Sunday, 2 March 2014

Pawse for thought about PADS!

There has been a lot more media interest and reporting lately of Post Natal Depression (PND).  This is in part to some very brave celebrities openly admitting that they have suffered from the syndrome.  Celebrities such as Gwyneth Paltrow and Courtney Cox have paved the way towards acceptance and more understanding of this awful illness and this can only help other mums to recognise their own symptoms and hopefully seek help.

Post Adoption Depression Syndrome or PADS is very similar to PND.  The symptoms are the same but this is a condition that is not widely talked about.  It is in fact a condition that is very much brushed under the carpet and talked about in hushed voices due to the fear of disrupting an adoption placement and a child being removed from their adoptive parents and put back into the care system.

The symptoms of Post Adoption Depression Syndrome are listed in a Factsheet by Adoption UK as:
Either a consistently low mood or marked reduction in the feeling of pleasure must be felt, accompanied by some of the following symptoms.
  1. Feelings of anxiety, panic, inadequacy, being overwhelmed by responsibility, being slowed down, inability to get any enjoyment out of life, worthlessness, guilt, low self-esteem, loss of identity, loneliness.
  2. Physical symptoms: aches and pains, stomach problems, back problems, sleep problems.
  3. Tension headaches, lack of energy, fatigue, lack of concentration, forgetfulness, loss of or gain in appetite. 
  4. Mood: irritable, angry, despairing, pessimistic.
According to a survey conducted by Harriet McCarthy in 2007 and reported in an article entitled Post Adoption Depression up to 65% of adoptive parents experience PADS.  That is a very high proportion and a figure that needs to be taken seriously by adopters and by Social Workers.  It is a figure that certainly shouldn't be spoken about in whispers.  Adoptive parents need to know that this is something that can happen and that they are supported if it does.  I can remember being told about the possibility of feeling depressed post-placement but equally I know of second time adopters who have felt vulnerable during their home assessment for admitting that they have felt a period of feeling low after adopting. The general feeling amongst adopters is that we don't really talk about Post Adoption Depression but that needs to change.  We need to be able to support one another; to access treatment and support without prejudice or a threat to an adoptive placement.

So what can cause depression in an adoptive parent?  Reports suggest that it is the primary carer who is most susceptible.  Depression can effect men as well as women.  If you think about it logically though it's hardly surprising that the figure is so high......

Many parents come to adoption after years of failed attempts to start a family biologically.  They may have experienced significant heartbreak during that time.  For most prospective adopters there is a lot tied up in hearing a Panel give approval for them to adopt.  It may be that they are a same-sex couple who has experienced discrimination and has felt that becoming a parent was something that was out of their reach.  For me, after repeated miscarriages, hearing someone say that I was going to become a parent meant everything to me.  I was incredibly ill after our first panel after the enormous build up of expectation and anxiety.  I think I was literally holding my breath for many months and the relief just spilled out of me.

So what happens next?  You wait anxiously to be matched and have an emotional decision when a match comes.  Is this your child?  You decide yes or no.  Both outcomes are filled with emotion.  Once you are matched the anxiety continues because the match has to be approved by another panel.  Adopters are discouraged from bonding with their prospective child in case the match is not approved by panel.  Of course you're going to bond.  That bond is so important to you and your child.  It's ridiculous to discourage those emotions.  We're not robots who can turn their emotions on and off. 

After matching panel there is a scurry of activity whilst you make preparations to your
home to accommodate your new child and then, once you are feeling really tired after all the painting and buying and preparations, you meet your child.  The anxiety and excitement surrounding meeting your child for the first time is indescribable. You then have a period of generally 1 to 2 weeks of introductions where you tear up and down your local county (generally) having to arrive at some ungodly hour to greet your new son or daughter as they awaken or go to bed and generally get to know their routine and their likes and dislikes.  Slowly you take over that routine and try to absorb everything their Foster Carer is able to share.  You have to cope with being in someone else's house (and they with you being there) which can feel awkward (I am incapable of changing a nappy quickly with a FC watching!).  Then, when you are even more tired than you knew it was possible to be before meeting your child, you are allowed to take your child home.

You arrive home exhausted and excited.  The day has finally arrived.  You may have fallen in love instantly with your child or you may not know how the heck you feel.  All you know is that you are now a parent. That first night when your child is sleeping in their room can bring about emotions you didn't even know you had within you.  What you are expected to feel by those around you is excitement, happiness...all your dreams have come true.

