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Adopting As a Child Psychiatrist: Lessons Learned
Over 100,000 children are adopted each year in the United States.
As a child and adolescent psychiatrist, I see children ages 2-18, adults with developmental disabilities, and specialize in the areas of trauma, neurodiversity, foster care and adoption. Finally, I am also an adoptive mother and used to be a foster mother. As an “expert” on adoption, trauma, and developmental disabilities, what advice do I have for adoptive or pre-adoptive parents? Listen to adoptees. As an adoptive mom to special needs children has prepared me in multiple ways. My medical training as a child psychiatrist has no doubt helped me in this journey. My own experiences as the daughter of an adoptee and as someone who is neurodiverse herself have helped me in this journey. However, the best thing I have ever done was listen. Through listening to adoptees and former foster youth, I come away with four significant opinions of adoption.
Adoption, the majority of the time, is unnecessary.
Even when it is essential, adoption always begins with trauma.
Adoptive and foster parents are not equipped to be trauma-informed parents.
Our children are not given adequate tools to navigate their feelings.
On this journey, I have come to understand the systemic issues that lead to a lot of needless adoptions (not exactly what people want to hear, but true). The fact is, that trauma begets trauma and that most foster care related adoptions are due to neglect (not abuse) and infant adoptions are due to lack of resources (not lack of wanting to be a parent). There are, of course, some cases where physical or sexual abuse leads to necessary removal or parents do not want to parent (regardless of resources or societal interventions), but those cases are a much smaller number than we are led to believe. Therefore, many adoptions are a result of a fundamental failure of society to take care of its’ people in treating their mental health and providing support. Becoming an adoptive and foster parent has opened my eyes to just how pervasive our systemic failures genuinely are. We know how to fix this. We have the research. We, as a society, must be willing to invest in children and families. However, this is a point that we, as a society, have not yet reached.
Adoption always begins with loss or trauma, oftentimes both. As adoptive parents, it is our childrens’ best interests to acknowledge this and hold space for this fact, even in infant adoptions. There is the loss of a mother they bonded to for nine months and even more so the loss of a family they are now legally no longer a part of. When we understand this fact, we will be able to serve our children so much better. We are not offended by the thought of open adoptions or the notion that the children will want to explore that loss, which can happen in multiple ways.
The amount of training that I had as a foster parent for trauma-informed parenting is laughable. The training I had was not necessarily useless; it was just extremely superficial. Foster and adoptive parents need to be taught the importance of the first family, the importance of being honest and open with your kids, the benefits of open adoptions and finally, how to parent in a trauma-informed manner. I learned some trauma-informed practices as a child psychiatrist, but even that was inadequate. A lot of this I have discovered myself through research and again listening to adoptees. Connected parenting and trauma-informed parenting is sorely lacking and is beneficial for all children, but especially for adopted children.
Our children are not given adequate tools to navigate their feelings about having two families, of being adopted and of transracial adoptions. They certainly are not taught how to manage their feelings around any history of trauma. Many therapists and psychiatrists are not trauma-informed or do not understand the nuances of adoptions. Lots of things are explained away as attachment issues that are trauma and need to be treated as such. A lot of adoptive parents are not aware or able to separate their feelings about adoption and allow themselves to be a safe space for their children.
We need to approach adoption with the understanding that: we need to do a better job of keeping families together, we need to listen to adult adoptees without defensiveness, we need to understand trauma and we need to allow our children the space to grieve what they have lost and work through their complicated feelings. When we utilize that approach, we can make the best of what is a less than ideal situation. If you are interested in becoming an adoptive parent, my recommendation is to join groups that are adoptee-centered. Follow adoptee activist. Listen, learn, honestly evaluate your reasoning and invest in learning about trauma. This list forms the building blocks to becoming a suitable adoptive parent.
Rishab Gupta is a third year resident in psychiatry at SUNY Downstate Medical Center in Brooklyn. He is also enrolled in a PhD in Neural and Behavioral Sciences at Downstate. He graduated from All India Institute of Medical Sciences (AIIMS), New Delhi in 2008. Being extremely interested in understanding human behavior since his medical school days, he joined Psychiatry residency at AIIMS in 2009. After finishing his training, he continued to work in the Department of Psychiatry at AIIMS as a trained psychiatrist. He is very passionate about academics and loves teaching and pursuing clinical research. He has presented his work at multiple national and international platforms and published numerous papers in different domains of psychiatry. Because of his unquenched thirst for learning he joined SUNY Downstate Medical Center as a Psychiatry resident in 2016. After graduating, he plans to pursue fellowship in Neuropsychiatry because of his active interest in disorders lying at the interface of Neurology and Psychiatry. He aims to be an academician and pursue research into the neurobiology of frontotemporal dementia, and psychotic disorder. When he is not in the clinic or learning psychiatry, he enjoys reading trivia, making jokes, doing social networking, trekking, listening to Punjabi music, and bingeing on various TV shows and movies.
Nwayieze Ndukwe
Dr.Nwayieze C. Ndukwe, MD, MPH, is a psychiatrist based in New York and New Jersey who enjoys exploring the interesection of mental health and popular culture. Dr.Ndukwe serves a associate professor at Mount Sinai Hospital systems in New York City and Mountainside Hospital in Montclair. Dr.Ndukwe was trained at Mount Sinai Beth Israel, and is board certified in Psychiatry by the ABPN. Dr.Ndukwe also holds a Master's in Degree in Public Health from Rutgers University.
