In 2002, Carrie Craft, a writer and the editor of adoption.about.com, became an adoptive parent. Not expecting to feel anything other than joy, Carrie was surprised at her own emotions at the adoption finalization. "It wasn't happiness like I thought I should feel" she says, "I think I was feeling more like '[I] can't believe this is over and here we are.'"

In their book The Post Adoption Blues: Overcoming the Unforeseen Challenges of Adoption (Rodale Books Paperback, 2004) Karen J. Foli and Dr. John R. Thompson attempt to shed light on the stresses often experienced by parents during the period following adoption. Partners in work and life, Foli and Thompson are themselves adoptive parents who battled with depression after they brought their daughter home.

Foli explains "Much of our book focuses in arguing that while conventional wisdom might suggest that adoptive parents have time to prepare and 'should be [ready],' this is not the case in many instances. The [similar] argument could be postulated that a pregnant couple has nine months to prepare for the baby; therefore, the parent should not be expected to have post-pregnancy letdown or depression. The argument is simply flawed."

Foli's research supports the idea that while adoptive parents are busy preparing to welcome their long-awaited child home, most don't spend enough time considering what will transpire after the momentous event. They may fantasize about tender moments with their new child. Those adopting infants may be bracing themselves for endless feeding, burping, diaper changing, bathing and bedtime rituals. But mostly, says Foli, they just envision the love and the sense of completion that finally having a child will bring.

So, for those who encounter it, the reality of what some experts call post adoption depression can come as a surprise.

What is Post Adoption Depression?

June Bond, an adoption advocate and writer, first coined the term post adoption depression (PAD) in a 1995 article for Roots and Wings, a magazine about adoption. According to Harriet McCarthy, who conducted a survey for the Eastern European Adoption Coalition (EEAC), as many as 65 percent of adoptive parents are affected to some degree by PAD. This is close to the 70 percent of all new parents who, according to the American Psychiatric Association, experience some type of mood disturbance during the post-partum period, feelings known as "baby blues," or, when they rise to the level of clinical concern, post partum depression. (About one in ten new mothers suffers symptoms severe enough to be characterized as post partum depression.)

Dr. Joyce Maguire Pavao, author of The Family of Adoption (Beacon Press, 2005) and Founder and CEO of the Center For Family Connections in Cambridge, MA prefers to characterize this as an adjustment reaction. "There is always a slight depression when people enter and leave a family even for wonderful reasons," she says.

Identifying PAD

Adoptive parents, deep in the trenches of caring for their new family member, often don't even know what is happening. They feel fatigued, overwhelmed, inexplicably sad and then guilty for feeling that way. New parents often feel they'll make it through those first dark, tired days "somehow" instead of reaching out for help.

Craft believes that the process of adoption contributes to the problem. "The adoption community sets up adoptive parents for depression and feelings of being overwhelmed. I think we adoptive parents feel that we have to put ourselves out there as perfect in order to be able to adopt. Then after the adoption we feel that we should be perfect and be able to handle everything perfectly. Then reality hits. We're dealing with real behaviors, issues, or just a normal crying baby. Suddenly, we don't feel perfect."

A useful way to gauge whether what parents are experiencing warrants seeking medical attention is to use the following warning signs for depression. Experiencing five or more in a two-week period is cause for concern and should lead parents to contact a medical professional:

• Feeling depressed or particularly irritable for most of the day, every day.
• Diminished interest in activities that used to be enjoyable.
• Significant weight loss or gain, and/or a change in appetite.
• Sudden changes in sleep pattern (insomnia or hypersomnia).
• Noticeable increase or decrease in motor activity (others notice that you're slower or more agitated than usual).
• A general feeling of fatigue and low energy day after day.
• Feeling worthless or excessively guilty on a regular basis.
• Indecisiveness or an impaired ability to think or concentrate every day.
• Suicidal thoughts.

