Terms and Definitions
Post-Adoption Stress – A set of events that occur after a child’s placement that triggers feelings that can include anxiety and feeling overwhelmed. If the stress is not alleviated it can develop into depression.
Post-Adoption Depression – A mood disorder that can occur either before or after the adoption is finalized. It is a sub-type of depression and can be classified as mild, moderate or severe. For some individuals the depression may be episodic in which some event or ongoing situation may trigger the return of their symptoms.
Why does Post-Adoption Depression Happen?
While depression after adoption shares many of the risk factors and characteristics with postpartum depression, some characteristics and risk factors are unique to adoption. Infertility is a common factor among adoptive families. Infertility comes with feelings of grief and loss. If this issue is not dealt with before placement of a child, then the mother is at a high risk for developing depression after the placement. Depression is more common in women but it is also seen in men, and it can appear shortly after a child is placed or up to a few years after the placement. A higher risk of developing post-adoption depression exists if one of the parents has a personal or family history of depression. Because post-adoption depression is not part of the “mainstream” types of depression, professionals often misunderstand or under-diagnose it, so the parent may not receive any treatment.
The Parents’ Expectations of Themselves
After going through the adoption process – attending all the classes and reading all the books – parents go into adoption feeling they are well prepared for whatever may happen in the future. Adoptive parents frequently have unrealistic expectations of what life will be like after a child is placed in their home. Some of these experiences may lead the parent to becoming depressed:
- The long road to becoming parents. Adoption takes time, usually years, and much of that time is spent waiting. For those adopting infants and internationally, adoption may also cost a lot of money. For those adopting through the foster care system, the many hours of training may lead them to believe they are prepared to handle any situation they will encounter in raising a child. Even if subconsciously, some adoptive parents expect the child to be grateful for what the parents went through and what they have to offer him or her. When the child isn’t grateful, the parents may feel some resentment. What many adoptive parents do not understand is that it is impossible for them to predict how they will feel or react after a child is placed in their home because a positive relationship with their child is about more than attachment and bonding.
- Infertility. For adoptive parents infertility is more than dealing with grief and loss. These parents are also dealing with the loss of their ability to produce a child. Frequently adults keep infertility a secret from everyone except a few intimate friends and relatives. Many prospective parents who are dealing with infertility believed they had addressed that issue before they decided to adopt only to find infertility continued to be a part of their life after a child was placed with them. If the loss of the dream of giving birth to a child is not completely dealt with before adopting, it can lead to post-adoption depression.
- Adoption process. People going through the adoption process feel they must make their entire life an open book for others to read and judge their suitability to become parents. Whether or not prospective parents get a placement is a decision that is ultimately made by others; they only get to decide if they want to be considered for a certain child.
- Feeling like a fraud. Many adoptive parents expected to feel like “real” parents once a child was placed in their home. What some discover is they love their child but don’t feel they are the parents; instead they are only pretending to be parents. Depending on their relationship with the child, this can be a temporary adjustment or it can continue for years.
- The birth mother and entitlement. Some adoptive parents struggle with conflicting emotions about the birth mother. They are grateful to the birth parents – or to the caseworker – for placing the child in their home and allowing them to parent, but they don’t feel they are entitled to parent the child. Entitlement deals with adoptive parents feeling they are given the privilege and responsibility of parenting a child. They may want the birth parent to be a part of their child’s life but then struggle with wondering if the birth parent regrets their decision to place the child or feels the right parents weren’t selected for their child. Adoptive parents’ joy over a child may be tempered by their guilt over the birth parent’s loss. For the adoptive mother the knowledge that the birth mother was able to do something – give life to her child – that she could not will always be with her.
- Immediate attachment to the child. Even if adoptive parents say they understand it will take time for a child to attach to them or for them to feel attached to the child, emotionally they expect it to happen immediately.
- Lifestyle changes. Bringing a child into a home changes the dynamics of a family. Even if other children are in the family, everyone’s relationships and behaviors will change due to the adjustment of another person in the home. Adults may have expectations or dreams for the new child they keep secret, but those dreams still influence the parent’s perspective.
- Control. Adoptive parents feel their training has provided them with skills they will need to handle any situation. What parents expected to happen when their child arrives and what does happen can be a reality check in how much impact their child will have on their lives in the future. While the uncertainty of a child’s reaction may have been stressed in the pre-adoptive trainings, it is hard to prepare for the loss of control.
Parents’ Expectations of Others
- Reactions of family and friends. Depending on the type of adoption, friends and family members may view the adoptive parents as really fortunate to receive a healthy infant or as saints for taking an older child and dealing with the behaviors. To the adoptive parents, reality may mean they were selfish because they adopted in order to be parents. They may feel the child is with them instead of his or her birth parents because of their own need to be parents.
