Transitions

This is the theme for this week's Weekly Adoption Shout Out but, a bit like when I posted about Play, it's hard to isolate a transition in Baby Spouse's life.
Other friends - parents of adopted and birth children - talk about transitions meaning changes of school and carer, I'm guessing moving house, that sort of thing. Obviously moving to a foster carer or an adoptive family would be under this heading too.

But I see Baby Spouse transitioning multiple times a day. This afternoon he woke up from his nap and yelled something approximating to "I'M AWAKE AND THIS IS WRONG". Every day when we go to nursery he has to adjust. He had three weeks off over Easter (it would normally be two but he was in hospital before that) and he was pretty upset when he went back. I was very pleased to hear he'd been clinging to his carer for most of the day - it means he knows she's safe. He's also only just started to get excited when I get his coat out, because he's worked out it means he's going somewhere, potentially exciting (rather than being grumpy becaOther friends - parents of adopted and birth children - talk about transitions meaning changes of school and carer, I'm guessing moving house, that sort of thing. 
Sadly, although we know his nursery is great, we are looking for somewhere else. The combination of location (near my work, not near home or the station that Mr Spouse commutes from), and hours (very short) and flexibility (never able to switch days) means I've been having to turn down important work travel - even just short overnight trips or long days - as only I can practically drop him off in the mornings.
Baby Spouse would have to change keyworkers at the end of the year anyway, but the nursery is lovely otherwise, so I am a bit sad to be thinking of taking him out. However I have had a clever idea, to see if he'd cope with some days at nursery and some with a childminder. I think we'd prefer to use a childminder for after school care if we need it in the future, anyway. So I'm crossing my fingers and going to do some ringing round later today or tomorrow. I didn't think they'd appreciate a daytime call today on the last day of the school holidays.
But in my "are they completely mad" mode commenting on adoption practice, I gather from other adopters of fairly young babies that the standard approach is to have a fairly short period of introductions (where adopters meet children first in their foster carers' home and then transitioning to their own home). I also know that adopters have fought - usually unsuccessfully - to have informal meetings before introductions, even where they are already parents of a biological sibling of a new child. Answer this question with your sensible hat on: who is a newly adopted baby going to feel safe with? Someone they've known for a couple of months and have seen at least weekly, and who has been caring for them daily for weeks? Or someone they met last week and who more or less immediately leapt into the parent role?

Last day

When I went back to work I started at 2 days a week and had some Wednesdays off to make up for some work days while I was on adoption leave. I had a few more before Easter and thought that was it, but then the last one ended up with Baby Spouse in hospital which happily comes under a different heading to actual holiday.
So I have a final day off tomorrow. It feels odd - like I'm really, properly going back to work, even though I'm still part time, and I started back in November. No more mummy and baby skiving off.

File under "mildly sceptical" - part 1

This isn't normally the kind of post I put here, it's not massively relevant to our family, and actually, I should be working, but for some reason I'm feeling a little fidgety and also mildly irritated by some things. I am debating whether to move this to my other blog (where I don't talk much about our family, but what the hey, everyone I know in real life knows we are adopters, so it's not a big secret).

So.

I've been having some Twitter conversations with psychologists who don't have anything to do with adoption, but who are getting increasingly irritated with scientists and clinicians publishing papers saying "this therapy is brilliant!" when it isn't. And I also follow a lot of quack-watch type people (Ben Goldacre etc.), and frankly, the state of "therapeutic" offerings for children who have had dreadful early life experiences is way, way below the standard offered by the slightly self-promoting scientists and clinicians. It seems in some cases to be nearer the homeopathy, cranial osteopathy, and pseudo-qualified nutritionists of this world that are the subject of quack watch types.


Let me say at this point that I know I am going to get comments by people saying "but but but we've tried A B or C and it was FABULOUS and our lives have been TURNED AROUND and this person is a God!".

Fine. You can believe that. But if something, on average, has no effect - then that means half the group gets better, half gets worse.  What if you ended up in the group that got worse? Would you be happy you spent your money on it?

And if on average children on a treatment get better (but only compared to themselves at the beginning, or only compared to children who weren't getting any treatment) then it could easily be because they are growing older (children learn things and become better behaved, mainly, as they get older) or because they've had some special attention.  This is usually cheaper than therapy.


