If you have a family in your practice that adopts a school-age child, coach the parents to expect an initial honeymoon period. The child says, “Yes, sir,” or “yes ma’am,” and offers to help around the house. After a few weeks or months, however, she may begin testing and become very oppositional. What she is symbolically saying initially is: “Please keep me. I’ll be good.” Then she gets to the point where she is asking, “Do you really mean it?” and “What if I’m a little bad? Will you still keep me?” No matter how badly she acts, a child needs to be told that she is loved and will be cared for forever.
Warn parents that adoptive school-age kids, like all children, test the rules. Sometimes children even overtly say: “My real mother would never treat me like that!” Advise parents to try their best not to show a lot of emotion to minimize repeat performances. It’s challenging but ideal for parents to say, for example: “You can imagine that your biological parents wouldn’t have taken your bicycle away for a week, but these are the rules here, and you live here now.”
School-age children benefit from a coherent explanation for the adoption that removes blame from them. A child this age often thinks “What was wrong with me that I was given up?” The parent can say: “Your mom was too poor and she couldn’t care for you,” or “Your parents were too ill and couldn’t take care of you.”
Instruct parents also to watch out for potential self-fulfilling prophecies. For example, parents may know that the biologic parent was bipolar, robbed banks, or did drugs. Those parents may be understandably extra vigilant for similar behavior to come out in the child, but they may also convey a sense that they don’t trust the child and are expecting the worst – instead of the best.
As a teen, establishing a sense of identity is a developmental imperative. Adolescents may wonder: Am I like my biologic parents? Am I like my adoptive parents? What kind of parent am I going to be? For example, knowing that their biological parents had sex and bore them at age 17 years, for example, can push some teens into promiscuity. Every teen needs a trusted adult to talk to and ideally not their parent. They may be better able to hear from a relative or a paid counselor that, “Just because your parents did that doesn’t mean you have to. You can be like them in some ways and not in other ways.”
Sometimes, as a pediatrician, you may end up in the middle of a manipulation during the adoption process. You may be asked to provide a statement about who has been involved in the child’s care and best supports their well-being. I’ve had long-absent biological parents, when asked to sign adoption papers, cause a problem, and even suddenly request visitation. They may have financial motives of potential disability payments related to the child or concern over child-support payments. Other times, it comes from pressure to appear responsible by a new girlfriend. You can encourage confidence and a strong stand in adoptive parents, which – in itself – may avoid legal battles.
While the vast majority of adopted children and families do very well, it is important to monitor for adoption issues that go beyond these ideas for coaching and to recommend a mental health referral in these cases. Parents of adoptive children are likely to be more open to counseling than are typical parents, as they fulfill their extraordinary promise to support their treasured child.
Dr. Howard is assistant professor of pediatrics at Johns Hopkins University, Baltimore, and creator of CHADIS. She said she had no other relevant disclosures. Dr. Howard’s contribution to this publication is as a paid expert to Elsevier.