How would you feel if you adopted a baby, and when he starts misbehaving everybody tells you it is your fault?

By Carmen Pinto

”This is how Lucas’ parents felt, when everybody around them said his behaviour was due to an attachment disorder: they had been unable to get him to attach to them!

I met Lucas when he was 15 and his adoptive parents were at the end of their tether. Lucas shouted and then damaged property, he threw things on a daily basis. He was easily irritated by anything, would lie, was cruel to animals and fascinated with knives. He stole money from his parents, and showed no remorse. He soiled himself, and did not care if he smelled. At school, he had similar problems.

In our assessment, we found a couple that had tried their best, and who were puzzled at what had gone wrong. They seemed to be using the standard parenting techniques one would expect to work with most children, and gave him a lot of love and affection. So, what went wrong and when?

We started by trying to understand what had happened in Lucas’ life, even before he was born. We learnt that his birth parents had mental health problems, and were aggressive-his father had even been in prison. Both of them took drugs, and birth mother took heroin during pregnancy. When Lucas was born, he was withdrawing from this drug and had to be taken into the incubator for a month. After that, he was discharged into foster care, where he spent the first ten months of his life, until he was adopted. This description gave us hints about what could have happened in Lucas’ neurodevelopment and what heritable risks he carried.

The months he spent in foster care, Lucas was very restless and irritable, and very hard to take care of. When he arrived to his adoptive parents, they noticed the same behaviours, and as he was growing up, he would be hurting children in nursery, soiling and smearing his poo, making mum sing the same song fifty times every night, and not liking to be touched.

His parents took him to CAMHS and he was diagnosed with "attachment disorder" because he was adopted. At 5 he was given intensive individual psychotherapy for five years, playing with a therapist while his parents just waited outside. Nothing changed at home, and his parents kept on blaming themselves.

Because Lucas was adopted, nobody had considered neurodevelopmental conditions, as some professionals still believe that all the problems in adopted and fostered children are related to the fact that they are adopted or fostered. They are not considered individuals, with multiple biological strengths and vulnerabilities, with positive and negative social experiences that make them stronger or weaker, different resiliencies and psychological processes that protect them or make them more vulnerable to different experiences that happen to them-and all of us- in life. It is a “one size fits all”.

Adopted and fostered children are individuals, and are not all "traumatised" children with "attachment problems", and you can read the whole story here...”

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Article details

Looked after and adopted children: applying the latest science to complex biopsychosocial formulations
Carmen Pinto
First Published September 26, 2019 Research Article
DOI: 10.1177/0308575919856173
Adoption & Fostering

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Carmen Pinto

Carmen is a Consultant Child and Adolescent Psychiatrist in the National Adoption and Fostering Clinic and National Conduct Problems Service at the Maudsley Hospital. Carmen has been working with Looked After and Adopted Children since she became a consultant in 2005. She has an attachment research background and is passionate about using evidence-base interventions in these group of children. Her other interests include Cognitive Behavioural Therapy, neurodevelopmental disorders in these vulnerable children and developing personalised formulations for complex cases.