Introduction to Special Needs Adoption Types of Adoptions > Domestic adoption of infants completed by private agencies, adoption centers, oF atiomeys > Inter-country adoption of infants or children by US altizens > Adoption of children in the foster care system by foster care providers, kin, or ‘adoptive parents Steps in any adoption > *Home Study" * Sra sos mT> Transfer of Legal Custody * Involuntary stusons, heh prans an Fequsl be Famly Couto terinat Wor eons ahs onder ol an edoplon woos “br stuatinsimohing abuse and nage the Deparment Soca! Serdees Chores Divion Isresponetle for ivestgaing. i here i evionoe ‘ot aban, Ihe Cour may take cus rm the parents ond vansfrt Chirens Brson. + inorder fr a adoption to cca, he Family Gout ‘moat delemine icin he beet meres ct hte > Finalization (competes, ogaices permenent) “The State of Missour requires a chi Ive with ‘potential adoptive parents for @ minum of six ‘months prior to zn adoption being finalized. ‘The Court grants the adoption based onthe ‘adoptive parants’ agreeing that they have al the ‘ighls and responses to the child as ihe or ‘she was bom to them. Reason for Children Entering Foster Care > Physical abuse > Sexual abuse > rysical nepect Soya tate ng anne > Educational neglect > Medical neglect > Parental drug abuse Parental incarceration > Abandonment wT> The goal for most children in alternative care is to return to thelr parents) when the ‘Greumstances which led to ou-o-home placement have been resolved. > Qutot home placements are soloced to provide secure, nurturing and homelike setings for cnlaren > Peimanency olanning and nq begin within he fret 24 houre afer e chia Is removed ‘As many as 80% of children in foster care have emotional, behavioral and developmental issues ‘As many as 30% of these children being considered to have severe clinical mental health and emotional problems. > Studies indicate children who have expenenced ‘bute or neglect are at higher risk for @ ‘multitude of socal problems, > Without traatment, they are *btcpemiy bn eee unten oe + Fine st cero sine nt eee {iisetan «tes a eat aan ees {rene sne, 208; Mactan 200) mTUp to 80% of people with significant issues ‘such 8 "alcohol or drug abuse, criminal of ‘gang involvement, emotional disorders, mental iiness, prostitution, teenage pregnancy, sexual offenses, suicide, ‘schoo! failures, sexual dysfunctions, school dropouts, violent crime and ‘run ‘away’ behavior were found to have been vvictins of child abuse" Adoption and Trauma > Some ways of thinking about trauma + Tee much too soon «+ Overvhelming « Single incident vs. multiple events Trauma Considerations in Adoption > Bere & “li wane mA Th> Biolooy > Connection with family of origin » Relational templte, repetition, and coping > Adoptive family or Kin family Developmental stage History with biological family Reasons for adopting Kids in Care > Over 5 million in care in 2006. Number hhas remained relatively stable > In any given year, approximately the same ‘number of children enter care as exit care, ‘oughly 300,000 > Approximately 60% of children placed in care live with nonrelative foster homes, 25% live with relatives > 16 porcent had bean in cae les than 1 month + 34 parcent hed been in care for 1 t0 11 months > 23 pareant hed baon in cae for 12 1023 months > 42 percent hed bean in care for 24 10 36 monthe > ® percent ned been in care for 36 to 68 months > 7 percent had been in care for 5 or more years ‘Median age of children in care: 10.2 years Median age at entry: 7.5 years Median age at exit 8.5 years mM IT» 40 percent were White/Non-Hispanic » 82 percent were Black/Non-Hispenic > 19 percent were Hispanic > ® percent were other races or muttracial Statistics > Disruptions ~nasotn pacanen. trate «Sti vary depencng on soplason sts however excuarg oer Chen fe rte vanes betwoan oe ana 86 «Stal on alder chien (ages 12-17) show arate oF wpa Corel: cate ineeases with age of hil, namber of iocement wn oster cave,tmover cS ‘Water semana: ane bahawora needs fhe > Dissolutions ~ ate trains action + Between 1 and 10% Conslats: fae increases with ago, mal, chien th ‘SPECIAL NEEDS. Stiies snow halons who ado eer wh spect nde fom fone cave uncer enarmout sugles a ace serious