Developmental Trauma Disorder In An Adoptee

“All diagnoses are wrong, but some are useful.” George Box

The kinds of complex issues that adoptees face can be difficult to treat. A 2013 study found that fewer than 25% of adoptive parents who sought mental health services felt that their mental health professional was adoption-competent. The symptoms and issues that adopted children experience are typically not taught in most graduate school mental health programs. Adding to the challenges faced by adoptive families, insurance companies will not cover what is really going on with these children and their families because it is not correctly conceptualized, coded, and diagnosed.

Some common diagnoses used with adopted children include Pervasive Developmental Disorders, Oppositional Defiant Disorder, Conduct Disorder, Reactive Attachment Disorder, Affective Disorders, Anxiety Disorders, Attention-Deficit Hyperactivity Disorder, Post-Traumatic Stress Disorder, and Borderline Personality Disorder. Each of these may characterize certain symptoms that these children demonstrate, but none of them systemically addresses the developmental aspect of trauma that most (if not all) adopted children experience. None take into account the sad possibility of being traumatized by birth or foster-parents. “There is no diagnosis for children that more than partially addresses the symptoms associated with these impairments in self-regulation” according to Julian Ford, PhD, who is a psychologist with the University of Connecticut.

“Developmental Trauma Disorder” or DTD includes symptoms that differentiate it from Post-Traumatic Stress Disorder PTSD more commonly associated with the “Battle-Fatigue” symptoms of WWI. Children are often traumatized in the context of relationships. Because children’s brains are still developing, this trauma has a much more pervasive and long-range influence on their self-concept, on their sense of the world, and on their ability to regulate themselves.

There are four diagnostic areas involved in DTD – [1] Exposure [2] Triggered pattern of repeated dysregulation in response to trauma cues [3] Persistently Altered Attributions and Expectancies and [4] Functional Impairment. Those who’s work has been focused on adopted children who have suffered various forms of Complex Trauma will recognize the manifestation of these. The American Psychiatric Association failed to include this in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (also known as the DSM-V).

The problem with this oversight is that after experiencing chronic trauma, the current standard of clinical practice often reveals no diagnosis, inaccurate diagnosis or inadequate diagnosis…all of which leads to misguided or complete lack of treatment plans. Further, because there is almost always considerable dysregulation of body (sensory and motor), affect (explosive/irritable or frozen/restricted), cognition (altered perceptions of beliefs, auditory and sensory-perceptual flashbacks and dissociation) and behavior (multiple forms of regression), the diagnoses of bipolar, oppositional defiant disorder/conduct disorder, attention deficit hyperactivity disorder (ADHD) or other anxiety disorders are made. Many of these disorders are co-morbid with developmental trauma disorder, as they tend to cluster in these complex families. But the importance is that the developmental trauma disorder would be primary and thus guide the treatment plan…and further, refine the inclusion (or not) of other co-morbid disorders.

Today’s blog was informed by an article Could My Adopted Teen Have Developmental Trauma Disorder? by Dr Norm Thibault, LMFT

Anti-Natalism

I have seen adoptees state that they wish they had been aborted. I had not heard of Anti-Natalism but apparently it is a thing. Back when I was concerned about over-population, I could have understood this concept better. With the pandemic, it appears the planet is going to experience a huge die off before it is all over.

So I discovered this concept today when someone in my all things adoption group posted – How do you all deal with anti natalism? How would you prefer people not adopted to deal with that discussion when it does come up? One of the number one things these people seem to say is adopt, even if you can have kids, because there’s too many people and it’s horrible if you procreate while others don’t have a home. This has been frequently debunked as a myth. Poverty is the number one cause of children being separated from their original parents. In the case of both of my parents, that was certainly the issue – not whether their mothers would have rather kept and raised them.

Back in 2019, The Guardian had an article (I wish I’d never been born: the rise of the anti-natalists) about this with subtitle – Adherents view life not as a gift and a miracle, but a harm and an imposition. And their notion that having children may be a bad idea seems to be gaining mainstream popularity.

The basic tenet of anti-natalism is simple but, for most of us, profoundly counterintuitive: that life, even under the best of circumstances, is not a gift or a miracle, but rather a harm and an imposition. According to this logic, the question of whether to have a child is not just a personal choice but an ethical one – and the correct answer is always no.

In my all things adoption group, the first comment was – infant adoption is a for-profit industry and feeds into producing babies as a commodity, so also contributes to over population. Adopting or (even better) providing guardianship for teens with a Termination of Parental Rights background who are currently in in foster care would be much more ethical.

