Neuropediatrics 2006; 37 - TP44
DOI: 10.1055/s-2006-945637

PSEUDONEUROLOGICAL SYNDROME IN INSTITUTIONALIZED INFANTS PRIOR TO BONDING AND ADOPTION

G Diamond 1, 2, Y Senecky 1, M Keren 1, D Inbar 1, 2, A Shufer 1, HJ Cohen 2
  • 1Schneider Children's Hospital, Tel Aviv University, Petah Tiqva, Israel
  • 2Albert Einstein College of Medicine, Bronx, N.Y., United States

Objectives: A pseudo- neurological syndrome is observed in institutionalized young children during their initial encounter with the adopting parents and in the immediate period thereafter. The features include: increased neuromuscular tone, oligokinesia, quasi-autistic patterns of interaction, and diminished mouthing behaviors. The signs are confusing to parents and professionals. It's not clear whether to attribute them to neurological impairment or as a sign of a transitional attachment disorder. A tool was needed to rate the severity of the neurological signs and behaviors in order to:1)grade the severity of the psychosocial deprivation prior to adoption, and 2)chart the progress of adjustment and bonding in the new family.

Methods: The checklist was organized into rating subscales with items in ascending order, depending on their similarity to normal neurological status and attachment behaviors for age. The six subscales were: body posture and movements, nonverbal communication, vocalizations, exploration, attention, and mouthing patterns. The scales were used by an observer on site or via videotape. All children had been previously screened for medical impairments and parents were coached prior to the encounters in order to enhance the chances for successful bonding.

Results: Fifteen videotapes, each at least two hours long, charted consecutive encounters between parents and children. Children receiving especially low scores on repeated measures (12 or less out of 30)were not adopted, despite medical eligibility. The scales were also used for purposes of counseling and guidance after the adoption.

Conclusions: The gradual diminution in pseudo-neurological signs and gradually higher scores on attachment measures favorably predict an easier initial adjustment to adoptive family life. The tool can be used to chart the child's progress over time. Long- term follow up and comparison with initial scores is needed to validate the scales.