[MenloAve]

We are in the process of adopting a toddler that has been diagnosed with PTSD. Any experience with this? She doesn't have the RAD symptoms instead she just simply "disappears". When she is in stressful situations her little eyes go blank and her mouth has a stressed expression. Just a loud voice will do this to her. This is an international adoption and therefore I am going to need some recommendations on how to get her back to the US without totally stressing her out. She is onlly the size of a 2 year old so I was thinking of the carrying slings for toddlers vs a stroller when we are in busy places. That way she will know she is near us vs. by herself in a stroller. We gave her a doll that she has attached to and she reacts well to the "play acting" so we were going to act out the trip with the doll and props - like putting the doll on a car, then a train, then a plane. Then we can all pretend we are in the car, train, plane, etc. That way it won't be too strange when we do something she has never seen or done before. Our five year old son will also be with us and he is a trooper traveler and knows the ropes (he actually has elite status on the airlines - and loves night trains in Eastern Europe). I think I will make sure he plays some part in helping her as well when we get to where we are going - like on the train or the plane etc. That way she can see that he as a little person isn't that worried.

Any other ideas?

Thanks

[lucyjoy]

You might want to cross post this in the special needs section as it gets more traffic and lost of parents there are familiar with PTSD.

I would recommend attachment parenting as a toddler with PTSD has obviously experienced trauma and will likely have trouble trusting and attaching.

Finding a therapist familiar with international adoption and attachment would also be good. They work with the family to help the child build trust and eventually, deal with the trauma that led to the PTSD.

I think slinging/carrying her vs the stroller is a very good idea.

[MilehighDad]

I agree that the sling is a great idea.

If this is PTSD, the "disappearing" is called dissociation. It indicates that her consciousness is not really present and will also effect her memory. I've dealt with PTSD repeatedly, but have no experience with a child so young. It is a condition that creates very strange and difficult to comprehend situations and behaviors. You will have a very long and difficult road with her in the future, because it will take many years for her to overcome the responses.

Hopefully, her PTSD will engage in a way during the travel that will not make it hard to get her moved. Dissociation is a survival behavior, it is developed to get the conscious mind through experiences that are too stressful to cope with. As long as she is small enough to carry, if she dissociates it will be just like she is sleeping in the sling. When she starts to come around, just talk quietly and continuously to her and she'll recover to her normal self. If she's really scared by the conditions, she may just stay away, mentally, until you're in a place she considers safe.

I don't think that play-acting is going to help here. The things you are talking about are too far beyond her comprehension for imagination to be much help. What I would try to do, is find some activities you can do that keep her absorbed as much as possible. I'm not even talking about complex games, just simple stuff like singing the same song over and over or playing finger wrestling games. The more time you have to learn how to engage her before traveling, the better. Your son also may be able to help keep her distracted. Most of all, you are just going to be trying to convince her that what is going on is not that big of a deal. For example, close the blinds on the plane, don't point out the ground disappearing below it!

However, the travel could go very badly, because PTSD is a mental process that interrupts memory. The newer the memories, the more likely they are to be disrupted. Translation - you could be traveling with her, she gets stressed, and she could forget she has ever met you. You could be holding her in a sling, seemingly unconscious, and when she wakes up she would believe she was being held by a complete stranger. Terror would ensue, she would likely create quite a ruckus, then collapse back into dissociation. If this happens, it is likely that she won't recover until she's had a full night's sleep in conditions that are quiet enough for sleep and a reorganization of her memories. --- I warned you that PTSD is strange stuff. But, as I said, hopefully the trip will not unfold that way. If it does, you'll still get through it and she won't remember how traumatic it was. I just want you to be prepared for the worst.

Long term, remember that PTSD is triggered by fear. It's likely you won't ever be able to yell at her to get her to do the dishes. Yelling will probably be counter-productive in all situations. And, I agree with Lucy's comments that you will need a lot of help, support and training. Start now.

Good luck. I am also sure that she deserves someone to love her unconditionally. Watching her bloom in the years to come may make other parts of your life seem almost meaningless.

