Introduction

The purpose of this article is to recommend strategies for social workers to deal with attachment problems in adoptive families (adoptive parents and adopted children). Forming a strong bond is one of the most important challenges for an adoptive parent and an adoptive child. Two to four percent of families in America include an adopted child (van den Dries et al., 2009).

When adoptive parents adopt a child, the process of attachment usually takes place naturally, however, there are sometimes impediments to forming secure attachments. Insecure attachment in its different forms can affect the adopted child's relationships in the future, as well as self-concept and self-esteem.

This paper reviews the literature on attachment theory and adoption, impediments to secure attachment in adopted children, ways to test attachment in adoptive children, issues other than attachment that may affect the bonds between parent and child or the child's self-concept, and strategies to help parents correct insecure attachment in children.

The article then discusses how social workers can help parents at every stage of the adoption process 1) to prevent insecure attachment, 2) to help parents develop better attachments with their children, and 3) to help families address attachment problems if they occur and to help adopted children develop emotionally in the healthiest way possible.

Review of the Literature

Attachment theory as a framework for dealing with adoptive parents and

adoptees

Scholars like van den Dries et al., (2009) have studied the question of attachment between adopted children and their adoptive parents and agree that children adopted after twelve months show problems forming strong bonds with their parents. However, there is a debate in the literature according to Barth et al., (2005) regarding the extent to which attachment problems are the central issues for adopted children's emotional development and argue that other factors need to be considered.

According to van den Dries' meta-analysis of attachment in adoptees (2008), scholars agree that children adopted after twelve months may have problems forming a secure bond to their adoptive parents, whereas children adopted before twelve months have bonds comparable to birth children. In addition, they claim that adoption itself is a correction for insecure attachment, because the child has a sense of belonging to someone.

Dr. Groze an assistant Professor at The University of Iowa School of Social work suggests that insecure attachment in adopted children can lead to other emotional problems particularly related to self-concept. According to Groze, self-concept and attachment are related and that children adopted at an older age may have difficulties with attachment. This can lead to children having difficulties with their self-image. (Groze, 1992) As Groze studied further he found that a significant minority of adopted children had difficulties with self-concept and attachment .There was a statistically significant relationship between self-concept and attachment.

The study also suggested that children who spent more enjoyable time with their parents had better self-concept and vice versus. According to Groze, while the trauma children experience before adoption can be at least partially rectified, some parents need professional assistance. Groze recommends social workers remind parents that self-concept and attachment affect each other so that working on one helps the other. Interventions should be focused on interrupting a negative pattern.

In addition both cognitive and behavioral approaches to enhance self esteem can help special needs children to feel better about them selves. (Shireman and Johnson, 1976; 1985; 1986; Shireman, 1988) The cognitive approach will help children to integrate their past, and the behavioral approach will help them to change unwanted behaviors. In addition, social workers should help the family as a whole by helping parents lower their parental expectations, since many parents have expectations that are too high. Also, social workers can give parents a better understanding of a child's pre-adoptive history.

Finally Groze claims that rituals, such as the anniversary of adoption can help a child and his or her parents feel a sense of entitlement and commitment, which then helps the family develop better attachment to one another .Groze also claims that adoption can correct attachment problems and that being adopted does not necessarily lead to a bad self-concept in children adopted soon after birth, though race and special needs in adopted children may affect self-concept.

Stams et al. (2002) also argue that attachment in early years is one of several factors that affect the child's development in later years. They argue that maternally sensitive responses, attachment, and temperament in early years affect cognitive and socioemotional development in middle childhood years. Stams studied children and their adoptive parents in order to isolate parenting and attachment from genetic factors and concluded that sensitive parents can serve as role models for children's interaction with peers by teaching them social skills. In particular, secure mother-child attachment helps children to develop working models of available care and, self-worth. Secure parent, child relationships seem to have an effect on children's behavior. In addition, they claim that infant temperament can exacerbate attachment problems and affect adjustment in middle childhood. Since parents and adoptive children are not matched by temperament, this may also exacerbate difficulties. Based on the evidence of this study, social workers can help parents to develop more sensitive parenting strategies, to identify any incompatibilities between parents and children and to help rectify them.