So... I thought I'd see what evidence there was for a couple of the really popular training and therapy centres that are talked about a lot by adoptive parents: the Child Mental Health Centre (Margot Sunderland's place) and Family Futures (which is a voluntary adoption agency,and I believe in that capacity has great inspection reports, I'm not sure that its training side gets inspected).

The Child Mental Health Centre says one of its aims is:

Dissemination of Research

To promote positive social change through disseminating the latest research in child, parent and family mental health

To make available to parents, teachers, child-care professionals, providers and custodians of services, politicians and the lay-public at large, a comprehensive up-to-date knowledge base in child and family well-being

To fund an effective dissemination of psychologically and neurobiologically based research. Organisational isolation can be costly: ...wasting time slowly re-discovering what is already known (Baron Peter Slade, 2000)

Family Futures says:

Our therapeutic interventions draw upon and are informed by the work of Dan Hughes, Theraplay, Bruce Perry, Bessel Van der kolk, Babette Rothchild and Dr A. Jean Ayres and many others.

I'm still looking for a list of research that the Child Mental Health Centre is disseminating, So I'll start with Family Futures. Let's take those in turn and see what evidence there is that these theories and therapies work.

Dan Hughes: I found this paper by him about his therapy and its basis. It doesn't present any evidence for its evaluation, and I am not completely sure (because it's not my area of specialisation) that his therapy described there is the same as Dynamic Developmental Psychotherapy, but DDP is compared in a few studies to treatment-as-usual, and it seems to come out well. The studies aren't large, but then fully diagnosed Reactive Attachment Disorder isn't common.  The studies don't tell us anything about DDP in children who haven't got RAD. This review suggests that the statistics in this study are pretty rubbish, and worries about some of the ethics of it.

Family Futures now offer a training course that includes DDP, which they call "Neuro-Physiological Psychotherapy". I'm not sure what makes it neurophysiological, as neurophysiologists are generally medical doctors who have a speciality in a branch of neurology, or lab scientists who work with lab animals. I'm also not quite sure whether the hyphen makes a difference.
The "Recommend to a Friend test": I might recommend this to a friend whose child had a diagnosis of RAD. But probably not. I'm not sure if enough is known about it to know if it would be harmful or helpful, or neither, to a child who didn't have such a diagnosis.

Theraplay: Chapter 5 in this book talks about the evaluation of Theraplay. The studies randomised children to either treatment or waiting list controls (which aren't necessarily the best control - partly because just giving children attention rather than no treatment can improve outcomes). A lot of the children in this study had some developmental disability, which is typical of children who also have the kind of behaviour problems Theraplay is often recommended for. The chapter says that the children who had therapy improved more than the children who were on the waiting list, though I can't seem to find (perhaps I'm not looking hard enough) any graphs or figures that directly compare these two groups, only graphs showing children's behavioural problems before and after Theraplay. A review I found here says there aren't any other studies showing Theraplay is effective, and makes a good point about its theoretical basis in attachment theory but the fact that it kind of ignores attachment theory in how it is supposed to work.
The RtaF test: I'm not convinced I would.  The Wettig book chapter is rather grandiose in how many different disorders it claims Theraplay can treat or influence, too, which puts me off considerably.

Bruce Perry: I can find a lot of articles by Bruce Perry on the theory behind what happens to children if they are neglected or abused.  Certainly (if they are validated) it can be helpful to understand what's going on when you have a child that's difficult to parent. He does talk a little about therapy, but doesn't recommend or describe any particular type, saying instead 

the Neurosequential Model of Therapeutics (NMT) allows identification of the key systems and areas in the brain which have been impacted by adverse developmental experiences and helps target the selection and sequence of therapeutic, enrichment, and educational activities.

It's beyond the scope of this post (read: I should be doing something else) to evaluate ALL of his ideas about what affects what when development is disrupted. He does have a tendency to say "brain" when he means "behaviour" or "cognitive development". For example he talks about "

NMT Functional Status and Brain ‘‘Mapping’ [...] An interdisciplinary staffing is typically the method for this functional review. This process helps in the development of a working functional brain map for the individual [see Figure 2, which is a rather odd pyramid showing the names of brain areas shaded in dark or light]. This visual representation gives a quick impression of developmental status in various domains of functioning: A 10-year-old child, for example, may have the speech and language capability of an 8-year-old, the social skills of a 5-year-old, and the self-regulation skills of a 2-year old. 

