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Section 22
Behavior Problems and Adopted Children

Question 22 | Test | Table of Contents

The cognitive behavioural intervention
The most direct influence in writing the manual for this approach has been the work of Carolyn Webster-Stratton and colleagues at the parenting clinic at the University of Washington, which has included interventions with foster and adoptive families (Webster-Stratton & Hancock, 1998; Webster-Stratton, 2003).  Recent UK based studies using this programme have shown largely positive effects of parent training for birth families (Scott et al., 2001).

Content of the cognitive behavioural intervention
Session 1 - Getting to know the parents and introducing the programme
Session 2 - Using positive attention to change behaviour
Session 3 - The value of play for establishing positive relationships
Session 4 - Using verbal praise
Session 5 - Praise and rewards
Session 6 - Learning clear commands and boundaries
Session 7 - Using ‘ignoring’ to reduce inappropriate behaviour
Session 8 - Defining for the child the consequences of undesirable behaviour
Session 9 - ‘Time Out’ and problem solving
Session 10 - Review and ending.

In this programme, adoptive parents are shown how to decrease unacceptable behaviour and increase acceptable behaviour, by using praise and rewards, by ignoring bad behaviour, by setting firm limits and using ‘logical consequences’ and problem solving.

Because adopted children have some very specific needs, the widely used cognitive behavioural parenting programmes have been adapted to meet them. Greater emphasis is given to how parent advisors should respond if the parents report that their child rejects their praise and/or their rewards. This has been added because children placed for adoption may have been deprived of praise from their birth parents, or have received varying amounts from different carers or have been treated negatively and may not see themselves as worthy of praise. These factors may make them more likely than the average child to reject praise or to resist being praised.

The value of clear communication and commands is given special emphasis because many recently placed children may have been exposed to inconsistent discipline by previous carers where expectations may have been unclear and the consequences possibly punitive or abusive. They may be more likely to protest and to respond with angry outbursts or show traumatic responses like withdrawal, fear or freezing. Therefore, the parent advisors will emphasise how important it is for parents to be clear about commands and setting appropriate boundaries and then help the parents to understand why their child often finds it hard to respond in a co-operative and timely manner.

A further adaptation is that this programme devotes more time, and places greater emphasis, on helping the parents to understand how challenging behaviour may have been acquired. This may help parents to understand why it can sometimes take a long time for significant changes in behaviour to occur.

This intervention includes a cognitive element because parenting behaviour is influenced by how adopters come to see their child (White, McNally, & Cartwright-Hatton, 2003). Perceptions and attributions are challenged if they seem unhelpful (e.g. ‘He’s doing it just to upset me’). Adopters without previous parenting experience might have unusual or mistaken ideas about the origin of problems, or inappropriate expectations, while experienced parents might carry over attributions that really belong to their ‘home grown’ children. Negative thoughts will be discussed (e.g. ‘My child doesn’t like me and will never become close to me’) and more adaptive cognitions offered in their place. Negative thoughts often lead parents to withdraw from their child, further decreasing the chance of developing a secure attachment. The programme tries to replace the idea that the child is rejecting the parent with acknowledgement that this child may have experienced chaotic and disturbed parenting so that developing new relationships may be slow. Altering the parents thoughts in this way will enable them to continue to behave in a positive way towards their child.  A further adaptation of this programme is that an even greater emphasis is placed on the need for parents to conduct daily play sessions with their child. This programme explains the importance of playing with the child for developing attachment relationships and also considers how the parent advisor should proceed if the child does not respond well to the parents_ attempts to play. This is particularly important as many adopted children may be resistant to the parents_ direct attempts to develop their relationship due to their prior negative experiences of close relationships or ambivalence about being with a new family. Play can provide a setting for developing relationships without un-nerving closeness.

Lastly, although this programme does discuss the Time Out strategy, parent advisors are asked to caution parents in its use and to encourage them to rely on alternative strategies such as ‘logical consequences’ and ‘problem solving’. This change has been made because practitioners have raised concerns that Time Out could be damaging if it reminds the children of aspects of their previous abusive experiences, which could affect developing relationships and the child’s self esteem.

If the adoptive parents themselves prove resistant to the programme, the parent advisors are encouraged to employ a problem solving approach, considering all the various possible solutions and together choosing the most helpful. If a parent is particularly reluctant to implement a particular strategy, a compromise could be reached, for example that the parent tries the strategy for several weeks, then if they still disagree with it they can stop doing it.

Behavioural approaches have sometimes been challenged as being too superficial or likely to be inadequate unless the intervention focuses on the adoptive parents deeper feelings and their own possible attachment difficulties. Such an approach is not the focus of this ‘early in placement’ study, although there may be special aspects of the new adoptive parent/child relationship that are distinct and may require different treatment.
- Rushton, Alan, Monck, Elizabeth; Enhancing Adoptive Parenting: Devising Promising Interventions; Child & Adolescent Mental Health; Feb 2006, Vol. 11, Issue 1.

Personal Reflection Exercise #8
The preceding section contained information about the cognitive behavioral intervention. Write three case study examples regarding how you might use the content of this section in your practice.

2022 Update
Mental health engagement
among foster and adopted youth:
the transition from in-person
to telemental health services

- Perez, V., Ruderman, M., Kussman, M., Waterman, J., & Langley, A. (2022). Mental health engagement among foster and adopted youth: the transition from in-person to telemental health services. Social Work in Mental Health, 1-20.

Peer-Reviewed Journal Article References:
Hornfeck, F., Bovenschen, I., Heene, S., Zimmermann, J., Zwönitzer, A., & Kindler, H. (2019). Emotional and behavior problems in adopted children—The role of early adversities and adoptive parents’ regulation and behavior. Child Abuse & Neglect, 98, Article 104221.

Melançon, F., Cossette, L., Smith, C., Beauvais-Dubois, C., Cyr, C., & Smolla, N. (2019). Parenting stress of adoptive mothers, mother–child conflict, and behavior problems during adolescence among international adoptees. Journal of Family Psychology, 33(8), 988–993.

Tan, T. X. (2018). Model minority of a different kind? Academic competence and behavioral health of Chinese children adopted into White American families. Asian American Journal of Psychology, 9(3), 169–178.

QUESTION 22
How does the cognitive behavioral intervention seek to adjust adoptee behavior? To select and enter your answer go to Test.

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