Season 1, Episode 11: Dr. Hanna Raaska, Chief Physician at the Pediatric Neuropsychiatric Unit at Helsinki University Hospital in Finland and member of the Finnish Adoption Study Group, discusses her research regarding behavioral and emotional outcomes among internationally adopted children and the ways that adoptive families can promote resilience and positive outcomes.
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Dr. Emily Helder: Hello, I’m Dr. Emily Helder and I’m here with Dr. Hanna Raaska, who is the Chief Physician at the Pediatric Neuropsychiatric Unit at Helsinki University Hospital in Finland. She’s also a member of the Finnish Adoption Study Group, which is conducting longitudinal research with international adoptees. She and her team co-wrote a chapter in the Handbook titled “Behavioral and Emotional Adjustment in Adoptees”. So thanks so much for being here.
Dr. Hanna Raaska: Thank You!
Dr. Emily Helder: Yeah, can you give me an overview of the Finnish Adoption Study? What are the goals and what’s your role in the project?
Dr. Hanna Raaska: Okay,this Finnish Adoption Study, it began, in 2007.
The principal investigators, Helena Lapinleimu and Jari Sinkkonen, they know this – that there is very little knowledge about Finnish adoptees. And so they began a big survey study, begin, Finnish scales, and the aim was defined, what kind of, physical or psychological problems Finnish adoptees have, where do they come from?
What is their health? Are there any factors that are associated with adaptation to the new family and environment? So later on, we noticed that there are, of course the limitations with the survey study. So we began follow-up study, which is the longitudinal study you mentioned. And, the aim of this study is to find measure or hallmark by which we could recognize those children who have the largest probability for problems later in their life. And we also try to measure stress of these adopted children. Also we, in this longitudinal study, we wanted to do a study of the velocity of catch-up growth and which environmental factors affect on it. We want to see what kind of neurological diseases Finnish adoptive children have.
And, also we would like to develop a Finnish measure, which helps to recognize language problems in adoptive children. So I, myself, began as a doctoral student in this group, and after my thesis, I have continued in this group as a post-doc researcher, and also I’m representing the child psychiatry point of view in this group nowadays.
Dr. Emily Helder: Yeah, what a comprehensive set of assessments and goals, I would think that’s really valuable . To be able to see…
Dr. Hanna Raaska: yeah
Dr. Emily Helder: …connections between the different facets of development.
Dr. Hanna Raaska: Yeah. Yeah. That’s very, very important and interesting also.
Dr. Emily Helder: Yeah. So, in turning to the chapter that you and your team wrote, it really begins with talking about the role of attachment.
And I’d love to ask you a bit more about, how is it that attachment is related to behavioral and emotional outcomes? What’s the connection?
Dr. Hanna Raaska: Yes, that is quite a tricky question. Yeah, I could spend all the time or the day talking about this issue, but the attachment is defined as a child’s tendency to seek proximity and connection when the child is in stress and there are a number of studies, a lot of studies, which indicate that more securely at that stage, children are better able to regulate their emotions and basis of these connections? I think as we know, children learn through their experiences with their caregivers, how to cope with negative emotions, especially in situations of distress and danger.
And when that is repeated day by day, this learning process reinforces child’s own emotion regulation. And what is the biological factor, which connects these two? I think we need a lot of more research in that field, but I myself think that one, factor may be the stress and stress hormones and stress reactions.
And that is why we have also included in FinAdo studies, some stress markers, in our study. We have a highlighted that attachment issue because, the children with insecure attatchment styles, they are known to have more behavioral and emotional problems later in their life, I think, if that is enough.
Dr. Emily Helder: Yeah, so I wanted to ask you too, one of the things I see clinically, and I’m sure you do as well, is that, two children might have very similar early experiences prior to adoption/early adversity, but have very different outcomes when it comes to behavioral and emotional outcomes. So, I wondered if you could say a bit about what might be behind that, you know, why, why would some, one child with the same experiences, really experience a lot of resilience and recovery. And another one really experience a lot of challenges.
Dr. Hanna Raaska: Yes, first of all, I think that, we must bear in mind that, there are a number of similarities in, in adopted children’s background. For example, all children have had to separate from their birth mothers and, have had more separations from their primary caregivers, but there are also many differences in their backgrounds and those differences, they may be very difficult to, evaluate afterwards and I, myself, as clinician, I think it’s very important to bear in mind that, adopted children can’t be taken as one homogeneous group. I think every child has to be evaluated, individually and, bearing in mind that something that seems to be, similar, there may be many differences also. In those experiences, we know that the period of pregnancy is important for later, for the developmental development of a central nervous system, malnutrition, prenatal exposure to drugs, maternal stress, which we know that are very difficult to detect after the, afterwards they all affect the developing brain system.
We are also all the time getting more information and knowledge about the crucial role of early environment. And there are a number of differences in that as well, the malnutrition, exposure to infections, lack of care, or maltreatment- they may differ a lot between children and may be difficult to evaluate after birth.