Thus, adoption can be a correction for attachment problems, and social workers should not be overly focused on the attachment theory paradigm when dealing with adoptive children who have conduct disorders. (Barth et al.2005) Being focused on attachment theory, only is problematic, because the research on attachment theory is not conclusive and because adoption itself provides a potential correction for attachment disorders.

Scholars have also isolated racial identity as a problem for adoption despite secure attachment. Juffer (2006) argues that internationally adopted children adopted by Caucasian parents show stress with regard to not being white and not being born from their adopted mother despite strong feelings and attachment to adopted parents. This stress can show itself in behavioral issues. Juffer (2006) claims further that stress about looking different and not being born from the adopted mother is more important than stress from interest in adoption or negative reactions to others. Thus, according to Juffer (2006), parents and adopted children need adequate support for these stresses.

On the other hand, Irhammar and Bengtsson (2004) warn parents not to be overly focused on the question of racial identity. They argue that adult adoptees do not show significant signs of attachment disorder except in the case of individuals who were adopted at an older age or those who showed interest in learning about their biological parents nevertheless, parents can help foreign-born adoptee's to resolve identity issues by showing interest in the adoptees country of birth since even adopted children with secure attachment and a strong identity linked to their adopted country may have an interest in their country of birth. Adult adoptees can also benefit from groups to discuss and resolve issues of identity and attachment.

Thus, while there is a consensus that children adopted after twelve months have problems with attachment that may continue to affect them in middle childhood and even later, there are differing views on how effectively adoption can correct attachment problems and the extent to which attachment is the source of other problems among adoptees or whether racial background, temperament, and special needs are factors that affect attachment or not. The literature thus supports a cautious use of attachment theory as a framework for dealing with adopted children and their parents.

Attachment theory as a framework for diagnosing behavioral problems in adoptees

Attachment theory (Bowlby, 1982) can be used as a tool for diagnosing problematic behaviors in children and the adults who care for them. Attachment theory posits that a strong and trusting attachment to their parents is healthy for children. Ainsworth et al. (1978) came up with a test called "The strange situation" to assess and identify a child's attachment to their parents. There are four types of attachments: secure attachment, insecure, avoidant-ambivalent, and disorganized (Walker, 2008). The strange situation can be used as a test to identify whether the child has a problem with attachment.

Bernier and Meins (2008) argue that when atypical parenting behaviors, called trait insensitivity (that is the person's individual make-up) is linked to environmental stresses, called state insensitivity, they can affect children's attachment. In addition, the theory suggests that studying infants' responses to atypical parenting can help researchers to understand the reasons for variations in infants' disorganized attachment, which can then help them to come up with corrective strategies.

Other scholars have claimed that social workers cannot examine attachment between adoptive parents and adopted children in isolation from siblings, because as Ryan (2002) argues that children with severe attachment disorders may not always benefit from being placed in foster homes or adopted with a sibling, since the sibling relationship can impede them from developing a bond with their foster or adoptive parents. On the other hand, children with a healthy bond with a sibling and openness to prospective adoptive parents may benefit from being adopted together. To conclude ( Ryan, 2002) suggests that in addition to identifying whether a child has an attachment problem it is important to think about the specific factors affecting the attachment problem including trait and state insensitivity in the parents and relations to siblings. However, the studies show that proper parenting can be an effective corrective to attachment problems.

Attachment theory as a framework for parenting and care giving strategies

Scholars claim that parenting strategies can have a positive effect on attachment in adopted children. Van den Dries (2008) argues that parents who adopt children with disorganized attachment need to show sensitivity and engage in therapeutic care-giving by challenging the children's alienating behavior so as to correct disorganized attachment. The author suggests that further research is needed to establish the types of therapeutic care giving that would be most effective. On the question of how to deal with children with severe attachment problems, Juffer et al. (2007) suggests that social workers can help parents to devise strategies for their children that can develop a set of expectations to guide their behavior. Parents can help adopted children recover from severe deprivation by helping them develop a healthy place in their new adoptive family. Parents should provide a warm and nurturing environment for the adopted child. Parents can help adoptees develop normative feelings of self worth. This can lead to a more secure level of attachment with the adoptive parents.