(In other words, they will do some behavioural and cognitive testing, make assumptions about which brain area is responsible in children, and tell parents they are making a brain map. My quack detectors are twitching. We know very little about how normal brain-behaviour links are mapped,and even less about how they develop in children who have difficulties. Many very clever and famous people have said this, lots of times). He is careful not to recommend any specific types of therapy but he also says:

the sequence in which these are addressed is important. The more the therapeutic process can replicate the normal sequential process of development, the more effective the are (see Perry, 2006). Simply stated, the idea is to start with the lowest (in the brain) undeveloped=abnormally functioning set of problems and move sequentially up the brain as improvements are seen.

Erm... well, I'm a developmental neuropsychologist, and I've never, ever heard of this principle. As he's quoting himself, do you think possibly he might be the only person who thinks this? 
OK, it's possible that he's right, and everyone else is wrong - 64 other articles have cited this article. The fact that I can't find any neuropsychologists who have cited it might tell you something.
The RtaF test: Go and do a university developmental psychology course, preferably also a university neuropsychology course, if you want to know how the brain develops.  The Open University is very good. 

If you have a child who's suffered trauma, there is an evaluated treatment for this - which is again mentioned by the Allen review article - Trauma-Directed CBT. I can't see either of the centres I'm looking at recommending this or training people on it.

Right - I'm supposed to be doing something else (oops). I will be back another time...

Play

At Baby Spouse's age, everything he does is play, apart from eating, sleeping, and filling his nappy, and I'm not too sure about those either. Play is how we can tell what he can do, how he fills his days (well, apart from the sleeping bit, which he's still very good at, and which we are very grateful for, but even then he wakes up and chats to himself), how he interacts with us, and in a well-used cliche, how he learns about the world too.

Most of this post will have nothing to do with adoption, and the parts that do, I hope don't sound too patronising.

We do have a few minor developmental concerns about Baby Spouse but to be honest, most of them are not genuine - he's meeting all his milestones, in the well worn phrase, and is doing just as well as many other children we know, though of course we'd like him to be doing better. There are a few children who are younger and doing things he can't, but with my professional hat on, I know that's OK.  

We know from the way he plays that he doesn't have several major developmental concerns. He can tell what we are thinking - and he tries to manipulate that - he will offer you a toy, hold on to it when you try to take it, and laugh. He can tease you, in other words. He will anticipate what you are going to do by lifting his arms to be picked up, by smiling before one of us comes into the room. He does not have autistic tendencies to any major degree.

He's appropriately active for his age, and we knew almost from birth that he didn't have major developmental delay, he wasn't floppy, he tried to move, he learned to smile on schedule; he responds to us talking, and has done all along (though he was quite placid in the face of loud noises, which we think we know a reason for, but we weren't worried as he'd passed his newborn hearing test).

I've noticed a couple of tendencies in other parents which I find a little interesting. One is that, as I mainly know parents of first (and at this stage only!) children, a lot of them are really eager to play with their children in ways that I (and they, really) know they aren't ready for.  

Most babies aren't that interested in cuddly toys till around a year old (maybe a bit younger), and then it seems to click - that's been true of Baby Spouse - but a lot of parents of newborns seem very keen to introduce a lovey very early which, actually, could be unsafe if it's a large toy they could get their face stuck in.  A lot of my friends took their babies to the park at a point when they found the swings and slides a bit scary (so did we - bit of a mistake!).  We all read books to them from very young, which is not wrong, but we have tended to buy books that are advertised for babies - flaps, touchy feely, animal pictures etc. - which they don't really appreciate until again nearer 5-6 months when they can handle/feel things, or a bit older when they can appreciate pictures. This is a very natural tendency as you see parents of older toddlers doing all these things and you want it for yourself and your baby. Especially if you have only a few months' maternity leave, you want to make the most of it and do lots of fun stuff.

The other tendency I've noticed, which is related to play but to new adoptive parents can seem more like care, or behaviour, or battles, is that a lot of new adoptive parents of toddlers have had very little training or experience of what babies and toddlers can and should do.  Some of what might be better seen as exploration or trying things out (which I'd include under play) can be seen as poor behaviour, a result of neglect, or of being slightly ignored and/or indulged by foster carers. 