Then the hard work really begins.  Helping your child settle in.  At this point you are probably so tired you just want to head off on a long holiday in the sun but you need to put all your energy into your child.  Your child is unlikely to be a baby who might sleep during the day.  This child is probably up and about and busy all the time.  You probably won't get a break from being No. 1 Entertainer as well as being a therapist and cook and washer of more clothes than you imagined it was possible to wash during a week.  Your child may be very unsettled and need a lot of reassurance.  You may already have another child who feels angry and unsettled by the arrival of their new sibling.  You will probably spend half the day wondering what on earth you are supposed to be doing.  You tie yourself up knots second guessing everything that is going on around you and hoping you're doing a good job.

I'm painting a dark picture and I don't mean to.  I'm trying to explain the emotions and exhaustion involved in an adoption.  This is also an incredibly happy time.  It is the best feeling in the world when your child comes home but there is so much more tied up into it than that.  Don't forget the fact that you will have weekly Social Worker visits, which will generally bring with them some mad and panicky cleaning to prove you are coping and on top of everything. 

Add to all this the anxiety around your child becoming legally adopted which can take many, many months post placement and I ask is is any wonder 65% of adopters experience a period of depression?  I wonder if the figure is actually higher?  The pressure and stress and expectation is very high throughout the whole process.

For me, all this has particular significance because I have suffered from several periods of depression in the past primarily linked to recurrent miscarriage and I was very anxious that this would prevent me from being able to adopt.  I recovered from each period of depression with the aid of counselling and anti-depressants but I was left with a susceptibility towards becoming depressed.  Add to this the fact that I am Coeliac and over the past few years have experienced periods of anaemia from malabsorbtion of nutrients.  Anaemia makes me feel very tired, not always ideal with two children around. I'm a fairly healthy and robust person generally though and get on with things to the best of my ability.  Whilst I was very tired after we adopted Katie and felt quite overwhelmed at becoming a parent whilst negotiating the adoption process, I wouldn't say I was depressed after she arrived at all.  It did take a while before I felt like I was back to myself again though.

A little over a year ago however we were going through the adoption process for our second time.  The process had already taken longer than it was supposed to.  I was feeling stressed and frustrated after our first panel date was postponed.  We also already knew about Pip being born and that there was a likelihood of being matched with him and were waiting for our panel date to arrive.  We didn't know what was going to happen with Pip and there was a wall of silence from Social Services on this subject after initially being asked if we would be happy to adopt him several months previously.  This was a time of possible excitement but also confusion.  What was going on?  We were also managing the fall-out from how Katie was experiencing the adoption process and life felt quite intense.  By the time we were approved and then finally officially matched with Pip I had started to feel quite disengaged from things.  I think I was probably on emotional over-load by that point.  Too many emotions to process and respond to.  Too much anxiety about Katie and how she would cope with having a sibling.  So much to prepare for Pip's arrival.  I was physically and emotionally exhausted by the time we met him.

Once we met Pip we were in the deep end again of introductions and managing not just ourselves but Katie as well.  Katie had a long period of difficult behaviour during this time, which was not unexpected but was challenging and I felt torn between all the different needs and roles in my life.  In addition I felt under enormous pressure to resolve the issue of Pip's weight.  This really weighed (pardon the pun) heavily on me and was the topic of endless conversation with Social Workers and health professionals.  People constantly commented to me about his weight and I suspect I felt all this more deeply due to anxieties about my own weight which is currently increasing at a rate of knots.

TCM has a very demanding job so I am the primary carer for our family.  Life is very busy.  I don't have much time to reflect but was aware that I started to feel emotionally disengaged from quite a lot of my life outside of the home but assumed that I was just tired or anaemic again.  And that was how it felt, like everything was going on around me.  I wasn't really sure where I was in the whole picture but I did know that I was supposed to be the conductor of this orchestra. I was supposed to know the score and somehow manage to bring it all together.  A tall order and I suspect I was being overly tough on the expectations of myself.  I noticed that I started to become very unemotional about things happening outside of the home and I felt less empathy towards others outside our family unit.  I started to feel unmotivated about going to tap dancing and Reiki.  I started to feel unenthusiastic about seeing other people.  Actually there were very few other people to see because Pip napped during the day so we didn't see many people for several months.  My world became very small, just me and Pip during the day and Katie after school.  I spoke to a close friend most days and have always been honest with her about my feelings but I was distracted and struggling to feel interested in anything else going on around me.  My blog has kept me engaged though and I love writing about my family and the life we have, warts and all.  I didn't recognise that my feelings of being unmotivated and stressed and anxious and flat were depression though.  Things got a bit better after the summer holidays and we picked up and carried on.

