Learning Objective #1: Describe the impact of institutionalized custodial childcare on the Eastern European adopted child's ability to establish the bonds of attachment.

Learning Objective #2: Discuss the impact of attachment disorder on family dynamics from the perspective of an adoptive mother.

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Adoptions from Eastern Europe bring over 4,000 children into American households every year. Most of these children resided in residental institutions before adoption. Attachment disorder occurs more frequently in this population and can increase the risk of an unsuccessful adoption. Mothers of adopted children with attachment disorder are subject to unique stressors because of the children's inability to give and receive affection. This may jeopardize the integration of the child into the family, increase the likelihood of the adoption being terminated, and put the child at risk of physical abuse. Since 1996, twelve children adopted from the former Soviet Union have been killed by their American parents. In most of these cases, the mother alone was implicated in the deaths, suggesting that interactions between a child with attachment disorder and the primary caregiver are particularly difficult.

This phenomenological study was undertaken to obtain a description of the experience of parenting an adopted child from Eastern Europe with attachment disorder from the perspective of the mother. Four themes were derived from 14 participant's interviews which describe isolation, disruption of the normal principles of childrearing, fears of being an inadequate mother, and the struggle for control between mother and child. Literary and artistic sources were also investigated to discover how attachment disorder is depicted.

The findings of this study indicate that adoptive mothers of Eastern European children with attachment disorder are in need of increased support and nderstanding. Nurses who work with adoptive families must be able to assess the degree of attachment between an adoptive child and their parents, evaluate the mother's ability to cope, and be prepared to refer the family to available therapeutic resources. Mothers of adopted children with attachment disorder must be evaluated for physical and emotional well-being at every point of entry in the health care system.