[MenloAve]

Wow, very helpful info. I didn't realize that the memory dissapeared during that time as well. Most of the info I've read about adoption is the aggressive behavior vs dissapearing. I was wondering if there was anything we would normally do with our son that might not be a good idea here - like looking out the window of the plane. We have already met with a pediatrician that will help us with specialists when we get back- so we can make sure we don't accidently make the problem worse. Are there any good books to read? I have read two and they don't seem to address this issue.

The first three days we were with her we saw it happen at least three times. Typically short time-frames. We just talked calmly to her and told her she was okay. Then you would see her little eyes start to sparkle again. She didn't seem to be upset when she came out of it - but maybe it was because she was still in the environment that she knew. We'll have 4-6 weeks together as a family before we attempt the trip back so hopefully that will help. I read to keep a journal so that you might be able to identify the causes. It seemed that loud voices and when she was unsure of what she was supposed to do seemed to provoke these "attacks".

We aren't really the yelling type or even time-out type of family. Since we have younger kids, we use calming count-down, consistent rules, thinking times, and incentives that provide some choice in chores yet instill a sense of team (family pride) and accountability.

I do hope that we can help her put some of this behind her. She is a little sweetie that seems to love to play, laugh, and learn new things.

[momraine]

Even though you will have a long time there with her before the trip home, save out a few new toys that you don't let her see till the trip home. That way you can occupy her and she may not be as aware of the strangeness of what is going on around her. Also some of her favorite snacks may help. Learn a few endearments in her native language and some soothing words. Remember that during that long trip home she will be exposed to new smells, sights and sounds and probably new languages all around. It will be scary. Even a little DVD player with headphones may help. If you can find one that is region free, you can buy some children's dvd's in her country or you can do Cartoons that don't use a lot of talking.

[MilehighDad]

I would keep going through the trip in your head as you get to know her and see what things you can identify that will be different, and therefore scary, and work on them if you can. For instance, has she ever been in a public restroom? If not, if you send her into a stall and close the door, she may just "check out" in there and never come out. But, if you have 4 to 6 weeks you can find somewhere to give her that experience first. Along those lines, get permission to take her for a day trip within the country and take a rail trip to the next city and back. Then, on your big trip a plane may not be all that different than the train was.

I think it is awesome that you have had a chance to meet her and are so committed to helping her and making it work. Her symptoms sound a bit different than what I'm used to, but PTSD is complex and covers a whole range of trauma-based effects. It sounds like she is on the more mild side of the spectrum so I doubt that she has acquired the ability to delete weeks worth of her memory. The biggest difference is that it sounds like she was sitting up and eyes open while dissociated. Often, it appears more like unconsciousness, with the body slack and eyes closed.

Also, it is really great that you will have so much time with her before the trip. You will know her and know what works and doesn't work with her. I think with preparation your trip will go just fine.

[UnconventionalMom]

My niece dissociates but in response to being around certain people and not so much to events or sounds. In my readings since my niece has come to live with us I'm seeing a lot of lines blurred between AD and PTSD and I'm not so convinced that in a child as young as your daughter and my niece that there's much difference. Trauma during the first few years of life is going to have an effect regardless of the acronym attached.

I'd consider looking up developmental therapists in your area, maybe even contact someone before your trip and ask for some ideas on how to help your new daughter cope. You'll never be able to plan the whole thing out, but you'd be surprised at what comes back to you in the heat of the moment!

Best of luck and please keep us updated.

[MenloAve]

Will do and thank you all for the advice and information.

Very interesting about AD. She focuses and stays on task really well for a three year old. I didn't get a sense that this was difficult for her. If you didn't know what was going on though, maybe you would think she was just spacing out, when instead she was really scared.

We're just waiting for our date to go now. Hopefully we will know by next week.

[Boulderbabe]

Just a quick question.....are you sure she's not epileptic? The "disappearing" you're talking about is also symptomatic of petit mal seizures. You may want to have her evaluated by a neurologist once you're home and settled.

