HE present study arose because it was our impression that a rather T I arge percentage of the children seen at the Hacker Clinic were adopted children, and that they as a group were extremely disturbed. Beyond the seriousness of their condition, they and their parents presented unusually difficult treatment problems. It was our intent to examine these cases as a group in order to determine what specific role, if any, the fact of the a d o p tion played in the etiology of the problems presented and in the treatment difficulties.Our original material was based on 8 cases of adopted children under 12 years of age, these representing about 10 per cent of the case load of children in this age group. The over-all study dealt with the psychodynamics of both parent and child, but for this presentation we will deal mainly with the child-the meaning of the adoption to him, and how it seemed to enter into his treatment. For purposes of study, we discarded one case, considering it too atypical, for here the child was the older of two boys who had been adopted by an unmarried man! Of the remaining cases 3 of the children were highly schizoid, with severe withdrawal trends and bizarreness in behavior; one showed a beginning narcissistic character development with marked acting-out tendencies; and the others were anxious, impulse-ridden children, showing considerable oral aggression.All but the two youngest children had been in treatment previously, this being described as unsuccessful by the parents. Reports from the previous therapists indicated that the attitudes especially of the mothers had mitigated against a more favorable outcome. Warned in advance about this we made special efforts to help these parents to understand and accept the role they needed to play in the treatment process. In spite of this, we too hit snags which led us to feel that there were some factors at work which were a t least intensified by the fact of the adoption. Two of the children had to be placed in residential settings, because in one instance the parents' own adjustment was so precarious, and in the other, the mother took to her bed, forcing the husband to choose between her and the child. One child had to be seen without the mother's being carried concomitantly in treatment; she confined her contacts with us to frequent telephoning, complaining that her daughter was not progressing fast enough. Even in the four cases
ARIE first came to the clinic a t the age of seven. A sister, 15 months M older, had just been hospitalized for schizophrenia and the parents were now able to focus on the problems of their younger daughter. They told of the extreme sibling rivalry which had existed between the children, of their constant fear that Marie would kill Helen. They had had to use two totally different approaches with these two children: the older, being extremely passive, had to be allowed freedom and to be encouraged to assert herself, while Marie, from the beginning overly aggressive, "had to be repressed." There were, however, some similarities in the children: neither would use her hands in play; both showed a precocity about words; and both, without formal schooling, developed considerable reading ability although neither could tolerate any fantasy in stories.Helen, who was described by another professional person who had seen her as "an inert lump, almost like a vegetable," had never been able to be in school a t all. Marie, my patient, had been in a nursery school a t three and her behavior there was described to me by the director. She was completely isolated, seemed not even to recognize anyone but the mother. She would scratch herself all over and move her hands around vaguely in the air. The school thought her mentally deficient since their tests showed an IQ of 60, and recommended institutional care. The parents then placed her in the home of an educational psychologist who was caring for about six disturbed children. They removed her after nine months because of their terror that she was getting more and more like her sister.When I first saw Marie she was a stocky little girl with round face, long braids, and eyes which appeared huge because of her thick-lensed glasses. Her teeth were exceptionally small and had been made even smaller by her constant habit of grinding. She volunteered no speech but answered when I asked her age, "I am four" (which was interesting because her mental age a t the time was four). If I suggested something like "You are painting i t black," she would echo, "I am painting it black, I am painting i t black." She struck me as quite awkward in motor behavior and there was occasional catatoniclike posturing. From time to time, Marie would dart around the room, whirling in a sort of figure eight. There was a constant tapping with her fingers. She seemed hardly to notice objects in a room. When she looked a t me she appeared to have difficulty in focusing. Disorders in perception were
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