CASE:eNewsletter

October 2005

In this issue

When does a child or teen need an evaluation?
Your Child's World: Adoption at School
Parent Perspectives
The Value of Role Models in Adoption

When does a child or teen need an evaluation?

I am a clinical neuropsychologist who specializes in the evaluation of children, adolescents, and young adults with learning disabilities, attention disorders, and/or social, emotional and behavioral problems. In addition, I am an adoptee who has known and admired the work at C.A.S.E. since its inception. Even though I was adopted myself, I am not as knowledgeable about the effects of being adopted on a child’s development as the therapists at C.A.S.E. I am thus delighted that we have developed a collaborative evaluation program that combines (a) my staff’s expertise in neuropsychological assessment with (b) the understanding of – and experience with – adopted children possessed by the staff at C.A.S.E. We call this new program Adoption-Sensitive Evaluation and Support Services (ASESS).

What is a neuropsychological evaluation?
Neuropsychological evaluation in my practice involves detailed assessment of language, visual-perceptual and visual spatial abilities, motor skills, attention, executive and self-regulatory functions, memory, conceptual reasoning, and problem solving. We also test academic skills and emotional functioning in order to obtain a comprehensive picture of an individual’s strengths and weaknesses. Most of the young people we assess are having problems in school, although some are good students who are struggling to manage their emotions or to get along with others. We see many adopted children in our office, which is not surprising in light of the fact that adopted children appear to be at greater risk for learning and attention disorders, as well as for problems with socialization and emotional regulation. This may reflect pre-adoption variables such as genetics, prenatal nutrition, prenatal alcohol or drug use, a stressful pregnancy, the stress associated with abuse and neglect, or a lack of sufficient early stimulation. It may also reflect post-adoption factors such as attachment problems and trouble adjusting to a new language or a foreign culture. Neuropsychological evaluation is often requested by physicians, therapists, and school personnel in order to help sort out if a child’s difficulties reflect biologically-based learning or attention disorders – or whether they are related primarily to factors such as attachment, anxiety, or depression.

How do I know my child needs and evaluation?
Young Children. Children younger than six years of age are most commonly seen for assessment due to concerns about their language, motor development, relationships with other children, and/or behavior (including hyperactivity, oppositionality, and/or aggression). Concerns about possible ADHD in young children usually focus on hyperactivity and impulsive behavior, although concerns about attention span, organizational skill, and ability to complete tasks is commonly raised by the time a child is four or five. While learning disabilities often cannot be reliably diagnosed until the third grade (given the limitations of academic achievement tests), we can tell with very high accuracy by kindergarten age who is at risk for learning problems by assessing the underlying weaknesses that contribute to learning disorders (e.g., deficiencies in aspects of language such as phonological awareness or rapid naming).

I advise parents of young children to read about developmental milestones and to seek feedback from preschool and kindergarten teachers and child care providers about their child’s skills in relation to those of peers. I recommend that parents initially consult with their pediatrician if their child is unduly anxious, is difficult to manage at home or in school, has trouble getting along with other children, or appears to be delayed in some aspect of development (e.g., immature speech or language skills, a lack of coordination, or weak fine motor control).

A more in-depth neuropsychological evaluation can also be helpful, in part because more comprehensive assessment can provide greater precision in targeting intervention. A neuropsychologist in private practice is also likely to be aware of the broad range of services available outside of the county or school district. In addition, private evaluators are likely to recommend more intensive intervention than is recommended by city or county personnel due to budget or staffing reasons. .

I want to emphasize that recent research has provided very compelling evidence to support the wisdom of early intervention for children who show signs of delayed development and/or struggle in the early stages of school learning. The old “wait and see” approach – which assumes that children will grow out of developmental problems – has given way to an “intervene early” approach. I thus recommend that parents of young children err on the side of caution – and seek professional evaluation sooner rather than later if they have concerns about their child’s development.