In another’s perspective – They’re applying an argument that makes sense for animals to humans, because they don’t see the difference. With pets, if more people adopt from shelters, then that saves lives, and puts puppy mills out of business. (In the Missouri Ozarks where I live – puppy mills are a hot issue.) And someone else quickly noted –  even in the dog world, this isn’t true. It’s a lot more complicated than that. I’d agree.

Another explained – I’m an adoptee and childfree by choice. It’s astounding how many people throw adoption round as a solution to infertility. There needs to be so much more education done around why this is wrong and support given to people to make their own choices…eg not everyone has to want or have children.

Another one found the argument confusing –  how do anti-natalism and adoption go hand in hand with the argument that you shouldn’t pro create. You should take someone else’s baby instead ? How does that solve the problem ? How is that any more ethical ?

Someone else explained – Anti Natalists are against people giving birth or choosing to make a baby in general. This does come across sometimes as not wanting children at all, but it doesn’t always go hand in hand. It reaches into adoption because it doesn’t automatically mean they dislike children or don’t want them, but rather that they tend to think it’s unethical to create life in a distressful world/ the earth is dying/there’s too many kids without parents/ why create something that will suffer/overpopulation/ other reasons I can’t remember at the moment, so they adopt rather than creating their own, if they do want to become parents.

Here’s the truth – adoption isn’t the answer for anti-natalism. Adoption is trauma regardless the intent. So if they’re about being ethical, I think they should do a little little more research on adoption trauma before they push that agenda.

Another noted – Usually people who are childfree by choice are very pro-abortion.  The foundation of the philosophy is that humans already born take precedence over the unborn or not yet conceived. That there is a finite amount of space/resources and we are close to exceeding or have already, thus births/continuous growth should be avoided.

The bottom line was – If you think it’s horrible to procreate, then don’t. But don’t traumatize children and families, so you can still fulfill YOUR dream of a family. If you really strongly believe it’s awful to have biological kids, no one is forcing you. But don’t look for a way out – that’s just as selfish, if not more so.

It’s A Fundamental Human Right

I certainly understand the need to know. I believe one of the purposes that I came into this lifetime was to heal some missing family history. I believe because I was aligned with my dharma, doors opened and answers revealed themselves. That black hole void beyond my parents became whole with ancestors stretching way back and into Denmark and Scotland as well as the English and Irish.

I believe in the principle that it’s a fundamental human right to know one’s genetic identity. I remember once talking to a woman who was trying to understand why it mattered that both of my parents were adopted if they had a good life. As I tried to explain it to her, she suddenly understood. She took her own genetic ancestry for granted because she knew that if she had any reason to want to know, she could discover all the details.

Not so for many adoptees with sealed and closed records (which was the case with my parents adoptions) and not so for donor conceived people whose egg or sperm donors chose to remain anonymous – many doing it for the money – and walking away from the fact that a real living and breathing human being exists because of a choice they made. Today, inexpensive DNA testing has unlocked the truth behind many family secrets. Some learn one (or both) of the parents who raised them are not their genetic parent from a DNA test. A family friend might tell a person mourning the death of their dad at his funeral, that their father suffered from infertility and their parents used a sperm donor to conceive them.

These types of revelations can be earth shattering for some people. I’ve know of someone recently who was thrown that kind of loop. The process of coping with such a revelation is daunting and life-changing regardless. Even for my own self, learning my grandparents stories has changed my perspectives in ways I didn’t expect, when I first began the search into my own cultural and genetic origins.

There is a term for this – misattributed parentage experience (MPE). It has to do with the fact that you did not grow up knowing your genetic parent.  That word – experience – best describes the long-term effects. It is not an “event,” a one-time occurrence. The ramifications of MPE last a lifetime to some degree.  I know how it feels, trying to get to know people, who have decades of life experience that I was not present for or even aware of. It is not possible to recover that loss. One can only go forward with trying to develop a forward relationship and whatever gems of the past make themselves known are a gift.

There are 3 primary communities with MPE in their personal histories.

[1] Non-paternity event (NPE): those conceived from an extramarital affair, tryst, rape or assault, or other circumstance

[2] Assisted conception: those conceived from donor conception (DC), sperm donation, egg donation, embryo donation, or surrogacy

[3] Adoption: those whose adoption was hidden, orphans, individuals who’ve been in foster care or are late discovery adoptees (LDA), etc.

There are also 3 primary topics for raising awareness and developing reform efforts – education, mental health and legislation. Right To Know is an organization active on all of these fronts and issues. They are advocates for people whose genetic parent(s) is not their supportive or legal parent(s). They work to promote a better understanding of the complex intersection of genetic information, identity, and family dynamics in society at large.

