Post Adoption Seminar Notes

Medical Information and the Referral

There are may resources for adoptive parents in terms of knowing all we can before we get our children. Accessing these is vital for us so that when we receive the referral we know what we are looking for and dealing with. There are many parts of international adoption that are not as glorious and storybook as we would like to see. The fact is that our children have been in an institution and this creates some issues that we would do best to consider carefully before we are faced with them in "real life".

The book, 'A Passage to the Heart' offers a fantastic collection of adoption stories and letters. Dr. Jenista said that if we read one book, this should be the one.

Another resource is the American Academy of Pediatrics. Dr. Jenista mentioned a provisional section on Adoption. She said the staff person to speak to is Eileen Casey at 1-800-433-9016 or http://www.aap.org  -- these resources could be used to help find a doctor that specializes in adoptive pediatrics.

The reasons that most people obtain a pre-adoption medical review are usually because either the paperwork is so obscure that it is unreadable or because the child has some special need that should be evaluated.

The reports that come from other countries should be looked at but should not ever be considered authoritative medical reports. For example, Chinese children are weighed with all of their many layers of clothes on. You simply can not depend of the records that have been sent to you. They may or may not be accurate.

It is still worth having your medical report looked at. A doctor that has seen many of them can sometimes have more insight into appropriate ways to interpret the data.

Dr. Jenista spent a great deal of time discussing the question of whether head size really matters. Yes it does, but there are many complicating issues involving environment, head size at birth, proportional size, etc.

The potential effect of home environment on adopted kids was also discussed. In essence, Dr. Jenista said the research indicates that the effect of environment on IQ was pretty modest within a normal range of environments but the effects in "markedly disadvantageous" situations was substantial.

The newest brain research indicates that IQ is really not just a genetic trait. Rather it is the result of interplay between genes and environment/experiences. Thus, while we may not be able to take a child who has the genetic predisposition to being an "average" learner and make them Einstein, we can significantly impact the possibility of our child reaching their fullest potential at what ever level that may be. Dr. Jenista indicated that thus far there seems to be a cross section of adoptive children that looks much like the "native" population. There have been a few kids identified as below the IQ line of 70 which is Mild Mentally Retarded. By the same token, some have been found above the 130 mark of giftedness. And the bulk seem to fall somewhere in between. (This portion is really summarized from my notes because I found it vastly interesting and though it was important to recognize that the possibility for any kind of kid is there with adoption just like birth)

In addition, the old research on IQ held that attachment and a secure relationship with a primary caregiver creates a favorable context for early development and learning. It used to be though that the brain was "hardwired" at birth, then 6 months, then a year, then three years...

Now the most recent research seems to indicate that the wiring is literally growing and developing through age 6. After age 6, our brains begin to figure out which synapses to eliminate and which to use. The research says that early interactions do not just influence but DIRECTLY affect the way our brains are wired.

Editorial comment: I thought that it was encouraging to hear that we can really influence the environment in such a way that perhaps synapses not formed earlier can be later. I would like to learn more since I don’t feel Dr. Jenista spent enough time on this, but it is interesting.

Dr. Jenista said that in her experience, citing research from her clinic and two others in the country, about 50% of families who sought a pre-adopt medical review refused the referral after the review. About 25% adopted the child regardless, about 25% later confirmed the foreign diagnosis, and about 25% had a new (most of the time related, but a bit off from the original) diagnosis made. This, however, included adoptions from all countries and special needs referrals as well.

Dr. Jenista’s conclusions were that medical records in referrals are often incomplete and difficult to assess. They can, however, provide valuable social and medical data. A pre-adoption consultation can provide some information based on the limited info received as well. A consultation may be helpful for families in assessing unknowns.

The last comment that Dr. Jenista said was this, Regardless of who your pediatrician is, regardless of whether they are an adoption specialist, every pediatrician has the….RED BOOK 2000 (or appropriate year)

This is the answer book for pediatricians. When you tell your Dr. your daughter needs thus and such latest and they say why, tell them to look in the Red Book. If you don’t like the doc answer, tell them to look in the Red Book. Ask what the Red Book says about that. RED BOOK. Critical.

Next installment… Medical evaluation AFTER you get home.

THERAPLAY ACTIVITIES BY DIMENSION

Activities are listed alphabetically under each dimension.  A few activities at the end of each list are especially suitable for use when parents enter the session or when more than one adult is present.  Depending on the way an activity is carried out, it may fit more than one dimension.  Other games enjoyed by young children also can be adapted and used in sessions.  In order to encourage give and take and extend the child's attention span, you can take turns with the child and vary the activity whenever possible.  We have not attempted to indicate the age level for activities since many activities can be used across a wide range of ages.  Activities for very young children must be within their physical ability and must make sense to them.  Simple activities can be adapted to make them more challenging or more interesting to older children.