A lot of this seems to be around eating - such as putting too much in the mouth, or being incredibly messy, flinging food.  Children can obviously revert to slightly younger behaviour, so if they'd fed themselves or grown out of playing with food quite so obviously in foster care, they may revert to this on placement.  But it's a stage all children go through and I feel that adopters should learn more about how most children behave and play and should be able to work out what's something they should worry about, and what is perhaps a bit immature but not worrying.  

For example, a poster was worried that her 19 month old threw bowls of food on the floor. Another poster said perhaps the child was seeking her attention by doing this. Now, we don't have a 19 month old yet, and I'm crossing my fingers ours will have stopped doing that by then - but we do have a nearly 15 month old and there's no way I let him have the whole bowl of food, ever. He can have a spoon or fork, and some days he uses them appropriately, some days he plays with them. That's how he learns. And yes, he looks at you to see if you noticed, but he does that with everything else he flings on the floor, and more or less every game he plays too. For his age, this is appropriate - food is a game - and it's not inappropriate for a slightly older child who's been unsettled, either.

The same is true of things like asking strange/inappropriate questions, how much children actually understand and remember (and what they are very unlikely to remember so are probably reconstructing). These are all things that come up when children are playing, and that the large number of people adopting under-3s get absolutely no training whatsoever on. It's completely mad. 

Mildly disappointing

So... 600 pages of paperwork is a lot. Very heavy.

Some interesting things emerged. For example, how much social workers plagiarise from the paperwork they ask you for. Well, plagiarised isn't exactly the right word. Some of it they tell you will be included. Some of it they paraphrase.

Some we had forgotten - particularly around the thorny subject of birth dad.  We had discussed getting OHP to try and contact him on his last known number/address and find out if he was willing to try and complete the medical information again, and see if he's open to contact.  Mr Spouse is not keen on that and has not been made more keen by any new information. 

Looking back at the old notes from our old social worker has, I think, changed my mind on the contact.  Although the social worker did mention photos and letters to him, we now know that he has, all along, had a very good way to get in touch with the agency and, indeed, us should we have wished. And he hasn't used it. I guess we were thinking he only had expired cell phone numbers for a social worker who doesn't do that job any more, and for Nella, but he doesn't. He could have asked for contact, and he hasn't.

My worry if OHP try to contact him is that the details will be out of date and it will be pointless. But Mr Spouse's worry is rather the opposite - that he will behave aggressively to us or Nella, as he did when contacted by the social worker before.  I'm not sure that is a huge risk if he was only contacted by a third party to ask to fill in a form that he had already said he would do. But now it seems he didn't say he'd do it, and he could easily have been in touch with the agency, but wasn't.

I haven't totally changed my mind about hoping we'll get medical information, but the notes also seem to say that he did not even say he would fill this form in, but then lost it. And reading between the lines, it has jogged my memory that the social worker was not completely convinced this was the only possible birth father. So, if we did get the information, it could be worse than useless.

So, and apologies for rambling, but where this leaves us is, I suppose, in kind of the same position as a parent whose child's other biological parent has walked out. I could, if I was feeling unhelpful, ask one of OHP's social workers to pursue the medical information unilaterally. But I think it's better that we are on the same page.

Gosh

You may remember from last year that Nice Little Agency had some serious problems last year. Some fairly important pieces of paper got lost.

We got a very random phone call tonight (from Official Hague Person's office) to say that some lost adoption paperwork has been found. They are sending it to us.

All 600 pages of it.

There are definitely some things we want, and apparently there IS some birth father information.

We also suspect there may be some things we probably shouldn't see. We won't tell if you won't.

Moving forward

Thankfully Baby Spouse was allowed home from hospital yesterday - he was checked off as fine about midday but Mr Spouse had to hang around for hours waiting for his medication.  He's having another epic nap at the moment, though he's intermittently been trying to crawl at sprint speed, and being very wimpy and tired, today.

We adore his nursery, which is at my workplace, but we are slightly wondering if we shouldn't investigate other childcare options. At his current nursery he moves rooms - and hence carers - once a year at the moment, so he can't have the same carer indefinitely anyway.  One of the immediate reasons we are thinking about this is the illness issue.  Everyone says babies in nurseries get sicker, and if he has a propensity to being seriously ill when other babies would just get snotty, we are wondering if a smaller setting (childminders here would have maybe 3-5 children, and if they had a higher number most would be older) wouldn't help with this.

