Dr. Jack Hinman is a clinical director for InnerChange, a company that specializes in the treatment of adolescent girls and their families. One of Dr. Hinman’s specialties is working to address attachment issues that are often associated with adoption. In this article, he discusses the connection between adoption, trauma and attachment issues in adolescent girls.
In your work with adolescent girls, how much does adoption come up as an issue?
Well, let me start by pointing out that 30 – 35% of our students are adopted as compared to the general population, which is comprised of only about 2% of adoptees. This greatly inflated rate of adopted kids in treatment is pretty typical for residential treatment programs. While it’s true that adoptive parents tend to be middle to upper income, educated and, therefore, more likely to access mental health services, this referral bias is not enough to account for the disproportionately high population of adopted teens in treatment.
What’s driving this high concentration of adopted teens in treatment programs? Are most of these teens late adoptees or does this statistic apply also to teens who were adopted at birth too?
We’re finding that adopted kids often struggle with attachment—the ability to connect effectively with others and form sustainable “attached” relationships. We now know that a child’s attachment to her mother starts in the womb, so even a child adopted at birth can experience severe attachment disruption later on in life.
An infant’s world changes radically when her biochemical connection to mom is suddenly absent. The baby is programmed—at the neurological, biochemical and limbic level, to attach to its biological mother. Separation can constitute an actual trauma and drive significant developmental changes. Some experts are even entertaining a diagnostic label of “developmental PTSD” for infants or children who experience attachment issues as a result of separation from the birth family.
This biological connection goes both ways, meaning that the biological mother is specially equipped to anticipate and respond to her child’s needs. An adoptive mother is, of course, perfectly capable of loving and connecting with her child, but she does so without some of the tools the biological mother has to intuitively respond to the child.
It’s important to remember that the right hemisphere is developing most quickly at this time. The right hemisphere is the relational/emotional side of the brain, so neurological events that occur at this time can have a long-term impact on relational and emotional functioning.
How do attachment difficulties show up in teenage girls?
We generally see a lot of emotional dysregulation as well as generalized relational difficulties with parents and peers. When I administer or analyze assessments, I often see what I call the “adoption cluster,” which includes symptoms of bipolar, ADHD and learning disabilities. When this cluster is evident in an adopted teen, a clinician has to wonder if, for instance, the girl’s emotional dysregulation is symptomatic of underlying abandonment issues or bipolar disorder.
Abandonment is the core issue for the young women we’re discussing; it’s often what drives all of the other issues. “Imagined abandonment” is part of what these teens are dealing with. Because of early attachment trauma (which they’re usually not even conscious of), the teen imagines that all the important people in her life will leave her. She’s braced against imagined future abandonment, which of course leads to high levels of relational ambivalence.
Remember that an infant doesn’t have a developed personality (or “pre-personality”) to help her cope with the trauma of separation from her birth mother. So that separation trauma can cause a kind of systemic and limbic reconfiguration that heightens the individual’s sensitivity to future emotional events.
Is treatment geared mostly toward lifelong management or can treatment actually resolve these attachment issues?
I like the word “healing” to describe what a good treatment experience can achieve. The first step in the healing process is to get the parents and child talking about the impact of adoption—acknowledging that there is loss involved. Adoption is a beautiful and redemptive event, but it’s one that does involve loss. For the child, the loss is not remembered but it’s also not forgotten; it can operate as an invisible force and, therefore, has to be brought to consciousness so that it can be dealt with.
Often there is a loss on both sides—the parents’ inability to have children and the child’s loss of her biological family. For the teen, we work to help her realize that she is continuing to behave as if she is going to be abandoned at any moment. We try to help her understand the very real (but until then mysterious) source of her fears, and then to distinguish between real and imagined threats of abandonment.
With a loving, supportive approach that addresses the core issue of abandonment, treatment results can be profound.