Who are children from “hard places?”

I often talk about children from “hard places” when I talk about the whys for using connected parenting. I figured it might be helpful to tell you exactly what the “hard places” are. Who knows? You may be parenting a child from a “hard place” and not be aware. It might help you understand a lot more about your child’s behavior.

Dr. Karyn Purvis coined the term “hard place.”

There are 7 Risk Factors that the Institute of Child Development recognizes:

  1. Prenatal Stress or Harm

    For children adopted at birth, it is likely that their pregnancy was not planned which automatically leads to a more stressful prenatal experience than most children. For children whose birth mother’s lived in places of extreme poverty, the stress of not knowing when the next meal was or where to sleep every night manifests as elevated cortisol levels. Even if your child is not adopted, many parents, when prompted, can recall an unusually high stress situation during pregnancy (extreme morning sickness, death in the family, contingent house buying or selling). Some research shows that stressful pregnancies can be linked to higher cortisol levels in children as long as 10 years later! (1)

  2. Difficult Labor or Birth

    Whether labor lasted for days on end or the cord was wrapped numerous times around baby’s neck causing oxygen deprivation or there was an emergency C-section, all of these cause surges of high cortisol levels in mama and consequently babies. (2)

  3. Early Hospitalization

    Infants with early medical issues and premature babies are often incubated or need care in a way that impacts the amount of physical touch they would normally receive. The decrease touch time (3) paired with the over-stimulation of their under-developed sensory system can have long-lasting impacts (4).

  4. Abuse

    There are many types of abuse including physical, emotional, spiritual, and sexual. Prenatal or early substance exposure also falls in this category (5).

  5. Neglect

    Neglect can happen for many reasons. A good mom doing her best who is just overtired and stressed or a mom who isn’t capable due to being under the influence substances. Children who grow up in institutions are often neglected. Neglect affects brain development in the same way, no matter what the reasons (6).

  6. Trauma

    Medical procedures, natural disasters, car wrecks, and tragedies are typical examples. In some ways, trauma is also in the eye of the beholder. Trauma is either a single event (or series of ongoing stressors) that renders a person feeling fearful and helpless.

  7. System Effects

    This could be any change in primary caregiver which automatically captures all children who have been adopted or fostered.

It’s important to note that prenatal stress, difficult birthing process, early medical trauma, and change of primary caregiver are often overlooked. Additionally, the first four risk factors can all apply to children even if they were adopted at birth (which is often misconceived as a lower risk adoption).

How many of the risk factors apply to your family?



  1. Sandi LermanMay 23, 2018

    Great overview – thanks for taking us back to basics!

    While I agree that all of these causes of developmental trauma, I also have heard some criticism for the term “hard places” from various members of the adoption triad in transracial families, and I am also not sure I am comfortable with this TBRI term because it can so easily be misinterpreted.

    I think we need to be really careful to use terms that do not perpetuate stereotypes of birth families who happen also to be POC, or assume that a birth family is always the “hard place” — in fact, number 7 “system effects” points out the fact that adoption itself is a CAUSE of trauma, so the “hard place” is quite often the new, adoptive home. I understand that Dr. Purvis’s term “hard places” was meant to signify traumatic experiences, not the fact that some of our kids happen to be KOC or come from marginalized countries and cultures. However, there are some that assume that the literal PLACE (country or birth family) my child is from is a “hard place” and that somehow being in the US and with my family is a “better place.” Adoptive families certainly aren’t perfect, and our country has lots of its own problems, so we can’t assume that we are always “better” than the “place” (family or country) our kids originally came from.

    Again, I totally understand that’s not what this was meant to address, but the reality is that there is a lot of “adoptive parents as white saviors” mentality out there in some circles, and white parents like myself need to acknowledge it and be super careful about birth family/country assumptions. Melissa – would love to know your thoughts on this as a mom and POC adoptee in a transracial family! 🙂

    1. MelissaMay 25, 2018

      Great points. Do you have a term you use instead?

  2. Joanne PetersonMay 23, 2018

    Both of my boys have had 6 risk factors. The only difference between them is we had one child is our home at 9 weeks, and the other child at 14 months. Both are full blooded brothers.

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