barlers onanng ‘ended senone. ‘The Wo ats ost fe ‘evtoned by edoptes fries ware lock at Information about where tego for eerdee and the costo services MIT“Special” Considerations » Safety and Predictability > Emotions behind the behavior » Behavior patterns > Attunement > Containment > Affective range ‘Some Considerations for the Professional > Abily fo tolerate strong affect > Values > Personal trauma history (known or unknown) > Coping strategies > Boundaries > Empathy > Understanding of Adoption issues > Access to resources When working with children or families who have trauma and adoption histories, professionals need to be aware of the Unique characteristics and issues involved, Past trauma thet occurred prior to entering ‘he family cannot be ignored. qmFor more information > ynww.chsmo.ora > www childwetfare. ora > wwwwutraumacenter ora > tmpcies.eton,nistouecuicestoarntinkrencomian! > hftoafwmnw cetrauma, oral > Ea, 2007. Te Boy Who was Raised as Doo > Keck 6 ee Koes Ro) Pret be ut Cae > Cosine, (200) Te Nwoncancy telson ‘Besehmar cha te Devslopng ran” WW Neon & CoreenCOMPLEX TRAUMA IN CHILDREN AND ADOLESCENT: Table 1: Domains of Impairment in Children Exposed to Complex Trauma |. Attachment Uncertainty about the reliability and predictebility of the word Problems with boundaries Distrust and suspiciousness ‘Social isolation Interpersonal difficulties Difficulty attuning to other people's emotional states Difficulty with perspective taking Difficulty enlisting other people as allies I. Biology ‘Sensorimotor developmental problems Hypersensitivity to physical contact, Analgesia Problems with coordination, balance, body tone Difficulties localizing skin contact ‘Somatization. Increased medical problems across a wide span, ‘e.6., pelvic pain, asthma, skin problems, autoimmune disorders, pseudoseizures lil, Affect Regulation Difficulty with emotional self-regulation Difficulty describing feelings and internal experience Problems knowing and describing internal states Difficulty communicating wishes end desires \W. Dissociation Distinct alterations in states of consciousness Amnesia Depersonalization and derealization Two or more distinct states of consciousness, with impaired memory for state-based events V. Behavioral Control Poor modulation of impulses Seif destructive behevior Aggression against others Pathological self soothing behaviors Sleep disturbances Eating disorders Substance abuse Excessive compliance oppositional behavior Difficulty understanding and complying with rules ‘Communication of traumatic pest by reenactment in day-to-day behavior or play (sex, aggressive, etc.) VL. Cognition Difficulties in attention regulation and executive functioning Lack of sustained curiosity Problems with processing novel information Problems focusing on and completing tasks Problems with object constancy Difficulty planning and anticipating Problems understanding own contribution to what happens to them Learning difficulties Problems with language development Problems with orientation in time and space Acoustic and visual perceptual problems Impaired comprehension of complex visual spatial patterns Vil. Self-Concept Lack of a continuous, predictable sense of self Poor sense of separateness Disturbances of body image Low selfesteem, ‘Shame and guilt Complex Treume in Children anc Adolescents Hetlonel Chile Traumatic Siress Network. Win. NCTSWet.org,FECL SRR, SEMA to “Bk ada ua S058 Relational Disorders and Relational Processes in Diagnostic Practice: Introduction to the Special Section Steven R. H. Beach University of Georgia Nadine J. Kaslow Emory School of Medicine “The spectal section acdreses a numberof salient issues that will arise as the revision process forthe Diagnostic and Statistical Mana of Mental Disorders (DSM) uafolds and the role of relational processes in mental health is considered. Tie collection ofatieles, which empha- ‘Sze historical, conceptual, and empirical contributions 10 the discussion, is intended to simulate debate inthe field and 10 serve as a esouree for individuals charged with proposing fs mike clear that the authors can improve on the current teatinent of relational procasses inthe DSB and that there is solid foundation of family esearch that can inform any discussion on this topic. ‘new diganostic guidelines. Jolly. he as Kerwords: mariage, family, diagnosis, mental health psychopathology “The connections between relational processes and mental health outcomes are manifold and, in some cases, rather ‘obvious, Relationships often change as a function of psy- chological disturbance (Wamboldt & Wamboldt, 2000), and in some cases, interpersonal difficulties are an jotegral part ‘of a disorder (¢., Chatoor, Hirsch, Ganiban, Persinger, d Hamburger, 1998: Reid, Patterson, & Snyder. 