School-aged Children. School-aged children are most likely to be seen due to concerns about academic learning problems, difficulty staying focused in school, trouble completing assignments, or difficulty with peer relationships. Again, getting an early jump on re-mediating learning problems is very important, as we want to do everything possible to ensure that a child does not fall far behind – especially in reading. Children should thus be evaluated who appear to find it hard to sound out words, whose oral reading is slow and choppy, who try to avoid reading, and/or who seem to have trouble understanding when being read to. This is true even if school personnel perceive a child to be performing at grade level. Exciting recent research has indicated that intensive early intervention with struggling early readers not only improves reading ability greatly but also normalizes the functioning of brain systems that are crucial for skilled reading.

Children should also be assessed if they have significant trouble with handwriting, resist writing, or seem to have marked difficulty expressing themselves on paper. Excessive demands for writing in school turn many children (especially boys) off to school, in part because most kindergarten and first grade boys are not neurologically mature enough to manipulate a pencil correctly. Many thus develop an awkward grip that leads to difficulty with writing – and that is extremely difficult to change when they are older. An evaluation can help to sort out true “built in” problems with writing from a lack of developmental readiness – and can provide parents with support to minimize the extent to which excessive demands are placed on the child.

Concern about problems with attention and executive functioning (e.g., planning, organizational, and time management skills) can arise at any point in a child’s education. Very often children who make good progress in the primary grades seem to have more trouble in the later elementary and early middle school years, when they meet increased demands for well-organized written language, independent work production, and efficient studying and test preparation. Neuropsychological evaluation can be very helpful in such cases, as it can help to discriminate subtle – and previously unidentified – attentional and/or executive deficits from anxiety, depression, and lack of motivation.

By Dr. William R. Stixrud, Licensed psychologist specializing in learning disabilities, Member of the Clinical Supervisory Faculty at Children’s Hospital

Your Child's World: Adoption at School

Of all the experiences we have in life that help us to know who we are and what we can be, school is surely one of the most powerful.

School’s enormous influence makes it a critical component in the growth of children’s self-concept, including what it means for them to be part of an adoptive family. From experience and research, we know that it is normal for children and teens to have a wide variety of feelings and thoughts about having been adopted, and those can impact school performance in different ways. In turn, kids are often greatly affected by how others at school perceive adoption. The more we can do to ensure that they receive positive feedback, the better chance they have of feeling self-confident about themselves. The less time they spend defending the past, the more energy they will have for the future.

Opportunity or Opportunity Lost?
The school environment can be a wonderful support for adoptees and adoptive families. If educators are comfortable with the subject of adoption, there are many possibilities for helping students learn that adoptive families are permanent and real. Teachers who are aware of the normal emotions of adopted kids can develop effective strategies to address some of the challenges they face at school, such as certain assignments and intrusive questions from others. Most importantly, educators are powerful adult role models who are in a position to easily and simply validate for all children that adoption is a good way to build families.

Unfortunately, educators do not normally receive training to prepare them to talk about adoption. Instead, most of them form their knowledge base like the majority of the public, that is, through personal contact with members of the adoption circle (including students who were adopted) and what they find in the media. The old standard of secrecy around adoption and the lack of preparation results in uncertainty about what to say. The consequence is often careful silence on the part of educators when adoption comes up at school. The possibility of having support for our children is lost, and for small children in particular, their teacher’s silence can be interpreted as disapproval or shame.

How is adoption handled at YOUR child’s school?
As parents, we probably do not know what is being said about adoption at school. Most kids keep that information to themselves after about third grade. Children in the Kids’ Adoption Network at C.A.S.E. routinely report being asked the toughest questions about their adoption stories when they are at school, where the bottom of the pecking order sometimes gets established by finding the most vulnerable difference. School personnel may not hear all of these questions, but the children also have never been told that they can seek help when it becomes too much for them. Without some education, teachers may not be aware how difficult it is for adopted children to handle questions and comments about adoption on their own.

Parents can learn from adult adoptees how important school-based support can be for their children. Nearly all of them report painful events that could have been avoided.

Every time something is on TV about adoption, kids ask me if that’s the way it happened to me. When I was little, they even thought I lived in an orphanage like Little Orphan Annie, and wanted to know if I had to clean all the time!