And also the time of exposure to these risk factors – it is crucial. And finally last, but not least, I think a very important thing is other genetic factors and we are all the time getting more knowledge about those things, especially the genetic factors, which are related to stress regulation.
They seem to be important and all these things, they are under research all the time. And I think in future we will know much more about these things.
Dr. Emily Helder: Yeah. Because the key, if we could identify which kids were at higher risk, because of those factors that you outlined, then we could really target intervention and resources that way.
Dr. Hanna Raaska: Yeah. that’s true. But I think as a clinician, as I began, I think that, main issue is that we have to take all the child individually and despite the common things, I think individual evaluation is what we have to base on.
Dr. Emily Helder: Yes, that’s best. Yeah. The next section of your chapter talks a bit about mediating factors, so things that link the early adversity that these, kids might face, with some of the later outcomes. And I wonder if you could say more about how these mediating factors help us understand why early neglect or abuse impacts later outcomes?
Dr. Hanna Raaska: Yes. All these factors I explained earlier, they affect our developing brain and, the brain connections and networks.
And we know that the neural basis for example, our behavior, our emotional style, executive functions, they lay on those neural networks. And I think that those basic functions, they affect our behavioral-emotional style. And of course that affects, our adjustment. But of course, the factors that happen after adoption, the family, the good care the child gets – it has impact. And that is exactly what we want to know in this FinAdo study about Finnish adopted children. That, what are the factors, how we promote those postive factors?
Dr. Emily Helder: Yeah. Those buffering kinds of things.
Dr. Hanna Raaska: Yeah. Yeah.
Dr. Emily Helder: So another thing that I see clinically that families asked quite a bit about are, kids will exhibit really good behavioral and emotional adjustment early in life and then, really sometimes when they enter adolescence or early adulthood, is when they might start, showing some difficulties. Do you have some explanations as to why that pattern might happen, but yet still be related to the early adversity that that kids might have experienced before adoption?
Dr. Hanna Raaska: I think there are, there is some research also about this issue that, in adolescence, children have an increasing need to understand his or her biological background and identity. And also in that age, you need more to belong to the age group of children. And I think differing ethnicity may cause some problems and of course, unfortunately, some children have experiences of racism and bullying in the background. I think that might be one explanation.
Dr. Emily Helder: I would love more research in that area as well. I think families have a lot of questions as to that. Your chapter ends with some very practical information for providers and for families.
So, I really want to highlight ways that you’ve suggested fostering that positive adjustment, and I wondered if you had some advice that you tend to give to families who are really seeking to promote resilience in their kids and positive adjustment for them.
Dr. Hanna Raaska: Okay. I think first we have to bear in mind that most of adopted children adjust well and don’t ever have any psychiatric problems, I think that is something we must not forget. And also we have to bear in mind that most adoptive parents have good abilities promote the child’s secure attachment and positive development and adjustment. And I think, if everything is going well, I think that’s fine and nothing has to be done. But if there, as we know that there are a number of risk factors in the child’s background.
I think if parents have any concerns, so I usually advise them to see professional help because there are the number of intervention programs that can promote positive outcomes. But I think that is something that is good to have some professional aid, because I think it’s difficult for parents to do that all themselves. I think there are a number of professionals who can help. I think it’s important to recognize the developmental problems if there are some in early childhood so that they could be recognized and child could get help for those problems. For example, if a child has language problems, it’s very crucial to give rehabilitation and help for that development.
So, that it won’t make more difficulties in the adjustment process. And I highly recommend to every child to have a proper medical examination quite soon after adoption, so that any medical conditions which need to be treated will be recognized and all those things that we can take care of should be recognized early enough and give child treatment for them.
But for very practically, I would say to parents that get to know your child, give yourself and your child, give it time, be patient and try to get to know your child and try to understand his reactions and behaviors and what might be, behind them, where they arise.
Some practical ideas to avoid misunderstanding, especially in the beginning, before the child gets language abilities. I have a, we’ve seen that many, many parents and children get help from visual aids or drawings and pictures to clarify the situations and what to parents and child himself wants to tell when they have no common words.
And of course the structure in situations, giving clear and short instructions, I think they help all the children and especially for older children. If the child needs aid for social situations, I think you must give child help. If, if the child can cope with one child at a time, don’t take him or her into a bigger group or give them help how to cope in the group.
I think, emotional regulation and emotional recognition can be helped every day by explaining the concrete situations and emotions. And that may be beneficial for many children. But I would like to say last but not least, I would say what is important for me, try to find moments when you both enjoy being together, it might be taking a bicycling trip somewhere or whatever, but I think the shared joy is very important to have joyous moments together.
Dr. Emily Helder: Yeah. It probably forms the basis for being able to work through the harder times, if you have some of those positive experiences, both for the child and the parents. Yeah. Thank you so much for sharing your research and your perspective and to your team for writing the chapter. There’s a lot of valuable information in there.