When Love and Church Aren't Enough

One of the most common refrains I hear from adoptive parents is, "We thought with enough church and enough love, everything would be fine." The look on their faces is one of shock and bewilderment. They had had the best of intentions - to give a loving home to a neglected and battered child.

But no one had told these prospective parents that a child who lived his early years in an orphanage or in an abusive home often spent long hours in isolation, hours in which no one spoke to, held, or played with him. It might be that the only time he was held may have been when he was being bathed or clothed.

In the orphanages overseas, no one person is responsible for the primary care of any particular child. In the child welfare system here in the United States, children come from an abusive or neglectful home only to endure constant moves from one foster home to the next, never having the opportunity to become attached to a primary caregiver. Neglectful caretakers, no matter the setting, establish a cycle of increasing emotional and behavioral difficulties for the child, making it progressively more likely that he will enter an endless cycle of repeated placements and disruption, never finding the permanency that children desperately need.

Trauma and neglect in the first years of life can create structural and functional changes in the developing brain, quite similar to the abnormalities created by prenatal exposure to alcohol and drugs. The combination of these biologically based deficits with ongoing psychological trauma ultimately limits the child's capacity to develop any emotionally connected interpersonal relationships throughout life. The child may segue into a set of peculiar behaviors, a condition called "institutional autism." Children with institutional autism are withdrawn and sullen, are resistant to touch, and have repetitive, self-stimulating behaviors such as head banging and rocking. Once they come into their adoptive home, they confound their parents by exhibiting indiscriminate friendliness and affection, something that can make adoptive parents feel good at first until they realize that the child is treating strangers more affectionately than family members. When distressed, the child may not seek comfort from her parents, but look to a stranger for comfort even when her parents are present. Despite being in a good foster or adoptive home, she may be unable to utilize her stable and caring environment to develop a sense of security and to rely on her parents in an age-appropriate way.

In a study we recently completed at the Children's Research Triangle, we found that in a clinical sample of 119 foster and domestically adopted children, over 90% met DSM-IV criteria for at least one mental illness and over 60% had two or more diagnoses. Further analysis of the data revealed that one of the major predictors of the development of the most serious mental illnesses in the children was the number of placements the child had undergone in the foster care system. With each placement the child's behaviors had worsened, and as problem behaviors intensified and became more difficult to manage, the risk for a disruption of the placement grew. The child would be moved to another home, and the downward cycle continued. We are taking children at biologically based risk of developmental, behavioral, and psychological disabilities and putting them in a system that makes them worse.

So what can be done? Clearly, the first step is to provide support to foster and adoptive families so that the parents are better equipped to meet the behavioral problems that many of the children bring to their new home. Second, we must provide comprehensive assessment and diagnostic services to the children so that a treatment plan that addresses all aspects of the child's and family's needs can be developed. And finally, treatment services that integrate effective practices and approaches from across multiple disciplines must be made accessible to all families.

The first protests to these suggestions will come from the budget hawks, who will cry out that we cannot afford such services. But the financial and human costs of denying appropriate support, treatment, and home placements for high risk children will in the future far outweigh any short term costs today.

Yes, church and love are powerful factors in securing a long, happy, and productive life for children. But when it comes down to it, this often is just not enough.