STRUCTURE

Purpose:  To relieve the child of the burden of maintaining control of interactions.  The adult sets limits, defines body boundaries, keeps the child safe, and helps to complete sequences of activities.

Bean Bag Game:  Place beanbag or soft toy on your head, give a signal and drop the beanbag into the child's hands by tilting your head toward the child.   Take turns.

Cotton Ball Hockey:  Lie on the floor on your tummies (or sit with a pillow between you).  Blow cotton balls back and forth trying to get the cotton ball past your partner's defense.  You can increase the complexity by saying how many blows can be used can be used to get the ball across the pillow, or by both trying to blow at the same time to keep the ball in the middle.

Drawing Around Hands, Feet or Bodies:  Make a picture of the child's hands or foot by drawing it on a piece of paper.  Full body drawings require the child to lie still for some time and are therefore more challenging.  Be sure to maintain verbal contact with the child as you draw, for example, "I'm coming to your ankle.  I'm coming to the tickle spot under your arm."

Eye Signals:  Hold hands and stand facing each other.  Use eye signals to indicate direction and number of steps to take, for example, when you wink your left eye two times, both you and the child take two side steps to your left.  For older children, you can add signals for forward and backward movements as well (head back for backward, head forward for forward).  You can hold a balloon or a pillow between you by leaning close to each other as you move.

Measuring:  Measure the child's height, length of arms, legs, feet, hands and so forth.  Keep a record for later comparisons.  measure surprising things, such as the child's smile, the length of his ears, how high he can jump, and so forth.  Yu can use fruit tape for measuring, then tear off the length and feed it to the child.  "This is just the size of your smile."  You thus combine structure with nurture.

Patty-Cake:  Hold child's hands and lead her through "Patty-cake."  Patty cake, patty cake, baker's man/Bake me a cake as fast as you can/ Roll it and pat it and mark it with a (child's initial)/And toss it in the oven form (child's name) and me!  You can use feet as well.

Peanut Butter and Jelly:  Say "peanut butter" and have child say "jelly" in just the same way.  Repeat five to ten times varying loudness and intonation.

Pop the Bubble:  Blow a bubble and catch it on the wand.  Have child pop the bubble with a particular body part, for example, finger, toe, elbow, shoulder or ear.  This is a structured way of playing with bubbles.  Bubbles readily capture the interest of young children and can be used as an engaging activity either in this structured form or in a manner that invites more spontaneity (for example, by having the chiod pop all the bubbles as quickly as she can.)

Red Light, Green Light:  Ask child to do something, for example, run, jump, move arms.  Green light means go, red light means stop.

Stack of Hands:  Put your hand palm down in front of the child, guide child to put his hand on top.  Alternate hands to make a stack.  Take turns moving the hand on the bottom to the top.  You can also move top to bottom.  This can be made more complicated by going fast or in slow motion.  Lotioning hands first makes for a slippery, stack and adds an element of nurture.

Toilet-Paper-Bust-Out:  Wrap child's legs, arms, or whole body with toilet paper.  To let a hesitant child know what is in store, have her hold her arms together in front of her body and wrap them first.  On a signal, have child  break out of wrapping.

Three-Legged Walk:  Stand beside the child.  Tie your two adjacent legs together with a scarf or ribbon. With arms across one another's waist walk across the room.  You should be responsible for coordinating the movement.  For example, you can say "inside, outside" to indicate which foot to use.  You can add obstacles (pillows, chairs) to make this more challenging.

Weighing:  Weigh the child, using the a simple bathroom scale.  Stand in front of child.  Have the child make himself heavier by pulling up on your hands or lighter by by pushing down on your hands.  Depending on the size of the child, you may need to stoop down to make this work.

With two adults:

Follow the Leader Train:  All participants stand in form a line holding on to the waist of person in front of them.  The first person moves in a particular way and all others copy.  The leader goes to the back of the line and the new leader demonstrates a new way to move around the room.  This can be done sitting in a circle and moving only arms, heads, and shoulders.

Funny Ways to Cross the Room:  One adult and and child stand at one end of mat (or play space), other adult stands at other end of mat.  Second adult directs child to come toward her in a certain way, for example, hopping, tiptoeing, crawling or walking backward.  Child is greeted upon arrival, then called back to first adult in a specified way.  Adult and child can come across mat together if child cannot manage alone.  With older children each participant can come up with a funny way to cross the room that everyone must try, for example, crab walk, elephant walk or scooting.

More Theraplay notes to come...check back!

Special Thanks to Kelly for putting this page together.