[RavenSong]

Originally Posted by Boulderbabe

Just a quick question.....are you sure she's not epileptic? The "disappearing" you're talking about is also symptomatic of petit mal seizures. You may want to have her evaluated by a neurologist once you're home and settled.

The same thing also happens in partial complex seizure disorder, also known as temporal lobe epilepsy (TLE). This type of epilepsy is very common among children who have sustained any type of head trauma -- it doesn't even have to be considered a serious injury.

One thing I'd like to add to the discussion on dissociation is that sometimes a person who is in a dissociative state will not have the blank appearance that we so often see with this type of altered consciousness. Instead, they'll carry on with activities and even conversations, and the people around them won't be aware that they've dissociated. This happens in cases of dissociative identity disorder, formerly known as multiple personality disorder, which can happen in extreme cases of child abuse. When the individual "switches" back, he or she will have no recall of what happened during the dissociative episode.

[MenloAve]

They did test her for epilepsy when she was littler and ruled it out. But it is something we should probably follow up on. Thank you for bringing it back up.

[MenloAve]

We are here and have about six more weeks before traveling back. We have been n here for a week and a half. The first week was really easy and she was in great spirits. Then she caught a cold, which turned into a fever, and started throwing up. Needless to say, she got scared and we have started to see what I would liken to a few panic attacks and then few dissociating episodes. In a few cases we have been able to see the panic attacks coming and help her calm down prior to the actual panic attack. To calm her down at this point holding, rocking, and singing works.

The dissociation seems to be harder to see coming and just happens. She seems to have her eyes open and her face freezes a bit. As someone mentioned she is still talking and interacting but at a much different level. We seem able to walk her through these and keep her held so that when she comes out we get a real smile and she is ready to move on. The panic attacks are much more to get her through because she seems to want to get to the lowest point she can find and if possible get herself covered. For example, if you are holding her she wants to turn upside down so that her head is down. She doesn't really fight you if you let her get into a "covered" spot. She hums quietly to herself. She is obviously scared and looking for cover. Eventually she will answer yes to wanting a doll or toy, or you singing to her, and then to being held and she will move into your lap. Then in a bit she will tell you she is safe and good and we get her real little smile.

We have noticed that she changes the vowel in yes and no when she is in an attack or coming out of a disasociated state. Once she is really back or calmed down the vowel in yes and no goes back to normal. In addition, we just saw the two types of episodes combined into one.

We are here for six more weeks before we can get her back and evaluated and find some help so I'm wondering if anyone has ideas on how to help her through these until then. Is there anything important not to do?

We haven't been able to find anything consistent about what is triggering the attacks. But we are still looking.

Thanks

[Mkuhlmann06]

my thought would be to post this over in special needs forum... there's a lot more traffic and someone may be able to provide some insight. Unfortunately I don't have any advice to offer, except to keep doing what you are doing. Take notes, maybe other areas will start to form triggers or patterns. Keep a journal about before an episode, during and after. Keep doing activities that help with bonding/attaching. Good luck and keep us posted!

[Rhubarb]

My LittleGirl has similar dissociative responses to fear (also DXed with PTSD). Although I have learned to predict and avoid certain obvious triggers, even after 2 years, I learn new ones when I least expect it, and not all situations can be avoided. One time, she accidentally stepped on my toe, and I yelped - not yelling or angry with her; just a sharp noise came out. She collapsed to the floor in a heap, and did not return for 1/2 hour. In these situations, I have learned to just hold her close and rock her, humming of speaking softly and soothingly.

Now, episodes are quite rare, and I can recognize the approaching signs, and often divert the response. Distraction helps, and even making a joke of the situation (I don't think I'd try that in your situation now, but perhaps down the road?)

For your trip, might a hooded sweatshirt help? She could easily pull up the hood to lessen sensory overload. Although learning and avoiding her triggers is a good goal, I think I would count on "damage control" techniques for the flight.

[UnconventionalMom]

I don't have any advice but just wanted to say good luck and I'll be thinking about you! You're doing a very amazing thing!