A Child Chosen - Perspectives of an Adoptive Parent

Post Traumatic Stress in Post Institutionalized Children

by Marcie on November 5th, 2007

Since adopting AJ we have been dealing with symptoms of Institutional Autism, something that the Autism community thinks is a quack theory but an illness and diagnosis that we know to be very real.

We know that AJ had a very traumatic life in the orphanage but we don’t know why. When we visited him he seemed happy, content, very excited to see us and comfortable with his caregivers, although they were rough with him. We do know that he spent almost 3 months in the hospital directly after birth before being transfered to the orphanage and that he had transfered orphanage rooms several times since his arrival. This, by itself could lead to trauma because of the consistency issues.

The American Psychiatric Association’s Diagnostic Manual of Mental Disorders (DSM-IV) for the diagnosis of PTSD is that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The person’s response to the event must involve intense fear, helplessness, or horror.”

Daniel Hughes, PhD, and author of Principles of Attachment says that the most common cause of PTSD is abuse and neglect. He calls neglect “the trauma of absence.” While many assume that abuse is far more traumatic than neglect, we now know that neglect is equally harmful. We also know that the combination of abuse and neglect can be shattering to a child’s psyche.

So could this be where AJ’s PTSD stems from? And is this where his Institutional Autism stems from? Is he so traumatized that he retreats?

The same article states that children resort to a fight or flight response but if they can’t flee they go internal. We see this often with AJ, especially if he gets in trouble. We often see his eyes glaze over and he retreats into his “autistic state”…using echolalia and a retreat and repeating nonsense words to escape from reality.

But, he also becomes hyperactive before bedtime because we know that that was a very scary time for him the orphanage. He avoids sleeping at all costs.

Interpersonal trauma (such as abandonment, neglect or abuse) is experienced as more severe than trauma of nonhuman origin (such as a car accident). In interpersonal trauma, the severity increases with the closeness of the relationship. Thus abandonment or violence inflicted by her mother would be experienced by a child as extremely devastating. Secondary adversities, such as displacement or relocation after the traumatic event add to the likelihood of developing PTSD. Therefore, an infant who has been abandoned by her birthparents, traumatized by a stay in an orphanage, and is then adopted by strangers is at exceptional risk for dissociation and chronic PTSD.

PTSD can also has an effect on the development on children, including delays in cognition, gross and fine motor, and language development. Children can relieve trauma in any number of way, though nightmares and sleep (AJ did this through night terrors every night for two years), through flashbacks, through imaginary play, through hyperarousal, (another one of AJ’s issues) or by shutting down (which AJ never does).

Treatment? Some suggest Holding Time but our attachment therapist said this was not something for sensory hypersensitive children and for adoptive children who don’t trust. They only time I hold is when he is not being safe (but that is another topic).

Eye Movement Desensitization Reprocessing helps people revisit trauma, reprocess and desensitize their memories, and resolve their feelings.

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