When I was in kindergarten, all of the kids had silhouettes done for Mother’s Day. The finished products were hung in rows on the wall of the classroom, and the moms were invited in to find the silhouette of their child. I will never forget how everyone identified mine first, because my features were not only different from my mom, but from everyone else in the class.

In 8th grade we had a unit on human development. We talked about sex, too. We were talking one day about teen pregnancy, and adoption came up. One kid said he thought any mother who gave away her kid was immoral.

In my school, kids aren’t supposed to say bad things about your race, but kids call me ‘Chinese eyes’ all the time and say I don’t look like my sister.

Teachers are Key to Adoption Awareness

The adopted child knows he’s accepted when the reality of his life is reflected in the culture of the classroom.
—Adoption and the Schools Project, FAIR

There are a number of factors which influence the way our children will experience adoption in the school environment.

The child’s changing perception of herself/himself as an adoptee.
Peer understanding and perception of adoption and children who were adopted.
Perception of school personnel about adoption in general and history of how it has been handled in the past.
School curriculum which raises some of the unique challenges of having been adopted.
Everyday references to adoption, some generated by media coverage, which are part of planned or unplanned classroom discussion.

Education for Educators
Parents can promote the need for open, informative communication about adoption in schools by talking to teachers and letting them know about resources for learning more on their own. Some parents have found their schools open to the concept of a parents’ committee which can help school staff plan in advance how to handle assignments or class discussions on adoption.

A second way to encourage learning is to let educators know about opportunities for professional preparation. In-service programs, such as C.A.S.E.‘s

S.A.F.E. at School: Support for Adoptive Families by Educators offer information, research, and specific strategies for creating a school environment that is positive and free of misunderstandings. Authors such as Holly van Gulden, David Brodzinsky, and Joyce Maguire Pavao have written excellent books which provide a foundation of knowledge for educators.

Another way to promote understanding about adoption is to empower children and teens to educate their peers and teachers themselves. We can share with them the kinds of things we hear, and how we handled each situation. We can encourage them to let us know what they hear in their world, and help them develop ways to advocate for themselves as adoptees. It usually helps kids to know that many people do not know a lot about adoption, and they can model appropriate ways of talking about it if they choose.

“I want it to be OK to be adopted,” is the way one child explained how he wanted to feel at school. As parents, we can help ensure that our children’s school is positive about adoption by opening communication with educators on this emotional, complex topic. It may not be easy, but the benefits for our kids can be great. Parents who would like to discuss how to talk with teachers about adoption are welcome to call C.A.S.E. at any time.

By Ellen Singer, LCSW-C

Parent Perspectives

““My daughter is in the first grade. Her friend at school have started asking questions about her adoption, such as “where is your real mother?” I think it would be a good time to go to her class to educate the children about adoption. When is the right time and how do I do this?”

Holly van Gulden, adoption expert and author, has noted it is not uncommon for adopted children to be asked questions, or even teased about the fact that they were adopted by their families, in first grade. Many parents don’t stop to think that their children’s classmates may begin to wonder adoption means at the same time their children are trying to understand it. The idea that you can “lose” parents or “be given away” can be frightening and unsettling to non-adopted children. They may ask questions or tease adoptees in order to feel that they are so different from the adopted child that this would never happen to them. Their questions often mirror the questions that our children are asking internally or to their parents, ”Where is my birth mother?”

Many adoptive parents rely on the parents of these children to explain adoption. However, this may not occur, or the parents of these children may be uncertain of what to say. The school setting is what the perfect context for this kind of learning to occur, as school today have increasingly assumed the responsibilities for education beyond the basic academic subjects. Tolerance for diversity is perfect lesson to be taught in school, and adoptive parents can help to be apart of this goal through in-school presentations. Most adoptive parent will find that their young children will be receptive to the idea of having their parents give a presentation to their class, at least until about third grade. After that, some children may be embarrassed to have their parents come to their classroom for any purpose! Should that be the case, parents may be able to enlist the support of other adoptive parents to give a presentation to their child’s class.

