The following are recommendations for psychological screenings for the Haiti adoptees before they leave Haiti and for the Haiti adoptees who have already arrived in their new country without a psychological screening.
All children in the throes of the disastrous earthquake in Haiti can be quickly and efficiently psychologically screened, as much as time allows, prior to their evacuation. This will provide invaluable, time sensitive information to those pre-adoptive parents awaiting these children in other countries.
Assessment data obtained prior to the evacuation should be viewed within the context of the child’s approximate chronological age as well as his/her overall cognitive ability. Obviously, given the dire circumstances of Haiti, a broad estimate might be needed.
In determining the current psychological and cognitive status of the distressed Haitian children about to be evacuated, the degree of the physical and emotional trauma each child has experienced should attempt to be ascertained. Specifically, factors to consider: the extent of the physical injury (body injuries and head injuries), the emotional trauma (loss of parents, siblings, relatives), as well as the child’s current overall functioning (is the child in a state of shock, under the effects of pain medication, and has he/she had the basic biological needs of food and water met?)
Any psychological assessment should take into consideration and note any significant culturally sensitive factors including the evaluator’s educational background, training, knowledge of the culture, and understanding of the language.
The psychological variables that ideally would be assessed for every Haitian child, within the context of the circumstances and transient state of the child, include: ability to understand questions, follow directions, and to be generally responsive; ability to speak, read, and write; long and short-term memory; insight and comprehension of what has happened especially to his/ her parents, siblings, extended family members, and friends; current and potential survival and coping skills (physical and mental); current fears and hopes; actual and perceived family support; future outlook; and his/her desire for, and understanding of, the pending departure from his/her country. Any overt signs of brain damage, mental deficiency, hallucinations or delusions should be noted.
Whenever young, intrinsically vulnerable children are subjected to sudden, unpredictable, unmanageable, overwhelming natural forces, such as happened to the Haitian children, immediate and long term profound psychological and emotional effects are to be expected. Generalized and specific symptoms of anxiety, phobias, depression, night terrors, eating problems, bed wetting, tactile defensiveness, hyper- vigilance and even aggression are common reactions traumatized children experience immediately and for years following the trauma. Of special consideration for Haitian children who are being abruptly evacuated to a foreign country to be cared for by unknown adults, is the realization that the children’s trust and faith that adults will be able to protect them from life’s uncertainty and physical harm, has been severely compromised if not destroyed. Future attachment and bonding to their awaiting adoptive parents will be directly correlated with the degree and depth of trust that they had with their Haitian family prior to their evacuation, as well as the extent and depth of the physical and emotional trauma they have experienced. A pre-evacuation psychological assessment will provide a crucial foundation of information upon which the long-term emotional healing process can begin.
For Children already evacuated and with no pre-evacuation psychological screening:
If a Haitian child has already been evacuated and there was no preliminary psychological screening conduced, it would be wise for the pre-adoptive/ adoptive parents to ask for a psychological evaluation at the time of their pediatric evaluation. A developmental assessment including a mental status evaluation can often be conducted by an experienced pediatrician or a referral can be made to a specialist such as a clinical psychologist, neuro-psychologist, or developmental psychologist.
It is very important for future treatment intervention that as much information as possible be obtained about the physical, emotional, and psychological condition of the children prior to, and immediately after, evacuation. Of course, any knowledge about the biological parents would be very helpful since genetics are powerful determinants on many variables including physical attributes, intelligence, unique abilities (artistic, athletics, creative, etc.), personality characteristics, and medical strengths and liabilities.
Finding a culturally-sensitive professional to help with an assessment can be difficult but not impossible. By making phone inquiries, Internet searches, and consultation with adoptive parents, experienced clinicians can be found. If a parent feels that some assessment findings did not sufficiently take into consideration a child’s cultural background, this should be noted and a second opinion sought. Consistent and frequent record keeping, written and video, will provide invaluable data that can be shared with other professionals now and as the child matures.
One final word of caution: With few exceptions, an “expert” can be found on every side of every issue. The antidote to a confusing barrage of conflicting “expert advice” are a well-informed, committed, and modestly skeptical parents who will never forego their own judgment, advocacy, or unconditional love for their children.
Lawrence B. Lennon, Ph.D., HSPP
Ethics, Transparency, Support
~ What All Adoptions Deserve.