[sak9645]

First off, remember that attachment disorders take many forms, and can range from very mild to very severe.

Severe attachment disorders -- the kinds where children fail to develop a conscience, fail to relate appropriately to parents, lie outrageously, manipulate people, throw the cat out the window, molest siblings, etc. -- are actually rare. We hear about them mainly because they are considered "newsworthy" by the media.

Children with these rare disorders often have to be placed in residential care, with 24 hour supervision, to prevent them from harming themselves or others, and therapy may or may not be successful. This is simply not the situation of most, or even many, children with attachment disorders, whether adopted or homegrown.

Many mild attachment disorders can be treated simply with love and time in a family. As an example, the child who has never experienced a lot of hugs and kisses may initially shrink away when a parent holds him/her tenderly, but will come to realize that hugs and kisses feel good and are a sign that the parent loves him/her. The child who has spent most of his babyhood in a crib, looking at the ceiling, may not know how to make eye contact, but the parent who plays mirror games with the child, feeds the child while looking at him/her, and so on, will soon be looking into the parent's eyes.

Children with moderate attachment disorders may need more than love and attention, but far less than residential placement. A good attachment therapist can work with both child and parent to promote attachment behaviors, and very good results can be expected in many cases. While it is true that moderately attachment disordered children can be very challenging to raise, and can tax a parent's emotional and financial resources, a lot of the children can go on to live productive lives and develop positive relationships.

Second, recognize that attachment disorders can occur in children of any age, but are most common in older children who have experienced multiple losses of parents or caregivers, or the sorts of abuse and neglect that teach them that adults cannot be trusted to protect and nurture them.

While you may see attachment disorders in homegrown children in loving families, or in families formed by newborn adoption -- we have a case in our family where an absolutely wonderful couple adopted a newborn, who grew up without a conscience and very manipulative, and later committed felonies involving defrauding people -- they are most likely to occur where bonds of trust between child and parent or caregiver are repeatedly broken or not allowed to develop.

The teen who spent her early life in a home with an alcoholic parent who beat her, and then was bounced around to six foster homes, is much more likely to have an attachment disorder than the 18 month old who was relinquished to an orphanage when her mother died, and adopted six months later by a loving family.

Third, remember that attachment disorder is often a convenient "catch-all" label for an adopted child who is experiencing emotional problems. Some children who are considered attachment disordered may actually have conditions such as clinical depression, bipolar disorder, ADHD, post traumatic stress syndrome, sensory issues, etc. They have been called attachment disordered mainly because they happened to be adopted. And they may fail to progress in therapy because the therapist employs a model of treatment that is suited to attachment disorder, but not to the condition they actually have, such as depression.

Attachment disorder may also coexist with other mental and emotional dysfunctions in a child. The issue may simply be one of resilience, in some children. Some children may endure years of abuse, neglect, and losses of caregivers, yet emerge reasonably healthy. Others may react to relatively mild stresses by becoming vulnerable to many physical and emotional problems. So it is not uncommon, for example, to find a child who has both attachment issues and depression. So it is often not clear, initially, when a child comes home and has behavioral issues, whether they result from the depression, the attachment disorder, or something else, such as drug or alcohol exposure prenatally.

And fourth, remember that Americans adopt over 20,000 children a year from overseas, and have been adopting internationally for decades. The vast majority of the children do extremely well, develop good relationships within their family, and go on to lead normal, productive lives. If they come home with some attachment issues, they are generally manageable by the average parent.

Go to any international adoption support group and, while you will certainly find parents talking about attachment disorders and other problems ranging from eczema to Hepatitis B to defiant behavior, you will also see dozens of parents with totally normal children. I went into adoption fairly well informed, and knew the risks, but I am blessed with the most healthy, balanced, attached, loving, intelligent child you can imagine.

Adopting does involve a leap of faith, and I will not delude you about that. There ARE risks, and they are very real. Besides attachment issues, one can wind up with a child with previously undiagnosed physical health problems, some of them severe. We have seen, for example, a number of children who turned out to have leukemia and other potentially life-threatening conditions. We may also not be able to recognize, on an early medical form, signs of worrisome conditions like fetal alcohol spectrum disorders, which can affect intellect and behavior significantly.

But as a Mom, I must tell you that, for me, adoption was a risk worth taking. My daughter has been home since 1997, and is now 13 years old. The challenges I face are those of any Mom of a teenager -- and the good news is that my daughter has always been extremely level-headed and reasonable, even in toddlerhood. I could not have become a Mom without the miracle of adoption, since I was 51, single, and minus my reproductive plumbing when I brought my daughter home. So I am very grateful that adoption is possible, and that China, my country of choice, entrusted me with a child.

Sharon