2002). Rela- tionship difficulties affect the burden associated with psy- chological impairment (see Whisman & Ubelaker, 2006) as ‘well as the long-term course of some mental disorders (see Hooley, Miklowitz, & Beach, 2006). In addition, conflict in primary relationships among adults can negatively impact ‘endocrinological and immunological systems (Kiecolt- Glaser, McGuire, Robles, & Glaser, 2002), further increas- ing the degree of functional impairment produced by a disorder. Likewise, disturbances in primary relationships carly in life can change neural systems that control emo- tional resilience (Suomi, 1999) and so create long-term changes in vulnerability to mental disorders (Gallo, Troxel, Matthews, & Kuller, 2003). As the work reviewed in the current special section suggests, adequately deseribing fam- ‘ly relationships has the potential to affect clinical practice by influencing the understanding ofthe basic psychopathol- ogy of mental disorders, highlighting factors influencing ‘maintenance and relapse of disorders, identifying sources of burden for family members, and helping better guide ‘amily-basod assessment and intervention. “Two types of family relationships appear to be of great ‘Steven R. H. Beach, Deparment of Psychology, Univesity of Georgia; Nadine 1. Kaslow, Grady Health System, Department of| Daychiaty and Behavior Seiences. Emory School of Medicine. ‘Correspondence concerning ths article should be addressed to steven RH, Beach, Institute for Bebavioral Research, 111 Barrow Hal, University of Georsia, Athens, GA 30602. E-mail: sbeach @ epon-psy.uga.eds 383 import. Intimate adult relationships (¢.g., Gallo etal, 2008; ‘Wamboldt & Wamboldt, 2000) and parenting relationships (e.g, Caspi etal, 2003: Caspi, Taylor, Moffitt, & Plomin, 2000; Liu etal, 1997) are quite powerful in their effects on psychopathology. This suggests that relationships in the family and events that occur in a family context may be panticulay relevant in understanding the development and ‘maintenance of psychopathology. The salience of family relationships and family events may arise because humans are “hard-wired” to respond to certain types of relationship fevents (Insel & Young, 2001; Young, Francis, & Insel. 2008), suggesting that they require special attention in the revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM), Practical considerations also dictate special attention to family relationships because family members are often the primary sources of support ‘and influence that are amenable to clinical intervention. In addition, mental health problems in one family member have a direct impact on the emotional well-being of other individuals im the family system. ‘Recognition of the interconnections between relationship context and outcomes of clinical interest has Jed to routine treatment of relationship difficules in inpatient and ouips- tient mental health settings, Indeed, the effects of relation- ships and relationship events are so central to every aspect ‘of psychopathology and psychological practice that it is hhard to imagine how any diagnostic system could deal adequately with Issues of impairment (see Whisman & Ubelaker, 2006), let alone etiology and treatment (see Da- vies e al, 2006; Hooley & Parker, 2006; Wamiboldt & Reiss, 2006), without substantial attention to the relation- ships that provide the primary context for the development, maintenance, and remediation of the disorders of intrest. ‘The current set of articles helps to illustrate recent eropirical progress in the study of relationships as related to psycho- logical symptoms and disorders and help to justify revisiting