ACADEMIA Letters

Symptomatology specific to children adopted or in foster

care and group therapy intervention in Bucharest,
Romania
Liviu Mihaileanu

This paper presents the results collected by Tzuby’s Kids Association in Bucharest (Romania)
from the assessment of children adopted or in foster care who benefited from group therapy
intervention programs.
The assessment was conducted during 2018 on a group of 30 children aged between 3 and
7, in order to identify therapeutic games that would offer them support to help them better
manage trauma, so that they can adapt more easily to the new family, the new situation or the
new context in which they find themselves. The references below take into account therapy
interventions carried out in the period 2018-2020; from March 2020 they have been suspended
in the context of the COVID-19 pandemic.
Tzuby’s Kids had a programmed approach to evaluate the symptomatology specific to
children participating in activities, and developed art and play based group therapy programs.
We used the Early Childhood Inventory-4 (ECI-4), a screening tool that assesses the most
prevalent psychiatric disorders in children aged 3-7. The items contained in ECI-4 are based
on the diagnostic criteria provided by the American Psychiatric Association (1994) in the
Diagnostic and Statistical Manual of Mental Disorders (DSM) and the test was calibrated to
a national standard. The chart below shows the “Top 10” of the identified disorders.

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Liviu Mihaileanu, mihaileanu@gmail.com

Citation: Mihaileanu, L. (2021). Symptomatology specific to children adopted or in foster care and group
therapy intervention in Bucharest, Romania. Academia Letters, Article 2130.
https://doi.org/10.20935/AL2130.
1
Figure 1: Common symptoms in children benefiting from group therapy intervention services
within the Tzuby’s Kids Association (2018)

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Liviu Mihaileanu, mihaileanu@gmail.com

Citation: Mihaileanu, L. (2021). Symptomatology specific to children adopted or in foster care and group
therapy intervention in Bucharest, Romania. Academia Letters, Article 2130.
https://doi.org/10.20935/AL2130.
2
 As mentioned earlier, the purpose of the initial assessment of the children was not to make
a diagnosis, but to identify a number of common difficulties or symptoms in order to subse-
quently develop ways of intervention to help children manage, improve or solve the problems,
the difficulties and the symptoms they were facing. Another goal was to provide feedback to
parents about their children.
The above data can be used as a guide to identify the types of disorders you can address
with the children you will be caring for, noting that they may differ from group to group.

Types of therapy games recommended for group therapy interven-

tions based on the identified symptoms
We noticed, both from the assessments made and from the practical observation, that, in gen-
eral, children’s difficulties are emotional and behavioral. Thus, the games, the activities and
the therapeutic exercises put in place as part of the therapeutic intervention program aimed
at the emotional development and the behavioral education of children. As our evaluations
highlighted a strong connection between the Sensory Processing Disorder (SPD) and the be-
havioral disorder, we also introduced games, activities and sensory stimulation exercises. The
cognitive dimension - the mental/rational processing of the trauma, dysfunctional thoughts,
etc., was generally addressed through therapeutic stories. The starting point of the meetings
was initially designed for accommodation, for breaking the ice, but gradually the theme of the
meetings was organized into the following steps:

1. Ice breaking,

2. Self-knowledge,

3. Presentation,

4. Knowing each other,

5. Interactive games.

Categories of games/activities used and their utility

1. GAME/ACTIVITY OF SELF-KNOWLEDGE, PRESENTATION, KNOWING EACH
OTHER, SOCIALIZATION (Utility from children’s perspective: “It helps me to know
myself, to present myself to others as I am, to accept myself.” It helps to shape self-
identity: “Who I am”, to know others, to accept them as they are, to accept diversity.”)

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Liviu Mihaileanu, mihaileanu@gmail.com

Citation: Mihaileanu, L. (2021). Symptomatology specific to children adopted or in foster care and group
therapy intervention in Bucharest, Romania. Academia Letters, Article 2130.
https://doi.org/10.20935/AL2130.
3
 2. SENSORY GAMES/ACTIVITIES (Utility: perception of the external environment,
adaptation to the environment, self-control, self-confidence - through body control)

3. EMOTIONAL GAMES/ACTIVITIES (Utility: the development of emotional intelli-

gence, the management of emotions, the control of emotional manifestations…)

4. BEHAVIORAL GAME/ACTIVITY (Utility: being aware of the inappropriate behav-

iors, learning the appropriate behaviors, learning the rules, following the rules)

5. COGNITIVE GAMES/ACTIVITIES (Utility: the elimination of dysfunctional thoughts,

their replacement with functional thoughts, the awareness of aspects related to trauma,
to relationship with parents)

Lessons learned
From our observations, it is necessary for the children’s activities to take place in the absence
of the parents, without the possibility of having direct interactions with them or see them.
We found that is it best when children were divided into age groups; the delimitation was
made around the age of 5 years. Thus, specific activities could be organized by age group.
Sensory, behavioral and emotional stimulation activities were introduced in the program pre-
dominantly for the young children, and, for the older ones, all types of activities, including
therapeutic stories.
As timing, we found that the best time for the activities was from 10.00 AM to 1 PM
on Saturday. The welcoming and accommodation time was between 10.00 and 10.30 and
the activities started at 10.30. The guided activities/games lasted on average 40-45 minutes,
followed by a snack break. After the break there was generally free play or less-structured
activities, such as crafts. The children’s activities were carried out under the supervision of a
young adult, the ratio being one supervisor to two or three children. Subsequently, an activity
moderator/coordinator was appointed for each age group. At the end of the activities, the
psychologist coordinator had a meeting with the parents and gave them feedback on how the
children interacted, presented his observations and gave suggestions on how to work with the
children at home.

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Liviu Mihaileanu, mihaileanu@gmail.com

Citation: Mihaileanu, L. (2021). Symptomatology specific to children adopted or in foster care and group
therapy intervention in Bucharest, Romania. Academia Letters, Article 2130.
https://doi.org/10.20935/AL2130.
4