Tuesday, June 19, 2012

Tuesday's Tears - Healthy & Unhealthy Attachment

I may or may not have once had a child who I was strongly concerned about going home.

My current placement is scheduled (well, that's putting it strongly since there is no set date) to start transitioning at the end of the month.  This may or may not be pure coincidence with my first statement.

This concern primarily rests for one child in particular.  The entire time this child was in my home he/she was significantly developmentally delayed.  At the doctor appt I had to take this child to, a hearing test was failed, which we hoped explained the reasons for the delays in speech and other forms of communication, including expressive language which consisted primarily of a raptor-like scream.  Only.  For everything.  So loud it's deafening - no joke.

At said doctor visit this child also failed the autism screening evaluation - which I filled out by answering a series of true/false statements.  The doctor was vary concerned.  I knew which ones were indicators as I filled it out - can't escape the educational background - so I knew as I completed it that he wasn't doing well.  I also was able to tell that the areas this child struggled in that may have indicated autistic behaviors were also caused by 3 known factors - poor hearing, severe neglect, and lack of ability to form healthy attachments since there was significant neglect with the birth parents for a year, then a first placement, then 3 months at our home by the time of the doctor visit.  There were no typical austism indicators, just a whole bunch of related indicators that, as I mentioned, were explained by the other factors of this child's experience.  As a result, the doctor and I (and the caseworker) agreed we'd work on the hearing problem, then see how much improvement the child was making with increased ECI therapy and consistent care in my home, and then revisit the concern about autism in a few months.

I was fully supportive of this plan and assumed getting the hearing fixed plus some additional time in my (consistent, structured, loving home) would help catch him up developmentally and put him on a better track for the future.  It also seemed like a great plan because at the time it appeared there would be 6 months or more in my home before any movement took place, if any did at all.

Fast forward 60 days and things had changed in many ways.  2 more months in our home indeed proved immensely helpful as much progress had occured on the developmental delayed.  A child who spoke no words and only shrieked was now saying 10 words or so, using more signs, and crying regularly at appropriate emotional moments (for that age).  A child who was violent and stand-offish with regular tantrums (and more shrieking), now threw appropriate tantrums, was learning to use his hands and feet with love, giving frequent cuddles, making great eye contact, and demonstrating his desire to be comforted by mie and his daddy.  He was smiling a lot more.  He still had some old behaviors and delays but was making great strides.

It became very clear to mie that the delays were primarily attachment and neglect related as opposed to having some other cause - like autism.  As bonding increased there was a direct correlation with developmental catching up (increased words, less shrieking, age-appropriate display of emotion and play, etc.).  This behavior was not present in visits - instead there was much aggression, fits, shrieking, and disassociation which was all exacerbated by a present sibling who was struggling with his/her own attachment related trauma needs and, therefore, was demanding all of the attention.  When caseworkers visited our home for the first time in a while they noted the difference between his behavior in visits and at our home.

We had not yet seen the doctor to work on the little one's hearing.  I really hoped that fixing the hearing challenges, probably through ear tubes, would give this little guy that extra push to rapidly propel him to catch-up developmentally and help him "complete" his healing process.

The dr appointment came and went with the conclusion that the hearing, though on the lower functioning side, was in the normal range and sufficient for language development.  A conclusion that specifically included a reference to attachment and psychological triggers for developmental delay.  A conclusion that confirmed my growing suspicion that this little one wasn't growing up "normally" due to attachment related trauma.  

This coincided with changes in the case plan so that reunification that was once uncertain and several months off was now imminent in a matter of a few short weeks.  Upon hearing that my child did NOT have a hearing problem I was devastated.  The degree to which his unhealthy attachment in the first year(s) of life had really harmed him, the only thing that could continue to heal was active therapeutic parenting in a stable, committed, home that could handle the child's crazy antics that were exacerbated by the sibling's manipulation and (unintentional) sabotage.  Except now this child was set to go home to a single parent with very minimal parenting skills who became overwhelmed at managing both children during a weekly 2 hour visit.  A parent who loved the children but clearly favored the other one - the one who demanded all of the attention in a more subtle yet destructive way.  A parent who didn't know how to effectively handle the aggression and shrieking and tantrums and bad stuff this child reverted to as default when she was around.  A parent to whom there was no bond and clearly with whom there was an unhealthy attachment.

All of this just as this child was learning to trust us as his primary caregivers.  And here we were - knowing that in a few short weeks we'd abandon him and place him with a virtual stranger with whom he'd demonstrated symptoms of a very unhealthy attachment.  

I did everything I could.  I worked with the play therapist to increase therapy for both children alone and together to help work on things.  I spoke to the doctors to see if there was anything else I could do.  I spoke to the caseworker to see if we could get a psychological evaluation with an emphasis on attachment for the kiddos and their mother and at the very least get them some targeted counseling or support to encourage bonding as the children began transition home.  I spoke to the mother about this child's needs.  I expressed (encouragingly) that it would be difficult but he'd need active parenting to help the bonding process and help him heal.  This parent insisted she would do everything it would take.  Then she insisted everything was fine before CPS to the children away and that she had it all together (parenting-wise) before he left, that there were no problems, and she could do it just fine.

And then I loved this child as fiercely as I could.  I prayed.  That's all I could do.

The story is never finished being written.  I pray this one in particular ends up well and we are able to have peace as we see it unfold.  

1 comment:

Anonymous said...

Oh Mie. I could have written so much of the story about this child's development -- this is eerily parallel to my son, Grover, and his early days with us. Until I became a parent to this child, I had never realized how much neglect and lack of attachment could look like autism.

I will say a prayer for your little one. What you have mentioned about this child's development are fears I have lived through with Grover. Ultimately he stayed with us, and has made leaps and bounds in two years. It sounds like you will not have the opportunity to help this child in that way, and I'm sorry. Clearly the two months have made a huge difference. I wish I had more encouragement to offer; I only have prayers and empathy.