ADOPTIONINSIGHTS

Diagnostic Challenges
When Things Don't Make Sense, But You Keep Hearing He's Fine

Toddlers often run for the swings when they visit the playground. Some enjoy the gentleness of being rocking through the air. Others love being pushed so high the swing hangs in the air for a second before heading back toward earth.

Of course, not every kid likes the same things, but for one 2 1/2-year-old Arlington boy it's not a matter of taste. Diagnosed with sensory integration dysfunction at 13 months, he has difficulty with what others experience as normal sensory stimulation noise and crowds, for example, are both stressful for him.

"The swing is scary for him, because he's not grounded," said his mom Virginia, who requested that her last name not be used to protect her son's anonymity. "He goes right to the slide."

Virginia and her husband suspected that something was amiss soon after their baby's arrival he spent the first 10 months of his life in a Russian orphanage.

"We knew he was very anxious, and something didn't seem right," she said. "But we were first-time parents, and we weren't sure."

Then a doctor expressed the same concerns. Virginia said it was "a relief to get the diagnosis. He really was an anxious guy. This way we had an action plan." After a full evaluation at 14 months, he began occupational therapy at 15 months.

"There was a profound change in him after just a few weeks of therapy," Virginia said. "It's the type of thing you're never really cured of, but you do your best to manage it ... We're not sure what we have ahead of us."

Finding the Right Path

Virginia feels fortunate to have found the appropriate resources for her little boy. But

it's not always easy to do, according to Dr. Lisa Albers, director of the Adoption Program at Children's Hospital in Boston.

"First you have to think about what's really going on here," she said. "There are a lot of things that can masquerade as an attention problem, for example ... First I want to know where a child is functioning cognitively."

To make that determination, she suggests evaluating the child's level of understanding and communication skills and considering possible medical, genetic or neurological causes for a child's challenges. Achievement and IQ tests, speech and language assessment, and neuropsychological evaluation can also be useful information gathering tools.

Often, Dr. Albers meets children between who have been in early intervention programs.

With occupational, physical, and speech and language therapy, they do well. But when they age out of the program as 3 year olds, issues may begin to surface. In preschool, some children will start to behave aggressively, have difficulty restraining their impulses and use behavior as a way to communicate.

"At that age, it's a real challenge to inhibit those impulses," she said. The parent has learn "the level at which the child can control those impulses and go from there."

For preschoolers, as well as school-aged children, the public school district may provide services if learning, emotional, or behavioral issues affect their ability to learn.

"I spend a lot of time helping families strategize how to get services, including school services, for their children," she said.

Listen to Intuition

A MetroWest mother uses a broad range of information sources Internet sites, other adoptive parents, early intervention, school services, the International Adoption Clinic at Tufts Medical Center to help her figure out what's going on with her 4-year-old daughter, adopted from Russia as a toddler. Impulsive and easily distracted, the child challenges her mother daily, but there has been no specific diagnosis.

Her mother, who preferred not to give her name, focuses on the positive. At the time of her adoption, the girl was half the usual height and weight of a child her age, but she caught up. She progressed well with early intervention services. At age 3, she began occupational therapy and improved her fine motor skills. Surgery corrected her crossed eyes, and she has adapted to her lack of depth perception.

Last winter, her mom was frustrated with her daughter's three to five tantrums a day and was advised to start sensory integration therapy. Of the 12 child psychologists recommended, none accepted her health insurance plan, so therapy was not an option.

Then something unexpected happened. "Things eased up," said the mom. Now her daughter is down to an average of three tantrums a week.

"You've got to recognize each child's time frame," she said, adding that her daughter had caught up in everything except social and emotional skills. "Maybe I just need to relax and let her work things out."

Suzanne Harrison, a Derry, N.H., consultant who works with families of challenging children, believes parents should follow their gut feelings about their children.

"You've got an innate sense about your kid," said Harrison. "You know if something's off, whether they have a stomach ache or they're feeling upset. It's the same with mental health issues. Parents know their kids. They know when something's not right, but sometimes they don't know where to turn. My bottom line is 'follow up.' "

Worcester Family's

Emotional Dilemmas

Life experience can be helpful, too, says Craig Van Batenburg of Worcester. He and his wife Deb adopted 5-year-old Michael in 1996, when they were both 44. They didn't expect it to be easy, and they didn't hesitate to seek out help.

"We're not lone rangers," he said.

After being removed from his birth mother due to neglect, Michael lived in several foster homes before coming to the Van Batenburgs with ADD, learning disabilities, and severe asthma.

"He didn't speak a lot," Craig said. "He was pretty pissed off, as you can imagine."

Along with seeking out services from the school department and the Department of Social Services, the family turned to the Attachment Institute of New England, in their hometown of Worcester, for therapy.

"Michael did develop the attachment necessary to work in a family," Craig said, adding that his son, now 15, does well in school, has developed a "terrific" social conscience, volunteers regularly, and speaks at adoption conferences.

"It took a long time for me to trust people when I moved in," Michael said. He still has vivid memories of leaving behind his stuffed animals, toy trucks, and pets when he went from one foster care placement to another. "Now I have everything I would ever want," he said.

Craig believes that the family's second adoption will ultimately be a success story, too. But the process has been much more difficult. The Van Batenburgs met their son, Will, in the fall of 2000, and welcomed him into their home shortly after. He was adopted in January 2003, just two

days before his 18th birthday. He had lived in group homes since age 6 and had two failed adoptions. After joining the Van Batenburg family, he dropped out of school, was arrested, joined a Job Corps, and spent time at a homeless shelter. But with cautious optimism, Craig reports that Will recently asked to begin therapy.

"We understand the value of deep psychological work," Craig said.

Harrison, the parenting consultant, recognizes that not everyone feels the same way as the Van Batenburgs about counseling.

"You can be diagnosed with leukemia and no one has a problem when you need time off from work to go to the doctor," she said. "With mental health issues, society has said, 'Oh, no. There's something different about that.' "

Harrison has worked hard to make sure her 14-year-old son, adopted at age 11, doesn't feel bad about getting the help he needs. A challenging child, he goes to regular counseling sessions not always willingly. When he balks at going, she tells him he can stop when he's all better. "It wouldn't be right for me to stop

sending him," she said. "Just like it wouldn't be right for me to give him candy if he were diabetic ... A child who has mental illness in whatever form needs help with it. They can't help it any more than someone who has diabetes or leukemia."

Marguerite Paolino is a Massachusettsbased freelance writer, who last year won a gold award for her three-part series on

adoption and the schools for Bay State Parent magazine.