Seeking Support

Parents should be heartened to know that more help is available now than ever before. The post adoption adjustment period is better understood, and it is easier to find information and support via adoption agencies, social workers, pediatricians, family doctors and the Internet.

When PAD struck Craft, she sought out her family therapist. "I found counseling for myself with the therapist that was working with my youngest son." But it wasn't easy, says Craft, in part because her family had not anticipated the need for services. "After [adoption] finalization we were told to fill out a form on the services we thought we'd need. We said we didn't need anything. We felt that with continuous interruptions into our lives we would still feel like a foster family and not a 'normal' family. But when we did seek help, when trouble started, we couldn't find anyone. We were turned away, told we lived in the wrong county or that the services didn't exist."

Experiences like these are precisely why Dr. Pavao is such a passionate proponent of pre- and post-adoption services. "It is often good for families to have a consultation both before and after [adoption]. The difficult thing is that although more and more clinicians are adoption-sensitive, there are still not very many who are adoption-competent. Many people think because they have seen one kind of adoptive family, that they understand the whole world of adoption. This is not true."

When a therapist is selected, Foli adds that "The treatment is situation-specific. Certainly, The Post Adoption Blues has several case studies that speak to the use of "talk therapy," anti-depressant therapy, individual and family counseling." She goes on to say, "The treatment would align with the severity [of the depression], the social support network, and the individual family needs. We encourage the parent to begin to disclose her feelings in a safe environment with a loved one who can accept the emotions that the parent is experiencing."

A depressed parent, say experts, can be particularly troubling for a newly adopted infant or child struggling with his or her own attachment and adjustment issues.

Bryan Shragge, Clinical Director and Manager of The Adoptive Family Resource Center at Sierra Adoption Services in Sacramento, California says that the time immediately after an adoption is finalized is the best time to seek support from professionals and fellow adoptive parents. Shragge's center offers post-adoption support groups in addition to parent-child interaction therapy, parent training, an adoption information, support and referral line and counseling services. Shragge says about 25 percent of the families that adopt through Sierra take part in one or another of the services that are offered. He'd like to see that increase.

A Light at the End of the Tunnel

Dawn Friedman, who adopted her daughter in January 2004, says "I'm convinced that too many [adoptive parents] are lying about their experiences because of shame." Some adoptive parents report that their families and even the professionals involved in their adoption expect them to feel just one way - ecstatic. Parents may therefore be especially hesitant to seek support from the agencies and professionals that they worked so hard to convince of their ability to parent.

Craft agrees that agencies often frame the finalization of an adoption as a happy ending as opposed to a new beginning. She adds, "Adoption is hard. It's hard on everyone involved. Society and experts sit back and look on adoption as a beautiful moment. They don't realize the work, tears, struggles that adoptive families go through. I have so many people tell me that they admire my family. I feel horrible when I hear these statements. I [sometimes] don't feel like I'm someone to be admired. I struggle with liking [my kids] or even liking myself some days. Would people still admire me if they knew that?"

Being aware of, accepting and working to resolve the inherent challenges of adding a member to one's family via adoption is imperative to creating strong bonds and a happy family environment. According to Dr. Pavao, "Families can surely benefit from a chance to look at things and reframe and understand the changes that happen when a family adds and loses members."

Resources:

• The Sierra Adoption Center in California has parent resources and information on foster child adoption.
• The National Adoption Center is a useful source of information.
• The Eastern European Adoption Coalition Inc. specializes in support and information for families adopting from Russia and former Eastern bloc nations.
• Learn more about author Karen J. Foli and her work.
• Dr. Joyce Maguire Pavao's Center for Family Connections works with families and children affected by adults.
• Visit Connect for Kids' Adoption topic page for more links and information.

Ninotchka Beavers is a mother and freelance writer based in Dallas, Texas. She is the author of "Twice Blessed, A Diary of Secondary Infertility: One Woman's Journey" (2004)