Approximately , children are adopted in the U. Most domestic adoptions occur through the foster care system, with about 50, adoptions per year, typically at around age six. About half are adopted by foster parents, and another third are adopted by relatives. Just 5, immigrant visas were issued to children adopted abroad in , down from 7, in and a 77 percent drop from the high of 23, adoptions in The greatest number of adopted children came from China, the Democratic Republic of the Congo and Ukraine in Although international adoption numbers have dropped, medically-complex cases have grown, said Dr.
Means and standard deviations for continuous descriptive variables by group for the primary caregiver. Frequencies and percentage for categorical descriptive variables by group for the primary caregiver. All participants provided informed consent before participating in research. All participants participated in an online pretest approximately 2 weeks before intervention began, as well as an online posttest approximately 2 weeks after intervention ended.
The questionnaires making up the pre- and posttest assessments were presented in random order at each administration. The SDQ is a item measure of behavior for children age 3 to 16 years old that can be completed by parents, teachers, or adolescents. Added together, scores from these four subscales give a Total Difficulties score. The SDQ has good reliability and validity Goodman The TSCYC is a item caregiver-report measure of acute and chronic posttraumatic symptomology in children age 3 to 12 years old.
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The TSCYC also contains two validity scales: Response Level, which indicates a tendency for reporters to over-respond, and Atypical Response, which indicates a tendency to under-respond. Participants in the treatment group attended a 4-day TBRI parent training 6 h per day designed to teach strategies and skills intended to improve behavioral outcomes for children with histories of complex trauma. The training utilized standardized presentations, presenter manuals, and participant workbooks routinely used in TBRI workshops with various audiences interested in creating changes for children with early adverse histories, including audiences of child welfare professionals, teachers, and adoptive and foster parents.
Each day of training consisted of interactive lectures with small and large group discussions, application activities such as role-plays and therapeutic groups, and video clips used to demonstrate principles and strategies.
Trainers each had approximately 2 years experience using the standardized presentations, manuals, and workbooks. Parents reported that older children had a greater decrease in problem behavior than younger children from pretest to posttest regardless of group. The current study reports on an intervention that is effective at reducing many behavioral problems and trauma symptoms among vulnerable children. In line with the principles of trauma-informed care, the core values of TBRI are felt-safety, self-regulation, and connection.
Although previous research suggests that focusing on these core values will result in behavioral change, this is the first TBRI study to empirically assess change in trauma symptoms.
Not surprisingly given their early adverse histories, children in the current sample are at risk for symptoms in line with a Post-Traumatic Stress diagnosis, including arousal, intrusion, and avoidance. That a 4-day parent training could effectively decrease trauma symptomology speaks to the importance of considering trauma in the context of the caregiver-child relationship.
These findings are encouraging for the multitude of families seeking help for the behavioral challenges exhibited by their at-risk adopted children every day and are also important for researchers who seek to identify developmental domains that should be targeted for interventions.
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Notably, the improvements evident after intervention were not limited to one domain, but appeared in various domains that are addressed by the intervention. Emotional problems are addressed in activities such as creating a clay model representing something the child is afraid of and then smashing the model. Although one goal of the intervention is behavioral change, it is most effective in the context of the safety, security, and sensitivity of a healthy attachment relationship.
Consistent with this perspective, it is important that the intervention target caregivers, with the intention that positive outcomes will be more long-lasting if the caregiver is the medium for change. Although promising, there are limitations to the current sample. Participants consisted of volunteers who were interested in learning strategies for improving outcomes for their adopted children. They had to have the means and time to travel to the training and the ability to be available for 4 days; therefore, this sample might not represent the population as a whole.
Another possible limitation is the use of parent-report measures of child behavior.
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It is possible that problem behaviors decreased in the treatment group after intervention because parents wanted behaviors to decrease. However, the post-intervention improvements in behavior and trauma symptoms are supported by post-intervention improvements found in other studies utilizing different measures for the same intervention principles, including changes in neurochemistry Cross et al.