I then went through an obvious depression in December and I wrote about my feelings  in a post called The Visitor. which was partly triggered by the time of year and partly by significant additional stress from a member of my family, which is still ongoing.  That depression lifted to a significant effect after Christmas but I've recently realised that those feelings of unmotivation and unenthusiasm and feeling flat have continued and that I've probably had them now in one form or another for the best part of a year.  I've noticed I'm eating and sleeping badly and questioning where my life is going a lot.  I'm lethargic and exhausted.  I feel like I don't fit in anywhere and have been feeling sensitive and invisible.  Things have certainly not been helped by a lot of stress surrounding Pip's adoption and lots of delays getting to court and now a postponement of his adoption whilst the location of a birth parent is established.  We have started contact with the Katie and Pip's middle brother, Kip, and, whilst this is very positive, it has not been without its stresses and concerns and it saps my energy significantly.

This second time adoption process has now been going on since September 2012.  That's nearly 2.5 years and an immense amount of stress in our lives.  The end result is wonderful.  I adore both my children and love being with them but it's not actually the end result yet.  We still haven't legally adopted Pip and we have no idea currently when the next court date will be.  There is still that anxiety that Pip could be taken back into care however unlikely it might seem.  At a review meeting this week our Independent Reviewing Officer (IRO) commented that I seemed resigned to it all.  I asked him what else I could be at this stage?  I am resigned to the fact that I have no control over any of this process other than looking after my family.  Contacting the courts will not speed up the DWP's tracking process nor will it make the courts write a letter to the missing birth parent any quicker or bring about a response to that letter.  I feel powerless and that doesn't help me feel motivated.  I would ask why the issue of consent (or not) from birth parents is not tackled by the courts at the point when the adoption placement order is granted?  Surely all the paperwork relating to birth parents should be tied up by the courts before a child is even placed with an adoptive family? It shouldn't be resurrected at the point of adoption when a contestment at that point causes strain on so many more people? Surely the courts should make a decision as to whether the birth parents can challenge an adoption before the child is placed within another family? The emotional impact on the adoptive family of all these uncertainties is ridiculously stressful. 

I have realised that I'm probably suffering from mild to moderate depression and that
it probably is Pre/Post Adoption Depression but exacerbated by the amount of other things impacting on our lives.  I'm functioning though, I've not taken to my bed.  Katie is getting to school on time.  I play with my children and do all that they need.  I gain a lot of pleasure from engaging with Pip during the day and Katie after school.  We do homework and go out and do lots of things but I do have to force myself to put on my entertainer hat on many days.  I shower and wash my hair and even put make-up on and make an effort with my appearance (as much as you can make jeans look good!).  I have conversations with the other mums at school.  I am lucky to have some lovely friends I see during the week and their support has kept me going.  If you met me you'd probably have no idea at all that I was feeling depressed but I emotionally switch off as soon as I've finished a conversation with someone or get in the car to go home from somewhere.  I have nothing in me left for outside the home.  I have little interest in anything going on around me that isn't my immediate family or friends.  I'm fed  up with feeling like I have a foot stuck in mud waiting for our family unit to be legalised.  It's hard to make family plans when you can't just take off without approval from Social Services and we can't really get a passport (well not one in our name) for Pip to travel abroad and when you have to carry a medical consent card everywhere with you in case your son needs medical treatment.

I will just note though that I think the adoption process has really triggered how I am feeling.  The intensity; the expectations on adopters; the stress caused by delays; the emotional exhaustion both pre and post placement; the feeling of scrutiny which is important for the assessment but can feel quite intense when under the microscope; the anxiety of how already adopted children will cope with the process; did I mention the endless delays?  Oh yes I did.  It feels like we have been in the adoption process for forever.  It really shouldn't feel like this or take this amount of time surely?

