother would have kept me").
Exposure to newborns and young infants, arrival of a new sibling (by birth or adoption), and passage through typical developmental stages (graduations or other achievements, dating, intimacy, marriage, parenthood) may all amplify a sense of loss associated with adoption. Pediatricians and adoptive parents must be sensitive and aware of possible triggers of depression at various lifestages.
From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.