We sought answers from the experts, starting with Casey’s pediatrician, Dr. Johnston, when she was three. We went over her history in the orphanage, her astounding transformation from a quiet, weak, sickly infant to a spunky and spirited toddler. But the out-of-control tantrums and defiance worried us. What were we doing wrong?
Dr. Johnston couldn’t see any signs of trouble (perhaps Casey had worked her charms on the doctor). “Three-year-olds are still trying to get a handle on their emotions and are easily frustrated,” she said, “and Casey was a preemie. They tend to be hyper-sensitive.” She’d grow out of this. She was just a strong-willed child.
This same conversation played out over and over as we took Casey from one therapist to another – she was adorable but just strong willed. Spunky was a good thing! You just need to be tougher with her. Set boundaries. Be consistent.
Casey may have been playing all the therapists from the beginning until she announced that she wasn’t going back to therapy and we couldn’t make her. She was right. By then she was 15. We couldn’t slap ankle bracelets on her and throw her in the car. She said she’d call her lawyer if we did (as if).
Now in retrospect, I realize how right Casey had been all along. She called the therapists “idiots.” I’d call most of them ignorant, one professionally arrogant. They had all of the clues but ignored them, treating her instead like any other misbehaving kid without any understanding of where her behavior came from.
How could this have happened?
As I was to learn after Casey died, the effects of attachment disorders were known to a relatively small group of specialists, but they hadn’t made it into the mainstream. The Diagnostic and Statistical Manual of Mental Disorders (the diagnostic bible for therapists) covers hundreds of mental disorders but devotes a scant page or two to attachment. Interviews with adoption therapists revealed that attachment-related issues were given little if any coverage in master’s programs for social work, one prerequisite for therapeutic work.
It wasn’t until the first wave of orphans from Romania and Russia had been studied over time that mental health experts began to understand the effects of early deprivation in children. One such study was the English and Romanian Adoptee Study in the 1990’s led by Professor Michael Rutter. It began to shed light on the devastating effects of abandonment and long-term institutionalization. According to this study (and much more I was to learn) Casey was at high risk for severe behavioral issues considering the dismal life she lived (despite the best of intentions) before we received her at 14 months. The fact that she was so “normal” most of the time is a testament to her will power, the “strong-will” that the clueless experts referred to.