Thursday, August 9, 2007

Special Needs

There has been a lot of discussion in the China adoption community this summer about whether all adoptions are special needs. I agree that all China adoptions are special needs, with a wide variety of physical and emotional needs, from virtually nonexistent to major life altering ones. It's important to be prepared for possible special needs, just as birth parents need to be prepared.

Doodle was adopted when she was 7 months old. Until she came home, she spent her days at the orphanage and her nights with a family that clearly loved her. She came to me with a plastic heart necklace from the foster family and the ability to give wonderful wet sloppy kisses. Yet, despite adoption at a young age and the loving care that she received, she has both minor physical and emotional special needs.

First the physical: the back of her head is flat from spending too much time on her back, which led to two neurological assessments to find that the problem is purely cosmetic. She also required a brief stint of physical and speech therapy when she was 1-2 years old due to low muscle tone from her time in China; she responded very quickly to the therapy, and by the time she was 20 months old, no one would have known that she once had low muscle tone. (On the plus side, she remains highly flexible, probably due in part to the low muscle tone. ) Somewhat more seriously, she had to have six baby teeth capped because of a combination of poor prenatal care and molars with deep crevices in which food gets caught. She also had to get braces at age 8 because her teeth were severely overcrowding. She will have to have several adult teeth pulled so she won't have as many teeth as most people do. None of these are serious physical needs; they have simply required many appointments and some expense. Fortunately she is a model patient.

The emotional needs are somewhat harder to pinpoint. I usually look at all of my worrier's concerns through the adoption lens, to evaluate whether there is any link. Sometimes there is, and sometimes there isn't. I probably coddle both girls more than I would a biological child. I sit with/lie down with both girls until they fall asleep most nights. Doodle sometimes lack confidence, and I spend a lot of time building her up. It is simply her personality to be a worrywart perfectionist with somewhat low self esteem, but I also think that the stresses of having such a personality are compounded by the stresses of being adopted and a bit different than most of her best friends who are for the most part Caucasian children from two parent households. She has friends from families that look like ours, but they aren't at her school and as the kids have gotten older, they see each other less often because of scheduling conflicts. She is creative and is a talented musician, so I hope that this will give her both an area in which to shine and a way in which to release stress.

Despite being a special needs adoptee at nearly age 3, in some ways Tootle has fewer special needs than Doodle. Tootle's cleft lip and palate has translated into three surgeries in two years, with multiple additional ear tube surgeries expected until she is a teenager. The ear tube surgeries are pretty routine, but I did worry quite a bit about the palate surgery and the three weeks of liquid diet that followed. Tootle came through the surgery and the aftermath with incredible ease. She didn't mind the liquid diet and still occasionally asks for her hamburgers to be blended. She also goes to the craniofacial clinic for a day of appointments every six months. But other than that, she is very healthy and has only had one fever in two years. She did not qualify for speech therapy, despite being tested twice. No one has any trouble understanding her; she is very vocal about her needs and wants, as well as her opinions on virtually any subject. She is a strong kid in every way: she is off the charts in size, is a natural athlete, is a leader, and has a strong sense of self.

Tootle is one of the most emotionally healthy children I have ever known, despite being in an orphanage/foster care environment for almost three years and having some scarring on her face from the cleft lip. She was with the same foster family from the age of 8 months until adoption, and they took excellent care of her. She easily expresses her emotions and works out any troubles. Her stubborn/bossy/leader personality appears to have blessed her with great resiliency. A more fragile child would have been more traumatized by going from her foster family, back to the orphanage, and then to strangers who she had only seen in pictures, all within two weeks. Tootle grieved, but only briefly. Her strong sense of self will serve her well throughout life. Parenting Tootle involves making her understand that the things that I require her to do are for her own good/safety (in other words, taming her stubbornness), while keeping her big personality/spirit intact. I look at Tootle's issues through the adoption lens too, but at least currently, it doesn't seem to be as relevant for her.

My girls have many nonadopted friends who have had surgery too, or who lack self esteem, or who are learning disabled. If you apply enough spin, you can probably find a special need in virtually any child. But I think internationally adopted children must be "handled with care" so that their parents are always alert to their needs and can monitor possible adoption-related problems. Not to pat myself on the back, because I can be clueless too, but a less alert parent wouldn't have sought physical and speech therapy for low muscle tone quite as quickly or spent hours helping alleviate a worrier's stress. My girls are very special kids. I may spend more time than the average parent dealing with health and/or emotional issues, but I can't imagine my life without these precious girls.

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