The staff at C.A.S.E. is also available for school presentation through our S.A.F.E at school program.

Some helpful tips for giving school presentations include the following:

Contact your child’s teacher early in the school year so that your presentation may coincide with the teacher’s lesson plans, for example, a unit on families.
Choose to focus the presentation just on adoptive families, or give a presentation about how families can be different in many ways, e.g., some have one child, some parents are divorced, some have mixed religions or ethnicity, some have two moms or two dads, some only have one mom or one dad and of course, some families are formed by adoption or foster care.
To protect privacy, do not focus on your child’s adoptive status or share details of his/her adoption story. (This also pertains to other adopted children you may know of in the class.) If the presentation is about diverse families, children may volunteer information about themselves, such as, “I live with my father and see my mother on weekends, or I have five brother and sisters.” Your child or other adopted children in the class may choose to speak up or not. You should not dwell on any one child’s story, but rather acknowledge the idea of differences being perfectly acceptable. If a child shares too much personal information, you and the teacher can help redirect the conversation.
Try to give a presentation that will foster discussion rather than provide a lecture.
Start with an age appropriate book that focuses on adoption or the idea of families being different. Some suggestions include Families by Meredith tax for young children, or for elementary school, The Foundling Fox by Irina Korschunow or Why Am I Different? By Norma Simon. (For further suggestions, please feel free to contact me at C.A.S.E.)
Presentations to adolescents which involve discussion of the reason why people are unable to raise children born to them can be challenging. Teens need help to understand the difficulties faced by birth parents as they cope with unplanned pregnancy, poverty, or other difficulties. Adolescents also often know little about the realities of modern adoption practices and need these educations. Lois Melna, editor of Adopted Child, suggest that teens can especially benefit from presentations that include a panel of adoptees, birth parents, and adoptive parents.

by Ellen Singer, LCSW, The Center for Adoption Support and Education, Inc.

The Value of Role Models in Adoption

Role models teach us about ourselves. For children in particular, they help to define what they feel is important and valuable. Children often use them as models of comparison with themselves, and when they believe that they share characteristics, it helps them to believe in themselves. If they find that they are like the person they admire—in some way—it is easier to believe that they are OK themselves. Sharing characteristics provides an important kinship.

Role models are teachers of:

*Character, helping to define what we value and admire, and perhaps over time, what we feel is less important;

*Possibilities, that we may not have thought obtainable and which inspire us to try harder and keep hoping;

*Strategies, for handling life’s challenges which help to make us think we, too, can overcome barriers;

*Goals, that we may not have set for ourselves if we did not have a role model to lead us.

Role models who also happen to be adoptees are particularly important for our children because adoption is a difference that is not shared with many others. It is a difference that can affect children’s self-esteem; we know that at certain times of their lives, children may feel that adoption somehow makes them less capable or valuable. Role models can help them to realize that there are millions of adoptees and the great majority grow up to be successful and happy. In some cases, adoption provides opportunities to make children more resilient, or to develop skills or interests they might not have otherwise.

To help our children find these role models, it is helpful for them to have the opportunities to interact with children from a wide variety of adoption experiences. It is important to provide them with opportunities to make connections to ALL adoptees, regardless of whether their adoption stories are similar or not. For example, Mayor Williams can inspire all of our children, although few will share commonalties with his adoption story. They can be empowered by learning how he incorporated his identity as an adoptee with the very successful person he is today.

This is one of the primary reasons we hold our annual Kids Adoption Network Carnival. Success is defined at our Carnival not by fame, but by finding our unique strengths and building on those to become a whole and happy person. Because of the way adoption is portrayed in literature, the media, and Hollywood , children are likely to be unaware of how common it is for adoptees to grow up as successful, “normal” adults. We strive to surround them with that message! We can educate the world about the overwhelming success of adoptees. We can let EVERYONE know that there are many adoptees—some famous, others who are not—who can be role models for others!

by Debbie Riley, M.S. Executive Director of C.A.S.E.