[korit]

My husband and I are adopting a 14 month old girl out of foster care. She has been in our home since age 11 months. Since she was placed with us, she has bouts of uncontrollable screaming and rage. These fits can last for 2 hours straight. It is a blood-curling scream that makes your heart race. At first, these fits were always for no apparent reason. She could be playing, and then start screaming and crying out of the blue. More recently, the screaming is sometimes triggered by not getting her way, and often triggered when she finishes a bottle or her food. She can gorge herself on food and sucks down a bottle in no time flat. Other times, she has a fit for no apparent reason. Sometimes she will stop if you pick her up, but only for a little while. She doesn't smile often but has a beautiful smile. She is often clingy, although wants to get up and down on your lap every 20 seconds.

Her history is that she was prenatally exposed to drugs (crank, cocaine, marijuana) and alcohol on a regular basis. She has an atrial septal defect (hole in her heart) but is asymptomatic. Her birth mother was described as developmentally delayed, but no known history of mental heath diagnosis. Our daughter is within normal ranges developmentally. Birth father completely unknown. She has been in one relative foster home since birth, but there was likely some neglect in that home, as CPS found out later that the home had their foster license revoked by the state previously.

My daughter's symptoms seem like neglect (severe?), possibly also attachment disorder? I have worked in the foster care system for years and haven't seen this screaming behavior before at this age. What is this? What type of treatment should we be using at home? I have demanded that our adoption agency make us an appointment with an attachment specialist.

[lucyjoy]

I assume you had her medically checked for ear infections and discussed food with the pediatrician? If that's bben done, I would purchase one of those front snuggly carriers and attach her to me. When she's on the floor crawling, I'd be on the floor.
The attachment specialist should be able to direct you after that.

[Dr. Art]

First, be sure the therapist you have selected is a real expert.
1. Is the person a licensed mental health provider?
2. Is over 1/2 of the practice with adopted and foster children?
3. Has the person had substantial training in attachment related issues; post graduate, at a recognized attachment center?
4. Is the person a member of Assoc for the Treatment and Training in the Attachment of Children ? or can they meet the standards for a Registered Clinician...they should at least meet those standards.

You may also want to have her evaluated by a developmental pediatrician for neurological issues related to prenatal exposure to alcohol/drugs...
You may also want an evaluation by an OT who is SIPT certified to assess for sensory-integration issues as those may be a factor here.

regards,