In addition, other studies have found high validity between parent reports of behavior and other behavioral measures, including teacher report Kriebel and Wentzel ; Miller et al. As is common in studies of adopted children with early adverse histories, especially post-institutionalized children, there was no direct measure of pre-adoption experiences. The current study reports on short-term improvements in behavior and trauma symptoms. Although encouraging, future research should assess long-term follow-up of outcomes following intervention to examine whether behavioral improvements last.
If decreases in child behavioral problems and trauma symptoms are the result of changes to parent-child interactions stemming from TBRI parent training, then a central question for future research is to what extent parents continue to use the skills and strategies learned in training.
On-site TBRI training conducted face-to-face with TBRI-trained staff is a valuable training model: it allows for a dialogue between participants and trainers during which questions can be answered immediately, skills can be practiced with feedback, participants have a devoted time and space in which to learn and have the context of a supportive environment from trainers and other participants.
However, on-site training also has its caveats: it limits the number of individuals who can attend training and it requires a lot of time and resources on the part of the training staff. Indeed, among the participants who were randomly assigned to the treatment group who had all indicated that they were available to attend training on location during the training dates , the main reason participants withdrew from the study prior to intervention was difficulty making travel arrangements e. The majority of participants who withdrew from the study expressed regret or frustration at not attending training.
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Future research will evaluate alternatives to on-site trainings led by research institute staff. A promising alternative is web-based training, which aims to provide the same content but allows participants to progress through training at their own speed on their own timeframe, no travel required.
Children who have experienced chronic or multiple early adversities can bear the scars of their trauma long after removal from harsh environments. The effects can manifest in a number of ways, including behavioral problems and trauma symptoms. However, results of this study suggest that trauma-informed TBRI training can improve child outcomes and give families hope.
National Center for Biotechnology Information , U. J Child Adolesc Trauma. Published online Aug 6. Karyn B. Hiles Howard , Casey D. Hall , and David R. Amanda R. Hiles Howard. Casey D. Jordan S. David R.
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Author information Copyright and License information Disclaimer. Call, Phone: , Email: ude. Corresponding author. Abstract Children who have experienced early adversities are at risk for behavioral problems and trauma symptoms.
Keywords: Trust-based relational intervention, Trauma-informed intervention, Attachment intervention, Out-of-home placement, Adopted children, Parent training, Child behavior, Trauma symptoms. Trust-Based Relational Intervention as Trauma-Informed Care The number of adoptive families potentially impacted by behavioral challenges and trauma symptoms in children with histories of early adversities is substantial.
Method Participants Participants consisted of 96 adoptive parents who responded to a recruitment notice for a study for parents interested in learning about the basic relationship and developmental needs of adopted children with histories of early adversities and practical strategies to improve outcomes for these children. Table 1 Means and standard deviations for continuous descriptive variables by group for the child. Mean SD F p Current age in years. Open in a separate window. Table 2 Frequencies and percentage for categorical descriptive variables by group for the child.
Table 3 Means and standard deviations for continuous descriptive variables by group for the primary caregiver. Mean SD F p Parent current age 2.
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Table 4 Frequencies and percentage for categorical descriptive variables by group for the primary caregiver. Table 5 Psychometric properties of the questionnaires pre and post treatment. Intervention Protocol Participants in the treatment group attended a 4-day TBRI parent training 6 h per day designed to teach strategies and skills intended to improve behavioral outcomes for children with histories of complex trauma.
Discussion The current study reports on an intervention that is effective at reducing many behavioral problems and trauma symptoms among vulnerable children. Limitations and Future Research Although promising, there are limitations to the current sample. Treatment of complex trauma in young children: developmental and cultural considerations in application of the ARC intervention model.
Journal of Child and Adolescent Trauma. Bruce Perry of the Child Trauma Academy. Articles and resources for parents of children who have experienced trauma. Deborah Gray. Provides information and resources for foster and adopting parents. Find therapists worldwide certified in Theraplay. It is based on the natural patterns of playful, healthy interaction between parent and child and is personal, physical, and fun. Some adopted children may appear healthy, but be deficient in key nutrients that are essential for future growth and brain development.
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