Walker (2008) argues that attachment theory can be used to select substitute carers and matching children with carers. Social workers should examine a caregivers' ability to manage a wide range of feelings, both in themselves and others; the resolution of any losses or traumas that they experienced; the acquisition of reflective function. Social workers can also use Narrative Story Stems (Walker, 2008) and the Child Attachment Interview (Walker, 2008) to assess' the child's ease in forming a bond. Social workers should also assess prospective adoptive parents' attachment patterns in order to help prospective parents to correct their own disorganized attachment if it exists and order to match parents and children. In particular social workers should be careful to match more traumatized children with substitute carers who have resolved their own traumas. The social workers should also look for a fit between child and carer, that is, carers and children with similar attachment styles should not be matched, and rather carers should have different attachment styles to the children so as to be able to challenge the child's attachment style.

Galtry and Callister, (2005) suggest that in order to help parents form stronger attachment bonds with their newly adopted children .Parents should take off time from work .This applies to both fathers as well as mothers. There is a strong benefit to taking time off from work as this time off is crucial in helping to form the attachment bond. Since attachments are gradual and evolve with time, parents can play a significant role in helping form secure attachments with their adopted children. The interactions can be influenced through "a process of familiarization and reciprocal interactions."

According to Inch (1999), she explores how foster fathers who adopt children through foster care develop and show attachment to their children. This is especially important in order to give children a positive male-role model and a positive relationship with men in their lives.

Thus, the literature suggests that there are a number of practices that may enhance attachment between adopted children and their parents including taking time off from work after the adoption, choosing caregivers and children with compatible attachment styles, helping adoptive fathers attach to their children, and aiding parents in dealing with the children's alienating behaviors.

Attachment theory as a framework for therapeutic parenting practices

While, scholars argue that more research needs to be done on therapeutic parenting techniques that could help children overcome alienating behavior, there are some new therapies available. Lacher et al., (2005) described family narrative attachment therapy. This therapy is a parental tool aimed at helping children transform their negative inner working model and transforming it into a new positive one. The authors claim that a child's inner working model is formed in response to three spheres of attachment experiences, life events, and levels of attachment. Stress affects attachment quality, and attachment quality affects how children perceive the world, and both impact development. The meaning derived from the three is what affects the child's development. The authors explore several types of narratives to address the negative meaning the child has adopted. The author thus explores means to identify the child's negative inner working model, how parents can be attuned to the child's negative inner model and behaviors, then narratives to change it. These narratives include calm story telling, which strengthen emotional connections within the family (these include narratives of what good parents would have done), trauma narrative, to help children make sense of the past (these are narratives of the child's own trauma told in the third person), developmental narratives to give children the emotional experience of a milestone event they might have missed out on (they tell of caregivers celebrating the children's accomplishments), and successful child narratives to encourage children to learn to control their behavior in a positive way.

Implications for Practice

Parental awareness of attachment Issues

The first implication for practice is that social workers must help parents to become aware of the importance of attachment for the child and of patterns of disorganized attachment. Social workers working with future and current adoptive parents can talk to them about the issue of attachment as an important factor in the child's development. In so doing, social workers should encourage adoptive parents by explaining to them that that the bonds they form with their adopted child can correct the attachment disorders the child may have. Social workers can thereby foster optimism in parents. However, they must explain to them that forming strong attachments is a process and it takes time, perseverance and patience.

Further, social workers can test for attachment disorders in the adopted children and determine which type of problem the child exhibits: disorganized attachment, insecure, avoidant, and ambivalent. (Bowlby, 1982) The social worker can thus help the parents become sensitive to attachment as an issue and empower them as the primary people to solve it.

Attachment disorders are not the only culprit

While research shows that attachment disorders can have an effect on behavioral problems, social workers must not get fixated on the attachment paradigm.

Rather, social workers must help parents to be sensitive and alert about all aspects of the child's behavior and self-concept so as not to misdiagnose the situation. In cases of severe behavioral issues, social workers should be open to a range of possible causes like mental illness, previous abuse or previous neglect.

