Therapist’s Quick Guide to Working with Children Who are Newly Adopted

adoptionI am an adoptive mother of a beautiful, goofy girl from China.

I am also a pediatric occupational therapist.

Before experiencing adoption personally, I would have said that I was competent as an occupational therapist at working with children who were adopted.

  • I knew the developmental concerns related to adoption, for example the potential sensory, motor, language, feeding, social, and emotional concerns.
  • I knew the effects of sensory deprivation and inconsistent caregivers has on development.
  • I knew how to engage children that had a hard time trusting adults.

While I knew all the facts, risk factors, and possible interventions, I didn’t really understand how to best work with families during their adoption journey.

After my experience as an adoptive parent of a child who needs therapy services, I felt I could share some important knowledge and my perspective to other speech, occupational, and physical therapists who are working with children who are newly adopted.

I know many therapists are short on time. Here is a one page summary for physical, occupational, and speech therapists.  I encourage families to print this off and share with their therapists!

Top 5 things that adoptive families need their OT/PT/ST to understand

1. We are still getting to know our new child.  It is really hard to face all the questionnaires and interviews about your adopted child’s history when all you can answer is “I don’t know.”  We desperately wish we knew all our child’s history, but in reality we are just getting to know what foods, toys, and TV shows our new child likes.  We worry about what our child’s past held and feel like we have to prepare for all the possibilities (trauma, abuse, malnutrition, or maybe a loving care-giver), but we often just don’t know.

  • How can you help?  Reassure us that it is okay that we don’t know.  Be patient and help us in the process of getting to know our new child.  Use assessment tools that don’t rely on knowing a full history (for example, filling out a sensory assessment or development check list can be really difficult).China Social Welfare Institute

child going through tunnel slide2. We want our child to like you, but not too much.  We are focused on learning to be a family.  We need your help, but please respect our boundaries and roles as a parent.  Please play with our child, give high-fives or fist bumps, but leave the snuggling, hugging, and bonding to us.  Many adoptive children continue to “parent-shop,” even after being with their new families for a significant time.  On the other hand, if our child trusts you, be respectful of that relationship and know it means a lot to our child (please don’t disappear or switch therapists on us!).

  • How can you help?  Having a consistent therapist is critical for the relationship with the family and child.  Ask us what our concerns are and how you can help respect our boundaries.  Invite us to stay and participate in the therapy sessions.

3. We trust you and value your opinion, but our priorities might not be the same.  You are a professional who has expertise that we need to help our child.  Adoptive families usually limit who interacts with their child when newly home, so know that if we are choosing to come to therapy, it is because we trust and value your services.  However, we have a different perspective given our child’s unique story, and we know what is best for our child.  We know that all the developmental goals you propose are important, but those goals may not be the top of our priority list.  We are working on showing our child that they are safe, loved, and in their forever-family.  Sometimes learning to self-feed, walk up and down stairs, or following one-step directions may have to wait.  However, some issues should be addressed right away, such as a positioning need that will lead to further damage, severe sensory seeking that needs to be managed, or an oral motor need that is preventing adequate nutrition.  Adoptive parents didn’t have the chance to figure out all the little things as our children grew-up, instead it was all thrown at us at once.  We want everything possible for our new child, but first we just want to be a family.

  • How can you help?  It can be hard for us to speak up, so please ask us and give us the chance to tell you what we know is best for our child (for example, ask us how we interpret our child’s behavior or whether it is okay to hug our child).  Give us information and ideas, but also give us permission to wait on some things.  If you see something that needs to be immediately addressed, please tell us and help us meet those needs.  We often have a very long list of things to address, but no idea which ones are critical.

adopted child4. Use a team approach, but keep it simple.  Many children who are adopted have multiple medical and developmental needs and would benefit from the expertise of many professionals (OT, PT, ST, etc). We want all the resources and help that is available, but sometimes it is too much for children newly home.

