by Harriet McCarthy

There is a crisis of epidemic proportion within the International Adoption Community. It has the potential to compromise the health and well-being of many adoptive families. Known as Post Adoptive Depression or PAD, it affects over 65 percent of adopting mothers according to a recent survey by the Eastern European Adoption Coalition (EEAC), yet goes unacknowledged or unrecognized by agencies, social workers, and most of the medical community.

Post Delivery Depression, long recognized as an expected part of normal pregnancy and delivery is an issue that is openly discussed and well understood by the medical community and the public. Estimates vary, but between fifty to eighty percent of mothers who have given birth will experience the mildest form of PDD called "The Baby Blues" according to Depression After Delivery, Inc. Of those, approximately ten percent will suffer a more serious form of Postpartum Depression which is of longer duration and has more symptoms. The cause of both these manifestations is attributed to hormone changes and imbalances. Families, physicians, and caretakers are alert for symptoms and offer unconditional support to new mothers during this usually brief crisis.

The public and medical attitudes toward PDD are a far cry from the silence and secrecy that surround a much more pervasive problem - Post Adoption Depression Syndrome (PADS) which is a term coined by June Bond in her Spring 1995 article for Roots and Wings Magazine. For those of us who are part of the International Adoption Community, in particular parents of orphanage children, we have the added complication of adopting children who are almost always older than newborns and have been in an institutional setting. In many cases, our new children are toddlers to school-aged, and their histories and language issues add an extra dimension to the possibility of their new adoptive mothers developing PADS.

Over the past seven years, I have been intimately connected to the international adoption community as adoptive mother to three older Russian boys, as a member of the Eastern European Adoption Coalition (EEAC), as Co-Owner and moderator for the Parent Education and Preparedness List at eeadopt.org, and as founder and Co-Chair of Piedmont Families Through International Adoption. Post Adoption Depression has been a recurrent and persistent issue in all my support experience. In the Fall of 1999, with the help of the EEAC which made our questionnaire available on-line, I launched a survey to see just how prevalent an issue PADS really is. The results were troubling. Our survey was accessible by members of the AParentRuss-List and the PEP-List whose combined membership now tops 3,100. Non-sufferers of Post Adoption Depression were especially encouraged to answer the survey. Of the 145 parents who responded, over 65% said they experienced Post Adoption Depression, yet only 8 people reported they had been advised by their social workers or agencies that this syndrome even existed. Preparation by those agencies would have been helpful, according to 61% of all respondents, sufferers and non-sufferers.

Why does PADS exist among the adoption community in such high numbers? There are a host of very concrete and understandable reasons. Most newly adoptive parents have spent literally years struggling to get to the point of having a child to parent. Their protracted and unfulfilled hopes, dreams, and longing may cause unrealistic expectations about exactly what it will be like to be a parent, and they are unprepared for the grief they feel when reality confronts the child of their imaginations. New parents may feel guilty about their feelings of ambivalence, resentment, or anger toward their new child. The belief in instant bonding or "love at first sight" is often an unrealistic one. Falling in love with a child is much like falling in love with a future mate -initial infatuation and euphoria give way to the lengthy and often difficult process of adjusting to the day to day presence of another human being. It often takes from two to six months for a real sense of attachment to blossom according to many of the posts of families who belong to EEAC. Being unprepared and unsupported, new adoptive mothers who become depressed often try to "tough it out" without asking for any help whatsoever. Many mothers worry that if they advise their agency or social worker (the ones they have spent months or years convincing of their superior parenting skills) that they are experiencing difficulty, those same agencies and social workers will think of them as unfit parents and, in the worst case scenario, remove the new child from their care. Consequently, a bad situation becomes worse because of lack of understanding and support. First line extended family support available to new birth mothers (and fathers) is often totally missing for adoptive parents. In many cases, after enduring years of disappointment with infertility, family members don't understand why the new mother isn't completely happy and content now that she finally has what she's wanted for so long. Rather than disappoint and confound her family, many new adoptive moms simply suffer in silence, filled with shame and guilt, feeling themselves imperfect or selfish.

Our survey didn't ask for gender specifics from our respondents, but we assume that most of the questionnaires were from women. An unknown but very important issue is Post Adoptive Depression in new fathers. Stress plays a major role in what we suppose to be an equally prevalent issue. New adoptive fathers are usually the ones to return to work sooner, and they have the added issue of juggling job and new fatherhood simultaneously.

While all of the above issues pertain to all adoptive parenting, our international community has additional components which load the deck. In almost no case are we adopting newborns. Among other things, we deal with grief over the loss of unknown histories and missed bonding opportunities. We see our children for a very brief time before the adoption is finalized and we often "discover" disturbing surprises about our children's backgrounds after the fact. Our older children come equipped with distinct personalities, some of which meld smoothly into our families, others of which are a jarring and daily reminder of our differences. We adopt children who have experienced an almost unimaginable amount of loss. We adopt children who have suffered the effects of institutionalism, hospitalism, and global neglect. We often adopt children with hidden academic, emotional, neurological and medical needs. Frequently, newly adopted children attach themselves to only one of the two parents, leaving the other parent saddened and disappointed. Add to all that the stress of out-of-country travel, jet lag, communication difficulties with our older kids and foreign country hosts, sleep depravation, and cultural shock. Our decks come loaded with the potential for frustration, powerlessness, and worry - a perfect prescription for the onset of depression.

