(CNN) — People who displayed behavioral problems as teenagers were likely to develop mental or personal problems in adulthood, according to a new study published in the British Medical Journal.

The study looked at more than 3,500 people , beginning in the teen years and following them for 40 years. The data came from a national survey of health and development from the Medical Research Council, an organization in the United Kingdom.

Teachers assessed these individuals at age 13 and 15, comparing them with their peers with respect to a number of behaviors. Problematic behaviors included disobedience, lying, lack of punctuality, restlessness, truancy, daydreaming in class and poor response to discipline.

“This research suggests that adolescent conduct problems are indicative of more serious problems in creating and maintaining positive social relationships, and this has a long-term effect on the young adult’s ability to maintain good mental health, stable employment, and a happy family life,” said Ian Colman, assistant professor at the University of Alberta’s School of Public Health and lead author of the study.

The authors were surprised that even adolescents with milder behavioral problems had poor outcomes in adulthood, Colman said.

More than 1,000 adolescents in this study who had moderate, but not severe, conduct problems were more likely to leave school early or be involved in teenage pregnancy, and later in life had increased likelihood of divorce, alcohol abuse, and overall life adversity, he said. These people would probably not get a diagnosis of conduct disorder according to modern criteria, he said.

One caveat is that teachers assessed their students in 1959 and 1961, meaning they may have used slightly different criteria for the problem behaviors from what would be used today, Colman said.

While there are few studies tracking behavior over such a long period of time, a large body of research has arrived at the similar conclusion that problems that emerge in adolescence are risk factors for mental disorders, such as alcoholism, in adulthood.

These results do not necessarily mean that adolescent behavioral problems cause complications later in life, experts say. But the correlation may be due to underlying factors, such as mental illness or a negative environment that do not change over time, said Dr. Martin Iguchi, professor at the University of California-Los Angeles School of Public Health, who was not involved with the study.

“Being born in poverty, many continue in poverty. Having a mental illness that goes undiagnosed, untreated — it’s not surprising that it might continue chronically,” Iguchi said.

One might think that people would learn to stop these behaviors and, “as we grow up, and we don’t like to do certain things, or we lie because we’re trying to get out of doing other things, [we] would come into natural consequences during adolescence which would force us to change our behavior,” said Vaughn Rickert, professor at Columbia University’s Mailman School of Public Health, who was not involved with the study.

But the period from age 14 to 26 is when people are at the greatest risk for psychiatric disease, he said. On the whole, the results of the study are not surprising, he said.

“Certainly there is a relationship between how you behave in adolescence, and as it’s left uncorrected and unchecked by your environment, you’re going to continue to engage in those behaviors because those behaviors get reinforced,” he said.

As for interventions, experts called for greater investment in resources for children and adolescents with behavioral problems. Iguchi noted that many of the existing resources for adolescents are being cut because of budget concerns.

“We don’t even have guidance counselors in schools anymore, and those would be the least expensive of the various options,” he said.

According to Anna Glendenning of the Adoptive Parents Network, the stages of adoption have certain developmental milestones, however most people don’t understand what these milestones are and sometimes expectations are too high for an adopted child. Below is a list of some of the stages of adoption developmental milestones and how they relate to an adopted child’s unique concept of self:

Birth through the Toddler Years

• Normal Life Issues:  Basic trust, attachment to primary caretaker.
• Adoptee issues:  Basic trust, attachment despite primary losses.
• Positive Parenting Responses:  Provide high levels of nurturing, consistency and security.

Pre-School Years (Ages 2 ½ to 5)

• Normal Life Issues: Developing Independence, and competence in the family.
• Adoptee issues: Questioning age, “Why was I adopted?” and “Where did I come from?”
• Positive Parenting Responses:  Provide truthful answers and have an open attitude with your child about the truth.

Early Grade School Age (Ages 6-10)

• Normal Life Issues: Begin to see themselves as a part of a peer group. Mastering skills and feeling competent.
• Adoptee issues: Questioning of the primary loss, an overall sense of being different some child her have issues over the primary rejection.
• Positive Parenting Responses: Parents provide information and help children deal with feelings of rejections.
• Development of open lines of communication is vital at this age.

Pre-Adolescence (Ages 8-12)

• Normal Life Issues: Bodies chance and peer relationships become very important.
• Adoptee issues: Adopted children often have questions about their birth family at this age and wonder about how they may appear or have similar talents as their birth family.
• Positive Parenting Responses:  This is one of the most important times for parents to share any information or pictures of the birth family with their child.  Answer any questions with concrete information. This is the age where grieving and self-esteem issues are most difficult for adopted children.

Early Adolescence (Ages 12-15)

• Normal Life Issues: Children tend to focus on peer groups more then family. This is when children typically develop their sexual identity.
• Adoptee issues: Adopted children may want to learn as much as possible about their birth family during this period. Many adopted children engage in a great deal of abstract thinking during their early adolescence.
• Positive Parenting Responses: Parents can best support their children by giving expressed permission to the child to think about their birth family.