The Damage Done

I came of age in the early 1970s. I will admit that I have way too much life history with drug use. In fact, addiction was the primary cause of my first marriage’s failure. So many children are removed from their parents due to addiction issues. The money that should be feeding and housing and providing all the basics for their family goes into drugs. I understand. I remember food and housing insecurity because of that in my first marriage. Today’s blog was triggered by this story of a foster care child.

My 11 year old foster daughter is (understandably) having an incredibly hard time coping with feelings of abandonment by her mother. While I don’t agree with it and have advocated otherwise, she is not allowed to talk to or see her mom until she takes a drug test. Mom has refused and my foster daughter is feeling unloved and abandoned. I’m at a loss for how to help her cope. She often asks me to validate her feelings by saying things such as “If she loved me, she would just go do the drug test, right?” or “She must be on drugs. She loves them more than me, doesn’t she?”. She wants me to answer her yes or no. I don’t know how to answer to help her. I don’t want to speak negative about her parents by agreeing with her but I don’t want to make her feel like her feelings aren’t valid by saying something like “She loves you but drugs are powerful and affecting her choices.” I have reached out to mom and tried to get her to take the drug test so they can have contact and let her know what is going on with her daughter. She always says she is going to but hasn’t yet. It has been over a year now.

She ends with this request for advice – Those who have been through similar situations, how would you recommend I help this child?

The first answers are good ones. Is she in therapy? She needs somewhere to process feelings and learn about addiction. Does she have a therapist? If not, that would be very helpful. Someone who is trauma informed, addiction experience, and foster care and adoption competent would be a good thing for her. Sounds like you and her therapist need to have a discussion about addiction with her.

I didn’t know about this person but it sounds like reasonable advice – I highly recommended listening to and reading Gabor Mate and as an addiction expert and particularly his compassionate, scientifically based approach to addiction. It will help you (and your subsequently foster daughter) understand with compassion rather that judgement, anger, exasperation or frustration.

Personally, I saw this perspective immediately and am glad this was said – Her mom probably can’t pass a test and doesn’t want to make things worse. I would start by explaining that. We wouldn’t make an illiterate person pass a reading test for a basic human right…sad. Being a child of an addict there is a lot of pain and hard days for sure but she should be able to see her mom. All the therapy suggestions are on point and hopefully the therapist can also advocate.

I had not heard of this concept (except from link below) but it also seems right to my own heart – I would advocate for safe use with the social worker on the case about safe use, and creating a safety plan. Passing a urine analysis doesn’t equal safety and not passing a urine analysis doesn’t equal unsafe. I don’t think “she loves you but drugs are powerful….” would invalidate her feelings. That statement and her feelings can both be valid at the same time.

Traditionally, the substance use field has focused simply on substance use and ways to measure, prevent and treat negative consequences. This has led to a continuum of laws, policies and services that runs from restricting supply to reducing demand and, for some, continuing on to harm reduction.

Various versions of this simple continuum have been used over time, all of them beginning with a focus on a disease or harm that must be avoided. While this may seem completely sensible at first glance, it makes less sense when considering that many people use psychoactive substances to promote physical, mental, emotional, social and/or spiritual well-being. In other words, people use substances to promote health, yet substance use services focus on how drug use detracts from health.

Health promotion begins from a fundamentally different focus. Rather than primarily seeking to protect people from disease or harm, it seeks to enable people to increase control over their health whether they are using substances or not.

Since many people use drugs often or in part to promote health and well-being, health promotion along these lines involves helping people manage their substance use in a way that maximizes benefit and minimizes harm. (Indeed, this is how we address other risky behaviors in our everyday lives, including driving and participating in sports.) It means giving attention to the full picture—the substances, the environments in which they are used and in which people live, and the individuals who use those substances and shape the environments.

Someone else shares their personal experience – My kids (adoptees) parents have issues they go through and are not always on the up and up but we make time together happen. It’s always (right now) supervised etc. However soon my daughter will be 16 and she will likely want to drop by their house when she’s driving etc and I have helped her understand enough on ways to stay safe emotionally and legally by going to see her family and having open discussion with her on addiction. Some may not agree but they eventually grow up. I prefer to help her work through it now than stumble more later. She has a therapist who is mainly focused on addictions as well.

One more from personal experience – I would probably say screw the social worker’s orders and let them have a visit. My adopted daughters’ mom had the same type of demand and I followed the rules. Their mom died, and it had been so long since they’d seen her in person. I frequently regret not breaking the rules. Life’s too fucking short and unpredictable. Using drugs doesn’t automatically equate to being unsafe. It’s going to be way harder for this mom to get clean and sober if she’s not allowed to see her child.

Addiction is a VERY complex issue. My heart breaks for the young girl.