When I reviewed the data concerning the length of time adoptive parents suffered from PAD, a very disturbing picture emerged. While most post delivery "Baby Blues" are of very short duration (less than two weeks), 77% of survey participants with PAD reported that they suffered their symptoms from two months to over one year with 45% suffering for six months or more. 85% of sufferers reported that their depression affected their health in some way (serious weight gain/loss was followed by sleep disturbances and headaches), 70% felt that PADS had interfered with smooth transitions and bonding with their new children. Clearly, Post Adoption Depression is a significant, multi-faceted issue that needs to be acknowledged, better understood, and unconditionally counseled and supported by the entire adoption community!

How To Weather The Storm

Knowing that the probability of having PADS is significant will give you a chance to prepare in the event that you are among the majority who suffer with this syndrome. Preparation might include discussing the possibility with your primary care provider as well as your child's future pediatrician. Make sure your agency is aware of the PADS and that they understand the dynamics and prevalence of this issue. They should be prepared to support your need to locate help and/or services should you need them. If you have previously suffered from depression in your life, you are at greater risk. Make sure your mental health care provider is standing by in the event that you need support with medication and counseling. Alert and educate your family and spouse. Explain that you may all need extra emotional support the same way new birth families do.

Dr. Bill and Martha Sears, The Baby Book lists several excellent suggestions for the Postpartum family which are equally relevant to Postadoptive families. When you finally arrive home from your international trip with your new child(ren), make sure that you have sufficient "nesting" time. Without guilt, hold visitors at bay for a few weeks. The exception to this rule would be the one designated family member or close friend who can provide domestic help and support in order to give time for the new nuclear family to learn about each other and start the bonding process. Before you travel, investigate your company's adoption benefits and maternity leave policy. Take the maximum allowable time before trying to go back to work. Be sure to get plenty of sleep and exercise. Fresh air and a brisk walk do wonders to mitigate mild depression. Taking a child for a walk is one of life's greatest inexpensive pleasures - fun for you, fun for your child, good for bonding. If you are single or if your spouse is unavailable to provide child care while you rest, arrange for a sitter who can come in while you nap, run errands, or simply take care of personal grooming.

New competence as a parent often means a deterioration of competence in other areas of your life. Don't allow yourself to feel guilty about less than perfect housework or a reluctance to cook your usual gourmet fare. Plan to put most of your life "on hold" while you settle in those first several weeks. If you know letting things go might drive you mad with anxiety, have alternate plans in place for others to take over for you with housework or chores. Have a store of good frozen foods on hand to help with meal preparation.

If you are married, one of the most profound changes that comes with parenting is the change in your relationship with your spouse. Prepare for that change and mitigate the negative impact by setting aside some special times for the two of you to be together without the new child. This is a vital part of successful parenting - important to both of you, but also important in the message it sends to your child. Your strong, dependable relationship with one another is one of the greatest gifts you provide to your new child. If you are fortunate enough to have a secure and happy marriage prior to adoption, spend the effort it takes to nurture and sustain it.

Preparation for PADS is the key to surviving it and shortening its duration. Accept the fact that adoption carries some risk. Expect surprises, frustrations, and setbacks with your new child as part of international adoption. Celebrate if there are none! Before your child comes home, take as many parenting classes as you can. Expect to be a therapeutic parent. Bonding and attachment are slow processes. Learn to be patient and give yourself and your child the one-on-one time required for attachment and bonding to grow. Your adoption journey doesn't stop the day you bring your child home. That day is really only a beginning. Plan for the continuation of your pre-adoption emotional roller coaster ride for at least the first year. If you have adopted a severely challenged child, plan on riding for two years! Reach out for help. Be honest with your social worker and agency. If you are having difficulties, tell them! You might be pleasantly surprised at how helpful they can be, but they can't help you if they don't know you're suffering. Join a support group such as those available at https://EEADOPT.ORG, or locally. There are literally thousands of people ready to help and lend support. Provide private time for yourself, your spouse, and your other children. Keep stimulation, social, and work pressures to a minimum for as long as you can. Ask your extended family and friends for understanding and support. Accept your limitations and don't be afraid to fail. We learn by making mistakes. If your adoption situation proves particular difficult, remember to tell yourself everyday that tomorrow will be better, because it probably will be.

Most of all, know that what you are feeling is a normal response to stress, that you are not alone, and that there is help for this difficult phase of your adoption experience

Symptoms of Depression

Diagnostic Criteria From DSM-IV

Five or more symptoms in a two week period.

1. Depressed mood most of the day, everyday (feeling sad, empty, or tearful) or feeling exceptionally irritable.
2. Markedly diminished interest or pleasure in all or almost all activities.
3. Significant weight loss or weight gain, increase or decrease in appetite.
4. Insomnia or hypersomnia nearly every day.
5. Psycho motor agitation or retardation nearly every day observable by others
   (restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness nearly every day.
9. Suicidal thoughts or ideation.