I am not someone who seeks to be overly negative so this post has been difficult to write.  It's long so awards to anyone who's made it to the end!  My natural positivity is a real blessing for me and it keeps me going.  Feeling depressed is really at odds with the person I naturally am.  I am a spiritual person who enjoys the small things in life.  I want to be honest about our experiences though.  I can't paint a perfect picture if this isn't an honest picture.  There is much in my life I am grateful for and gratitude keeps me from disappearing into myself.  I am so lucky to have my family.  I waited so very long for my children that I still can't believe they are here.  I don't want to feel depressed, it's not something I've consciously become, but recognise that under so much pressure and stress that I've not been taking care of myself as well I should and those feelings have crept in and recognise it's time to take action.  I will be going to the GP as soon as I can and will be asking for some help.  I feel confident that I will overcome this period of depression just as I have in the past.  Being depressed does not scare me.  I am able to challenge my negative thoughts although some days they do feel relentless.  I do not feel that this is insurmountable.  I do not feel like I am unable to parent or be an effective parent but it does use energy reserves that are now dwindling fast.  I do recognise that I've allowed too many peripheral stresses to creep in though and need to feel strong and assertive enough to get everything back on track and for that I need some help (and for a significant person in my wider family to lead a less dramatic life!).  I'm actually glad I've recognised what is going on with me and that is mostly due to reading an article in this season's Adoption UK magazine which featured an article on Post-Adoption Depression.   A light bulb flicked on in my head and relief immediately followed.  This is why I've been feeling this way.  I'm not a failure or unwanted.  Now I can do something about it. 

I've decided to speak out and write about this although I do feel anxious at giving myself the label of being depressed particularly as our adoption isn't legalised but I feel it's important to speak out and let people know so that others can do the same and seek help.  I am very confident I will get better. I'm cross with myself for not recognising how I was feeling earlier and why but life is just too busy to focus much on myself these days.  In fact now I know I need help I feel more positive than I have done for months.

I'd love to hear other people's stories.  Have you been effected by Post Adoption Depression?  Did you feel able to let people know how you were feeling or did you feel too anxious about jeopardising your placement?


  1. Thank you, this has shed some light on how I am feeling at the moment xx

    1. You are not alone. Hope you feel better soon xxx

  2. I'm not sure where to start... perhaps by drying the tears from my eyes. I can relate to a lot of what you have wrote. I was sharing with a friend earlier how hard and exhausting the introduction period is and how nearly a year on I don't actually think my husband and I have stopped. I would give a a lot (as bad as it sounds) to go on holiday just my hubby and I - to escape the madness that parenting can bring. As you know from my latest blog I can relate to your feelings around the court process - it really is backwards and unfair for all parties concerned. I too see myself as a positive person and to think that I may be struggling and even depressed is a hard thing for me to write, say or even admit. I'm one of these people that think I can do it all and then find out that I can't but rather than accepting that I beat myself up and think I should try better. On the recommendation of my social worker I have started counseling and my SW now comes out weekly to support us. My hope is that over the next few months I can begin to put myself back together again and shake the feeling of being low and yes depressed. Thank you for sharing your inner most thoughts - I hope that as a result more and more people will come forward and share their experiences - we should not feel ashamed.

    1. I'm not sure how I missed replying to this reply. I'm so sorry. I'm hoping that the support you have been getting is helping things for you now. I will get my head out of my own stuff and pop over to check on you xx

  3. Firstly than you for talking about PADS. I've been depressed since Nov, month 6 of our placement. My SW arranged counseling and I got antidepressants from my GP. I'm still on them. I have struggled to bond with my eldest who is challenging and now find myself delaying the AO due to fears of that ultimate commitment. I plan to stay on the medication until after the adoption celebration as I know this is going to be a stressful time for me and I want everyone to think I'm fine. Nobody knows I go to bed every afternoon for 2 hours. I'm not sure why but it really helps.
    Thanks again.

    1. I feel so sad reading your reply and how difficult things must be for you at the moment. It must be incredibly difficult when your relationship and feelings about a long awaited child isn't how you hoped, especially when making a decision about the AO. I know how disengaged I felt at first with Pip which I found confusing after how excited I had initially felt. Thankfully it passed and Pip helps because he's an easy child. The challenges with Katie's behaviour however have been stressful so I really can understand your feelings. I've been prescribed anti-depressants and counselling so hope I will also start to feel better. It must be hard to keep all this to yourself. Do you have friends you can talk to and who will support you? I know how it feels to feel isolated and how much better it is with support. Do email me at if you need someone to all to. Gem xx

    2. Someone to talk to......blooming iPad!

  4. Yes. I was v depressed with our eldest. I didn't dare tell anyone though for fear of judgement; that the child may be removed (we were ages waiting for the AO); for fear that yet more professionals would be in our house, watching, judging. I was in tears most days and nights. I really don't know how I got through. I think it definitely affected our bond in the beginning .. I couldn't stand to be on my own with our child and sought refuge in housework... I woke up feeling sick every morning. It's a horrible place to be. Thank God for my family otherwise I feel almost certain we would have disrupted... Thank you for writing this. I will never forget those first 6 or so months and my heart goes out to anyone else suffering. I would urge them to get help. I wish I had. x