Later Adolescence: (Ages 16-21)

• Normal Life Issues: Children are developing their own identity and planning for their futures. During this age, peers are much more important then family.
• Adoptee issues: This is the age where critical thinking becomes more developed and adopted children may consider search and reunion with their birth family.
• Positive Parenting Responses: Even if it is difficult this is the time when adoptive parents need to be supportive and help the adopted child find information to assist in their search.

Developing healthy attachment behavior

• Parent must be attuned to their child’s needs in order to create and develop healthy attachment
• Create joy, elation, interest, and excitement together with your child
• Parents should maximize opportunity for positive emotions and minimize opportunity for negative emotions
• Reciprocal behaviors between child and adult
• Respectful eye contact, body language
• Respectful verbal language
• Calming, soothing, nurturing responses
• Physical proximity and touching while respecting boundaries
• Careful, deliberate listening
• Accepting limits – boundaries
• Interventions for consideration
• Attachment Parenting

Interventions

Attachment Parenting
Attachment Parenting International publishes educational and research articles related to attachment parenting. In their Eight principles of attachment parenting, they offer a guide for areas that are key to the optimal development of children.

Eight principles of attachment parenting

• Preparation for Pregnancy, Birth and Parenting
• Feed with Love and Respect
• Respond with Sensitivity
• Use Nurturing Touch
• Engage in Nighttime Parenting
• Provide Consistent Loving Care
• Practice Positive Discipline
• Strive for Balance in Personal and Family Life

Support Groups
Attachment Parenting International is a resource for parents wanting to connect with other parents around attachment parenting techniques and ideas and support during difficult times for parents and child(ren),

Family Therapy
Family therapists are able to explore the connections between what happened in past generations and what is happening now in the family. Family therapists can help to determine if what happened in the past is happening now and whether or not that is helpful in moving forward towards healthy family relationships.

Understanding how an adoptive child’s development differs from that of a biological child’s is key in understanding any cognitive and/or emotional issues that may arise.   Temper expectations while arming yourself with the information needed to help process difficult questions around identity that may come up.  Review the above-mentioned interventions and see which ones you you might pursue.  As always, we are here to help and answer any questions you may have about attachment parenting and adopted children.

Adopting a child or becoming a foster parent can be an emotionally rewarding experience for parents.  However this experience can be marred with failed expectations and a lack of historical and in depth information around the child and birth parents.  This information is critical to helping parents understand the cognitive, emotional and physical needs of their children. And, what was to be a rewarding experience is now wrought with a search for answers on how to close the gap between parent and child.

Slowly, as parents enter into the journey of bonding with their children, they may begin to see the signs of a child exhibiting the signs of insecure attachment.  This can often be a frustrating process as the expectations of a child who is to be happy and grateful for a clean home with loving parents, just didn’t quite materialize in the way it was suppose to in the minds of many parents.  So the question becomes, how do new foster and adoptive parents create secure attachments with their children?

Enter attachment parenting of foster and adopted children.

What Is Attachment And Why Is It Important?

Building a secure attachment between parent and child is key to the pair developing a healthy and emotionally secure relationship.  Early attachment styles determine how children will relate to the world around them. Foster/adopted children often struggle with this as they have been removed from their primary caregivers at an early age.  In some cases, the primary care givers may have been present but the emotional bond needed to build a secure attachment was not.  According to Attachment Parenting, this often times results in a child who may exhibit the following attachment styles:

1) Secure- these infants actively explore, they get upset when their mother leaves, are happy upon reunion and seek physical contact with their mother. Mothers of secure babies are typically loving and responsive to their infant, quick to pick them up when they cried, hold them longer and “with more apparent pleasure.”

2) Insecure-ambivalent (anxious/resistant): these infants stays close to their mothers, there is limited exploration, they become very distressed upon separation and ambivalent toward their mother upon reunion but remain near her. Mothers of anxious babies were observed to be “more mean-spirited to merely cool, from chaotic to pleasantly incompetent. Though well meaning, these mothers have difficulty responding to their babies “in a loving, attuned, consistent way.”

3) Insecure-avoidant: these infants show little distress when separated, ignore their mother’s attempts to interact, are often sociable with strangers or may ignore them as they ignore their mother. These mothers often have an aversion to physical contact themselves and speak sarcastically to their babies.

4) Insecure-disorganized/disoriented: these infants are the most distressed upon separation and are considered the most insecure. They seem confused upon reunion and exhibit behaviors that appear to be a combination of resistant and avoidant.

Debra Wesselmann gives us the following ingredients for a secure attachment:

Physical

• Consistent touch and eye contact
• Cradling and cuddling an infant before bedtime
• Hugging a teenager periodically to increase the sense of a physical connection

Emotional

• Build an emotional connection by becoming attuned with your child’s feelings.  Children can sense their parents’ level of emotional attunement based on how they respond in different situations
• Empathize with feelings of disappointment or insecurity in order to build a secure emotional connection.  This reassures the child that they are loved and accepted in good and bad times.
• Execute discipline in a manner that is consistent and empathetic as this can increase the emotional connection between parent and child.

