If you did not read yesterday’s entry, do that first, before reading today’s followup.

The situation in a nutshell: An adopted Chinese girl, now 3.5 years of age, has a “reactive attachment disorder” that is commonly expressed by night terrors, parental rejection and an overlay of other cognitive problems. Every standard therapy has been tried, without much success. What can we say about the neurology of this situation as it applies to the child and to her primary caregivers that might be helpful for them?

  1. The parents should be hopeful. Their positive good spirits, and the consistent signals that arise from them, are going to be a key to overcoming this estrangement. The brain of this little girl is massively plastic. It CAN change positively, to slowly replace rejection with acceptance, to slowly free itself from its capture by ongoing stresses and anxiety, and to slowly recover its cognitive and expressive potential.
  2. Change requires a heavy schedule of repetition and learning. Understand that the child has a long distance to travel, from her present, reactive state of response and control, to normal strong bonding. REWARD EACH LITTLE STEP toward improvement. If the child makes a small step in a corrective direction each week, the difference in a year would be wonderful. Work for clear progress, week by week and month by month; this is not the realm of ‘miracle cures’.
  3. Be hypersensitive to those moments when the child herself REQUIRES your response. Be there, as much as possible, when it really matters to her. Again, it is not strictly a matter of how often you are helpful and loving. What matters more is that you respond to the child when she really asks for and needs it. No one said that making these judgments is easy. Try your hardest.
  4. The primary caregiver(s) should be with the child when she is in a rewarding situation as often as is possible. That includes those mundane activities like regular, predictable meals that the child can be expected to enjoy, play periods with other children at home or in a preschool environment — and special activities sure to be fun for the child, like a trip to a zoo or park or beach or fishing or boating or to the amusement park or mall. The goal is two-fold: a) The continuing development of a growing association of the care-giver with unequivocally rewarding outcomes (mom and/or dad = fun, rewards) ; and b) a rich schedule of positive, novel experiences, which contributes to the weakening of the impacts of self- and unintentionally-externally-generated stressful inputs on the ‘stress axis’ of the brain.
  5. The child came from a simpler, routinized environment where needs were met on a schedule. She came from a predictable environment in which the stresses were also right on schedule. You might reflect on all the little ways that you might help her feel safe and protected and secure in a home in which life is relatively organized and predictable, in which things happen on time, and in which distress is held to a minimum.
  6. Every parent (and especially every parent with a ‘difficult child’) knows that parenting is no walk in the park! Improving this situation is going to take a helluva lot of focus and effort on YOUR part. Believe me when I say that this kind of personal investment can pay off wonderfully, for all concerned. There are going to be lots of ups and downs in this journey. Work HARD at it. Persist.
  7. The cognitive deficits must be dealt with. This child is NOT going to live up to her academic or cognitive performance potential unless she gets some special help in this respect. I would think about enrolling her in intensive computer-based training ‘games’ like the Fast ForWord language exercises when she is 4 or 5 (i.e., when her attention span will sustain game play). Educational games and books, playing card or board games with her and reading to her are also valuable activities, if and when she’ll put up with them!
  8. Try to engage the child outside of home in ways that will promote her social skills development as it applies in the wider world of children and adults.
  9. “Loving” the child means that she becomes a part of You. Think of your daughter as a natural extension of You that will grow stronger as time passes. With any luck at all, you shall also be able to see that you are also becoming an increasingly stronger extension of Her, as time passes. Thinking of yourselves as growing parts of one another should help you begin to understand just a little better where she is coming from.

All such ‘advice’ is easy to deliver — but of course difficult to implement with an intractable child. As a parent with three grown daughters and three grand-daughters, with all of the pressures and complexities of a modern life, I understand that our obligation as parents is to do the best job of it that we can. Even while we try our hardest, every outcome is not perfect. In the same way, in a sense, our children — and certainly this little girl — are also doing the best that they can, given their history and their present circumstances. I wish you great good look, in meeting this difficult challenge. I hope very much that she can (literally, neurologically) grow into your ‘heart’ — and that you can grow into hers.

A final word: If you therapists out there have good advice for this grandmother and these parents, don’t hold back!