In addition, for inter-racial adoption, the feeling of not being of the same race as the adoptive parents may be more of a stress than attachment problem, especially if the child was adopted at an early age. Social workers can encourage parents with children who are dealing with this issue by explaining to them the positive impact of showing interest in the child's country of birth and by reassuring the parents that such interest will not confuse the child or inhibit their socialization in the majority culture. Rather it will help the child integrate their different identities in a positive way. Further, since attachment has been linked to self-concept in a feedback loop, social workers can give parents strategies to help the child develop a better concept, which in turn will improve attachment, in addition to helping the child form a better bond, which will improve self-concept. Thus, while attachment issues are one of the key issues facing adoptive parents and children, social workers must always help parents to keep an open mind and open ears, especially since adoption itself has been shown to be a way to heal attachment problems when there is love between adoptive parents and children.

Skills for sensitive parenting

Once social workers sensitize adoptive parents to the question of attachment, they can give them additional skills to be sensitive parents. In particular they can help the parents understand that they should not take avoidant or ambivalent attachment behavior personally, but rather should engage in therapeutic care giving which challenges the child's alienating behavior.

In addition, as researchers have shown that the personalities of parents and children can be an additional factor in improving or worsening attachment issues, social workers can assess parents' own attachment style and then talk to them about ways to make a better fit between them and their adopted child. A nurturing parent can be a good match for a child who has a disorganized attachment. In this way the constant nurture can help the child overcome his or her disorganized attachment.

Social workers can thereby perform the added benefit of helping parents themselves form better attachments with others in general.

Activities to improve attachment

There are several things that social workers can help parents with such as the optimal amount of leave time they will need to take to welcome the child. In addition parents can do specific activities to help children with attachment problems. Social workers can teach parents these activities. These include story-telling as part of a narrative attachment therapy, which helps children develop a positive inner model through stories that include a claiming narrative, a trauma narrative, and successful child narratives. Further, parents can perform rituals and make a party on the anniversary of the child's adoption to help the child and parents reaffirm the child and parents' commitment. Parents who do not feel comfortable with such rituals can make a point to give their children special treatment by taking them out on a special outing and reaffirming the love they have for them.

In support of adult adoptees

Adult adoptees may also benefit from group work Irhammar and Bengtsson (2004) if they had or continue to have attachment problems. Therefore, social workers working with adult adoptees may consider group work and may wish to help them address questions of attachment. Further, as many scholars have indicated the importance of doing more research on parenting strategies to correct attachment problems and on the sources of attachment problems, social workers need to stay on top of the literature in this field.

To support adoptive parents and educate them, groups can be formed to allow adoptive parents to share fears, worries and implement good coping strategies with one another.

Conclusion

Social workers need to be aware of attachment problems in adoptees and give parents a variety of strategies to cope with problems if they occur. At the same time they should be open to the possibility that attachment disorders are only one of many sources of behavioral problems and identity issues in adopted children. Social workers dealing with adoptive families should consider attachment issues among other issues when dealing with an adopted child's behavioral problems, particularly if the child was adopted after the first year.

They need to know about attachment theory (Bowlby, 1982), how to test for attachment problems in adopted children, and develop parenting strategies to help parents form better bonds with their children. These strategies range from claiming narrative techniques to sensitive parenting.

Social workers need to consider attachment at all stages of the adoption process, from matching parents and children with complementary attachment styles, to helping parents take off enough time from work to form bonds with their children, to helping parents develop therapeutic parenting strategies such as narrative attachment therapy and resisting children's alienating behavior. Social workers need to keep up with the literature on parenting strategies, as scholars suggest that more work still needs to be done in this field. Social workers need to be creative and continue to research and in this way can help their clients. In addition, social workers should not rely solely on attachment theory when dealing with behavior problems as other issues may play a role, especially among international adoptees, such as mental illness, prior abuse and or prior neglect.

Finally, social workers should remind adoptive parents, especially of children who suffered neglect prior to adoption, of the overwhelming evidence that adoption itself is a corrective to the attachment problems, even if the child still shows some difficulties with their adoptive parents. Social workers can encourage and comfort adoptive parents who go through difficult periods with their adopted children with this message as well.

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