The other issue is the location of the nursery - there is another one very near our house and hence near the station Mr Spouse commutes from - currently he can't do a full day's work and pick up Baby Spouse but a different arrangement would mean he could pick up sometimes. I know he misses doing this, too.

As always there's an added adoption layer to this. It's not a huge layer, I have to say, as we did tell his existing nursery that he was adopted but they have not asked any questions (certainly not the concentrated level of questioning we got in the hospital!). We know that in any of these places he'd be with children who would be in his class at primary school, so it's something that will be permanently out there. And although the nursery staff seem to be very sensitive we can't guarantee that everyone will be like that.  Again, the hospital staff seem to be rather surprised to the point of nosiness!

It's hard to get the balance right.  We have a few minor concerns about his development, which, especially with my professional hat on, I know are OK, but it's hard to get some people to take them seriously without disclosing probably more than we want to unless we have to. To them he is a normal, happy boy with a past that can be forgotten. But others see the situation as so unusual and shocking that they want to know all about it. And we don't want that either.

Intermission

Briefly - I've been in hospital with Baby Spouse since Monday (it's now Wednesday night) - I am very grateful that we live 15 minutes walk from the hospital.  Mr Spouse came in Monday night to relieve me while I got stuff, and yesterday while I napped because I hadn't slept on Monday night because Baby Spouse's oxygen levels tanked and the nurses were trying everything to get them back up.

He has a chest infection and either the antibiotics, or the steroids, or the inhaler/nebuliser, or all of those, have helped. He had to have more oxygen last night but I slept, and so did he, and tonight Mr Spouse gets to sleep on the hospital bed. He should be home tomorrow.

We are anxious, but he is doing a lot better, and I think we're more shocked that we weren't even going to take him in, and the hospital thought he would be OK at home but kept him in to be on the safe side.

I've explained to what seems like 25 million people about his adoption, what age he was when placed, to about half of them where he came from, and to one doctor (who did ask "do you mind") why we chose to adopt from the US not the UK. I explained that the same kinds of children need adopting in both countries, but the system allows for birth parents to choose not to allow their child to go into foster care, but can have a say in who adopts their child, in the US. I did not say (as I was not asked, but I did say this to a friend) that they do it that way "because it's sensible to do it that way". I am very aware that there are ethical issues around this, and that the US foster care system is probably at least as broken as the UK system, but something needs to change for babies in the UK.

This whole serious illness is a big thing to get your head round, though, and it's left me at least thinking about other parts of his/our lives (especially childcare).  I'll try and keep you posted.

Update: here. 

Grownups

So, like Christmas, my birthday came and went, and was mainly slightly nicer than I thought it was going to be, and generally less scary.

Mr Spouse and I had a little chat about where we might go for adoption no 2.  He is not keen at all to adopt from the US again, I said it wasn't my first choice but I wouldn't rule it out.  He however sounds like he'd be able to cope with the idea of concurrent adoption, which they are introducing in quite a few councils across the country, including our county council.  His main concern actually seems to be that he had a lovely time being a mainly work-from-home student while I was on adoption leave with Baby Spouse, and he wouldn't get that again.  I have to say I can see his point.

If it was up to me, I'd be on the phone to them tomorrow about applying, but it is really too soon, my head says it is too soon, and I generally hear on the grapevine that about a year after an Adoption Order (the equivalent to finalization) is when they might consider you to apply again. So that would be some time in the summer.

In concurrent adoption at placement of a baby you are foster carers and then if (which is always more likely than not, based on the children chosen for this scheme) the child cannot go home the carers adopt the baby.  I know how besotted Mr Spouse was with Baby Spouse from day 1 and I was worrying he wouldn't want to think about this because of the risk that the baby might go home.  But given that he's always said he'd be interested in foster care, we applied initially for foster care (though we weren't going to foster babies), I shouldn't have been too surprised that his reaction was positive - his philosophy, he says, is that we must see ourselves as foster carers. And that's exactly the right attitude, which I will try very hard to emulate.

I will keep you all posted, but this sounds like it might be plan A.