  5. Thank you for posting this, I have ALL the symptoms that describes PADS every single day. In the end it got so so bad I HAD to go to the doctor who is, thankfully, putting it down as PMT symptoms. I say "thankfully" because I'm scared witless of our daughter being taken off us because I've got depression. Our Adoption Order court date is still yet to be set and we've waited 7 months as it is. Your right, no wonder adopters get depression. Isn't It awful that I'm so scared our daughter will be taken away because I'm feeling down/anxious/despairing and losing hope. I wake up every day feeling anxious. I go to sleep every night with my mind whirring. I feel low in the day and cry at least once. Lately I've been better but only because I've fought with myself to get out and do something, anything! I think we all feel like we have to be so "perfect" to become adopters that's the reason behind people not coming forward to ask for help when they feel like they've "got what they want" & "should be coping". But, as you've said, it's not that straight forward.

    Thank you again for writing this, I certainly don't feel like I'm going mad any more. X

    1. Hi there and thank you for sharing how you're feeling. I'm glad you feel like you're not alone now. I also suffer from an extreme form of PMT and this has been what's confused my symptoms over the past 6 months. It was when I realised that the low mood I generally get in the second half of my cycle wasn't lifting as normal that I could see there was more to it. I am nervous about posting how I'm feeling and the possible repercussions before our court date but I'm glad I did if it helps another person feel more connected. I can really resonate with how you're currently feeling. I felt like that back in the summer. Forcing myself to get out and do things like soft play and interact with other mums really helped me. I also agree with what you say about feeling you need to be "perfect". We have an enormous amount of pressure heaped on us as adopters and many people just don't get it. They think we have our child and it is all hunky dory and we are skipping through the daisies singing at the top of our voices. The reality of the process is far more dramatic for adopters than that. You have the highs of becoming a new parent plus the realities of settling in a child that has already had a minimum of 1-2 other carers before you. The worry and anxiety that brings is phenomenal really. I know I often worry about how Katie is impacted on by events around her and what unsettles her and how I can be the best parent for her. That is a lot of pressure on top of all the general day to day houseworky and general parenting tasks. I suspect we are all too hard on ourselves. I know I am. Sending a big hug to you. Do keep in touch with how you're getting on. xxxx

  6. Wow. Thanks for sharing, Gem and all the comments here. I didn't suffer from PADS, but know people who have. And as with depression in general it is no laughing matter. In the above, I hear the fear of judgement, which adoptive parents really don't need. On top of everything else. I have myself suffered from depression on a few of other occasions, and have learnt what to do when the symptoms appear, and that has held other possible episodes at bay. Open acknowledgment in early stages for me is key. And that does't well with the experience of the child finally arriving, and the self deprecation of adoptive parenthood 24/7. I am surprised that I didn't suffer in the end. And my east goes out to every one who does. Take good care of yourselves.

  7. Thanks for writing this, ita really struck a chord with me, and explains why I have gone from bonding well, to withdrawing and feeling like I have an alien in the house. Since we put in the AO her behaviour has gone really challenging and to cope, I don't think of her as my daughter any more, just something to deal with and this is being to impact emotionally. I don't really feel much at all, its easier this way. I don't want to give up and disrupt, but I don't see how it can improve either, i don't even like her most of the time now. Though i think thats more my problem due to her changing behaviour. I'm trying to remember the lovely little girl underneath.

    1. Thank you for speaking out. It's a first step in helping yourself. It sounds like life is very hard for you currently. Dealing with challenging behaviour is tough emotionally. I find it very hard to stay in a loving place internally with Katie when her behaviour is challenging. I think that's self preservation. I would urge you to talk to someone about how you're feeling and the stress on you regarding your daughters behaviour. It's not incommon for adopted children's behaviour to regress and become more challenging as they settle and start to push to see if you really do mean forever. You most certainly aren't alone in this so please know how you're feeling and what you're experiencing us common. You do need outside help though be it from your GP and from your SW or other adopters. Visit The Adoption Social and you'll find a community of other adopters who will welcome you and you can read about their similar experiences. Feel free to email me if you would like. My contact detail are at the link on the top of the page. You are not alone and it can get better xx