Letters to the Editor
A Romanian Adoptee’s Journey From Latency Age to Adolescence
Dear Editor:
Studies on attachment and prenatal environment demonstrate difficulty with attachment and physical and neurocognitive functioning in children who suffered significant early adversity (1). The plight of children in Romanian orphanages became known following the fall of the CeauÕescu regime in 1989. Some of these children were adopted into Canadian families (2), and as they reach adolescence, some are presenting with psychiatric morbidity consistent with research findings (3).
I report a case wherein the developmental challenges of adolescence brought to the fore the effects of disrupted attachment without cognitive damage that had no harbinger in the patient’s latency years.
Case Report
Jane, aged 15 years, was adopted at age 2 years by a Canadian family. Prior to adoption, she had lived for 8 months in a Romanian orphanage. At her initial introduction to the family, Jane was seen to be overfriendly (that is, she showed indiscriminant approach behaviour). She adapted rapidly to her new home in Canada. Upon starting school, she coped well socially and academically.
Jane’s first contact with child psychiatry was at age 11 years and was initiated by her adoptive mother as a proactive consultation prior to taking her to Romania to meet her biological mother. Her adoptive mother wanted to ensure that this meeting would not have a detrimental effect on Jane’s psychological well-being. Jane was seen after she returned from the visit and appeared to be coping very well. No evidence of any psychiatric disorder was observed. Her adoptive mother was noted to be a warm and caring woman who provided well for Jane’s needs.
At age 14 years, Jane presented in crisis to the emergency room after having expressed homicidal thoughts toward a younger sibling. The imminent arrival of a fourth adoptee into the home was noted to be a precipitant. While obviously distressed by these thoughts, Jane was adamant that she was capable of carrying them out and stated that she had similar thoughts toward a teacher. Her family’s assurances of their commitment to her and reminders about the implications of such threats had no effect. Jane stated that she would happily move to a different family.
This led to hospitalization for crisis intervention and stabilization. Cognitive assessment showed average intelligence. Attachment problems, together with early neglect and deprivation, were considered etiologic factors in a diagnosis of undersocialized aggressive conduct disorder. Difficulties in Jane’s attachment patterns were noted. She received no other psychiatric diagnosis. She was charged for her threats and remanded to a youth facility for a period of 1 month. The family was very reluctant to have her return home. Family therapy was offered to address problems within the family. This was difficult, because they felt they had successfully assimilated their children and saw Jane’s behaviours as a problem limited to her alone.
The developmental tasks of adolescence, including the bid for autonomy and identity formation with the ambivalent need for security, serve as additional stressors for the insecurely attached and can disrupt a tenuous attachment. In Jane’s case, a nurturing and consistent environment had contained and provided security during her latency age, but it was unable to contain the adolescent thwarted by yet another younger child needing to share in her mother’s affections. This could have caused feelings of abandonment to emerge, together with escalating attention seeking alternating with hostile rejection of the family. The family felt bewildered by the changes in this girl, and it required an expert family therapist to help them come to terms with the limitations imposed on her by early experiences.
References
1. O’Connor TG, Marvin RS, Rutter M, Olrick JT, Britner PA, and the English and Romanian Adoptees Study Team. Child–parent attachment following early institutional deprivation. Dev Psychopathol 2003;15(1):19–38.
2. Chisholm K. A three-year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Dev 1998;69:1092–106.
3. O’Connor TG, Rutter M. Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up. English and Romanian Adoptees Study Team. J Am Acad Child Adolesc Psychiatry 2000;39:703–12.
Renee Fitzpatrick, MD, MRCPsych, FRCPC
Kingston, Ontario
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