Consistent Environment

• Provide a safe, consistent and predictable environment
• Even during times when behaviors are out of control, children need to know that parents and/or guardians will be steady and calm
• This may include: a consistent schedule, consistent limits and consistent parental responses.

Without these ingredients, children build emotional walls which may prevent secure emotional attachments to parents and/or primary caregivers.  It is also important to also assess your own attachment style as a parent which can often give some insight into the attachment issues with a foster/adopted child.  Often, parents don’t realize that their own attachment styles are indicative of whether or not their children will in turn attach in a healthy manner.

Individual and/or family therapy is also an option which gives parent and child a chance to come together and face the issues they are experiencing with each other head on.  An astute family therapist with experience in dealing with attachment issues can bridge the chasm and help put these issues in perspective.

Many adopted and foster children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiving relationship. Such a history can lead to the development of Complex Trauma (Cook et. al., 2003; Cook et. al., 2005), disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems (Gauthier, Stollak, Messe, & Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These children are likely to develop Reactive Attachment Disorder (Greenberg, 1999; Lyons-Ruth & Jacobvitz, 1999).

Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990). Many of these children are violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and as adults are at risk of developing a variety of psychological problems (Schreiber & Lyddon, 1998) and personality disorders, including antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman, 2000), narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder (Dozier, Stovall, & Albus, 1999). Therapeutic Parenting is often necessary to help these children heal (Becker-Weidman, A., & Shell, D., 2005/2008). This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation.

Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:

• Sensitivity
• Responsiveness
• Following the child’s lead
• The sharing of congruent intersubjective experiences
• Creating a sense of safety and security

The effective implementation of these principles requires parents who:
• Are strongly committed to the child.
• Have well developed reflective abilities
• Have good insightfulness
• Have a relatively secure state of mind with respect to attachment

This type of parenting is consistent with Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for children with trauma and attachment disorders (Becker-Weidman & Hughes, 2008). Many foster and adoptive parents find their children’s behaviors strange, frightening, disturbing, and upsetting. They often don’t understand why their child behaves as the child does; “after all, my child is now safe, doesn’t he get it?” It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.

Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child’s behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to “anyone” for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive. By understanding what is driving the behavior and appreciating the child’s fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stop…they may change into other problems, but if the underlying cause remains, then the problems will surface again and again.

Let’s discuss the principles required. These principles are more fully elaborated elsewhere (Becker-Weidman & Shell, 2005; Becker-Weidman, 2007)

SENSITIVITY. Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child’s level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.

RESPONSIVENESS. Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child’s need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.

FOLLOWING THE CHILD’S LEAD. By this I mean that the parent will need to respond to the child and follow the child’s lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child’s pace. It is very important to move at the child’s pace to create the necessary sense of safety and security that these children need.

THE SHARING OF CONGRUENT INTERSUBJECTIVE EXPERIENCES. Intersubjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.). Or another example, when talking about the death of the child’s loved grandparent, you both may share the same emotions (grief), both are recalling memories of the grandparent (shared intention and attention). It is the sharing of congruent intersubjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.

CREATING A SENSE OF SAFETY AND SECURITY. Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.
Unless the child feels safe, exploration is not possible.

So, what sort of parent is needed? We know form extensive research, that one of the best predictors of placement stability is the parent’s commitment to the child (Dozier, Grasso, Lindhiem, & Lewis, 2007). Therefore, building or rebuilding parental commitment is an important first step. Unless there is strong commitment, the child cannot feel safe and, as discussed above, safety is the most important first step in helping a hurt child heal.

Reflective capacity is also vital to placement stability and to the healing of adopted and foster children. The parent must be able to reflect on the child’s underlying emotions, how the past may be re-enacted in the present, and what in the parent’s own past is being triggered by the child. A well developed reflective function is necessary if the parent is to respond to the child in a healthy and healing manner. We all have buttons. The job of the therapeutic parent is to understand one’s buttons so that these can be disconnected so that when pushed, nothing happens.

Insightfulness (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001; Oppenheim, & Koren-Karie, 2002; Oppenheim, Goldsmith, & Koren-Karie, 2005) is related to reflective capacity.

A parent’s state of mind with respect to attachment is the best predictor of the child’s. (Main, & Cassidy, 1988; Main, & Hesse, 1990). If the parent has a Secure state of mind with respect to attachment, then the adopted or foster child is more likely to develop a healthy and secure pattern of attachment and heal (Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008). We know that when young children are placed in a foster home, the child will begin to develop a pattern of attachment that is the same as the foster parent’s state of mind with respect to attachment (Dozier, Stovall, Albus, & Bates, 2001). Obviously, in older children, this is a more difficult task. In the general population, about 60% of the adults have a secure state of mind with respect to attachment. For parents who have an insecure state of mind with respect to attachment, they can still learn to parent effectively with help (Becker-Weidman, A., & Shell, D., 2005/2008; Bick & Dozier, 2008).

Arthur Becker-Weidman, Ph.D.
Center For Family Development
Reposted from: International Adoption Articles Directory

USEFUL RESOURCES FOR PARENTS
1. Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
2. Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.
3. Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.
4. Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .
5. Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.