  • How can you help?  Focus on a team approach.  Can a child see just one therapist for awhile, while others are consulting as needed?  Can team members discuss needs to prioritize and create a single home program together?

5. Our lives at home may be chaos.  Bringing home a newly adopted child of any age is similar to bringing home a newborn. It can be emotionally and physically exhausting.  Our days are filled with sleep issues, feeding issues, and constant supervision and care of our new child.  We are trying to give as much time and attention as we can to our new child, which means that many other things in life get put on the back burner.  Be really considerate when asking a parent to do homework for therapy.  Sometimes it needs to be done, but make an extra effort to find ways to make it practical.

  • How can you help?  Ask what our daily life looks like; ask if we are able to do any activities at home (the answer may be “no”).  Some children are ready to work on developmental needs, other are not.  Find out if your therapy plan can fit within the activities we are already enjoying at home.  

Things that can help when working with children newly home in therapy sessions (or within the first year or two):

  • Keep it simple, children are still absorbing all the new things (language, culture, people)child8park
  • Reduce sensory stimulation
  • Be playful and fun, reduce demands and stress
  • Create familiar routines and use simple structures
  • Limit the number of people interacting with the child
  • Include parents in everything you do– let them be the cheerleader, comforter, and playmate whenever possiblechild4park.  Ask a parent for advice, such as what their child’s atypical behavior might mean.  Ask permission if you are unsure before attempting new tasks, demands, or interactions.
  • Assume a child will act much younger than they are, allow this regression and work with it.  Don’t rush a child to “act their age.”
  • Assume a child will have attachment issues, read up on attachment and adoption to be well educated on this topic.  Most children will have some issues, but they can be subtle.  Assuming a child will have issues gives the framework to best help them, and if they don’t have issues, you will have done no harm.
  • Discuss appropriate consequences and discipline with parents, typical technique may not work (or may be harmful) to children who are adopted 

The basics of attachment for therapist:

  • When children are newly adopted, most families place attachment as a priority.  Attachment is a process that takes time (and for some children takes a long time), and this process is critical to a child’s trust of his or her family and long-term mental health.
    • mother and childWhat is attachment?  It is a bond between two people (that has a physiological component in neural development).  For most children, it develops between an infant and a primary caregiver.  For adoptive children, this natural process is often disrupted.  Adoptive families need to re-create this experience through daily interactions that allow attachment to develop.  The goal is to develop secure attachment (where the child trusts a caregiver and can feel safe both with and without the caregiver present).  Attachment is a process with skills that need time to develop.  A child first has to feel secure and safe with a new caregiver and family, then learn to explore his or her world from this secure foundation.
  • Most families take time when first home to “cocoon,” meaning they limit contact with others, keeping close to home and focusing on their new child.  This can last weeks or a year.  If attachment is a struggle, families will often return to “cocooning” at home.  During this phase, many parents want to be the only adult who provides for their child’s basic needs (feeding, dressing and diaper, etc) and who provides the majority of the positive social interactions (hugs, kisses, snuggling, comforting when hurt).
    • During this phase, most families will allow and encourage their child to regress and will focus on having the parents meet all their child’s needs to build attachment.  This may mean bottle-feeding and rocking a toddler to sleep, co-sleeping with a preschooler, or dressing and feeding a school-age child.  Dependence on parents is a key part of attachment.  Having age-appropriate behavior is not a goal until attachment needs have been met.

I would encourage any therapist who may work with children who are adopted (or children in foster care, or children with any history of trauma) to spend an hour or two online looking at resources on adoption and attachment.  Here are some high-quality resources:

Paige Hays is an occupational therapist who provides in-home, pediatric occupational therapy services in the south metro area of the Twin Cities, MN. She is a mother of 2 girls, avid DIYer, and a highly skilled and experienced OT. She specializes in working in pediatrics, with diverse expertise ranging from cognition and sensory issues to working with children with neuromuscular disabilities or complex medical needs.