Candace Good
Dr. Good specializes in college mental health as a staff psychiatrist at Penn State Counseling and Psychological Services. She is also the founder of Sig: Wellness, LLC, an integrative psychiatry practice in State College, PA. Her office includes a mind-body studio to encourage yoga, meditation, and other healing arts for stress management. The space serves as an incubator for other female wellness practitioners to grow their presence in the community. Dr. Good welcomes freelance writing and editing projects relevant to her specialty and blogs at https://howtoshrinkashrink.com.
Dr. Good is board-certified in both general and child & adolescent psychiatry. She maintains a clinical faculty appointment with the Penn State College of Medicine, where she also completed her medical degree and residency training. Over the past 15 years, her clinical work has included care of families in both rural and underserved communities as well as academic settings. Administrative roles have included medical director at the Western Psychiatric Institute and Clinic Center for Children and Families, vice president of Sunpointe Health, and both unit director of behavioral health services and department chair of psychiatry at the Mount Nittany Medical Center. In 2017, she was elected to the Board of Trustees of the Pennsylvania Medical Society (PAMED) and was recognized as a Distinguished Fellow of the American Academy of Child & Adolescent Psychiatry (AACAP).
Dr. Good enjoys knitting and spending time with her family, especially her daughter and rescue hounds, Abbott and Flip.
Dr. Chepke attended NYU School of Medicine and completed psychiatry residency at Duke University, where he also completed undergraduate studies. He is Board Certified by the American Board of Psychiatry and Neurology and is a Fellow of the American Psychiatric Association. He currently has a private practice in Huntersville, NC, serves as medical director for a level 3 residential adolescent treatment facility, and is an Adjunct Clinical Professor of Psychiatry for the University of North Carolina-Chapel Hill Medical School at the Charlotte Campus.
Dr. Chepke has particular interests in treatment-resistant/severe persistent mental illness, as well as patients with both psychiatric and neurological disorders. He is a member of the CURESZ Foundation Clozapine Experts Panel and Tardive Dyskinesia Experts Panel, as well as a member of the International Parkinson and Movement Disorder Society. He also emphasizes engaging his patients in psychotherapy and strongly encouraging integrative approaches including physical health and wellness through exercise and dietary modification and supplementation. Dr. Chepke’s research interests are in neuropsychiatry and drug metabolism/interactions and is currently a principal investigator for several clinical trials.
Nishi Bhopal, MD is Board Certified in Psychiatry, Sleep Medicine, and Integrative Holistic Medicine. She grew up in Vancouver and completed her undergraduate studies at the University of British Columbia. Her interest in medicine and love of travel took her halfway across the globe where she graduated with a degree in medicine from the National University of Ireland, University College Cork School of Medicine. She went on to complete her Psychiatric residency training at Henry Ford Hospital/Wayne State University and then a fellowship in Sleep Medicine at Beth Israel Deaconess Medical Center/Harvard Medical School. She now calls the Bay Area home and practices outpatient psychiatry in San Francisco. Dr. Bhopal is passionate about helping her patients find health and wellbeing through a combination of modern medical science and the wisdom of traditional eastern practices.
Dr. Nissa Perez completed her undergraduate work in psychobiology at UCLA and then obtained her medical degree from University of Southern California. She completed residency at UCLA San Fernando Valley Psychiatry Training Program and is a Board Certified Psychiatrist. She worked for one year as an attending in her residency program and has been in private practice for the last four and a half years, now in San Jose, CA. She incorporates psychopharmacology and psychotherapy into her practice and draws from multiple therapeutic modalities, primarily psychodynamic and mindfulness, but also incorporates cognitive behavioral therapy.
Dr. Perez is also an avid meditator and yogi. She meditates daily, regularly practices yoga and has attended multiple silent meditation retreats. She blogs at AMindfulMD.com.
Dr. Leslie Walker obtained her MD and MS (Neuroscience) degrees from the University of Michigan. She finished residency at Johns Hopkins Hospital in 2000 and has been in solo practice since then, first in Baltimore and then in Cleveland. She has particular interests in treating women as well as physicians, and for five years served part-time as the psychiatrist for the Women's Trauma Treatment Program at the Cleveland VA Hospital. She enjoys teaching residents and medical students at Case Western Reserve University School of Medicine, and she speaks nationally to physicians on psychiatric topics, work/family balance, resilience, and self-care. She is married to an academic neurologist and has one child in college and one in graduate school, making her officially an empty nester! Next goals: starting a blog and publishing a book.
Erik Messamore, MD, PhD is an expert in the fields of psychopharmacology, complex mood disorders, psychosis and schizophrenia.
He earned a PhD in neuropharmacology from Southern Illinois University and completed a Postdoctoral Fellowship at the Karolinska Institute in Stockholm, Sweden. He received his Medical Degree from the University of Illinois and completed a residency in Psychiatry at Oregon Health & Science University in Portland.
His current research is focused on characterizing the blood flow response to niacin among people with schizophrenia. This research may ultimately improve our ability to detect schizophrenia at its very early stages and to categorize psychiatric illness along physiological lines.
He currently serves as an Associate Professor of Psychiatry at the Northeast Ohio Medical University (NEOMED) in Rootstown, Ohio. He is also the Medical Director of NEOMED’s Best Practices in Schizophrenia Treatment (BeST) Center.
He is a seasoned clinician and accomplished scientist, with a passion for improving the lives of those affected by mental illness.