- Adoptive parents expected their friends and family to provide the emotional support they needed. For some parents the support they needed was more than others were prepared for or capable of providing. When an adoptive parent talks about not feeling attached to their infant child, others may not understand that dynamic and think the parent has no right to complain. Friends and families may not understand why the adoptive parents are dealing with the behaviors of a child adopted out of foster care when they could just send the child back since the child isn’t grateful for being adopted. Parents who adopted infants may have the least support from friends and family because everyone may assume there are no issues or doubts about parenting the “perfect” child. An adoptive parent may not feel they can express their thoughts freely without being judged as ungrateful for the gift they were given. Support dwindles when others start to view the parent as complaining or when the child’s behavior becomes troubling. At this point the adopted parent finds they aren’t dealing with things how they imagined they would, and their friends aren’t as supportive as they promised. Depending on the situation, the parents may start to feel they are all alone, or they are embarrassed by their child’s behavior and start to isolate themselves from the rest of the community.
- Society’s view. Adoptive parents may feel society is judging them and finding them lacking. They become even more withdrawn and are afraid to voice to their thoughts. Living a life of secrets can start the downward spiral of going into post-adoption depression.
What Does Post-Adoption Depression Look Like – Emotional Symptoms
Like any type of depression, the emotional symptoms can range from mild to being severe. On the severe side, a parent can become suicidal or feel very lost and hopeless about the future because he or she doesn’t feel any love for the child and is “just a mother.”
On the mild to moderate range, the adoptive parent may struggle to make decisions, even simple things like what kind of vegetable to serve becomes difficult. At times the adoptive parent may break down and cry because she can’t make a decision or for a reason she can’t verbalize. The parent may feel guilty because she can’t justify her behavior. She thinks she should feel happy and grateful for having the child she always wanted. Feeling judged by others, the parent becomes more isolated.
What Does Post-Adoption Depression Look Like – Physical Symptoms
The adoptive parent may have trouble sleeping. In severe situations the parent may not even be able to get out of bed and take care of their child and then will feel guilty over their lack of care. With the lack of sleep comes fatigue that can be severe enough that the parent can’t take care of herself let alone her child. Frequently, the parent can be in physical pain; migraine headaches may develop. With all of this happening, the parent’s appetite can change. For some parents it’s a need to eat constantly for comfort while for others it is a lost of appetite.
All of these symptoms may be triggered by a child being placed in the home, but they are about more than the physical presence of the child. The parent who can’t get out of bed during the day still won’t get out of bed if the child is in daycare all day.
Dealing with Post-Adoption Depression
Workers can help families understand that some degree of post-adoption depression is a normal response to the stress associated with the placement of a child. Coping strategies that have proved to be effective in helping adoptive parents deal with post-adoption depression include:
- The first step for a parent dealing with depression is to see a doctor, get a thorough exam and have that tough discussion about their own thoughts and feelings. The doctor may decide medications will help.
- Recognize that post-adoption depression is common and several reasons are valid for feeling down after a child is placed. This does not mean a parent made a bad decision or is different from many other new parents.
- Birth mothers experience very similar moods and emotions and a sense of grief and loss over placement of their child. Adoptive parents should recognize the birth mother made a positive plan for herself and her child, and they are an integral part of that plan. Adoptive parents can do some things to support the birth mother and in turn help themselves, such as making a photo album or writing a letter expressing their appreciation. The adoptive parents need to accept that the birth mother’s grief is a natural part of the healing process.
- Being anxiety ridden about certain legal risks and unresolved or unexpected issues can be a major source of stress. Adoptive parents are aware certain risks are inherent with adoption. When discussing those risks during the preparation phase, prospective parents usually think they will be able to handle them when they arise only to discover it is a lot harder than they had imagined.
- Most hospitals offer infant parenting seminars along with their birthing classes. Adoptive parents of infants can also attend these seminars. For those parents interested in adopting an older child, information about parenting techniques is usually part of family preparation. Added confidence can relieve some of the adoptive parents’ feelings of anxiety and inadequacy about properly caring for their child.
- Many adoptive couples feel they must be super parents. Since they didn’t give birth to their child, they don’t always understand or consider the importance of taking enough time off work and regular activities to help their family adjust and to begin the bonding process.
- Adoptive parents benefit from sharing feelings that admittedly they would rather not share. Typically, they believe they should always feel grateful for having their child. Adoption support groups are safe places to talk honestly about feelings and problems.
Post-adoption depression impacts the entire family. Seeing a parent not able to be themselves is scary to children because parents are supposed to take care of them. Many children assume it is their fault. For children with a history of multiple moves, they start to assume they will have to move again and start withdrawing emotionally to protect themselves.
For most parents suffering from post-adoption depression, it is a temporary illness that is not debilitating. Having family members and friends be there for them both physically and emotionally helps the parent recover quickly.